Postcricoid carcinoma: is organ preservation justified in T3?

INTRODUCTION: Postcricoid carcinoma in India, is seen especially in middle-aged females. Surgical treatment for postcricoid carcinoma has reduced because of increased organ-preserving nonsurgical strategies. Surgical intervention leads to morbidity in the form of laryngectomy.

OBJECTIVES/HYPOTHESIS: To study the outcomes of nonsurgical management and to assess whether organ preservation is justified or if radical surgery should be the first line of management for T3 postcricoid carcinoma.

STUDY DESIGN/METHODS: This retrospective study analyzed 59 patients with T3 postcricoid carcinoma who were treated with nonsurgical modality in the form of radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). End points studied were locoregional control, disease-free survival (DFS), and overall survival. We also observed feeding tube and tracheostomy tube dependency.

RESULTS: Locoregional control rate, DFS rate, and overall survival at the end of 2 years were 8.98%, 8.59%, and 15.71% respectively. Seventeen and 12 patients of the study population were dependent on nasogastric tube and tracheostomy tube, respectively, until their last follow-up.

CONCLUSION: Results of organ preservation with radical RT or CCRT do not show promising outcomes in the locally advanced T3 carcinoma of postcricoid. Radical surgery with appropriate reconstruction and postoperative radiotherapy is probably better in terms of local control as well as overall survival. Proper preoperative counseling and postoperative rehabilitation of speech and stoma can improve the quality of life of T3 postcricoid carcinoma patients.

LEVEL OF EVIDENCE: 4.