Glottic carcinoma with a fixed true vocal cord: Outcomes after neoadjuvant chemotherapy and supracricoid partial laryngectomy with cricohyoidoepiglottopexy

Abstract

Twenty patients with glottic squamous cell carcinoma and a fixed true vocal cord underwent neoadjuvant chemotherapy followed by supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Phonation, respiration, and deglutition were preserved. Local control was better than has been previously reported for either extended vertical partial laryngectomy or radiation therapy. All patients were monitored for at least 3 years or until death. The Kaplan-Meier 3-year survival, local recurrence, nodal recurrence, distant metastasis, and second primary rates were 75%, 10.8%, 5%, 10.8%, and 10.8%, respectively. Overall local control was achieved in all cases, and laryngeal preservation in 90%. Our experience suggested that neoadjuvant chemotherapy with supracricoid partial laryngectomy with cricohyoidoepiglottopexy deserves further consideration in the treatment of glottic tumors with a fixed true vocal cord.

Supracricoid partial laryngectomies: Oncologic and functional results

“…The high percentage of relapse in vertical laryngectomy reported by other American authors 11 is, in our opinion, a consequence of the approach through the cartilage, considering the vast resection of the subperichondrium required to remove the tumor. 14 The cartilage, however, is a solid barrier, protecting against invasion of the tumor, and other authors have shown that the paraglottic area is reached by means of invasion of the muscles.…”

Fatores prognósticos no tratamento do carcinoma epidermóide da laringe: cirurgia conservadora x radical

“…19,20 Today there is a trend to treat T3 tumors to preserve the larynx, through organ preservation protocols, in addition to surgery, such as supracricoid laryngectomy. 18,19,21 When surgical preservation is indicated, it is important to point out the difference between the fixation of vocal folds and of arytenoids. 16,21 The first does not necessarily invalidate partial surgery, since the most frequent cause is invasion of the thyroarytenoid muscle, while the latter can mean involvement of the cricoarytenoid articulation, making it impossible to preserve the larynx.…”

“…18,19,21 When surgical preservation is indicated, it is important to point out the difference between the fixation of vocal folds and of arytenoids. 16,21 The first does not necessarily invalidate partial surgery, since the most frequent cause is invasion of the thyroarytenoid muscle, while the latter can mean involvement of the cricoarytenoid articulation, making it impossible to preserve the larynx. 13,16 Laccourreye clearly demonstrated the feasibility of the articulation, and, therefore, the possibility of preserving the larynx with neoadjuvant chemotherapy, prior to the supracricoid laryngectomy.…”

“…13,16 Laccourreye clearly demonstrated the feasibility of the articulation, and, therefore, the possibility of preserving the larynx with neoadjuvant chemotherapy, prior to the supracricoid laryngectomy. 20,21 Clinical preservation was well supported through randomized protocols from the Veterans Affairs Laryngeal Cancer Study Group. 23 Today, the results improved with concomitant chemo and radiation therapy regimens.…”

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

“…Advantages of the function-sparing surgical option are a precise delineation of the tumor, accurate margin assessment, optimal neck management, and the maintenance of adequate airway and swallowing functions. The addition of chemotherapy to function-sparing surgery is currently under investigation [22,23]. Unfortunately, no improvement of locoregional control or disease-free survival could be shown by the addition of neoadjuvant chemotherapy to surgical therapy in randomized controlled trials [24].…”