A total laryngectomy remains the gold standard for the initial treatment of advanced (T4) squamous cell carcinomas of the larynx without evidence of distant disease. Adjuvant radiotherapy (RT) is also recommended for such cancers. In the absence of other adverse histological features such as involved margins and / or regional lymph node involvement, it may be tempting for both patients and their treating clinicians to question the value of further treatment in addition to the surgery they have undergone. This paper sought to quantify the benefits of adjuvant RT by comparing the outcomes of patients recorded in the US National Cancer Database with pathologic T4 laryngeal or hypopharyngeal SCC who underwent a total laryngectomy, with or without adjuvant radiotherapy. Patients were excluded if they had regional or distant metastases or positive margins. A total of 2823 patients were included, of whom 841 (29.8%) did not receive adjuvant RT. Factors associated with no RT included increasing age, increasing comorbidities and increasing travel distance to the treating centre. Adjuvant RT was associated with a statistically significant improvement in overall survival (HR 0.71, p < 0.001). Median overall survival (OS) among patients who received adjuvant RT was 103.3 months, whereas median OS among those who did not receive RT was 79.3 months. The data from this large cohort study help to quantify the improvement in overall survival associated with adjuvant RT following a total laryngectomy. Whilst this is a retrospective study limited by multiple potential confounding factors, it is valuable to know that adjuvant RT is associated with a survival advantage of two years on average following a total laryngectomy.
Adjuvant radiotherapy for T4N0 laryngeal cancers treated with laryngectomy
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