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Page 4 of 14 Galli et al. J Cancer Metastasis Treat 2022;8:48 https://dx.doi.org/10.20517/2394-4722.2022.19

Figure 1. Flowchart with considered, excluded, and included patients. (C)RT: Radiotherapy with or without concomitant chemotherapy;
ND: neck dissection; STL: salvage total laryngectomy.

Data analysis
Summary statistics and diagnostic values were calculated using SPSS statistics software version 25 (IBM,
New York, USA). Survival curves were plotted according to the Kaplan-Meier method and were compared
using the log-rank test performed with GraphPad Prism (GraphPad Software Inc., San Diego, USA). All
P-values were two-sided and statistical significance was set at P < 0.05.

RESULTS
Characteristics of the patients with recurrent LSCC
Of 153 patients with recurrent LSCC who were managed at our institution during the study period, 71
underwent STL along with ND following local or loco-regional failure after (C)RT. Out of these patients, 18
were excluded because of unavailable MRI and/or PET/CT, 1 because of a secondary primary tumor after 21
years, and 11 because of incomplete clinical/histopathological data, bringing the final number of included
patients to 41 [Figure 1].

The median age at the time of STL was 67.5 years (range: 49.7-85.1 years). The median time to relapse after
(C)RT was 24.4 months (range: 6.2 months to 6.7 years). All but one patient were male. Table 1 summarizes
the baseline characteristics of the patients included in this study. Sixty-one percent of the patients initially
had glottic carcinomas, and 70.7% had early-stage local disease (UICC Stage I-II). Only 12.2% of the patients
had regional LN metastases at initial diagnosis.

While all primary tumors were irradiated with a median dose of 72 Gy (range: 60-72 Gy), 24 (58.6%)
patients received unilateral or bilateral neck irradiation. Sixteen patients (39.0%) had no primary neck RT,
with 2 of these 16 patients (11.1%) having nodal metastasis at the time of STL, both staged as rpN2c. In the
24 patients (58.6%) with primary neck RT, two (8.3%) had LN metastasis, with one of these being staged as
pN1 and the other as pN2c.

In contrast to the initial tumors, most patients (69%) with disease failure had advanced recurrent stage
cancers (UICC Stage III-IV). Bilateral and unilateral NDs were performed along with STL in 82.9% and
17.1% of these patients, respectively [Table 2]. ND was carried out from at least level II-IV in all cases. Four
patients underwent modified radical ND including level I and V, and six underwent modified radical ND
with additional dissection of level VI.