Survival Outcomes in T3 Laryngeal Cancers: Primary Total Laryngectomy vs. Concurrent Chemoradiation or Radiation Therapy—A Meta-Analysis

• Type of Material: Article
• Authors: Karthik Nagaraja Rao, All India Institute of Medical Sciences; Prathamsesh S. Pai, Tata Memorial Hospital; Prajwal Dange, All India Institute of Medical Sciences; Luiz P. Kowalski, A.C. Camargo Cancer Center; Primoz Strojan, Institute of Oncology Ljubljana; Antti A. Makitie, University of Helsinki; Orlando Guntinas-Lichius, Jena University; K. Thomas Robbins, Southern Illinois University; Juan P. Rodrigo, Hospital Universitario Central de Asturias; Avraham Eisbruch, University of Michigan; Robert P. Takes, Radboud University; Remco de Bree, University Medical Center Utrecht; Andres Coca-Pelaz, Hospital Universitario Central de Asturias; Cesare Piazza, University of Brescia; Carlos Chiesa-Estomba, Donostia University; Fernando Lopez, Hospital Universitario Central de Asturias; Nabil F Saba, Emory University; Alessandra Rinaldo, Policlinico Città di Udine; Alfio Ferlito, International Head and Neck Scientific Group
• Language: English
• Date: 2023-08
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2023 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.3390%2Fbiomedicines11082128
• Title of Journal or Parent Work: Biomedicines
• Volume: 11
• Issue: 8
• Start Page: 2128
• Grant/Funding Information: This research received no external funding.
• Keywords: organ preservation; head and neck cancer; T3; laryngeal cancer; total laryngectomy
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Oncology

Abstract

Background: The management of cT3 laryngeal cancers remains controversial, with studies recommending surgical or non-surgical approaches. Despite the many papers that have been published on the subject, there is a lack of studies showing which treatment has better results in terms of survival. Objective: To determine the difference in survival outcomes following total laryngectomy (TL), concurrent chemoradiation (CRT) or radiation therapy (RT) alone in T3 laryngeal cancers. Methods: Search of PubMed, Scopus, and Google Scholar databases from 1995 to 2023 employing specific keywords and Boolean operators to retrieve relevant articles. Statistical analysis was conducted using a random-effects model, and heterogeneity was evaluated using the Q-test and I2 statistic. Funnel plot asymmetry was assessed using rank correlation and regression tests. Results: The qualitative data synthesis comprised 10,940 patients from 16 included studies. TL was performed in 2149 (19.4%), CRT in 6723 (61.5%), RT in 295 (2.7%), while non-surgical treatment was not specified in 1773 (16.2%) patients. The pooled 2-year overall survival (OS) rates were TL = 73%, CRT = 74.7%, RT = 57.9%, 3-year OS rates were TL = 64.3%, CRT = 62.9%, RT = 52.4%, and 5-year OS rates were TL = 54.2%, CRT = 52.7%, RT = 40.8%. There was a significant heterogeneity in the included studies. There was no statistically significant difference in 2-year OS (logOR= −0.88 (95% confidence interval (CI): −1.99 to 0.23), p = 0.12), 3-year OS (logOR = −0.6 (95% CI: −1.34 to 0.15), p = 0.11), and 5-year OS (logOR = −0.54 (95% CI: −1.29 to 0.21), p = 0.16) between TL and CRT. Instead, there was significant difference in 2-year OS (logOR= −1.2383 (95% CI: −2.1679 to −0.3087), p = 0.009), 3-year OS (−1.1262 (95% CI: −1.6166 to −0.6358), p < 0.001), and 5-year OS (−0.99 (95% CI: −1.44 to −0.53)), p < 0.001) between TL and RT alone. Conclusions and Significance: TL followed with adjuvant (chemo)radiation on indication and CRT with salvage surgery in reserve appear to have similar OS outcomes. Both resulted in better OS outcomes compared to RT alone in the treatment of T3 laryngeal cancers. If patients are unfit for chemotherapy, making CRT impossible, surgery may become the choice of treatment.