A 10-Year Study on Larynx Preservation Compared With Surgical Resection in Patients With Locally Advanced Laryngeal and Hypopharyngeal Cancers

Abstract

Background: Few reports from China provide confirmed evidence of the effectiveness of the larynx preservation strategy compared with surgery on the treatment of laryngeal and hypopharyngeal cancers. This study assessed the clinical outcomes of patients with locally advanced laryngeal and hypopharyngeal cancers treated with larynx preservation and determined the optimal larynx preservation procedure.

Methods: Data of 1,494 patients treated with total laryngectomy or larynx preservation between 2006 and 2014 were retrieved from the database of Sun-Yat Sen University Cancer Center in Guangzhou, China, and 366 eligible patients were selected for final analysis. The clinical outcomes of 228 patients received total laryngectomy and 138 patients received larynx preservation treatments, which comprises induction followed by radiotherapy and concurrent radio-chemotherapy, were compared.

Results: There was no statistical difference in the 3-, 5-, and 10-year PFS and OS in patients received larynx preservation compared with patients treated with laryngectomy. With respect to T stage, a better overall OS in T2-stage disease (P = 0.036) but poorer PFS (P = 0.005) in T3-stage disease was observed in the larynx preservation group compared with the surgery group in Univariate analysis. T3-stage disease had poorer PFS in multivariable analysis (P = 0.022). With larynx preservation intent, induction chemotherapy followed by radiotherapy showed no advantage in the control of disease progression and survival compared with concurrent chemoradiotherapy. The patient subpopulations who received efficacy assessment after induction chemotherapy exhibited significantly longer PFS and OS compared with those without efficacy assessment.

Conclusions: This is the largest sample size study on larynx preservation treatment for laryngeal and hypopharyngeal cancers in China. Our results indicated that larynx preservation treatments did not jeopardize the survival of patients with advanced resectable laryngeal or hypopharyngeal cancers. Efficacy assessment should be emphasized in induction chemotherapy.

Keywords: hypopharynx cancer; laryngeal cancer; laryngectomy; larynx preservation; overall survival; progression free survival.

Figure 1

Screening flowchart for eligible patients.

Figure 2

Overall survival data of the 366 patients with laryngeal and hypopharyngeal cancers.

Figure 3

Comparison of overall survival data between surgery and larynx preservation groups.

Figure 4

Stratification analysis of survival data by T stage between surgery and larynx preservation groups.

Figure 5

Comparison of survival data in induction chemotherapy treated groups, with or without efficacy assessment.

Figure 6

Comparison of survival data between induction chemotherapy/radiotherapy (CT/RT) group and concurrent CT/RT group.

Figure 7

Comparison of survival data between triplet TPF group and doublet TP or PF group. PF, platinum plus fluorouracil; TP, docetaxel plus platinum; TPF, docetaxel, platinum and fluorouracil.