Local response to chemoradiation in T4 larynx cancer with cartilage invasion

Patients with cartilage invasion were excluded from organ preservation protocols treating laryngeal and hypopharyngeal cancer. Treatment choice between chemoradiotherapy (CRT) and total laryngectomy (TL) remains controversial for these patients.

To assess local response and local recurrence after CRT for patients having T4 larynx or hypopharynx cancer with cartilage invasion.

Retrospective intervention study.

: Tertiary-care, urban public hospital.

Patients with T4 squamous cell carcinoma of the larynx/hypopharynx with cartilage invasion treated from 2003 to 2009.

Curative-intent CRT, compared to TL.

Local response and local recurrence.

Of 34 patients included in this study, 21 completed CRT and 13 underwent TL with postoperative RT or CRT. With CRT, 19 patients were noted to have a complete response at the primary site while two patients had persistent local disease. Of 19 patients with complete response, 4 developed local recurrence over a time period 76-226 days (mean: 177 days). This resulted in a 29% incidence of persistent/recurrent disease at the primary site. The remaining 15 patients (71%) remained free of local disease (mean follow-up: 369 days). For 13 patients undergoing TL with adjuvant therapy, there were no cases of local recurrence (mean follow-up: 389 days).

Although there was a high initial complete response rate after CRT, this response was not durable with a high local recurrence rate within 1 year. In comparison, patients undergoing TL demonstrated markedly better local control. For patients with cartilage invasion, a prospective trial comparing medical versus surgical therapy is needed.