Organ-preservation (chemo)radiotherapy for T4 laryngeal and hypopharyngeal cancer: is the effort worth?

• Published in: European archives of oto-rhino-laryngology Vol. 276; no. 2; pp. 575 - 583
• Main Authors: Al-Mamgani, Abrahim, Navran, Arash, Walraven, Iris, Schreuder, Willen Hans, Tesselaar, Margot E. T., Klop, Willem Martin C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2019
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Chemoradiotherapy; Chemoradiotherapy, Adjuvant; Female; Head & Neck; Head and Neck Surgery; Humans; Hypopharyngeal Neoplasms - mortality; Hypopharyngeal Neoplasms - pathology; Hypopharyngeal Neoplasms - therapy; Laryngeal Neoplasms - mortality; Laryngeal Neoplasms - pathology; Laryngeal Neoplasms - therapy; Laryngectomy; Larynx; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Organ Sparing Treatments; Otorhinolaryngology; Retrospective Studies; Laryngeal cancer; Hypopharyngeal cancer; Total laryngectomy; Organ preservation; Chemoradiation
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-018-5241-8

Purpose
We aimed to analyze the oncological and functional outcomes of chemoradiation for T4 laryngeal and hypopharyngeal cancer.
Methods
Patients treated between 2008 and 2015 with chemoradiation (
n
 = 39) were retrospectively analyzed for oncological and functional (laryngo-esophageal dysfunction-free survival, LED-FS) outcomes and compared with 32 consecutive patients treated primarily with total laryngectomy (TL). LED was scored as event in case of local failure, TL for any reason, persistent tracheotomy and/or feeding tube dependency 2 years after chemoradiation.
Results
The 5-year local control (LC) rates in the chemoradiation and TL groups were 64 and 87%, respectively (
p
 = 0.030). The disease-free survival was 54 and 59% (
p
 = 0.810), and overall survival (OS) was 46 and 47% (
p
 = 1.00). In the chemoradiation group, the 5-year cumulative incidence of LED-FS was 46%, but was significantly worse in patients with poor pre-treatment laryngeal function, compared to those without (20% and 74%, respectively,
p
 = 0.001). Furthermore, patients with LED have significantly worse OS compared to those without (32% and 65%, respectively,
p
 = 0.041). Multivariate analysis showed that primary treatment type is significantly predictive for LC, while tumor site and extra-capsular extension were predictive for OS. Poor pre-treatment laryngeal function is the only significant predictive factor for LED.
Conclusions
TL resulted in significantly better LC, as compared to chemoradiation in T4 laryngeal and hypopharyngeal cancer patients and the LED-FS is worse in patients with poor pre-treatment laryngeal function. These patients might benefit more from primary treatment with TL followed by radiotherapy. These issues should be taken into consideration, as patients are counseled about different primary treatment options.