Primary total laryngectomy versus organ preservation for T3/T4a laryngeal cancer: a population-based analysis of survival

Abstract

Background: For 20 years, laryngeal cancer survival has been decreasing. Moreover, the use of radiotherapy (RT) and chemotherapy-radiotherapy (CRT) has risen and the use of total laryngectomy plus radio/chemotherapy (TL-R/CT) for advanced disease has declined.

Objective: To assess the survival outcomes of TL-R/CT, RT, and CRT in patients with T3 and T4a laryngeal cancers in Alberta, Canada.

Design: Population-based longitudinal cohort study.

Setting: Tertiary care cancer treatment centres.

Methods: The Alberta Cancer Registry was accessed to collect data on laryngeal cancers in Alberta from 1998 to 2008. Patients were included if they had T3 or T4a cancers treated with curative intent. Outcomes were compared via Cox regression and Kaplan-Meier analyses.

Main outcome measures: Overall and disease-free survival were determined for T3 and T4a laryngeal cancers per treatment group.

Results: A total of 727 laryngeal cancers were identified, and 258 were included. The mean follow-up was 3.43 years. Overall survival for T3 cancers at 2 and 5 years for TL-R/CT was 89% and 70%, for RT was 48% and 18%, and for CRT was 66% and 52%, respectively. The hazard ratios of RT and CRT compared to TL-R/CT were 3.1 (p < .001) and 2.6 (p = .004), respectively. Overall survival for T4a cancers at 2 and 5 years for TL-R/CT was 60% and 49%, for RT was 12% and 5%, and for CRT was 32% and 16%, respectively. The hazard ratios of RT and CRT compared to TL and RT were 4.9 (p < .001) and 2.3 (p = .04), respectively.

Conclusion: TL-R/CT provides superior survival for T3 and T4a laryngeal cancers versus RT or CRT. Therefore, the current standards of care and clinical guidelines warrant reassessment.