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Comparing surgical and nonsurgical larynx‐preserving treatments with total laryngectomy for locally advanced laryngeal cancer
Author(s) -
Patel Sagar A.,
Qureshi Muhammad M.,
Dyer Michael A.,
Jalisi Scharukh,
Grillone Gregory,
Truong Minh Tam
Publication year - 2019
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.32292
Subject(s) - medicine , laryngectomy , larynx , laryngeal neoplasm , cancer , surgery
Background The declining 5‐year overall survival (OS) of patients with laryngeal cancer has been associated with increased nonsurgical management of stage III/IV disease. To further assess this hypothesis, the authors evaluated recent OS trends and patterns of use between larynx‐preserving approaches with chemoradiation (CRT) or partial laryngectomy (PL) and total laryngectomy (TL) stratified by tumor and nodal burden. Methods The National Cancer Data Base was used to identify 8703 patients with stage III/IV (excluding T1 tumors) laryngeal squamous cell carcinoma treated between 2003 and 2011 with CRT or upfront PL or TL with or without adjuvant therapy. OS was analyzed using the Kaplan‐Meier method and a Cox proportional hazards model. Results Among patients with non‐T4, low nodal burden (T2N1 or T3N0‐N1) disease, no survival differences were observed between CRT, PL, and TL. Patients who had non‐T4, high nodal burden (T2‐T3N2‐N3) disease who underwent TL with or without adjuvant treatment had a higher risk of death compared with those who received CRT (hazard ratio, 1.25; 95% CI, 1.04‐1.51; P = .016). For T4N0‐N3 tumors, TL compared with CRT was associated with improved OS (hazard ratio, 0.80; 95% CI, 0.62‐0.92; P = .002). No statistically significant difference in outcome was noted between CRT and PL for all stage groups. The use of CRT has declined and receipt of TL has increased since 2006 for T4 disease, whereas PL rates have remained stably low. Conclusions No survival differences were noted between surgical and nonsurgical approaches for patients with non‐T4, low nodal burden laryngeal cancer. Patients with non‐T4, high nodal burden disease may benefit from definitive CRT. Total laryngectomy remains advantageous in patients with T4 disease.