Is there a role for adjuvant radiotherapy after partial laryngectomy? A propensity score matched analysis

Objective. To evaluate the impact of postoperative radiotherapy (PORT) on survival outcomes in patients with laryngeal cancer treated with partial laryngectomy. Methods. In this retrospective multicentre study, 312 patients with supraglottic or glottic squamous cell carcinoma treated with transoral laser microsurgery (TLM) or open partial horizontal laryngectomy (OPHL), with or without PORT between 2005 and 2022 were analysed. Propensity score modelling and inverse probability weighting were applied to balance baseline characteristics. Endpoints included disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS), and locoregional control (LRC). Results. Of 312 patients, 175 underwent surgery alone and 137 received PORT. Treated patients had more adverse features. PORT significantly improved DFS (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.25-0.77) and LRC (HR 0.06, 95% CI 0.01-0.25). A significant benefit was also observed for DSS (HR 0.40, 95% CI 0.18-0.92). No statistically significant difference in OS emerged (HR 0.75, 95% CI 0.40-1.37). Conclusions. PORT significantly improves DFS and LRC after partial laryngectomy in high-risk patients, supporting its role in carefully selected cases.