Outcomes for Organ Preservation with Chemoradiation Therapy for T4 Larynx and Hypopharynx Cancer

Abstract

Objective: Limited data is available to guide non-surgical management of Stage T4 larynx and hypopharynx cancer patients who have inoperable disease or refuse surgery. We aim to review the nonoperative management of T4 laryngeal and hypopharyngeal cancer and report the long-term therapeutic and functional outcomes.Methods: We reviewed the nonoperative management of T4 laryngeal (n = 44) and hypopharyngeal (n = 53) cancer from 1997 to 2015 and performed a univariate analysis (UVA).Results: The 2-/5-year OS rates were 73%/38% for larynx patients and 52%/29% for hypopharynx patients. Locoregional failure (LRF) occurred in 25% and 19% of larynx and hypopharynx patients, respectively. On UVA of the larynx subset, N3 nodal status and non-intensity-modulated radiation therapy were negatively associated with OS; treatment with radiation therapy alone impacted disease-free survival; and age >70 was associated with LRF. On UVA of the hypopharynx subset, only T4b status significantly impacted OS. In the larynx and hypopharynx groups, 68% and 85% received a percutaneous endoscopic gastrostomy (PEG) tube and 32% and 40% received a tracheostomy tube, respectively. At the last follow-up visit, 66% of our larynx cohort had neither tracheostomy or PEG placed and 40% of our hypopharynx cohort had neither. Conclusion:We report better than previously noted outcomes among T4 larynx and hypopharynx patients who have unresectable disease or refuse surgery.

Survival in an era of organ preservation: an update on laryngeal cancer in Ireland

“…Conservation of the anatomical larynx, as famously described in the landmark publication by Wolf et al [ 6 ], now forms the basis for much of the treatment rationale for advanced laryngeal cancer. It additionally represents one of the more controversial areas in head and neck cancer; despite a strong body of evidence that T4 disease mandates primary ablative surgery [ 7 , 20 – 22 ], there are multiple recent reports of the successful use of concurrent chemoradiotherapy regimes for organ preservation in such disease [ 23 – 25 ]. No notable difference in survival was detected in the reported data for patients with T4 disease treated with primary surgery or radiotherapy.…”

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“…Reported rates of larynx preservation in these studies range from 29% to 86% for chemoradiation approaches and less for RT alone techniques. In these reports the long-term tracheostomy rate was 23% to 45%, and the long-term feeding tube rate was 23% to 32%, highlighting some of the risks for aspiration, high-grade dysphagia, and airway compromise in this population [11,[15][16]. Many of these reports spanned decades and employed older radiation techniques and staging guidelines [2,13,14].…”

“…Proper patient selection is vital, as several recent reports show inferior survival outcomes for T4a patients treated with nonsurgical approaches [13,[15][16][17][18][19]. One important selection criterion appears to the be volume of the primary tumor.…”