Which is the Best Strategy in Local Advanced Larynx Cancer? Total Laryngectomy Plus Radiotherapy or Larynx Preservation with Chemoradiotherapy: Single Center Experience

INTRODUCTION: The treatment of locally advanced laryngeal cancer (LALC) is very challenging. In the last few decades there has been a shift from total laryngectomy towards organ-sparing approaches. The aim of the current study is to compare oncological outcomes between surgery (total laryngectomy) followed by radiotherapy and larynx preservation with chemoradiotherapy (CRT).
METHODS: 114 patients with stage III-Iva-b laryngeal cancer were included in the study, between 2009 and 2018. Thirty-six patients (31.6%) were performed total laryngectomy followed by radiotherapy and 78 (68.4%) underwent the larynx preservation approach. Survival differences between the groups were examined with the Kaplan-Meier test and cox-regression tests for factors affecting survival.
RESULTS: 5-year overall survival (OS) was found 66.3 months and 74.1 months, in the larynx preservation and the surgical groups, respectively (p=0.29). There was no statistically difference between groups for OS in the patients with T3/N0-N1 (p=0.76), but surgical groups had longer OS in the patients with T3/N2-N3 (p=0.04). There was no statistically difference between groups for OS in the patients with T4/N0-N1 (p=0.47), however CRT groups had longer OS in the patients with T4/N2-N3 (p=0.02). The N2-N3 was the factor associated with poor progression-free survival and distant metastasis free survival in multivariate analysis (p<0.01). Age (≥65) was found to be associated with 2.1 times increased risk of death (p=0.01). The trans-glottis tumors were associated with a 3.6-fold increased risk of tracheostomy (p<0.01).
DISCUSSION AND CONCLUSION: The N0-N1 and N2-N3 should also be considered as well as advanced T-category for the treatment of LALC.

Lokal Ýleri Evre Larinks Kanserinde Hangi Strateji En Ýyisi? Total Larenjektomiye Radyoterapi Eklenmesi mi Organ Koruyucu Kemoradyoterapi mi? Tek Merkez Deneyimi

GÝRÝÞ ve AMAÇ: Lokal ileri larinks kanserinin tedavisi çok zordur. Son birkaç on yýlda total larenjektomiden organ koruyucu yaklaþýmlara, yani kemoradyoterapiye doðru bir kayma olmuþtur. Bu çalýþmanýn amacý, cerrahi (total larenjektomi) ardýndan radyoterapi ve kemoradyoterapi ile larinksin korunmasý arasýndaki onkolojik sonuçlarý karþýlaþtýrmaktýr.
YÖNTEM ve GEREÇLER: 2009-2018 yýllarý arasýnda evre III-IVa-b larinks kanserli 114 hasta çalýþmaya dahil edildi. 36 hastaya (%31,6) radyoterapi ve 78 hastaya (%68,4) larinks koruyucu yaklaþým uygulandý. Larinks koruma yaklaþýmlarý, indüksiyon kemoterapisi sonrasý kemoradyoterapi veya eþ zamanlý kemoradyoterapi idi. Gruplar arasýndaki saðkalým farklýlýklarý Kaplan-Meier testi ve saðkalýma etki eden faktörler cox-regresyon testi ile deðerlendirildi.
BULGULAR: 5 yýllýk genel saðkalým larinks koruma ve cerrahi gruplarda sýrasýyla 66,3 ay ve 74,1 ay olarak bulundu (p=0.29). Evre III hastalarda 5 yýllýk hastalýk spesifik saðkalým (HSS) oraný cerrahi grupta %63,3 iken kemoradyoterapi grubunda %66,2 idi (p=0,83). Evre IV hastalarda 5 yýllýk HSS oranlarý cerrahide %68,6, kemoradyoterapi grubunda %46,2 bulundu (p=0,22). Ýleri N kategorisi (N2-N3), çok deðiþkenli analizde kötü progresyonsuz saðkalým ile iliþkili faktör olarak bulundu (p<0.01). Yaþ (≥65) 2,1 kat (p=0,01), ileri T kategorisi (T4) 2 kat artmýþ ölüm riski (p=0,03) ile iliþkili bulundu. Trans-glottik tümörler 3.6 kat artmýþ trakeostomi riski ile iliþkili bulundu (p<0.01).
TARTIÞMA ve SONUÇ: T3/N0-N1 ve T3/N2-N3 alt gruplarý ayrý ayrý deðerlendirildiðinde, T3/N0-N1 hastalarda, kemoradyoterapi yüksek düzeyde larinks korumasý saðlayan bir tedavi seçeneðidir.