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Curative-dose Chemoradiotherapy Versus Total Laryngectomy For Stage T3-T4 Squamous Cell Carcinoma of the Larynx

An “Apples-to-Apples” Analysis of the National Cancer Database

Bates, James E., MD*; Amdur, Robert J., MD*; Morris, Christopher M., MS*; Hitchcock, Kathryn E., MD, PhD*; Dziegielewski, Peter T., MD; Boyce, Brian J., MD; Silver, Natalie L., MD; Shaw, Christiana, MD; Mendenhall, William M., MD*

American Journal of Clinical Oncology: June 2019 - Volume 42 - Issue 6 - p 527–533
doi: 10.1097/COC.0000000000000550
Original Articles: Head and Neck

Objective: Chemoradiotherapy (cRT) and total laryngectomy (TL) are acceptable treatments for locally advanced laryngeal squamous cell carcinoma (LSSC). We aimed to compare the outcomes in patients receiving full-dose treatment.

Methods: We identified 11,237 patients in the National Cancer Database treated 2004 to 2015 for T3-4N0-3 LSCC with either TL (with 60 to 80 Gy of adjuvant RT) or cRT (70 to 80 Gy). We evaluated differences in overall survival (OS) using Kaplan-Meier and Cox proportional hazards modeling.

Results: For patients with T3 disease, there was no difference in OS regardless of N stage (N0: hazard ratio [HR]=0.94, P=0.38; N+: HR=0.92, P=0.19). TL was associated with improved OS in patients with T4 disease (N0: HR=1.39, P<0.001; N+: HR=1.22, P=0.001).

Conclusion: In patients who receive optimal therapy, both TL and cRT offer similar outcomes in T3 but not T4a disease.

Departments of *Radiation Oncology


Surgery, University of Florida College of Medicine, Gainesville, FL

The authors declare no conflicts of interest.

Reprints: James E. Bates, MD, 2000 SW Archer Road, P.O. Box 100385, Gainesville, FL 32610-0385. E-mail:

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