Examination of Laryngoesophageal Dysfunction-Free Survival as an Endpoint in Nonsurgical Treatment of Squamous Cell Carcinomas of the Larynx and Hypopharynx

BACKGROUND: A recently published consensus guideline suggested a new endpoint for clinical trials involving cancer of the larynx and hypopharynx: laryngoesophageal dysfunction-free survival (LEDFS). The authors of this report examined LEDFS in the context of definitive radiotherapy alone (RT) or with concurrent chemoradiotherapy (CRT). METHODS: Patients with a stage III to IVB squamous cell carcinomas of the larynx or hypopharynx who received definitive radiotherapy were included. Consensus guidelines also suggested analysis of the following: tumor classification, lymph node status, pretreatment tracheotomy, pretreatment swallowing dysfunction, and subsite. LEDFS was assessed using Kaplan-Meier survival analyses. RESULTS: Eighty-five patients (73.9%) received CRT, and 30 patients (26.1%) received RT. For the entire cohort, the 3-year LEDFS rate was 28.9%. CRT was associated with an improved LEDFS at 3 years (32.2% vs 20%; P = .02). Pretreatment dysphagia (P = .06) and N2 or N3 lymph node status (P = .09) demonstrated a trend toward poorer LEDFS, but patients who had T4 tumors had an LEDFS similar to that of patients who had T2 and T3 tumors. CONCLUSIONS: LEDFS was superior in patients who received CRT compared with patients who received RT alone. T4 status was not associated with a worse LEDFS. Cancer 2011; 117: 4447-51. (C) 2011 American Cancer Society.