Treatment of Laryngeal Cancer at the Brooklyn VA

Abstract

Objective: 1) To compare survival outcomes in patients treated with advanced laryngeal cancer. 2)To illustrate the prevalence of tracheotomy and percutaneous endoscopic gastrostomy (PEG) placement in the organ preservation group and its implication for counseling patients. Method: A retrospective chart review was performed from January 1999 to December 2009 of patients with larynx cancer AJCC stages III and IV at the Brooklyn VA Hospital. The endpoints examined were 2-year overall survival and disease-free survival. The secondary endpoints were the rate of salvage laryngectomy, tracheotomy, and PEG in each cohort. Results: Kaplan-Meier survival for the surgery/RT group at 2 years was 75.6% (95% CI; 54.9% to 96.3%) and the survival for the chemo/RT group at 2 years was 62.2% (95% CI; 43.6% to 80.8%). There was no statistically significant difference in overall survival between the surgery/RT vs chemo/RT group. The laryngeal preservation rate was 19 out of 28 (68%) which was lower than the RTOG 91-11 (84%), and over half these patients required a tracheostomy (52%) or a PEG (68%). Conclusion: Our study has not shown a significant survival difference between surgery and radiation vs chemoradiation protocols. However, chemoradiation as an organ-sparing technique does not ensure normal laryngeal function, particularly with frequent need for tracheostomy and gastrostomy. We hope our study will highlight the potential for problematic functional outcomes in these patients.