Primary organ preservation vs total laryngectomy for T4a larynx cancer
Justin Oh MD  Eitan Prisman MD  Robert Olson MSc, MD  Eric Berthelet MD  Jonn Wu MD  Eric Tran MD Brendan Bakos MSc  Rojin Kaviani BS  Sarah Nicole Hamilton MD
First published: 19 June 2019 https://doi.org/10.1002/hed.25838
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Abstract
Background
There is a lack of consensus regarding the management of T4a larynx cancer. We evaluated the outcomes of organ preservation and laryngectomy for T4a laryngeal cancer.

Methods
Retrospective analysis of patients with T4a larynx cancer at BC Cancer from 1984 to 2014 was performed. Outcomes in patients treated with surgery alone (Sx) (n = 47), surgery with adjuvant radiotherapy (Sx/RT) (n = 94), radiation alone (RT) (n = 152), and radiation with concurrent chemoradiotherapy (chemoRT) (n = 36) were compared.

Results
The 5‐year overall survival (OS) was 40% for chemoRT, 34% for RT, 23% for Sx, and 45% for Sx/RT. On multivariate analysis (MVA), Sx/RT (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.48‐0.91) and chemoRT (HR, 0.44; 95% CI, 0.26‐0.72) were associated with better OS than RT alone (P = .001). Sx had similar OS compared to RT (HR, 1.17; 95% CI, 0.82‐1.68).

Conclusions
ChemoRT and Sx/RT were associated with better OS compared to single modality treatment. ChemoRT may be considered as an option for T4a larynx cancer.