Approaches to Preserve Larynx Function in Locally Advanced Laryngeal and Hypopharyngeal Cancer

Abstract

Randomized controlled studies have shown that preservation of the larynx function in patients with advanced resectable laryngeal and hypopharyngeal cancer is possible without compromising survival compared to total laryngectomy (TL). Options for preserving the larynx include function-sparing surgery, radiotherapy alone, induction chemotherapy followed by radiotherapy of responders, and concomitant radiochemotherapy. The current data suggest that induction chemotherapy followed by radiotherapy of responders is an acceptable alternative to TL for patients desiring larynx preservation. Concomitant radiochemotherapy (platinum/5-FU) leads to superior local control and larynx preservation rates compared to induction chemotherapy followed by radiation. The optimal treatment sequence for newer cytotoxic agents is, however, unclear. Such cytotoxic agents and more effective fractionation regimens as well as more advanced surgical techniques are currently evaluated. Predictive tests to successfully stratify patients for the optimal treatment option and more effective systemic therapy are needed to improve therapeutic possibilities and survival.

Larynx Preserving Treatments in the Early and Advanced Laryngeal Cancers; A Retrospective Analysis

“…In the study by Rudat et al (2004), concomitant radio -chemotherapy (platinum/5FU) leaded to superior local control and larynx preservation rates compared to induction chemotherapy followed by radiation (Rudat et al, 2004). …”

Mental Disorders after Laryngectomy

“…The second direction of research is to compare the incidence of psychiatric morbidity between patients undergoing mutilating surgery and those treated with organ sparing protocols. The later are not without significant treatment-related late effects, but are nevertheless strongly preferred by patients [3,4]. In conclusion, we would like to comment on the importance of this research for the choice of the treatment of laryngeal cancer.…”

New Developments for Optimal Management of Head and Neck Cancer

“…It has to be remembered that these heavy protocols need to be administered within the setting of a clinical trial in specialized multidisciplinary institutions. With the emphasis on preservation of organ and function, investigational treatment regimens using altered fractionation schedules of radiation and the combination of chemotherapy and radiation have recently emerged [7]. It is currently impossible to predict if non-surgical treatment will yield a complete response.…”

“…It is currently impossible to predict if non-surgical treatment will yield a complete response. Therefore, Rudat et al [7] state: 'Predictive tests to successfully stratify patients for the optimal treatment option and more effective systemic therapy are desired to improve the therapeutic ratio and survival.' To this end, several tumor characteristics have been analyzed and related to clinical outcome in HNSCC patients treated with radiotherapy.…”