Primary organ preservation vs total laryngectomy for T4a larynx cancer

Abstract

Background There is a lack of consensus regarding the management of T4a larynx cancer. We evaluated the outcomes of organ preservation and laryngectomy for T4a laryngeal cancer. Methods Retrospective analysis of patients with T4a larynx cancer at BC Cancer from 1984 to 2014 was performed. Outcomes in patients treated with surgery alone (Sx) (n = 47), surgery with adjuvant radiotherapy (Sx/RT) (n = 94), radiation alone (RT) (n = 152), and radiation with concurrent chemoradiotherapy (chemoRT) (n = 36) were compared. Results The 5‐year overall survival (OS) was 40% for chemoRT, 34% for RT, 23% for Sx, and 45% for Sx/RT. On multivariate analysis (MVA), Sx/RT (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.48‐0.91) and chemoRT (HR, 0.44; 95% CI, 0.26‐0.72) were associated with better OS than RT alone (P = .001). Sx had similar OS compared to RT (HR, 1.17; 95% CI, 0.82‐1.68). Conclusions ChemoRT and Sx/RT were associated with better OS compared to single modality treatment. ChemoRT may be considered as an option for T4a larynx cancer.

Matched-Pair Analysis of Survival in the Patients with Advanced Laryngeal and Hypopharyngeal Squamous Cell Carcinoma Treated with Induction Chemotherapy Plus Chemo-Radiation or Total Laryngectomy

“…Our results are consistent with historical evidence [6,7,16,21,27,28] that responders to ICT have a survival advantage compared with non-responders, but in our series, the differences were only statistically significant in hypopharyngeal cancers. Survival outcomes differ in the different subsites of head and neck cancer, with the hypopharyngeal subsite having one of the worst prognoses.…”

“…Our results showed non-significant differences in 5-year OS and DSS between the chemo-selection treatment group (59% and 67%, respectively) and the surgical group (46% and 62%, respectively). These results compare well with the 5-year OS rates reported in randomized trials [5][6][7]16] and with other retrospective studies that reported 5-year OS rates between 36% and 58% [21][22][23]. Like our study, Rades et al [17] conducted a paired study for nine potential prognosis factors: they presented 44 patients treated with definitive CRT matched (1:2) to 88 patients treated with surgery plus CRT.…”

The Prognostic Utilities of Various Risk Factors for Laryngeal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

“…Any differences of opinion were resolved in a panel discussion with a third reviewer. We collected the name of the lead author, the year of publication, the study design, patient numbers, age, sex, nationality, survival outcomes, TNM stages (the American Joint Committee on Cancer TNM system), and HRs with 95% CIs for OS and DFS [ 2 , 6 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. HRs and 95% CIs were assessed using the usual methods if not specifically indicated in any study [ 33 , 34 ].…”

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“…The remaining literature reporting laryngeal preservation outcomes for T4a tumors relies on single or small multi-institutional experiences, often using an induction or chemo-selection approach, with some being prospective protocols and others retrospective analyses [6][7][8][9][10][11][12][13][14]. Reported rates of larynx preservation in these studies range from 29% to 86% for chemoradiation approaches and less for RT alone techniques.…”