2023 Volume 163 Pages 89-95
Introduction: Laryngeal cancer is the second most commonly encountered head and neck cancer in clinical practice. The survival prognosis of patients with laryngeal cancer is relatively favorable as compared with that of those with other aerodigestive epithelial malignancies, but loss of laryngeal function with laryngectomy is inevitable, especially in patients with advanced disease. To validate our treatment strategy, we conducted a retrospective analysis of the outcomes of laryngeal cancer patients treated at our institution.
Methods: Data of a total of 548 cases of laryngeal cancer were analyzed. Under our fundamental treatment strategy, we treat the patients as follows: transoral laser microsurgery or radiation therapy for T1 and early T2 stage tumors, radiation with systemic chemotherapy or selective intraarterial infusion of cisplatin (RADPLAT) for T2-3 tumors; partial or subtotal laryngectomy for T1-3 tumors in whom chemoradiation is contraindicated; total laryngectomy for T3-4 tumors. The 5-year overall survival (OS), disease specific survival (DFS) and laryngeal preservation rate (LPR) in patients with tumors at each of the laryngeal subsites were analyzed by the Kaplan-Meier method.
Results: The 5-year OS/DSS rates were 83.2%/93.9% for patients with cancer of the glottis (glottic cancer), 71.9%/80.9% for patients with cancer of the supraglottis (supraglottic cancer), and 83.3%/83.3% for patients with cancer in the subglottis (subglottic cancer). In the patients with glottic cancer, the 5-year OS/DSS rates were: 90.0%/100% for T1a tumors, 87.7%/100% for T1b tumors, 89.3%/96.3% for T2 tumors, 68.1%/84.9% for T3 tumors, and 44.8%/54.7% for T4 tumors. The OS/DSS rates in patients with supraglottic cancer were: 68.4%/87.8% for T1 tumors, 89.3%/87.9% for T2 tumors, 67.8%/79.3% for T3 tumors, and 62.0%/68.2% for T4 tumors. The overall 5-year LPR was 80.7% for patients with glottic cancer, 54.9% for patients with supraglottic cancer, and 75.0% for patients with subglottic cancer. Stratified by the T stage, the LPR in cases of glottic cancer were 96.4%/93.9%/90.1%/48.2%/7.1% for T1a/1b/2/3/4 tumors, and those in cases of supraglottic cancer were 80.7%/79.0%/46.8%/13.1% for T1/2/3/4 disease.
Discussion: The results showed almost the same and satisfying survival and laryngeal preservation outcomes as compared with previous reports. The higher LPR in our T3 cases than in previous reports could be attributable to the use of RADPLAT, which is indicated for T3 cases to avoid total laryngectomy. In conclusion, our treatment strategy appears to be acceptable. In cases of laryngeal cancer, the appropriate treatment for individual patients should be selected to not only manage survival, but also the laryngeal function.
