Long‐term outcomes after multidisciplinary management of T3 laryngeal squamous cell carcinomas: Improved functional outcomes and survival with modern therapeutic approaches

Abstract

BACKGROUND Evaluate long-term outcomes after initial definitive or adjuvant radiotherapy for T3-larynx cancers. METHODS We reviewed 412 patients treated for T3 laryngeal squamous cell cancer 1985–2011. RESULTS 10-year OS was 35%; disease-specific-survival (DSS), 61%; locoregional control (LRC), 76%; freedom from distant metastasis, 83%. Chemotherapy, age, performance status <2, node-negative status, and glottic sub-site were associated with improved survival (all P<0.03). Larynx preservation with induction and/or concurrent chemoradiotherapy (LP-CRT) had better laryngectomy-free survival (LFS) than radiotherapy alone (LP-RT) (HR, 0.62; 95% CI, 0.47–0.81; P=0.0005); 10-year LFS rates of the LP-CRT cohort (37%) were higher than those of the LP-RT cohort (18%). 5-year DSS and OS rates of the LP-CRT cohort (79% and 67%) were better laryngectomy with post-operative radiotherapy (TL-PORT) (61% and 50%) and LP-RT (64% and 46%; P<0.006 for all). CONCLUSIONS In patients with T3-larynx cancers, LP-CRT provides better functional, oncologic, and survival outcomes than historical TL-PORT or LP-RT does.

Age‐adjusted comorbidity and survival in locally advanced laryngeal cancer

“…Multiple studies have demonstrated that pretreatment comorbidity status is an independent predictor of overall survival (OS). (1–9, 11–13) …”

Organ preservation following radiation therapy and concurrent intra‐arterial low dose cisplatin infusion for advanced T2 and T3 laryngeal cancer: Long‐term clinical results from a pilot study

“…Table summarizes a literature review of the different therapeutic options. In several studies of surgical treatments, including total laryngectomy, the 5‐year OS rates ranged from 41% to 85.5% . Although it is difficult to compare these earlier results directly with our findings, the survival rates in our study tended to be favorable.…”

“…In a recent study of LP, Timme et al calculated a 2-year LEDFS rate of 40% in patients with T3 disease treated with IV-CRT 24. Fuller et al reported 5-year LFS rates of 38% and 62% in patients with T3 disease treated with definitive RT or systemic CRT, respectively, and 5-year LEDFS rates of 37% and 59% in patients with T3 disease treated with definitive RT or systemic CRT, respectively 25. Therefore, our findings appear to demonstrate more favorable outcomes of disease control, survival, and LP, compared to previous studies.…”

Elective neck dissection in patients with radio‐recurrent and radio‐residual squamous cell carcinoma of the larynx undergoing salvage total laryngectomy: Systematic review and meta‐analysis

“…Laryngeal squamous cell carcinoma (SCC) is managed by both surgical and nonsurgical treatment modalities and its management has evolved over recent years, trending towards nonsurgical, organ‐preservation treatment in the primary setting. The current management for advanced laryngeal SCC is supported by evidence from the landmark Veterans Affairs Larynx Trial and subsequent organ‐preservation studies in laryngeal SCC which recommend delivering nonsurgical, organ‐preserving regimens to patients with good pretreatment function . After primary nonsurgical treatment, up to 25% of laryngeal cancers recur, therefore requiring salvage total laryngectomy.…”

“…The current management for advanced laryngeal SCC is supported by evidence from the landmark Veterans Affairs Larynx Trial 1 and subsequent organ-preservation studies in laryngeal SCC which recommend delivering nonsurgical, organ-preserving regimens to patients with good pretreatment function. 2,3 After primary nonsurgical treatment, up to 25% of laryngeal cancers recur, therefore requiring salvage total laryngectomy. The optimum management of the neck in a locally recurrent laryngeal SCC after initial radiotherapy (RT) or chemoradiotherapy (CRT) remains unclear, with no high-level evidence on the topic and the majority of data arising from retrospective case series.…”