Salvage total laryngectomy after external-beam radiotherapy: A 20-year experience

Abstract

Background: The purpose of this study was to present our evaluation of the clinical and functional outcomes after salvage total laryngectomy (STL).

Methods: We conducted a retrospective review of 218 patients who underwent STL between 1994 and 2014.

Results: Seventy percent of patients originally had T1 or T2, N0 tumors and 73% had definitive external-beam radiotherapy (EBRT) alone. A majority utilized tracheoesophageal prosthesis (77%) and were gastrostomy free (80%) at last follow-up. The 5-year disease control and overall survival (OS) rates were 65% and 57%, respectively. Patients with a disease-free interval after initial treatment <2 years were more likely to develop a recurrence (p = .001) and die of disease (p = .032) after STL. The disease-free interval after EBRT impacted disease control (p < .001), with 5-year disease control of 92% for >5-year disease-free interval and 60% for <2-year disease-free interval.

Conclusion: Most patients remain disease-free after STL, achieve intelligible tracheoesophageal speech, and maintain an oral diet. Delayed recurrence after initial treatment portends better survival and may indicate a distinct biological profile. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1962-E1968, 2016.

Keywords: complications; disease-free interval; fistula; free flap; laryngectomy; radiotherapy; recurrence; salvage; squamous cell carcinoma.

Figure 1. Survival

A) Time to recurrence following STL. B) Overall survival following STL.

Figure 2. Impact of DFI following EBRT on time to recurrence and overall survival post STL

A) Most patients exhibited a DFI of <2 years post EBRT. B) DFI post EBRT impacts time to recurrence post STL. Trend analysis demonstrated a statistically significant relationship between the three groups (p-value = 0.001). C) DFI post EBRT impacts overall survival post STL (DFI <2years vs DFI 2–5 years p=0.037).