Comparison of the therapeutic effects of total laryngectomy and a larynx‐preservation approach in patients with T4a laryngeal cancer and thyroid cartilage invasion: A multicenter retrospective review

Abstract

Total laryngectomy may be a better therapeutic option to treat T4a laryngeal cancer featuring thyroid cartilage invasion, especially in patients exhibiting limited nodal involvement (N0/N1). © 2016 Wiley Periodicals, Inc. Head Neck, 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38:1271-1277, 2016.

Comparison of MR Imaging and Dual-Energy CT for the Evaluation of Cartilage Invasion by Laryngeal and Hypopharyngeal Squamous Cell Carcinoma

“…1 When tumor extends through the thyroid cartilage into the superficial soft tissue of the neck, the patient is staged T4a and may require total laryngectomy. [2][3][4][5][6] In cases in which cartilage invasion is localized without transcartilaginous extension, potentially organ-preserving treatment may still be performed. [2][3][4][5]7,8 Therefore, inappropriate treatment choices secondary to over-or underestimation of thyroid cartilage invasion can have grave implications for a patient's quality of life.…”

Current Role of Total Laryngectomy in the Era of Organ Preservation

“…There are several retrospective studies showing that patients with LC with extralaryngeal extension through the thyroid cartilage (T4a primary tumor, Figure 3) included in an organ-preservation program experienced poor survival and LP rates [13,14,[21][22][23]. Chen and Halpern, in a retrospective observational cohort analysis (American National Cancer Database, NCDB) of 7019 patients with stages III and IV LC, showed that the risk of death was similar with CRT and primary TL for stage III tumors but higher with CRT than with primary TL for stage IV tumors [22].…”

“…At 5 and 10 years, the rate of patients alive with a functional larynx (no feeding tube, no tracheostomy) was 32% and 13%, respectively [25]. In another retrospective study on 89 patients with T4a laryngeal cancer featuring thyroid cartilage invasion who were treated initially with either TL (n = 53) or an LP strategy (n = 36), Choi et al reported that primary surgery was associated with a longer median OS than an LP strategy (87.2 vs. 31.3 months) [21]. Taken together, these results indicate that primary TL should be the preferred therapeutic option for most patients with T4a LC and, particularly, for those exhibiting thyroid cartilage invasion.…”

Larenks karsinomu cerrahisinde cerrahi marjinlerin önemi

“…[18] In case of its involvement at the preoperative period, aggressive surgical treatment is warranted. A retrospective 89-patient study by Choi et al [19] reported that thyroid cartilage involvement was one of the most influencing factors on survival and that total laryngectomy should be performed instead of chemotherapy if it was found to be present. The same study demonstrated that occult involvement of the thyroid cartilage worsened prognosis in T 1b and T 2 tumors and that there was a 25 to 50% possibility of thyroid cartilage involvement in patients with no such finding detected by magnetic resonance imaging or computed tomography.…”