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Efficacy of laryngectomy alone for treatment of locally advanced laryngeal cancer: A stage‐ and subsite‐specific survival analysis
Author(s) -
Cervenka B. P.,
Rao S.,
Farwell D. G.,
Bewley A. F.
Publication year - 2018
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/coa.13018
Subject(s) - medicine , laryngectomy , radiation therapy , glottis , proportional hazards model , cancer , stage (stratigraphy) , survival analysis , surgery , multivariate analysis , oncology , larynx , paleontology , biology
Objective Total laryngectomy is a well‐established treatment for locally advanced laryngeal cancer. Evidence for the benefit of post‐operative radiotherapy after laryngectomy in patients with locally advanced primaries and N0 or N1 nodal disease is limited. This study aimed to determine whether total laryngectomy alone is adequate therapy for certain patient subgroups with locally advanced laryngeal cancer. Design We performed a retrospective survival analysis of patients in the surveillance epidemiology and end results ( SEER ) database with locally advanced laryngeal cancer between 2004 and 2012. Outcome Measures Primary outcome measure was overall survival. Results For all patients with T3‐4aN0‐1 tumours, overall survival was worse for those treated with laryngectomy only when compared using the Kaplan‐Meier with a log‐rank test and when accounting for demographic and tumour data using a Cox multivariate regression. Other independent predictors of poor survival included age >65 years old, Medicaid or uninsured payor status, supraglottic primary and N1 nodal disease. Stage‐ and subsite‐specific analysis revealed that patients with T4a primary tumours, N1 nodal disease and supraglottic subsite had worse overall survival when treated with laryngectomy alone. Alternatively, patients with T3 primary tumours, N0 nodal disease, glottic subsite had equivalent overall survival and disease‐specific survival when treated with laryngectomy alone vs laryngectomy with post‐operative radiotherapy. Conclusion Locally advanced laryngeal cancer patients with T3 primaries, no nodal disease or primaries of the glottis may not benefit from post‐operative radiotherapy when treated with primary total laryngectomy.