Background: The aim of this study was to determine whether patients with clinically node-negative (cN0) locally advanced squamous cell carcinoma (SCC) of the larynx who receive total laryngectomy (TL) benefit from elective neck dissection (END) before adjuvant postoperative radiotherapy (RT). Methods: A retrospective review of 36 patients who received TL and adjuvant postoperative RT for laryngeal SCC between 1988 and 2013 was carried out. Patients had either T3 (n = 7; 19%) or T4a (n = 29; 81%) primaries, and all had clinically node-negative disease. All patients underwent TL and adjuvant RT. Patients underwent either a planned unilateral END, a bilateral END, or no END. Results: Median follow-up was 3.3 years (range, 0.3-18.4 years). Occult nodal metastases were found in 9 (32%) of 28 patients receiving END. 5-year control and survival rates for all patients were: local-regional control, 92% (END 91% vs. no END 100%; p = 0.4922); cause-specific survival, 80%; distant metastasis-free survival, 88%; and overall survival, 52%. Local-regional control and survival were not influenced by END. 5 (14%) patients experienced grade 3 or 4 toxicities. Conclusion: In this patient population, those not receiving END at the time of TL had equivalent rates of local-regional control and survival as those receiving END, although our sample size not receiving END was relatively small.

Grover S, Swisher-McClure S, Mitra N, Li J, Cohen RB, Ahn PH, Lukens JN, Chalian AA, Weinstein GS, O'Malley BW Jr, Lin A: Total laryngectomy versus larynx preservation for T4a larynx cancer: patterns of care and survival outcomes. Int J Radiat Oncol Biol Phys 2015;92:594-601.
Yuen AP, Wei WI, Wong SH, Ho WK: Comprehensive analysis of nodal recurrence of advanced laryngeal carcinoma following surgery. Eur J Surg Oncol 1996;22:350-353.
Hicks WL Jr, Kollmorgen DR, Kuriakose MA, Orner J, Bakamjian VY, Winston J, Loree TR: Patterns of nodal metastasis and surgical management of the neck in supraglottic laryngeal carcinoma. Otolaryngol Head Neck Surg 1999;121:57-61.
Maillard S, Jovenin N, Cauchois A, Froissart D, Merol JC, Chays A, Nguyen TD: (Postoperative radiotherapy in N0 laryngeal cancer). Cancer Radiother 2005;9:285-292.
Spector GJ, Sessions DG, Lenox J, Newland D, Simpson J, Haughey BH: Management of stage IV glottic carcinoma: therapeutic outcomes. Laryngoscope 2004;114:1438-1446.
Kligerman J, Olivatto LO, Lima RA, Freitas EQ, Soares JR, Dias FL, Melo LE, Sa GM, Duccini E: Elective neck dissection in the treatment of T3/T4 N0 squamous cell carcinoma of the larynx. Am J Surg 1995;170:436-439.
Dagan R, Morris CG, Kirwan JM, Werning JW, Vaysberg M, Amdur RJ, Mendenhall WM: Elective neck dissection during salvage surgery for locally recurrent head and neck squamous cell carcinoma after radiotherapy with elective nodal irradiation. Laryngoscope 2010;120:945-952.
Chera BS, Amdur RJ, Morris CG, Kirwan JM, Mendenhall WM: T1N0 to T2N0 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy. Int J Radiat Oncol Biol Phys 2010;78:461-466.
Farrag TY, Lin FR, Cummings CW, Koch WM, Flint PW, Califano JA, Broussard J, Bajaj G, Tufano RP: Neck management in patients undergoing postradiotherapy salvage laryngeal surgery for recurrent/persistent laryngeal cancer. Laryngoscope 2006;116:1864-1866.
Basheeth N, O'Leary G, Sheahan P: Elective neck dissection for no neck during salvage total laryngectomy: findings, complications, and oncological outcome. JAMA Otolaryngol Head Neck Surg 2013;139:790-796.
Pezier TF, Nixon IJ, Scotton W, Joshi A, Guerrero-Urbano T, Oakley R, Jeannon JP, Simo R: Should elective neck dissection be routinely performed in patients undergoing salvage total laryngectomy? J Laryngol Otol 2014;128:279-283.
Derks W, de Leeuw RJ, Hordijk GJ: Elderly patients with head and neck cancer: the influence of comorbidity on choice of therapy, complication rate, and survival. Curr Opin Otolaryngol Head Neck Surg 2005;13:92-96.
Teymoortash A, Bohne F, Kissing L, Daniel H, Kurt B, Wilhelm T, Halmos GB, Hoch S: Oncological and surgical outcome of total laryngectomy in combination with neck dissection in the elderly. Eur Arch Otorhinolaryngol 2016;273:1825-1833.
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