Local response to chemoradiation in T4 larynx cancer with cartilage invasion

Background: 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. Objective: To assess local response and local recurrence after CRT for patients having T4 larynx or hypopharynx cancer with cartilage invasion. Design: Retrospective intervention study. Setting: Tertiary-care, urban public hospital. Patients: Patients with T4 squamous cell carcinoma of the larynx/hypopharynx with cartilage invasion treated from 2003 to 2009. Intervention: Curative-intent CRT, compared to TL. Outcome Measures: Local response and local recurrence. Results: 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). Conclusions: 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. Laryngoscope, 2011