Concurrent Chemoradiation for T3 Glottic Squamous Cell Carcinoma: A Reasonable Alternative to Upfront Laryngectomy

Abstract

Upfront treatment options for stage 3 and 4 larynx carcinoma include laryngectomy or chemoradiation (CRT). The functional consequence of laryngectomy is debilitating and thus significantly affects patients' quality of life. Previous studies comparing the two treatment approaches reported 40%-50% rate of larynx preservation with induction chemotherapy and radiotherapy. This study specifically examined the rate of organ preservation and associated late morbidity for T3N+/-M0 glottic carcinoma treated non-surgically with upfront concurrent CRT. Between January 2000 and November 2007, 17 patients presented with T3N+/-M0 glottic carcinoma were treated with definitive concurrent CRT at the Royal Brisbane and Women's Hospital. All patients were treated with curative intent. Charts were reviewed and relevant data on disease status and morbidity (voice changes and dysphagia) were collected. The primary end point was laryngectomy free survival (LFS) at 5 years. The secondary end points were relapse free survival (RFS) and overall survival (OS) at 5 years. Prevalence of greater or equal to grade 2 voice changes (Common Terminology Criteria for Adverse Events, Version 3) and dysphagia were reported at baseline, 12 months post-completion of treatment and at date last seen. One patient developed local recurrence salvaged with total laryngectomy, one patient developed regional relapse salvaged by neck dissection, one developed both local and regional recurrence who subsequently declined surgery, while one patient died of distant metastasis. The rate of LFS, RFS, and OS at 5 years was 76%, 71%, and 89%, respectively, The prevalence of voice changes (grade 2 or worse) at 12 months and date last seen were 41% and 31%, respectively. The prevalence of dysphagia (grade 2 or worse) at 12 months and date last seen were 6% and 6%, respectively. Definitive concurrent CRT appears to be a reasonable alternative to upfront laryngectomy for patients with T3N+/-M0 glottic carcinoma. The rate of late dysphagia associated with such treatment appears to be highly acceptable. Such non-surgical approach should be considered by the head and neck surgeons for this subset of patients.