INSTITUTIONAL EXPERIENCE OF ORGAN PRESERVATION IN LOCOREGIONALLY ADVANCED SQUAMOUS CARCINOMA OF THE LARYNX AND HYPOPHARYNX

Introduction: Conservative treatment of locoregionally advanced squamous carcinoma of the larynx and hypopharynx (LRASCLH) with chemoradiotherapy protocols is an option aimed at preserving the function of the larynx. However, this may also lead to the need of a laryngectomy or functional sequelae in the preserved larynx. Objective: To evaluate the overall survival of the patients with locoregionally advanced laryngeal and hypopharyngeal cancer, the organ preservation rate and functionality in patients with LRASCLH. Methods: A single institution retrospective study that evaluated patients with LRASCLH, undergoing cancer treatment from 2008 to 2015. Results: A total of 212 patients were included, of which 47.2% had larynx-supraglottic, 36.3% larynx-glottis and 16.5% hypopharynx. 39.2% had stage III, 48.6% stage IVa and 12.3% stage IVb. 82.5% of the cases were considered resectable. In regards to pre-treatment laryngeal function, 26.9% were tracheostomized and 7.1% required an alternative feeding route (AFR). The initial treatment in 56 (26.4%) of the patients was surgery, preceded or not by neoadjuvant chemotherapy in 17 (30.3%)%, and radiotherapy associated or not with chemotherapy in 156 (73.6%). Among patients that initially received organ preservation treatment, 28 (17.9%) required salvage surgery. In 81 (38.2%) of the cases, a total laryngectomy was performed and partial laryngectomy in 3 (3.6%). With a median follow-up of 42 months, the overall survival at 3 years was 58.2%. At the end of the follow-up, 54 (25.5%) required AFR and 36 (19%) a definitive tracheostomy with larynx. The rate of a functional and disease-free preserved larynx was 42% and that of disease-free, non-functional larynx was 4.7%. Conclusion: In our field, treatment with chemoradiotherapy for LRASCLH, even outside of randomized clinical trials, represents an excellent option when in selected cases, the goal is to preserve a functioning and disease-free larynx.