Efficacy of laryngectomy alone for treatment of locally
advanced laryngeal cancer: A stage- and subsite-specific
B. P. Cervenka
D. G. Farwell
A. F. Bewley
Department of Otolaryngology, Division of
Head and Neck Surgery, University of
California Davis, Sacramento, CA, USA
Department of Oncology, Division of Head
and Neck Surgery, University of California
Davis, Sacramento, CA, USA
B. Cervenka, Department of Otolaryngology,
Division of Head and Neck Surgery,
University of California, Davis, Sacramento,
Objective: Total laryngectomy is a well-established treatment for locally advanced
laryngeal cancer. Evidence for the benefit of post-operative radiotherapy after laryn-
gectomy in patients with locally advanced primaries and N0 or N1 nodal disease is
limited. This study aimed to determine whether total laryngectomy alone is ade-
quate therapy for certain patient subgroups with locally advanced laryngeal cancer.
Design: We performed a retrospective survival analysis of patients in the surveil-
lance epidemiology and end results (SEER) database with locally advanced laryngeal
cancer between 2004 and 2012.
Outcome Measures: Primary outcome measure was overall survival.
Results: For all patients with T3-4aN0-1 tumours, overall survival was worse for
those treated with laryngectomy only when compared using the Kaplan-Meier with
a log-rank test and when accounting for demographic and tumour data using a Cox
multivariate regression. Other independent predictors of poor survival included age
>65 years old, Medicaid or uninsured payor status, supraglottic primary and N1
nodal disease. Stage- and subsite-specific analysis revealed that patients with T4a
primary tumours, N1 nodal disease and supraglottic subsite had worse overall sur-
vival when treated with laryngectomy alone. Alternatively, patients with T3 primary
tumours, N0 nodal disease, glottic subsite had equivalent overall survival and dis-
ease-specific survival when treated with laryngectomy alone vs laryngectomy with
Conclusion: Locally advanced laryngeal cancer patients with T3 primaries, no nodal
disease or primaries of the glottis may not benefit from post-operative radiotherapy
when treated with primary total laryngectomy.
Approximately 13 000 patients are diagnosed with laryngeal cancer
each year, and 85-95% of these tumours are squamous cell carcino-
The majority of patients with laryngeal cancer present
with advanced stage disease, most of which is locally advanced.
Advanced stage laryngeal cancer has a poor prognosis, carrying
a five-year survival rate of 39%-60% independent of treatment
Advanced stage laryngeal cancer can be treated with surgery
with or without adjuvant therapy or primary chemoradiation with
similar overall long-term survival outcomes.
However, recent litera-
ture suggests that primary surgery may be more effective than
chemoradiotherapy for specific subgroups of patients, such as those
with T4a or supraglottic primaries, or N0 nodal disease.
standard surgical management for locally advanced disease is total
laryngectomy and neck dissection although some T3 laryngeal
tumours can be effectively managed with partial laryngectomy.
Accepted: 16 October 2017
© 2017 John Wiley & Sons Ltd wileyonlinelibrary.com/journal/coa Clinical Otolaryngology. 2018;43:544–552.