Effectiveness of chemotherapy and radiotherapy for laryngeal preservation in advanced laryngeal cancer: a meta-analysis and systematic review

This meta-analysis compared the efficacy of laryngectomy and three larynx-preservation treatments in patients with advanced laryngeal cancer. Medline, Cochrane, EMBASE and Google Scholar databases were searched (until May 5, 2014) for studies that evaluated total laryngectomy followed by radiation and three larynx-preserving strategies in patients with advanced laryngeal cancer. The outcomes assessed were the 2- to 5-year overall survival (OS), disease-free survival (DFS), and laryngectomy-free survival (LFS) The search identified ten studies which were used for the meta-analysis (N = 2013 patients). The meta-analysis found that among different treatments, RT alone was associated with the highest rate of OS (71.6 %), DFS (57.8 %), and LFS (79.0 %). OS was similar among the following treatments: laryngectomy -> RT vs. CT -> RT [P = 0.402]; RT+CT vs. RT alone [P = 0.440]; and RT+CT vs CT -> RT [P = 0.588]. DFS rate was higher in patients receiving laryngectomy -> RT than CT -> RT (P = 0.001) and was similar for RT+CT compared with CT -> RT (P = 0.590). These findings suggest that of the larynx-preserving treatments, RT alone was associated with highest rates of OS, DFS, and LFS in patients with locally advanced cancer of the larynx and hypopharynx. Laryngectomy provided a better rate of DFS than CT and RT, but OS were similar across the different larynx-preserving treatments and laryngectomy.