ESTRO 2025 - Abstract Book

S1106

Clinical – Head & neck

ESTRO 2025

risks. This study compares survival outcomes for T2N0 laryngeal cancer patients treated with surgery or radiotherapy, contributing to ongoing discussions.

Material/Methods: We conducted a retrospective unicentric study including 282 patients with T2N0 glottic squamous cell carcinoma treated at Gustave-Roussy Institute (1998–2020). Patients underwent either surgery (cordectomy/partial/total laryngectomy) or radiotherapy (+/- chemotherapy). Those treated with induction chemotherapy or without cT2 diagnoses were excluded, yielding 252 patients. Outcomes assessed included overall survival (OS), progression-free survival (PFS), disease-specific survival (DSS), local failure-free survival (LFFS), locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), and total laryngectomy-free survival (TLFS). Propensity score (PS) matching was performed to balance baseline characteristics. Subgroup analyses evaluated surgery alone, surgery with adjuvant therapy (S-adj), radiotherapy alone, and radiotherapy with chemotherapy (RT-CT). Age interaction (≥60 vs. <60 years) was also analyzed. A sensitivity analysis included only patients treated with 3D/IMRT radiotherapy. Results: Of 252 patients (141 surgery, 111 radiotherapy), median follow-up was 6.9 years for surgery and 6 years for radiotherapy. Five-year outcomes favored surgery: OS 90% vs. 73.7% (p < 0.001), PFS 82.5% vs. 56% (p < 0.001), DSS 97% vs. 90% (p = 0.018), and locoregional/distant control. TLFS at 5 years was higher for surgery (83.1% vs. 62.3%, p < 0.001). The adjusted hazard ratios for OS and PFS were 1.24 ([0.68–2.26], p = 0.50), and 1.64 ([1.02–2.65], p = 0.043) respectively. Radiotherapy was associated with a significantly higher risk of locoregional progression compared to surgery in univariable (p < 0.001) and multivariable analysis (LRFFS: aHR [95% CI] = 1.64 [1.02–2.64], p = 0.043). The PS-matched analysis obtained broadly similar results. In the subgroup analysis, the results for radiotherapy combined with chemotherapy were not significant for any of the outcomes studied, except for TLFS (aHR [95%CI] = 1.58 [1.02-3.34], p = 0.042). Sensitivity analysis with modern radiotherapy techniques did not improve the results either, which remained more or less identical to the results obtained in the entire cohort of patients. Conclusion: While PS matching reduced disparities, surgery consistently outperformed radiotherapy in local and regional control for T2 laryngeal cancer. RT-CT showed improvement over radiotherapy alone but remained inferior to surgery. These findings suggest surgery may provide better long-term outcomes, even when modern radiotherapy techniques are considered.

Keywords: Laryngeal, surgery, radiotherapy

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