Partial Laryngectomy versus Chemoradiotherapy

Objective Chemoradiation protocols for organ preservation has relegated surgery to salvage in many institutions. However, open partial laryngectomies and endoscopic procedures provide an option for function preservation. The aim of this study is to review the outcomes of T2‐T4 laryngeal and hypopharyngeal cancer patients treated with either partial laryngectomy or chemoradiotherapy. Method Retrospective review of patients with T2‐T4 laryngeal and hypopharyngeal squamous cell carcinoma treated with either partial laryngectomy or chemoradiotherapy between 2001 and 2009 at the authors’ institution. Primary endpoints were local control rate and laryngo‐esophageal dysfunction‐free local control (LEDFLC, patients without tracheostomy or feeding tube in the last contact). Results Surgical group: 47 patients, with 50% of locally advanced tumors (T3‐T4). Chemoradiotherapy group: 36 patients with 72% of locally advanced tumors. Median follow‐up was 49.5 months. Local control rate was statistically higher for the surgical group (84.3% vs 63.6%, P =. 021), although no differences in LEDLC were observed. When local control rate is analyzed by T stages, a significant difference is found for T2 (95.2% vs 70%, P =. 035) favoring surgical group, and a nonsignificant trend for T3‐T4 (72.7% vs 61.4%). A nonsignificant trend in overall survival, disease‐specific survival, and disease‐free survival favoring primary surgical treatment was found. Conclusion When properly indicated and performed, partial laryngectomy achieves similar function preservation outcomes to chemoradiation protocols. A noticeable better local control rate has been observed for the surgical group. These techniques should endure in the armamentarium of surgeons. Choosing the most appropriate treatment for each patient is the key for success.