Head and Neck Cancer

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MO_32_2477 - Survival Following Definitive Surgery or Radiation Therapy for Locally Advanced Squamous Cell Carcinoma of the Larynx: An Analysis of the National Cancer Database

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Survival Following Definitive Surgery or Radiation Therapy for Locally Advanced Squamous Cell Carcinoma of the Larynx: An Analysis of the National Cancer Database
J. E. Bates1, C. G. Morris1, P. T. Dziegielewski2, W. M. Mendenhall1, and R. J. Amdur1; 1Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, 2Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL

Purpose/Objective(s): Multiple prospective trials have established that radiotherapy (RT) with platinum-based chemotherapy has equivalent efficacy to total laryngectomy (TL) in the treatment of locally advanced laryngeal squamous cell carcinoma (LSCC). While the use of definitive RT has increased, survival for LSCC has declined. Several analyses of large national databases have shown that RT is associated with worse outcomes than TL in these patients. We hypothesized that these differences may be related to suboptimal RT doses or delivery of RT alone. We aimed to analyze survival in patients treated with full-dose RT with chemotherapy (cRT) compared to TL using a large hospital-based registry.

Materials/Methods: Within the National Cancer Database (NCDB), we identified 16,832 patients with T3-4, N0-3, M0 LSCC with complete data treated with RT between 2004 and 2015. Of those, 7,706 received TL and 9,756 received 70 – 80 Gy of RT with chemotherapy (cRT group). Cox proportional hazards and Kaplan-Meier analyses were used to evaluate overall survival (OS) differences between the TL and cRT groups. All OS percentages reported reflect 5-year OS rates.

Results: Overall, the median follow-up was 32 months. Among patients with T3 N0-3 disease, cRT was associated with a benefit in OS (51.4%) relative to TL (46.3%; hazard ratio (HR) = 0.9; 95% confidence interval (CI) = 0.8 – 0.9; p < 0.01). This benefit persisted in both the T3 N0 (56.0% vs 50.7%; HR = 0.8; CI = 0.8 – 0.9; p < 0.01) and T3 N+ (46.6% vs 39.3%; HR = 0.8; CI = 0.8 – 0.9; p < 0.01) populations. Among those with T4 N0-3 disease, cRT (38.0%) was associated with worse OS relative to TL (44.3%; HR = 1.2; CI = 1.1 – 1.2; p < 0.01). Upon analysis by N stage, a statistically significant decrement in OS with cRT was seen only in T4 N0 patients (42.8% vs 49.4%; HR = 1.2; CI = 1.1 – 1.3; p = 0.002) and not in patients with T4 N+ disease (35.1% vs 38.5%, HR = 1.1, CI = 1.0 – 1.2, p = 0.16). These relationships persisted on multivariate analysis, including age, gender, and Charlson-Deyo score.

Conclusion: Among patients receiving optimal cRT for LSCC, only those with T4 N0 disease experienced a decrement in OS relative to TL; further, the decrement was small (~6%). Our findings affirm the results of prior prospective analyses that suggest both cRT and TL are acceptable treatment of LSCC. Strategies to optimize the selection of LSCC for cRT, such as primary tumor volume or neoadjuvant chemotherapy, may help identify patients most likely to have a positive response to cRT.

Author Disclosure: J.E. Bates: None. C.G. Morris: None. P.T. Dziegielewski: None. W.M. Mendenhall: Employee; University of Florida. R.J. Amdur: Partnership; RadOnc eLearning Center, Inc. Head and Neck Oral Exam Director; ABR. RRC Member; ACGME. Editorial Board; AJCO, JCO, PRO.

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