Survival and Function following Primary Laryngectomy or Primary Chemoradiotherapy +/- Salvage laryngectomy in Advanced Laryngeal Cancer: 11-Year Retrospective Cohort Study
Authors List:
McElroy, D., Cardiff University, School of Medicine, Cardiff, United Kingdom
Heyman, J., Smith, D., Exarchos S., Doddi NM., Department of Otolaryngology, Royal Glamorgan Hospital, Llantrisant, Cwm Taf Morgannwg Healthboard, United Kingdom
Introduction:
For advanced laryngeal cancer, larynx-preserving primary radiotherapy/chemoradiotherapy (P-CRT) may benefit from avoiding post-laryngectomy complications, and breathing, vocalisation or swallowing dysfunction which is paramount to patients' quality of life. However, risk of salvage total laryngectomy (STL) following non-surgical management failure is an important consideration where outcomes can be uncertain.
Aims:
This paper aims to elucidate locoregional oncological and post-treatment functional status following P-CRT +/- STL or primary total laryngectomy (PTL), hypothesising comparable survival outcomes.
Methods:
11-year retrospective analysis of 61 patients who underwent PTL (n=29) or P-CRT +/- STL (n=32) across Welsh regional health board. Outcomes were overall and disease-free survival, recurrence, post-treatment nutritional and vocal status, and post-laryngectomy complications. Survival estimates were analysed with Kaplan-Meier method.
Results:
Recurrence following P-CRT was higher but not statistically significant at 1- and 3-years compared to PTL (17.9 and 9.1% at 1 year; 45.5% and 20.0% at 3 years respectively), with a substantial proportion later receiving STL (31.3%). Overall survival rate and median disease-free survival were not significantly different between modalities at 1 and 3-years. Significantly greater late complications were associated with STL versus PTL (p=0.027), along with longer hospital stays and time to oral feeding (p<0.001). 81.8% and 85.2% of patients maintained oral nutritional intake following P-CRT and PTL, respectively. 86.4% of patients had a functional larynx following P-CRT, while 80.8% achieved vocal restoration following PTL.
Conclusion:
This retrospective analysis in a Welsh population shows comparable survival outcomes following both PTL and P-CRT +/- STL. Management of advanced laryngeal cancer involves a trade-off between the quality of life offered by preserving the structural and functional integrity of the larynx, with the higher chance of recurrence necessitating salvage surgery and associated morbidity.
McElroy, D., Cardiff University, School of Medicine, Cardiff, United Kingdom
Heyman, J., Smith, D., Exarchos S., Doddi NM., Department of Otolaryngology, Royal Glamorgan Hospital, Llantrisant, Cwm Taf Morgannwg Healthboard, United Kingdom
Introduction:
For advanced laryngeal cancer, larynx-preserving primary radiotherapy/chemoradiotherapy (P-CRT) may benefit from avoiding post-laryngectomy complications, and breathing, vocalisation or swallowing dysfunction which is paramount to patients' quality of life. However, risk of salvage total laryngectomy (STL) following non-surgical management failure is an important consideration where outcomes can be uncertain.
Aims:
This paper aims to elucidate locoregional oncological and post-treatment functional status following P-CRT +/- STL or primary total laryngectomy (PTL), hypothesising comparable survival outcomes.
Methods:
11-year retrospective analysis of 61 patients who underwent PTL (n=29) or P-CRT +/- STL (n=32) across Welsh regional health board. Outcomes were overall and disease-free survival, recurrence, post-treatment nutritional and vocal status, and post-laryngectomy complications. Survival estimates were analysed with Kaplan-Meier method.
Results:
Recurrence following P-CRT was higher but not statistically significant at 1- and 3-years compared to PTL (17.9 and 9.1% at 1 year; 45.5% and 20.0% at 3 years respectively), with a substantial proportion later receiving STL (31.3%). Overall survival rate and median disease-free survival were not significantly different between modalities at 1 and 3-years. Significantly greater late complications were associated with STL versus PTL (p=0.027), along with longer hospital stays and time to oral feeding (p<0.001). 81.8% and 85.2% of patients maintained oral nutritional intake following P-CRT and PTL, respectively. 86.4% of patients had a functional larynx following P-CRT, while 80.8% achieved vocal restoration following PTL.
Conclusion:
This retrospective analysis in a Welsh population shows comparable survival outcomes following both PTL and P-CRT +/- STL. Management of advanced laryngeal cancer involves a trade-off between the quality of life offered by preserving the structural and functional integrity of the larynx, with the higher chance of recurrence necessitating salvage surgery and associated morbidity.
