Oncologic and Functional Outcomes of Surgical and Nonsurgical Treatment of XXXX of the Supraglottic Larynx.

@entity5 @entity1 @entity957 @entity1349
Importance: Nonsurgical treatment of advanced supraglottic @entity5 is widely used as part of a larynx preservation protocol. However, recent studies have suggested that nonsurgical treatment may be associated with inferior survival. Furthermore, it is not clear whether preservation of the larynx provides superior voice or swallowing function in the long term. Objective: To test the hypothesis that surgical treatment of advanced-stage @entity957 of the supraglottic larynx is associated with superior @entity1349 ( @entity1349 ), freedom from recurrence (FFR), and noninferior voice and swallowing function. Design, Setting, and @entity1 : Retrospective medical record review of @entity1 treated for stage III or @entity957 of the supraglottic larynx between January 1990 and June 2013 at a tertiary referral center: 97 @entity1 underwent surgical treatment and 138, nonsurgical treatment. Exclusion criteria included prior definitive treatment for @entity5 or evidence of distant metastatic disease at presentation. The median follow-up for all 235 @entity1 was 63 months. Interventions: Surgical or nonsurgical therapy. Main Outcomes and Measures: Freedom from recurrence (FFR), @entity1349 , larynx preservation, voice graded from 1 to 5, and swallowing graded from 1 to 6 using our voice and swallowing function scales. Results: Surgical treatment was associated with superior FFR (5-year FFR: 75% vs 55%; P   =   .006) but not @entity1349 (5-year @entity1349 : 52% vs 52%; P   =   .61). The larynx was preserved in 83% of @entity1 in the nonsurgical group vs 42% of @entity1 in the surgical group (P   <   .001). Voice function was superior in the nonsurgical group at all time points through 5 years after treatment (mean voice score, 3.8 vs 2.6; P   <   .001). Swallowing function was comparable between surgical and nonsurgical groups. Multivariable analysis revealed that advanced age (hazard ratio [HR], 1.43 per 10-year increment; 95% CI, 1.19-1.72) and clinical N stage (HR, 1.17 per 1-level increment; 95% CI, 1.05-1.30) were associated with worse @entity1349 , while treatment with chemotherapy was associated with superior @entity1349 (HR, 0.61; 95% CI, 0.41-0.92). Conclusions and Relevance: Compared with surgical treatment, nonsurgical treatment as part of a larynx preservation protocol is associated with a higher likelihood of recurrence but has similar @entity1349 and should continue to be viewed as a viable alternative for the treatment of advanced supraglottic @entity5 .
