K.S. Mak

Abstract 25: Optimizing patient selection for total laryngectomy versus larynx-preservation chemoradiotherapy for locally advanced laryngeal squamous cell carcinoma: An analysis of the National Cancer Data Base

Purpose: The decline in survival of patients diagnosed with laryngeal cancer over the past two decades has been associated with a rise in nonsurgical management for stage III/IV disease following results from the VA Larynx Trial and RTOG 91-11. To clarify the potential driving factors for the decrement in outcomes, this analysis assesses patterns of use and overall survival (OS) amongst the primary NCCN-recommended modalities of therapy stratified by T-stage and radiation (RT) dose. Methods: The National Cancer Data Base was used to identify 11,551 patients with stage T2N+ 1-3 or T3-4N0-3-any glottic/supraglottic SCC squamous cell carcinoma (SCC) treated between 2003-2011 with total laryngectomy (TL) or definitive chemoradiation (CRT). Treatment modality was divided into concurrent CRT, TL alone, and TL + with adjuvant RT/CRT (TL+A). Kaplan-Meier method was used to estimate OS for each treatment group. Hazard ratios (HR) with 95% confidence intervals (CI) were computed using Cox regression modeling, adjusting for date of treatment, treatment facility (community vs. academic), age, gender, race, insurance status, tumor grade, T-stage, and Charlson-Deyo comorbidity score. Results: The median follow-up was 29.6 months for the entire population and 42.6 months for surviving patients. Among this cohort, the use of CRT increased from 63.92% to 88.75% for T2, 60.74% to 88.75% for T3, and 43.28% to 44.15% for T4 tumors; the use of TL for T2/-3 tumors had a correlative decline, while there was a modest increase of TL for T4 from 47.06% to 50.49. With 5,800 deaths reported, the estimated 3 and 5/5-year OS for CRT, TL, and TL+A was 60.6/47.1%, 56.5/46.4%, and 63.3/50.8%, respectively (omnibus p Conclusion: In this population-based cohort, CRT and S+A resulted in equivalent OS for T2N+ 1-3 and T3N-0-3any glottic/supraglottic SCC. However, when including T4 patients in this analysis, S+A was associated with better OS compared to CRT, even after including only optimal RT regimens. Given a relatively steady use of larynx-preservation for T4 tumors over this time, these results suggest that the OS decline seen with laryngeal cancer may be driven by T4-tumors treated with larynx-preservation CRT. Citation Format: Sagar A. Patel, Muhammad M. Qureshi, Kimberly Mak, Nicholas J. Giacalone, Scharukh Jalisi, Gregory Grillone, Minh Tam Truong. Optimizing patient selection for total laryngectomy versus larynx-preservation chemoradiotherapy for locally advanced laryngeal squamous cell carcinoma: An analysis of the National Cancer Data Base [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; April 23-25, 2017; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(23_Suppl):Abstract nr 25.