Introduction – Laryngo–hypopharyngeal carcinoma constitutes one of the commonest Head and Neck cancer in India, with a high incidence seen in the North–eastern states of the country.  T4a laryngo–hypopharyngeal disease has been classically treated by Surgery (Total laryngectomy) followed by adjuvant radiotherapy with or without chemotherapy. In recent decades, treatment paradigm has shifted from primary surgery towards non–surgical organ preserving treatment using chemoradiotherapy. We sought to present our experience on management of T4a laryngo–hypopharyngeal disease with extralaryngeal spread with or without cartilage erosion.

Methodology – A retrospective analysis was conducted from 2010–2015 on T4a laryngo–hypopharyngeal cancer cases from a prospectively maintained Institutional database. Only the cases who took treatment at our Institute were taken for analysis. The T4a cases with extralaryngeal spread were then analysed on the basis of whether they had cartilage erosion or not. The purpose of this study is to review the surgical and non–surgical treatment options and their impact on the survival.

Results – A total of 179 T4a cases were included in the study. 45.8% cases had extralaryngeal spread with cartilage erosion at presentation. Among the cartilage erosion group, 48.7% cases underwent primary surgery and 51.2% cases had chemoradiation.  In non–cartilage erosion group with only extralaryngeal spread, only 2% underwent surgery and the rest had chemoradiation. Overall recurrence was seen in 17.3% cases, but no significant difference was noted among surgical and non surgical group. 5 years overall survival (OS) was 48.1% with surgical vs non–surgical arm having OS  55.9% vs 38.2% which was not found to be statistically significant (p value=0.052).  5 years Disease Free Survival (DFS) was 57.9% with no statistical significance noted in surgical and non–surgical arms. Also, no statistically significant difference in survival was noted among cartilage erosion and non–cartilage erosion group even when crosstabulated with surgery and non–surgical treatment.

Conclusion – Management of T4a laryngo–hypopharyngeal disease has evolved towards predominance of non surgical treatment in an endeavour to adopt organ preservation strategy. However, ongoing challenges include development of strategies to reduce toxicity and adverse functional outcome. Hence, a randomised controlled study is needed for understanding the behaviour of such cases and to chalk out an adequate treatment protocol.