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Scientific Oral Presentations

Head and Neck Surgery

Session: Scientific Oral Presentations 5 - Head and Neck Surgery

Functional Outcomes in Locally Advanced Laryngeal Squamous Cell Carcinoma Treated With Upfront Surgery vs Primary Chemoradiation

Monday, September 30, 2024
1:06 PM – 1:12 PM EDT
Location: MBCC, 208
Disclosure(s):
Arianna V. Ramirez, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Viran J. Ranasinghe, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The absence of randomized clinical trials impedes the evaluation of functional and survival outcomes in locally advanced squamous cell carcinoma (SCCa) of the larynx (T3 and T4a).

Methods: This study uses the TriNetX global health network database to compare outcomes in T3 and T4a laryngeal SCCa patients treated with upfront surgical treatment versus primary chemoradiation therapy (CRT). After propensity matching, 1,662 patients were included, with 50% undergoing primary CRT and 50% receiving upfront surgery +/- adjuvant therapy. Outcome measures, including dysphagia, aspiration pneumonia, feeding tube dependence, survival, and the percentage of primary CRT patients undergoing tracheostomy or salvage laryngectomy, were assessed at 1, 3, and 5-year intervals. Cohorts were further divided into T3 and T4a groups.

Results: When considering functional outcomes, CRT-treated T3-T4a laryngeal SCCa patients exhibited significantly increased risks of aspiration pneumonia at years 3 (OR, 1.3; 95% CI 1.028 - 1.605) and 5 (OR, 1.3; 95% CI 1.019 - 1.565) posttreatment, and increased G-tube dependence at all time frames (1 yr OR, 1.3; 95% CI 1.043 - 1.553; 3 yr OR, 1.3; 95% CI 1.027 - 1.517; 5 yr OR 1.2; 95% CI 1.006 - 1.481). By year 5 posttreatment with upfront CRT, 23% required salvage laryngectomy, and 45% had a tracheostomy. Stratifying by tumor stage, survival showed no significant difference between upfront surgery vs primary CRT at any time frame. However, T4a patients with primary CRT had worse G-tube dependence (1 yr OR, 1.4; 95% CI 1.046-1.806; 3 yr OR, 1.4; 95% CI 1.077-1.837; 5 yr OR 1.4; 95% CI 1.06-1.813). By year 5 posttreatment, over half (53%) of primary CRT T4a patients required tracheostomy.

Conclusions: This multi-center study revealed increased risks of dysfunctional larynx as shown by the increased risk of aspiration pneumonia and G-tube dependence in T3-T4a laryngeal SCCa patients treated with definitive CRT, underscoring the need to consider functional outcomes in guiding treatment decisions for this patient group, despite comparable survival rates.

    Presenting Author(s)

  • Arianna V. Ramirez, MD

    Resident
    University of Texas Medical Branch
    Galveston, Texas, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • SS

    Sepehr Shabani, MD

    Assistant Professor
    University of Texas Medical Branch
    Galveston, Texas, United States

    Disclosure information not submitted.

  • Orly M. Coblens, MD

    Associate Professor & Residency Program Director
    University of Texas Medical Branch at Galveston
    Galveston, Texas, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Viran J. Ranasinghe, MD

    Assistant Professor
    University of Texas Medical Branch
    Galveston, Texas, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.