A comparison of overall survival for patients with T4 larynx cancer treated with surgical versus organ‐preservation approaches: A National Cancer Data Base analysis

• Published in: Cancer Vol. 123; no. 4; pp. 600 - 608
• Main Authors: Stokes, William A., Jones, Bernard L., Bhatia, Shilpa, Oweida, Ayman J., Bowles, Daniel W., Raben, David, Goddard, Julie A., McDermott, Jessica D., Karam, Sana D.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15.02.2017
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer; Chemotherapy; Cisplatin - therapeutic use; Combined Modality Therapy - adverse effects; Confidence intervals; Data processing; Disease-Free Survival; Female; Humans; induction chemotherapy; Intervention; Laryngeal cancer; Laryngeal Neoplasms - drug therapy; Laryngeal Neoplasms - epidemiology; Laryngeal Neoplasms - radiotherapy; Laryngeal Neoplasms - surgery; laryngectomy; Laryngectomy - adverse effects; Larynx; Male; Matching; Middle Aged; Multiagent systems; Multivariate analysis; National Cancer Database; neoadjuvant chemotherapy; Neoplasm Staging; Oncology; organ preservation; Partitioning; Patients; Preservation; Radiation therapy; Radiotherapy, Adjuvant - adverse effects; Surgery; Survival; neoadjuvant chemotherapy; laryngeal cancer; National Cancer Database; induction chemotherapy; laryngectomy; organ preservation
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.30382

BACKGROUND Although laryngectomy is the treatment of choice for patients with T4 larynx cancer, many patients are unable or unwilling to undergo laryngectomy and instead pursue larynx‐preservation strategies combining radiotherapy (RT) and chemotherapy. Herein, the authors analyzed the National Cancer Data Base to evaluate overall survival (OS) between patients treated with surgical and organ‐preserving modalities. METHODS The National Cancer Data Base was queried for patients diagnosed from 2004 through 2012 with T4M0 laryngeal cancer who underwent either laryngectomy (surgery) with adjuvant RT (SRT), chemotherapy starting concurrently within 7 days of RT (CCRT), or multiagent induction chemotherapy starting 43 to 98 days before RT (ICRT). Multivariate analysis and propensity score matching were used to explore the association between the intervention and OS. Recursive partitioning analysis was performed to identify groups benefiting from particular modalities. RESULTS A total of 1559 patients who underwent SRT, 1597 patients who underwent CCRT, and 386 patients who underwent ICRT were included. Adjusting for covariates, CCRT was found to be associated with inferior OS compared with SRT (hazard ratio [HR], 1.55; 95% confidence interval [95% CI], 1.41‐1.70 [P<.01]) and with ICRT (HR, 1.25; 95% CI, 1.07‐1.45 [P<.01]). OS among the patients treated with SRT did not appear to differ significantly from that of the ICRT cohort (HR, 0.87; 95% CI, 0.73‐1.03 [P =  0.10]), a finding confirmed with propensity score matching. Recursive partitioning analysis identified no subset of patients that derived an OS benefit from either approach over the other. CONCLUSIONS OS among patients undergoing SRT was found to be superior to that of patients treated with CCRT but did not significantly differ from that of those undergoing ICRT. Because these intriguing findings require validation, SRT should remain the standard of care for patients with this disease. However, organ preservation with ICRT may be a reasonable alternative in certain patients. Cancer 2017;123:600–608. © 2016 American Cancer Society. Although laryngectomy is the treatment of choice for patients with T4 laryngeal cancer, many patients pursue larynx preservation instead. In this National Cancer Data Base analysis, survival with an organ‐preservation approach consisting of radiotherapy plus induction chemotherapy did not differ significantly from that with standard‐of‐care laryngectomy plus radiotherapy.