Quality of life for patients following total laryngectomy vs chemoradiation for laryngeal preservation

Background: The incorporation of chemotherapy and radiation, either sequentially or concurrently, has been increasingly used for organ preservation in patients with advanced laryngeal cancer. Traditional outcome measures of clinical response such as locoregional control and survival have been similar for patients treated with chemoradiotherapy and those treated with total laryngectomy (TL). The impact of concurrent chemoradiotherapy for laryngeal preservation on the overall quality of life (QOL) of patients has not been clearly evaluated, particularly in direct comparison with TL. Objective: To compare the QOL of patients treated with concurrent chemoradiotherapy with those treated with TL. Design: Nonrandomized, retrospective, cross-sectional study. Setting: Academic tertiary care referral center. Methods: The study included 42 patients with advanced stage III or IV cancer of the larynx, who were treated with either concurrent chemoradiotherapy or TL with postoperative radiation therapy. Patients had to be without evidence of recurrence and to have completed therapy at least 3 months prior to inclusion in the study. Quality of life was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) in tandem with the head and neck module (EORTC QLQ-H&N35). Results: On the core questionnaire (QLQ-C30), there were no statistically significant differences in the over-all QOL score between the 2 groups. Functional subscale analysis revealed a trend for patients in the surgery and radiotherapy group to experience greater difficulties with social functioning (P = .18) relative to the chemoradiation group. On the QLQ-H&N35, surgery patients reported significantly greater difficulties with sensory disturbances (smell and taste, P = .001), use of pain-killers (P = .049), and coughing (P = .004). On the other hand, chemoradiation patients reported significantly greater problems with dry mouth (P = .02). Conclusions: Both chemoradiation and TL affect, albeit differently, the QOL of patients treated for advanced cancer of the larynx. Although these differences can be detected by functional and subscale analysis, the overall QOL scores of both groups seem similar.