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High relevance larynx chemoradiotherapy

Total laryngectomy improved local control over chemoradiotherapy in selected advanced laryngeal cancer

Surgery provided substantially better local control in T3–T4a N0–N1 laryngeal cancer, while disease-specific survival remained similar and CRT preserved laryngeal function in 79%.

RadOncToday · ·1 min read

KEY POINTS

  • This multicentre retrospective cohort included 311 patients with T3–T4a N0–N1 laryngeal squamous cell carcinoma treated between 2008 and 2025: 160 received definitive CRT and 151 underwent total laryngectomy followed by postoperative RT with or without chemotherapy.
  • Baseline treatment selection was strongly imbalanced. 81.3% of CRT patients had T3 disease, whereas 70.9% of surgically treated patients had T4 disease. The authors therefore used propensity matching and full-cohort inverse probability weighting in addition to conventional analyses.
  • With a median follow-up of 98 months, disease-specific survival was similar in the unmatched cohort. Five-year DSS was 92.1% after definitive CRT versus 93.7% after surgery, with no significant difference (p=0.351).
  • Local control strongly favored surgery: 5-year LC was 98% after laryngectomy + postoperative therapy versus 79% after definitive CRT (p<0.001); at 10 years, corresponding rates were 95% versus 77%.
  • Propensity matching produced 59 patients per group. In this selected matched cohort, definitive CRT was associated with worse 5-year OS of 64.5% versus 84.0% and worse local control; cluster-robust OS HR was 2.08 (95% CI 1.12–3.86; p=0.021).
  • Importantly, the full-cohort IPTW analysis did not confirm an overall-survival advantage for surgery (HR 0.93, 95% CI 0.64–1.36; p=0.715). The inconsistent adjusted OS estimates argue against a stable causal survival effect of treatment modality.
  • Definitive CRT achieved functional laryngeal preservation in 126/160 patients (78.8%). Local recurrence developed in 31 patients (19.4%); 20 underwent salvage total laryngectomy, and 15/20 were alive and disease-free at last follow-up.
  • The 5-year cumulative incidence of salvage laryngectomy after definitive CRT was 13.5%. Permanent tracheostomy occurred in two patients without local recurrence and long-term feeding-tube dependence in one.

CLINICAL TAKEAWAY

For carefully selected T3–T4a N0–N1 laryngeal cancer, total laryngectomy provides a clear local-control advantage, but this dataset does not establish a consistent survival benefit over modern definitive CRT. CRT therefore remains a reasonable organ-preservation strategy when baseline laryngeal function is suitable, surveillance is close, and effective salvage surgery is available.

SOURCE

Cancers

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