title: Long-term outcomes after surgical or nonsurgical initial therapy for patients with T4 squamous cell carcinoma of the larynx: A 3-decade survey.
abstract: BACKGROUND
  The current study was conducted to evaluate long-term disease control, survival, and functional outcomes after surgical and nonsurgical initial treatment for patients with T4 larynx cancer.
  
  
  METHODS
  Demographics, disease stage, and treatment characteristics were reviewed for 221 sequential patients treated for T4 laryngeal squamous cell cancer at a single institution between 1983 and 2011. Survival and disease control outcomes were calculated.
  
  
  RESULTS
  The median follow-up time was 47 months (71 months for patients still alive at the time of analysis). The overall 5-year and 10-year overall survival rates were 52% and 29%, respectively, and the corresponding disease-free survival rates were 57% and 48%, respectively. Overall 5-year and 10-year locoregional control rates were 78% and 67%, respectively, and the corresponding rates for freedom from distant metastasis were 76% and 74%, respectively. On both univariate and multivariate analyses, lymph node-positive disease at the time of presentation was associated with overall mortality (P<.0001). Patients treated with laryngectomy followed by postlaryngectomy radiotherapy (161 patients) achieved better initial locoregional control than patients treated with a laryngeal preservation (LP) approach (60 patients) throughout the follow-up period (log-rank P<.007) yet the median overall survival times were equal for both groups (64 months; 95% confidence interval 47-87 months and 38-87 months, respectively [P =.7]). Patients treated with an LP approach had a tracheostomy rate of 45% and an any-event aspiration rate of 23%. Rates of high-grade dysphagia at the time of last follow-up were worse for patients treated with an LP approach (P<.01).
  
  
  CONCLUSIONS
  Surgery and postoperative radiotherapy can produce substantial long-term cancer control and survival rates for patients with T4 larynx cancer. Caution should be taken when selecting patients for initial nonsurgical treatment because of significant rates of functional impairment despite survival equivalence.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.forename: Abdallah S R
authors.initials: AS
authors.lastname: Mohamed
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
authors.forename: Parag R
authors.initials: PR
authors.lastname: Sevak
authors.forename: Merril S
authors.initials: MS
authors.lastname: Kies
authors.forename: William H
authors.initials: WH
authors.lastname: Morrison
authors.forename: Jan S
authors.initials: JS
authors.lastname: Lewin
authors.forename: Adel K
authors.initials: AK
authors.lastname: El-Naggar
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Ginsberg
authors.forename: Esengul
authors.initials: E
authors.lastname: Kocak-Uzel
authors.forename: K Kian
authors.initials: KK
authors.lastname: Ang
authors.forename: Clifton David
authors.initials: CD
authors.lastname: Fuller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D003680:Deglutition Disorders / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D007825:Laryngectomy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D064706:Vocal Cord Dysfunction / Q000209:etiology
keywords: T4; laryngeal preservation; laryngectomy; larynx cancer; locally advanced; radiotherapy; survival