Cleveland Clinic Cancer Center (Taussig) Outcomes
Head and Neck Cancer
Primary Total Laryngectomy Versus Organ Preservation for Locally Advanced T3/T4a Laryngeal Cancer
2000-2018
Organ preservation (OP) treatment for advanced laryngeal cancer has increased compared to primary total laryngectomy. Our study compares oncologic and functional outcomes between these approaches.
Overall Survival in All Patients Stratified by Treatment
2000-2018
| Number at Risk | 0 Months | 12 Months | 24 Months | 36 Months | 48 Months | 60 Months |
|---|---|---|---|---|---|---|
| OP | 119 | 102 | 77 | 64 | 55 | 45 |
| Surgery | 118 | 97 | 68 | 55 | 46 | 35 |
OP, organ preservation.
Overall Survival in T4 Patients Stratified by Treatment
2000-2018
| Number at Risk | 0 Months | 12 Months | 24 Months | 36 Months | 48 Months | 60 Months |
|---|---|---|---|---|---|---|
| OP | 23 | 19 | 13 | 12 | 8 | 7 |
| Surgery | 77 | 60 | 43 | 34 | 28 | 20 |
OP, organ preservation.
Overall Survival in T3 Patients Stratified by Treatment
2000-2018
| Number at Risk | 0 Months | 12 Months | 24 Months | 36 Months | 48 Months | 60 Months |
|---|---|---|---|---|---|---|
| OP | 96 | 83 | 64 | 52 | 47 | 38 |
| Surgery | 41 | 37 | 25 | 21 | 18 | 15 |
OP, organ preservation.
Disease-Free Survival in All Patients Stratified by Treatment
2000-2018
| Number at Risk | 0 Months | 12 Months | 24 Months | 36 Months | 48 Months | 60 Months |
|---|---|---|---|---|---|---|
| OP | 119 | 86 | 60 | 51 | 43 | 35 |
| Surgery | 118 | 89 | 63 | 51 | 43 | 33 |
OP, organ preservation.
Disease-Free Survival in T4 Patients Stratified by Treatment
2000-2018
| Number at Risk | 0 Months | 12 Months | 24 Months | 36 Months | 48 Months | 60 Months |
|---|---|---|---|---|---|---|
| OP | 23 | 17 | 11 | 9 | 6 | 5 |
| Surgery | 77 | 55 | 40 | 31 | 25 | 18 |
OP, organ preservation.
Disease-Free Survival in T3 Patients Stratified by Treatment
2000-2018
| Number at Risk | 0 Months | 12 Months | 24 Months | 36 Months | 48 Months | 60 Months |
|---|---|---|---|---|---|---|
| OP | 96 | 69 | 49 | 42 | 37 | 30 |
| Surgery | 41 | 34 | 23 | 20 | 18 | 15 |
OP, organ preservation.
Overall Survival in cT3 Patients Receiving Laryngectomy
2000-2018
| Number at Risk | 0 Months | 12 Months | 24 Months | 36 Months | 48 Months | 60 Months |
|---|---|---|---|---|---|---|
| Primary | 41 | 36 | 25 | 21 | 18 | 15 |
| Salvage | 18 | 14 | 9 | 7 | 5 | 4 |
Disease-Free Survival in cT3 Patients Receiving Laryngectomy
2000-2018
| Number at Risk | 0 Months | 12 Months | 24 Months | 36 Months | 48 Months | 60 Months |
|---|---|---|---|---|---|---|
| Primary | 41 | 33 | 23 | 20 | 18 | 15 |
| Salvage | 18 | 12 | 9 | 7 | 5 | 4 |
Overall Survival in cT3 Patients Receiving Laryngectomy
2000-2018
| Number at Risk | 0 Months | 12 Months | 24 Months | 36 Months | 48 Months | 60 Months |
|---|---|---|---|---|---|---|
| OP: No LR | 85 | 69 | 55 | 48 | 41 | 33 |
| Primary TL | 118 | 97 | 68 | 55 | 46 | 35 |
| OP: LR | 34 | 33 | 22 | 16 | 14 | 12 |
LR, local recurrence; OP, organ preservation; TL, total laryngectomy.
Disease-Free Survival in cT3 Patients Receiving Laryngectomy
2000-2018
| Number at Risk | 0 Months | 12 Months | 24 Months | 36 Months | 48 Months | 60 Months |
|---|---|---|---|---|---|---|
| OP: No Surgery | 99 | 82 | 64 | 54 | 45 | 37 |
| Primary TL | 118 | 97 | 68 | 55 | 46 | 35 |
| OP: Salvage Surgery | 20 | 20 | 13 | 10 | 10 | 8 |
LR, local recurrence; OP, organ preservation; TL, total laryngectomy.
There was no difference in survival by treatment in T4 patients, possibly because of strict patient selection. However, disease-free survival was worse in T3 patients receiving OP, likely due to a high local recurrence rate. Approximately 40% of patients with local recurrence were not eligible for salvage laryngectomy. Total laryngectomy (TL) patients had comparable swallowing and speech outcomes with OP patients.
