KEY POINTS
- The institutional cohort included 309 patients with locally advanced squamous cell carcinoma of the oropharynx, hypopharynx or larynx. Propensity matching for age, T stage and N stage produced 61 surgery-plus-adjuvant-RT and 61 definitive-RT patients.
- Definitive treatment delivered a median 70.2 Gy to the high-risk CTV, compared with 66 Gy postoperatively. Concurrent platinum therapy or cetuximab was used according to clinical indication.
- Five-year overall survival was 63.9% after surgery plus adjuvant RT versus 60.0% after definitive RT, with no meaningful difference (HR 1.05, 95% CI 0.50–2.22; p=0.70).
- Disease control numerically favored the surgery-based approach: median PFS was 81.0 versus 43.4 months (p=0.09), but the study was underpowered to establish a significant difference.
- Locoregional recurrence occurred in 12% versus 23%, again numerically favoring surgery plus adjuvant RT but without statistical significance (p=0.149). Most recurrences occurred within previously irradiated high-dose volumes.
- Lymphedema was significantly more common after surgery plus RT (33% versus 13%, p=0.017); dysphagia, xerostomia, mucositis, dermatitis and most other RT-associated toxicities were comparable.
CLINICAL TAKEAWAY
These data support both definitive RT and surgery followed by postoperative RT as valid approaches for appropriately selected locally advanced pharyngeal and laryngeal cancers. The apparent disease-control advantage after surgery is hypothesis-generating only; treatment selection, different clinical versus pathological staging and residual imbalance remain major limitations.