Outcomes following laryngectomy refusal after insufficient response to induction chemotherapy

Objective: To review patients who refused a total laryngectomy and were treated with radiotherapy (RT) after insufficient response to induction chemotherapy in a larynx preservation protocol for advanced-stage cancer of the larynx and to compare their outcomes with good responders. Study Design: Retrospective cohort study. Methods: Eighty-six patients treated with induction chemotherapy followed by RT were included in the analysis: 75 good responders and 11 insufficient responders who refused surgery. We compared overall survival (OS), disease-free survival (DFS), and laryngo-esophageal dysfunction-free survival (LEDFS) of the cohort populations in univariate and multivariate analyses. Results: The median follow-up was 44 months. The 2-year and 5-year survival rates were respectively 72.2% and 58.8% for OS, 62.8% and 49.4% for DFS, and 59.5% and 44.3% for LEDFS. No survival endpoint was significantly decreased among insufficient responders, contrary to what we expected. When we focused on patients with an initially fixed larynx, the recovery of larynx mobility after induction chemotherapy was not associated with OS (P = 0.6055), DFS (P = 0.459), or LEDFS (P = 0.7403). Conclusion: To the best of our knowledge, our study is the first patient treatment evaluation focused on subjects who refused a total laryngectomy after insufficient response to induction chemotherapy in a larynx preservation protocol for advanced-stage cancer of the larynx. Surprisingly, these patients treated with RT in our cancer center did not experience decreased functional and oncologic outcomes compared to good responders. Further studies will explore the relevance of response criteria and their evaluation methods. Level of Evidence: 4. Laryngoscope, 127:1791–1796, 2017.