Long-term oncological and functional outcomes of laryngeal compartmentalization in the multidisciplinary management of cT3 glottic carcinoma: a multicenter Italian study

Background. The management of cT3 glottic carcinoma remains debated between organ-preserving strategies (surgical and non-surgical) and total laryngectomy (TL). We evaluated long-term oncologic outcomes and functional profiles, exploring the impact of posterior compartment involvement. Methods. Multicenter retrospective study of 115 cT3 patients treated between 2007 and 2022 across Italian centers; groups: OPHL (n=64), TL (n=22), and non-surgical protocols (definitive radiotherapy [RT] or concurrent chemoradiotherapy [cCRT], with or without induction chemotherapy [IC]) (n=29). Median follow-up was 67.6 months. Endopoints were overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), local control (LC), and locoregional control (LRC), analyzed with Kaplan–Meier curves and log-rank tests. A functional subcohort (n=13) underwent MDADI, EORTC QLQ-HN35, FOIS/DOSS, FEES/VFSS with the PAS, YALE, DIGEST Scale and “Padova Score” and a predefined protocol for vocal-function assessment. Results. No significant differences emerged among approaches for OS, DFS, DSS, LC, or LRC (log-rank p: 0.133; 0.895; 0.601; 0.151; 0.520). In the three-arm comparison, LC was worse in the TL group (log-rank 0.009), plausibly reflecting a higher rate of close/positive margins and a slightly larger share of pT4a cases. Posterior compartment involvement did not significantly affect OS/DFS/DSS, although there was a trend toward better survival when the posterior compartment uninvolved. In the functional subcohort: mean FOIS 6.5 and mean DOSS 6.15 indicate near-complete oral intake. A nasogastric tube was required in 11/13 (mean removal at 12 days); tracheostomy in 11/13 with decannulation in all OPHL cases (mean 62 days). No between-group comparisons could be conducted regarding the functional data. Conclusions. In cT3 glottic carcinoma, OPHL, TL, and non-surgical protocols yield comparable survival; TL does not guarantee superior local control and remains sensitive to margin status. Extension to the posterior compartment alone should not preclude laryngeal-preservation strategies. Swallowing outcomes appear generally favorable, but a larger and mor homogeneous cohorts are needed for robust comparative analysis. Treatment selection should integrate imaging, laryngeal compartmentalization, and expected function to maximize organ preservation without compromising oncologic efficacy.