Outcomes of the contemporary management approach for locally advanced
(T3-T4) laryngeal cancer: a retrospective cohort study
Abstract
Background: Our centre has favoured primary surgery over
chemoradiotherapy(CRT) for specific advanced laryngeal cancer patients
with large volume tumours, airway compromise, significant dysphagia and
T4 disease. Some reports suggest surgery is associated with higher
oncological control than organ-preservation strategies. This study
reports the survival outcomes for a modern, high-volume head and neck
centre favouring surgical management approaches. Methods: Patient data
was collated retrospectively over a 7-year period from a tertiary head
and neck specialty centre. Kaplan-Meier survival analysis and the
Cox-proportional hazards model were employed for survival analyses.
Results: The study population included 121 patients with T3(n=76) or
T4(n=45) laryngeal cancer with a mean follow-up of 2.9 years.
104(86.0%) patients were treated with curative intent. Of which,
14(11.6%) received radiotherapy, 40(33.1%) received chemoradiotherapy
(CRT), 19(15.7%) underwent surgery alone and 31(25.6%) underwent
surgery with adjuvant therapy. In the cohort treated with curative
intent, the 2-year and 5-year estimated disease-specific survival was
77.9% and 64.1% respectively. CRT had the highest 2-year DSS(92.5%),
followed by surgery with adjuvant therapy(81.8%), RT alone(75%) and
surgery alone(72.4%). Prognostic factors identified for
disease-specific survival included age, tumour subsite and treatment
modality. Conclusion: For a centre favouring primary surgery for certain
advanced laryngeal cancers, the DSS appears no higher than published
literature. The DSS following CRT is encouraging and we postulate that
more of our patients may have benefitted from this treatment. To truly
enhance survival, future research needs to move away from identifying
treatment superiority and focus on precision medicine to define
treatment pathways in this disease.