Efficacy of Laryngectomy alone for Treatment of Locally Advanced Laryngeal Cancer: A Stage and Subsite Specific Survival Analysis

Abstract

Objective

Total laryngectomy is a well-established treatment for locally advanced laryngeal cancer. Evidence for the benefit of post-operative radiotherapy after laryngectomy in patients with locally advanced primaries and N0 or N1 nodal disease is limited. This study aims to determine whether total laryngectomy alone is adequate therapy for certain patient subgroups with locally advanced laryngeal cancer.

Design

We performed a retrospective survival analysis of patients in the surveillance epidemiology and end results (SEER) database with locally advanced laryngeal cancer between 2004-2012.

Outcome Measures

Primary outcome measure was overall survival.

Results

For all patients with T3-4aN0-1 tumors, overall survival was worse for those treated with laryngectomy only when compared using the Kaplan-Meier with a Log-Rank test and when accounting for demographic and tumor data using a Cox multivariate regression. Other independent predictors of poor survival included age > 65 years old, Medicaid or uninsured payor status, supraglottic primary and N1 nodal disease. Stage and subsite specific analysis revealed that patients with T4a primary tumors, N1 nodal disease and supraglottic subsite had worse overall survival when treated with laryngectomy alone. Alternatively, patients with T3 primary tumors, N0 nodal disease, glottic subsite had equivalent overall survival and disease specific survival when treated with laryngectomy alone versus laryngectomy with post-operative radiotherapy.

Conclusion

Locally advanced laryngeal cancer patients with T3 primaries, no nodal disease or primaries of the glottis may not benefit from post operative radiotherapy when treated with primary total laryngectomy.

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