Outcomes of the modern management approach for locally advanced (T₃–T₄) laryngeal cancer: a retrospective cohort study

BACKGROUND: Our centre has favoured primary surgery over chemoradiotherapy(CRT) for specific advanced laryngeal cancer patients (e.g. large volume tumours, airway compromise, significant dysphagia, T4 disease). This study reports the survival outcomes for a modern, high-volume head and neck centre favouring surgical management to determine whether this approach improves survival. METHODS: Retrospective analysis of patient data over a 7-year period from a tertiary cancer centre. RESULTS: 121 patients were identified with T3(n=76) or T4(n=45) laryngeal cancer(mean follow-up 2.9 years). In the cohort treated with curative intent(n=104;86.0%), the 2-year and 5-year estimated disease-specific survival(DSS) was 77.9% and 64.1%. CRT had the highest 2-year DSS(92.5%), followed by surgery with adjuvant therapy(81.8%), radiotherapy alone(75%), and surgery alone(72.4%). CONCLUSION: For a centre favouring primary surgery for certain advanced laryngeal cancers, the DSS appears no higher than published literature. To enhance survival, future research should focus on precision medicine to define treatment pathways in this disease.