Survival Outcomes in T3 Laryngeal Cancers: Primary Total Laryngectomy vs. Concurrent Chemoradiation or Radiation Therapy—A Meta-Analysis
Karthik Nagaraja Rao,
Prathamesh S. Pai,
Prajwal Dange,
Luiz P. Kowalski,
Primož Strojan,
Antti A. Mäkitie,
Orlando Guntinas-Lichius,
K. Thomas Robbins,
Juan P. Rodrigo,
Avraham Eisbruch,
Robert P. Takes,
Remco de Bree,
Andrés Coca-Pelaz,
Cesare Piazza,
Carlos Chiesa-Estomba,
Fernando López,
Nabil F. Saba,
Alessandra Rinaldo,
Alfio Ferlito
Affiliations
Karthik Nagaraja Rao
Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur 492099, India
Prathamesh S. Pai
Department of Head Neck Surgery, Tata Memorial Hospital, Mumbai 400012, India
Prajwal Dange
Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur 492099, India
Luiz P. Kowalski
Department of Head and Neck Surgery and Otorhinolaringology, A.C. Camargo Cancer Center, São Paulo 01509, Brazil
Primož Strojan
Department of Radiation Oncology, Institute of Oncology Ljubljana, Faculty of Medicine, SI-10000 Ljubljana, Slovenia
Antti A. Mäkitie
Research Program in Systems Oncology, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
Orlando Guntinas-Lichius
Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany
K. Thomas Robbins
Department of Otolaryngology Head and Neck Surgery, Southern Illinois University, Carbondale, IL 62901, USA
Juan P. Rodrigo
Department of Otolaryngology, Hospital Universitario Central de Asturias-Instituto de Salud del Principado de Asturias (ISPA), 33011 Oviedo, Spain
Avraham Eisbruch
Department of Radiation Oncology, University of Michigan Medicine, Ann Arbor, MI 48109, USA
Robert P. Takes
Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
Remco de Bree
Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
Andrés Coca-Pelaz
Department of Otolaryngology, Hospital Universitario Central de Asturias-Instituto de Salud del Principado de Asturias (ISPA), 33011 Oviedo, Spain
Cesare Piazza
Otorhinolaryngology—Head and Neck Surgery, ASST Spedali Civili di Brescia, School of Medicine, University of Brescia, 25121 Brescia, Italy
Carlos Chiesa-Estomba
Otorhinolaryngology—Head & Neck Surgery, Donostia University Hospital, 20014 Donostia, Spain
Fernando López
Department of Otolaryngology, Hospital Universitario Central de Asturias-Instituto de Salud del Principado de Asturias (ISPA), 33011 Oviedo, Spain
Nabil F. Saba
Department of Hematology and Medical Oncology, The Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
Alessandra Rinaldo
ENT Unit, Policlinico Città di Udine, 33100 Udine, Italy
Alfio Ferlito
Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy
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 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.
