title: Treatment Selection for T3/T4a Laryngeal Cancer: Chemoradiation Versus Primary Surgery.
abstract: OBJECTIVE
  We report the treatment outcomes, including organ preservation, for patients with locally advanced (T3/T4a) laryngeal cancer receiving both surgical and nonsurgical approaches. We hypothesize that selection of treatment protocols aimed to optimize organ preservation does not compromise survival provided careful selection is done through the process of multidisciplinary treatment planning.
  
  
  METHODS
  Patients with T3-4a laryngeal squamous cell cancer were evaluated and recommended for primary treatment with total or partial laryngectomy (37 patients) or chemoradiotherapy (34 patients). Treatment outcomes were compared between the 2 cohorts. In addition, the laryngeal preservation rate and laryngoesophageal dysfunction-free survival (LEDFS) were determined for the chemoradiation group.
  
  
  RESULTS
  The 5-year overall survival rate for patients with T3 lesions was 41% and 40% for the surgical and nonsurgical groups, respectively, and for T4 lesions it was 54% and 53%, respectively. For the chemoradiation group, the rate of overall laryngeal preservation was 79%. LEDFS at 2 years was 40% for T3 lesions and 33% for T4 lesions.
  
  
  CONCLUSIONS
  Through careful selection, some patients with locally advanced laryngeal cancer can be offered chemoradiation (organ preservation) without compromising survival. However, the patients selected to receive chemoradiation have a high rate of laryngeal and esophageal dysfunction.
authors.affiliation: Department of Surgery, Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA dtimme@siumed.edu.
authors.forename: David W
authors.initials: DW
authors.lastname: Timme
authors.affiliation: Department of Surgery, Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: Sashikanth
authors.initials: S
authors.lastname: Jonnalagadda
authors.affiliation: Department of Surgery, Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: Raunak
authors.initials: R
authors.lastname: Patel
authors.affiliation: Department of Medicine, Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: Krishna
authors.initials: K
authors.lastname: Rao
authors.affiliation: Department of Surgery, Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: K Thomas
authors.initials: KT
authors.lastname: Robbins
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery; D059248:Chemoradiotherapy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery; D006801:Humans; D007087:Illinois; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery; D007825:Laryngectomy / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D018579:Patient Selection; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate; D016896:Treatment Outcome
keywords: laryngeal cancer; laryngoesophageal dysfunction-free survival; larynx preservation