Size matters.

ASCO clinical guidelines currently suggest: “For selected patients with extensive T3 or large T4a [larynx cancer] and/or poor pretreatment laryngeal function, better survival rates and quality of life may be achieved with total laryngectomy.” So what makes a T3 tumor “extensive?” It’s still T3, after all. This retrospective analysis of patients receiving definitive radiation for cT3N0-3 laryngeal tumors across seven Canadian centers suggests it’s all about size. Remarkably, every 1 cc increase in tumor volume was associated with significantly worse disease-free (HR 1.04) and overall (HR 1.07) survival. Importantly, this was largely ameliorated in the roughly half of patients who received concurrent chemo. The authors conclude by refining the above to suggest large volume laryngeal tumors without candidacy for concurrent chemo may do better with upfront surgery. | Malik, JAMA Otolaryngol Head Neck Surg 2022