Definitive Chemoradiotherapy Versus Total Laryngectomy Followed by Postoperative Therapy in Selected T3–T4a N0–N1 Laryngeal Cancer: Comparative Outcomes
Articles > Article · 2026
Authors: Özlem ÖZKAYA AKAGÜNDÜZ, Tuğçe BOZKURT VARDAR, Ecem Yiğit, Gözde Yazıcı, Fethiye ODACI, Kerem ÖZTÜRK, Mustafa Cengiz, Oğuz Kuşcu, Gökhan Özyiğit
Cancers, Journal Indexed in SCI Expanded, International, WoS, 2026, vol 18, pp 2966-2966
Summary
Background/Objectives: Management of locally advanced laryngeal squamous cell carcinoma remains controversial. This study compared definitive chemoradiotherapy (CRT) with total laryngectomy followed by postoperative radiotherapy with or without chemotherapy (TL + PORT/CRT) in T3–T4aN0–N1 disease. Methods: This multicenter retrospective cohort included 311 patients treated between 2008 and 2025 at two centers: 160 received definitive CRT and 151 underwent TL + PORT/CRT. Survival was estimated using Kaplan–Meier and Cox regression analyses. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used as adjusted analyses. The primary endpoint was disease-specific survival (DSS). Results: Median follow-up was 98 months. In the unmatched cohort, 5- and 10-year DSS rates were 92.1% and 92.1% after CRT versus 93.7% and 83.5% after TL + PORT/CRT (p = 0.351), while 5-year local control favored TL + PORT/CRT (98% vs. 79%; p < 0.001). After PSM (59 patients per group), cluster-robust Cox analysis showed inferior overall survival (OS) after CRT (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.12–3.86; p = 0.021) and inferior local control (HR, 12.83; 95% CI, 3.75–43.87; p < 0.001). In the 2015–2025 intensity–modulated radiotherapy (IMRT)-restricted analysis, OS also favored TL + PORT/CRT (HR, 3.64; 95% CI, 1.09–12.22; p = 0.036), whereas full-cohort IPTW showed no significant OS difference (HR, 0.93; 95% CI, 0.64–1.36; p = 0.715). Functional laryngeal preservation was achieved in 126/160 patients (78.8%) after CRT. Conclusions: Definitive CRT was associated with inferior local control, while DSS remained comparable. OS estimates varied across adjusted analyses and did not support a stable treatment-specific survival effect. Definitive CRT remains an organ-preservation option in appropriately selected patients.