Results and Survival of Locally Advanced AJCC 7th Edition T4a Laryngeal Squamous Cell Carcinoma Treated with Primary Total Laryngectomy and Postoperative Radiotherapy

Purpose: The objective of this study was to analyze the results and survival of patients with T4a laryngeal squamous cell carcinoma (SCC) treated, according to clinical practice guidelines, with total laryngectomy and postoperative radiotherapy (TL–PORT) in a large and homogeneous series. Methods: Initial staging assessment, treatment details, pathologic features, follow-up, and patterns of recurrence were retrospectively reviewed in a large series of 100 patients treated in our center between 2001 and 2013 for T4a laryngeal SCC with TL–PORT. Results: Two-, 5-, and 10-year overall survival rates were 65, 52.4, and 33.3 %, respectively, while 2-, 5-, and 10-year disease-free survival rates were 55, 42.6, and 31.8 %, respectively. In addition, 2-, 5-, and 10-year locoregional control rates were 77, 74, and 65.9 %, respectively. Central lymph node involvement was associated with pathologic subglottic extension (p = 0.01), lysis of the cricoid cartilage (p = 0.03), and tracheal extension (p = 0.02). Extracapsular spread of central lymph node metastases, the main prognostic factor identified by multivariate analysis, was associated with decreased locoregional control and survival rates. Conclusion: In this homogenously treated cohort, with consistent guideline application, surgery for T4a larynx cancer remains a standard of care, with current results used as a benchmark.