Comparing treatment outcomes of radiotherapy and surgery in locally advanced carcinoma of the larynx: A comparison limited to patients eligible for surgery

Purpose: The use of radical radiotherapy and surgery for salvage (RRSS) in locally advanced squamous cell carcinoma (SCC) of the larynx is controversi al. In the absence of randomized studies, it is unclear if RRSS can match t he rates of locoregional control and survival reported for primary surgery in this setting. The aim of this study was to compare treatment outcomes of radiotherapy and surgery in comparable patients with CS III-IV SCC of the larynx. Methods and Materials: Eighty-two patients with untreated T2N+M0 or T3T4NM0 SCC of the larynx were treated with a policy RRSS at the Toronto-Sunnybroo k Regional Cancer Centre between June 1980 and December 1990, The medical r ecords at presentation were reviewed independently by a panel of three surg ical oncologists blinded as to treatment outcome to determine patient suita bility for laryngectomy and neck dissection using eligibility criteria adop ted by recent clinical trials. Treatment outcomes for surgery-eligible pati ents were compared to results of comparably staged patients in the surgical literature since 1980, Results: Sixty-three patients (77%) were eligible for study, With a median follow-up of 3 years, radiotherapy controlled the primary in 8/20 evaluable glottic primaries and 21/41 evaluable supraglottic primaries. Forty-five p ercent of patients surviving 5 years retained a functional larynx. Sixteen of 29 relapsing patients were salvaged with surgery. Disease above the clav icles was controlled in 65% of T3T4N0N+ glottic primaries (compared to a pu blished range of 53% to 79%) and 82% of T3N0 glottic primaries (compared to a published range of 69% to 84%), The 5-year overall survival of patients with T3T4 glottic cancer was 54% compared to a published range of 50% to 63 %, The cause-specific survival (CSS) of patients with T3N0 glottic primarie s (86% at 1 year and 73% at 2 years) was identical to the only published re port of CSS in the surgical literature. Conclusion: A policy of RRSS offers a good chance of laryngeal conservation without compromising ultimate locoregional control or survival when compar ed to primary laryngectomy and neck dissection in patients with locally adv anced carcinoma of the larynx meeting the surgical eligibility of clinical trials. (C) 2000 Elsevier Science Inc.