Long-term Therapeutic and Functional Outcomes With Organ Preservation for T4 Larynx and Hypopharynx Cancers.

Purpose/Objective(s) Stage T4 larynx and hypopharynx cancers were poorly represented in the original organ preservation trials, so concerns over reduced outcomes with nonoperative management have led to a preference for surgery. For patients who refuse surgery or are not surgical candidates, there is little data to guide decision making and counseling. Therefore, we conducted a retrospective analysis of nonoperatively managed T4 larynx and hypopharynx cancer to report long-term therapeutic and functional outcomes. Materials/Methods Patients with primary larynx (n = 44) and hypopharynx (n = 53) cancer treated non-surgically with definitive radiation therapy (RT) or chemoradiation therapy (CRT) between 1/1/1997 and 12/31/2015 were included. Data collected included age, sex, KPS, smoking status, cancer site, T stage, N stage, CRT versus RT alone, IMRT versus non-IMRT, RT dose, resectability (as noted by surgeon), percutaneous endoscopic gastrostomy (PEG) and tracheostomy status, locoregional failure (LRF), distant metastases (DM), disease-free survival (DFS), and overall survival (OS). The Kaplan-Meier method was used to estimate time-to-event outcomes on univariate analysis (UVA). Results Median follow-up of surviving patients was 59 (range 15-154) and 45 (range 14-190) months for larynx and hypopharynx patients, respectively. The 2-/5-year OS rates were 73%/38% for larynx patients and 52%/29% for hypopharynx patients. LRF occurred in 25% (n = 11) and 19% (n = 10) of larynx and hypopharynx patients, respectively. Median disease-free interval to recurrence was 12 and 7 months in larynx and hypopharynx patients, respectively. On UVA of the larynx subset, N3 nodal status and non-IMRT treatment (n = 20, 45%) were significantly associated with detriment to OS (P = 0.046 and 0.037); treatment with RT alone impacted DFS (P = 0.028); age > 70 was significantly associated with LRF (P = 0.038, Gray's test). On UVA of the hypopharynx subset, only T4b status significantly impacted OS (P = 0.009) with no other predictive factors on outcomes analysis. In the larynx group, 75% required a tracheostomy and/or PEG, 55% of whom had neither device at most recent follow-up. Likewise, of the 86% of hypopharynx patients requiring tracheostomy and/or PEG, 27% had neither at last follow-up. Conclusion We report very encouraging disease control and survival for patients with stage T4 larynx and hypopharynx cancer who are not surgical candidates or refuse surgery. Overall, outcomes are better for larynx cancers than hypopharynx. With adequate supportive care and rehabilitation, patients are able to reach functional preservation, especially in the larynx subset. Given our analysis, we predict that both functional and therapeutic outcomes are further improved in the current IMRT era.