Which is the Best Strategy in Local Advanced Larynx Cancer? Total Laryngectomy Plus Radiotherapy or Larynx Preservation with Chemoradiotherapy: Single Center Experience

Objectives: The treatment of locally advanced laryngeal cancer (LALC) is very challenging. In the last few decades there has been a shift from total laryngectomy towards organ-sparing approaches. The aim of the current study is to compare oncological outcomes between surgery (total laryngectomy) followed by radiotherapy and larynx preservation with chemoradiotherapy (CRT). Materials and Methods: 114 patients with stage III-IV laryngeal cancer were included in the study, between 2009 and 2018. Thirty-six patients (31.6%) were performed total laryngectomy followed by radiotherapy and 78 (68.4%) underwent the larynx preservation approach. Survival differences between the groups were examined with the Kaplan-Meier test and cox-regression tests for factors affecting survival. Results: 5-year overall survival (OS) was found 66.3 months and 74.1 months, in the larynx preservation and the surgical groups, respectively (p=0.29). There was no statistically difference between groups for OS in the patients with T3/N0-N1 (p=0.76), but surgical groups had longer OS in the patients with T3/N2-N3 (p=0.04). There was no statistically difference between groups for OS in the patients with T4/N0-N1 (p=0.47), however CRT groups had longer OS in the patients with T4/N2-N3 (p=0.02). The N2-N3 was the factor associated with poor progression-free survival and distant metastasis free survival in multivariate analysis (p<0.01). Age (≥65) was associated with a 2.1-fold increased risk of death (p=0.01). The trans-glottis tumors were associated with a 3.6-fold increased risk of tracheostomy (p<0.01). Conclusion: The N0-N1 and N2-N3 should also be considered as well as advanced T-category for the treatment of LALC.