Salvage total laryngectomy after external-beam radiotherapy: A 20-year experience

Background The purpose of this study was to present our evaluation of the clinical and functional outcomes after salvage total laryngectomy (STL). Methods We conducted a retrospective review of 218 patients who underwent STL between 1994 and 2014. Results Seventy percent of patients originally had T1 or T2, N0 tumors and 73% had definitive external-beam radiotherapy (EBRT) alone. A majority utilized tracheoesophageal prosthesis (77%) and were gastrostomy free (80%) at last follow-up. The 5-year disease control and overall survival (OS) rates were 65% and 57%, respectively. Patients with a disease-free interval after initial treatment <2 years were more likely to develop a recurrence (p =.001) and die of disease (p =.032) after STL. The disease-free interval after EBRT impacted disease control (p <.001), with 5-year disease control of 92% for >5-year disease-free interval and 60% for <2-year disease-free interval. Conclusion Most patients remain disease-free after STL, achieve intelligible tracheoesophageal speech, and maintain an oral diet. Delayed recurrence after initial treatment portends better survival and may indicate a distinct biological profile.