Comparing surgical and nonsurgical larynx-preserving treatments with total laryngectomy for locally advanced laryngeal cancer.

Patel et al. from  Boston University School of Medicine, analyzed the National Cancer Data Base  between 2003 and 2011 (published in Cancer,June 2019) comparing surgical and nonsurgical larynx-preserving treatments with total laryngectomy for locally advanced laryngeal cancer.

They identified 8703 patients with stage III/IV (excluding T1 tumors) laryngeal squamous cell carcinoma treated with chemoradiation (CRT) or partial laryngectomy (PL) and total laryngectomy(TL)  with or without adjuvant therapy.

The authors found that:

• Among patients with non-T4, low nodal burden (T2N1 or T3N0-N1) disease, no survival differences were observed between CRT, PL, and TL.
• Patients who had non-T4, high nodal burden (T2-T3N2-N3) disease who underwent TL with or without adjuvant treatment had a higher risk of death compared with those who received CRT.
• No statistically significant difference in outcome was noted between CRT and PL for all stage groups.   

The authors concluded that patients with non-T4, high nodal burden disease may benefit from definitive CRT. Total laryngectomy remains advantageous in patients with T4 disease.