title: Salvage laryngectomy for failed conservative treatment of laryngeal cancer.
abstract: OBJECTIVE
  To determine the rate of salvage laryngectomy after failure of radiation or chemoradiation over 10-year course, identify factors associated with increased risk of treatment failure, assess survival after salvage laryngectomy.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Twenty patients who underwent salvage total laryngectomy were studied. Overall interval to recurrence (ITR) was 9.9 months, overall postsalvage-laryngectomy survival (PSL-OAS) 25 months, and interval to death (PSL-ITD) 15.8 months. Mortality was 85%.
  
  
  RESULTS
  Four patients failed chemoradiation and 16 failed radiation alone. Based on treatment, there was no difference in ITR (12.8 vs. 8.8 months, P = .27) or PSL-OAS (27.5 vs. 24.4 months, P = .86). PSL-ITD was significantly higher after chemoradiation (27.5 vs. 12.2 months, P = .02). Advanced T-stage patients were significantly younger than early-stage (53 vs. 64 years, P = .02), but had no significant difference in ITR (12.7 vs. 6.8 months, P = .08), PSL-OAS (20.1 vs. 33.6 months, P = .35), or PSL-ITD (12 vs. 21.6 months, P = .1). Analysis by site and differentiation showed no significant differences. Heavy alcohol use/alcoholism was reported in >50%. Rate of fistulization was 20%. Three patients currently survive, with average postsalvage-laryngectomy disease-free survival (PSL-DFS) 77 months.
  
  
  CONCLUSIONS
  Salvage laryngectomy is an uncommon procedure (7% over 10-year period). There is no difference in survival after salvage laryngectomy for radiation or chemoradiation failure. Patients failing chemoradiation have longer PSL-ITD than those failing radiation alone. Patients with T3-4 tumors tend to be younger. T-stage of tumor does not affect rate of salvage procedure. Fistulae formed in 20%. Neither location nor differentiation affects survival. Surgical salvage after primary conservative treatment is associated with an approximately 2-year survival.
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of Louisville, Louisville, Kentucky, USA.
authors.forename: VyVy N
authors.initials: VN
authors.lastname: Young
authors.forename: Brannon D
authors.initials: BD
authors.lastname: Mangus
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Bumpous
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D012720:Severity of Illness Index; D017211:Treatment Failure