title: T4a laryngeal cancer survival: retrospective institutional analysis and systematic review.
abstract: OBJECTIVE
  To assess the survival outcomes of a homogeneous group of pT4a laryngeal cancer patients treated at our institution by primary total laryngectomy and neck dissection with adjuvant therapy when indicated, and to systematically review studies reporting overall survival outcomes in T4a laryngeal cancer.
  
  
  METHODS
  Systematic review of PubMed and Embase databases.
  
  
  METHODS
  Records of 108 laryngeal cancer patients treated by total laryngectomy were reviewed. pT4a cases treated by primary total laryngectomy between 1998 and 2010 were included. Overall and disease-free survival at 2 and 5 years were reported. A systematic review was performed including all published studies reporting overall survival outcomes by treatment modality in T4 laryngeal cancer patients.
  
  
  RESULTS
  Thirty cases met the inclusion criteria. At 2 years, overall and disease-free survival were 81.3% and 78%, respectively. The 5-year overall and disease-free survival rates were 60%. The systematic review retrieved 24 articles. Overall survival at 2 years ranged from 12% to 21.2% with radiotherapy, <30% to 65% with chemoradiotherapy, and from 30% to 100% with surgery. At 5 years, it ranged from 0% to 75% with radiotherapy, 16% to 50.4% with chemoradiotherapy, and 10% to 80.9% with surgery.
  
  
  CONCLUSIONS
  Primary total laryngectomy provides a high survival rate for pT4a laryngeal cancer patients. Randomized controlled trials including homogenous patients are still needed before shifting to organ preservation protocols in these patients.
  
  
  METHODS
  NA.
authors: Department of Otolaryngology-Head and Neck Surgery, Hôtel Dieu de France Hospital, Beirut, Lebanon; Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.
authors: Evana
authors: E
authors: Francis
authors: Nayla
authors: N
authors: Matar
authors: Nadim
authors: N
authors: Khoueir
authors: Charbel
authors: C
authors: Nassif
authors: Chadi
authors: C
authors: Farah
authors: Amine
authors: A
authors: Haddad
mesh_terms: D003131:Combined Modality Therapy; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D007861:Lebanon / Q000453:epidemiology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
keywords: chemoradiation therapy; chemotherapy; organ preservation; pT4a laryngeal cancer; primary total laryngectomy; radiotherapy; squamous cell carcinoma; survival