Outcomes of definitive chemoradiotherapy for laryngeal squamous cell carcinoma: A single-center experience
Abstract
Objective: Definitive chemoradiotherapy (CRT) is an established organ-preservation strategy for laryngeal squamous cell carcinoma (LSCC). However, real-world data regarding long-term survival and prognostic factors remain limited. This study evaluated survival outcomes, prognostic factors in LSCC patients treated with definitive nonsurgical therapy. Materials and Methods: In this retrospective study, 68 patients with pathologically confirmed stage II–IVA LSCC treated with definitive CRT between 2010 and 2022 were analyzed. Forty patients (58.8%) received induction chemotherapy followed by concurrent CRT, while 28 (41.2%) received upfront concurrent CRT. Recurrence-free survival (RFS), disease-free survival (DFS), metastasis-free survival (MFS), and overall survival (OS) were estimated using the Kaplan–Meier method. Prognostic factors were evaluated using univariable Cox regression models. Results: The median follow-up was 27.4 months. Three-year survival rates were: RFS 77.6% (95% CI, 66.6%–88.6%), DFS 76.3% (95% CI, 65.1%–87.5%), MFS 94.4% (95% CI, 88.1%–100%), and OS 62.9% (95% CI, 50.4%–75.4%). Univariable analysis revealed no significant association between survival outcomes and age, sex, stage, induction chemotherapy, RT technique, SUVmax, or RT duration. Stratified by RT duration (≤ 51 vs. > 51 days), RT duration did not significantly affect RFS in upfront CRT patients (70.7% vs. 66.7%; p = 0.160). However, in patients receiving induction chemotherapy followed by CRT, prolonged RT duration (> 51 days) showed a trend toward poorer 3-year RFS (53.7% vs. 62.9%; p = 0.077). Grade 3–4 toxicities included dysphagia (14.7%), hematologic toxicity (11.8%), and xerostomia (4.4%). Ten patients underwent salvage total laryngectomy during follow-up. Conclusions: Definitive nonsurgical therapy provided satisfactory disease control in LSCC. Although overall RT duration was not significantly associated with survival across the cohort, prolonged RT duration following induction chemotherapy showed a trend toward inferior RFS, highlighting the importance of avoiding treatment delays after induction therapy.