Oncological results of surgical treatment versus organ-function preservation in larynx and hypopharynx câncer

Abstract

Introduction:Since the beginning of the 1990s, non-surgical radiochemotherapy treatment has become popular with the prospect of maintaining oncological results and preserving the organ in patients with advanced squamous cell carcinoma of the larynx and hypopharynx. However, subsequent studies demonstrated increased recurrence and mortality after the non-surgical treatment became popular. Objective: To compare the oncological results of surgical and non-surgical treatments of patients with larynx and hypopharynx cancer and to evaluate the variables associated with disease recurrence. Method: This is a retrospective cohort study of 134 patients undergoing surgical (total or partial laryngectomy) or non-surgical (isolated radiotherapy, chemotherapy or induction chemotherapy followed by radiotherapy and chemotherapy) treatment, with 62 patients in the surgical group and 72 in the non-surgical group. Results: Disease-free survival rates were higher in the surgical group (81.7% vs. 62.2%; p=0.028), especially in III/IV stages (p=0.018), locally advanced tumors T3 and T4a (p=0.021) and N0/N1 cases (p=0.005). The presence of cervical lymph nodes, especially N2/N3, was considered a risk factor for disease recurrence in both groups (HR=11.82; p<0.0001). Patients not undergoing surgical treatment were 3.8 times more likely to develop recurrence (HR=3.76; 95CI 1.27-11.14; p=0.039). Conclusion: Patients with larynx or hypopharynx cancer non-surgically treated had a poorer disease-free survival, especially in cases with locally advanced tumors (T3 and T4a) and in which the neck was only slightly affected (N0/N1).

Swallowing, voice and quality of life of patients submitted to extended supratracheal laryngectomy

“…(6)(7)(8)(9) However, there is evidence, especially in advanced staging, that the sequelae of these techniques can also be drastic, leading to the preservation of a non-functional organ with significant structural alterations. (8,10) In view of the failure of RT treatment and low efficacy of non-surgical protocols with high levels of toxicity, open horizontal partial laryngectomies are performed in specialized centers as a viable alternative to the other procedures. (10) This conservative surgical technique for laryngeal carcinoma removes the tumor and its safety margin free of the disease, reconstructing a functional neolarynx.…”

“…(8,10) In view of the failure of RT treatment and low efficacy of non-surgical protocols with high levels of toxicity, open horizontal partial laryngectomies are performed in specialized centers as a viable alternative to the other procedures. (10) This conservative surgical technique for laryngeal carcinoma removes the tumor and its safety margin free of the disease, reconstructing a functional neolarynx. (3,10,11) Horizontal partial laryngectomies have been established as surgical options for the treatment of laryngeal cancer in the intermediate/advanced stages.…”

Aspectos funcionais e epidemiológicos da deglutição na laringectomia supratraqueal extendida com traqueohiodoepiglotopexia

“…Sendo assim, outros meios de tratamento são necessários, como a quimioterapia e radioterapia. Porém, em estadiamentos avançados, as sequelas destas técnicas podem ser drásticas, acarretando na preservação de um órgão não funcional com danos estruturais significativos 6,7 .…”

Treatment modality and outcomes in larynx cancer patients: A sex‐based evaluation

“…Treatment modality choice is still somewhat controversial and involves a multidisciplinary approach. For T4 cancers, surgical therapy has been shown to have superior outcomes, however for the remaining T classifications, there is still debate as to the ideal modality or combination of modalities . Recent Surveillance, Epidemiology and End Results (SEER) investigation has demonstrated that in patients with advanced laryngeal cancer (T3 and T4), surgical therapy was more prevalent in younger patients residing in low‐income counties.…”

“…For T4 cancers, surgical therapy has been shown to have superior outcomes, however for the remaining T classifications, there is still debate as to the ideal modality or combination of modalities. [3][4][5] Recent Surveillance, Epidemiology and End Results (SEER) investigation has demonstrated that in patients with advanced laryngeal cancer (T3 and T4), surgical therapy was more prevalent in younger patients residing in low-income counties. Interestingly, they did find female sex and married status provided a survival benefit, indicating that further investigation into the disparity between male and female patients should be undertaken.…”