1. Laryngeal Cancer Anh Q. Truong MS-4 University of Washington, SOM

2. Anatomy

3. Vaezi, MF . Nature Clinical Practice Gastroenterology & Hepatology (2005) 2 , 595-603 Anatomy – cont’

4. Anatomy – subdivision Source: AJCC Cancer Staging Manual, 6 th Ed (2002)

15. Stage Grouping Early stage Advanced stage Stage 0 Tis N0 M0 Stage I T1 N0 M0 Stage II T2 N0 M0 Stage III T3 N0 M0 T1-3 N1 M0 Stage IVA T4a N0-1 M0 T1-4a N2 M0 Stage IVB T4b any N M0 any T N3 M0 Stage IVC any T any N M1

21. Treatment – Advanced Stage (III/IV) – VA Study cont’ Department of Veterans Affairs Laryngeal Cancer Study Group, N Engl J Med 1991;324:1685-90. Overall Survival Surg + XRT Chemo + XRT 2 yr OS = 68% in both groups, P = 0.9846 Surg + XRT Chemo + XRT Chem + XRT shorter disease free interval, but dif not significant Disease Free Survival

22. Treatment – Advanced Stage (III/IV) – VA Study cont’ Department of Veterans Affairs Laryngeal Cancer Study Group, N Engl J Med 1991;324:1685-90. Site of recurrence Surgery (N = 166) Chemotherapy (N=166) Primary 4 (2%) 20 (12%) Regional 9 (5%) 14 (8%) Distant 29 (17%) 18 (11%) All 42 (25%) 52 (31%) No difference in rate of recurrence, significant difference in site of recurrence, significant difference in development of a 2nd primary CA (surg 6%, chemo 2%)

23. Treatment – Advanced Stage (III/IV) – VA Study cont’ Of the 166 pts in the chemo arms - 107 (64%) patients had preserved larynx - 30 patients (18%)  laryngectomy before definitive XRT - 29 patients (18%)  laryngectomy after definitive XRT Department of Veterans Affairs Laryngeal Cancer Study Group, N Engl J Med 1991;324:1685-90.

26. Treatment – Advanced Stage (III/IV) – RTOG 91-11 Study 2 yr 3.8 yr 5 yr update A - induction chemo  XRT: 75% 72% 70.5% - concurrent chemoXRT : 88%* 84%* 83.6% - XRT alone : 70% 67% 65.7% Laryngeal Preservation Forastiere AA et al, N Engl J Med 2003;349:2091-8. A Forastiere AA et al, Journal of Clinical Oncology , Vol 24, No. 18S(June 20 Supplement),2006:5517.

27. Treatment – Advanced Stage (III/IV) – RTOG 91-11 Study Locoregional Control Forastiere AA et al, N Engl J Med 2003;349:2091-8. A Forastiere AA et al, Journal of Clinical Oncology , Vol 24, No. 18S(June 20 Supplement),2006:5517. 2 yrs 5 yr update A - induction chemo  XRT: 64% 54.9% - concurrent chemoXRT : 80% 68.8% - XRT alone : 58% 51%

28. Treatment – Advanced Stage (III/IV) – RTOG 91-11 Study A Chemo therapy  significant decreased in dz free survival compared to XRT alone (P =0.02 compared w/induction, P = 0.06 compared w/conccurent Tx) B No significant difference C Difference only significant comparing concurrent chemoXRT vs XRT alone. Forastiere AA et al, N Engl J Med 2003;349:2091-8. Concurrent chemoXRT Induction chemo  XRT XRT alone 2 yrs 5 yrs 2 yrs 5 yrs 2 yrs 5 yrs Dz Free Survival A 61% 36% 52% 38% 44% 27% Overall Survival B 74% 54% 76% 55% 75% 56% Distant mets C 8% 12% 9% 15% 16% 22%

29. Treatment – Advanced Stage (III/IV) – cont’ Forastiere AA et al, N Engl J Med 2003;349:2091-8.

32. An Actual Picture of a Laryngeal Cancer (L) Source: http://www.medscape.com/content/2002/00/44/25/442595/442595_fig.html (R) Source: http://www.som.tulane.edu/classware/pathology/medical_pathology/New_for_98/Lung_Review/Lung-62.html

33. Questions?