Definitive Radiotherapy versus Surgery for the Treatment of Verrucous Carcinoma of the Larynx: A National Cancer Database Study

Abstract

Introduction Traditionally, larger lesions of laryngeal verrucous carcinoma are treated with surgical excision, with definitive radiotherapy generally reserved for smaller lesions. However, data utilizing modern databases is limited. Objective The authors sought to assess, utilizing the National Cancer Database, whether overall survival for patients with laryngeal verrucous carcinoma was equivalent when treated with definitive radiotherapy versus definitive surgery. Methods A retrospective cohort study was conducted utilizing the National Cancer Database. All cases of laryngeal verrucous carcinoma within the National Cancer Database between 2006 and 2014 were reviewed. Patients with T1–T3 (American Joint Commission on Cancer 7th Edition) laryngeal verrucous carcinoma were included and stratified by treatment modality. Demographics, treatment, and survival data were analyzed. Results A total of 392 patients were included. Two hundred and fifty patients underwent surgery and 142 received radiotherapy. The two groups differed in age, transition of care, clinical T stage, and clinical stages. There was no significant difference in survival between T1–T3 lesions treated with surgery or radiotherapy (p = 0.32). Age, comorbidities, insurance status, and clinical T stage impacted overall hazard on multivariate analysis (p < 0.01). For patients treated with radiotherapy, age, insurance status, and clinical T stage were predictive of increased hazard. Conclusion Overall survival is equivalent for patients with clinical T1 and clinical T2 laryngeal verrucous carcinoma treated with primary radiotherapy versus primary surgery. Thus, radiotherapy should be considered as a non-inferior treatment modality for certain patients with laryngeal verrucous carcinoma.

Some Considerations on the Treatment of Laryngeal Verrucous Squamous Cell Carcinoma

“…The resulting 5-year DSS, overall survival (OS) and laryngeal preservation rates of 87%, 97% and 81%, respectively, suggest that effective (limited) salvage surgery is still possible after unsuccessful radiotherapy. This is supported by large population studies that have found no differences in DSS and OS between those treated with primary surgery or primary radiotherapy, at least in patients with early-stage LVSCC [ 5 , 9 ]. Obviously, surgical salvage after unsuccessful radiotherapy could contribute significantly to achieving very high cure rates for these tumors.…”

Laryngeal verrucous cell carcinoma

“…The controversy regarding the role of radiotherapy persists within two recent studies [48 ▪ ,49]. Based on a national cancer database, Kompelli et al reported that overall survival may be equivalent for patients with cT1 and cT2 LVC treated with primary radiotherapy compared with those treated by primary surgery [49].…”

“…The controversy regarding the role of radiotherapy persists within two recent studies [48 ▪ ,49]. Based on a national cancer database, Kompelli et al reported that overall survival may be equivalent for patients with cT1 and cT2 LVC treated with primary radiotherapy compared with those treated by primary surgery [49]. In the same vein, Takenaka et al reported from the SEER database that the 5-year overall survival rates in the radiation and surgery groups were 72.7 and 72%, respectively.…”

Epidemiological, Clinical and Oncological Outcomes of Laryngeal Verrucous Carcinomas: A Systematic Review

“…Surgery has long time been considered as the treatment of choice with overall survival and disease-free survival rates ranging from 86.8 to 100% [ 2 , 3 , 5 ]. The overall survival (OS) and disease-free survival (DFS) of radiotherapy were both lower than surgery with up to 70% of patients with disease free at follow-up [ 2 , 3 , 6 , 7 ]. The radiotherapy was moreover controversial regarding the potential risk of anaplastic transformation after treatment [ 8 ].…”

“…The radiotherapy was moreover controversial regarding the potential risk of anaplastic transformation after treatment [ 8 ]. The discussions about the most effective treatment continue regarding recent studies supporting the usefulness of radiation approaches for the treatment of LVC [ 6 , 7 ].…”