ASO Author Reflections: Comparison of Survival Outcomes Between Total Pharyngolaryngectomy and Chemoradiotherapy for T4aM0 Hypopharyngeal Cancer Using Nationwide Real-World Data

In principle, for patients with locally advanced hypopharyngeal cancer (HPC) for which larynx-preserving surgery is not feasible, treatment can be divided into total pharyngolaryngectomy (TPL) and chemoradiotherapy (CRT). TPL is the conventional and standard treatment for locally advanced HPC, and excellent locoregional outcomes are expected when the patient accepts the loss of voice associated with laryngectomy.¹ Meanwhile, CRT is another treatment for patients who request preservation of the larynx. For patients with T4aM0 HPSCC, the guidelines of the National Comprehensive Cancer Network recommend TPL (as category 2A), induction chemotherapy followed by TPL or CRT (as category 3), and CRT (as category 3).² A prospective randomized trial to compare these treatments is practically impossible because of the patient’s request for laryngeal preservation. Therefore, it has been a longstanding clinical challenge to clarify which treatments provide better survival outcomes. …