Long-term functional outcome after laryngeal cancer treatment

Abstract

Background The functional outcome after the treatment of laryngeal cancer is tightly related to the quality of life of affected patients. The aim of this study is to describe the long-term morbidity and functional outcomes associated with the different treatment modalities for laryngeal cancer. Methods Retrospective chart review of 477 patients undergoing curatively intended treatment for laryngeal cancer at our tertiary referral center from 2001 to 2014: Details on patient and disease characteristics, diagnostics and treatment related functional outcomes were analyzed. Results With a median follow-up of 51 months, the crude rate of functional larynx preservation was 74.6%. Radiotherapy +/− chemotherapy was the dominant treatment modality ( n = 359–75.3%), whereas 24.7% ( n = 118) underwent primary surgery, with 58.5% (69) receiving adjuvant treatment. The 5-year laryngectomy-free survival was 57% (95% CI, 48–66%) after surgery vs. 69% (95% CI, 64–75%) after chemoradiotherapy ( p < 0.01). In stage III-IVB, these rates were 26% (95% CI, 16–39%) vs. 47% (95% CI, 36–59%), respectively ( p < 0.01). Aspiration occurred in 7%, tracheostomy was necessary in 19.8% and feeding tube placement in 25.4%. Feeding tube and tracheostomy necessity was higher in the initially surgically treated group. Primary surgery (HR: 1.67, 95% CI: 1.19–2.32; p < 0.01), stage III-IVB (HR: 4.07, 95% CI: 2.97–5.60; p < 0.01) and tumor recurrence (HR: 3.83, 95% CI: 2.79–5.28; p < 0.01) remained as adverse factors for laryngectomy-free survival. Conclusions Preserving the laryngeal function after cancer treatment is challenging. Advanced tumor stages, primary surgery and recurrence are related to a poor functional outcome. Therefore, the criteria for initial decision-making needs to be further refined. Electronic supplementary material The online version of this article (10.1186/s13014-019-1299-8) contains supplementary material, which is available to authorized users.

Lung cancer‑associated transcript 1 facilitates tumorigenesis in laryngeal squamous cell carcinoma through the targeted inhibition of miR‑493

“…To further investigate the molecular mechanisms underlying the role of LUCAT1 in the tumorigenesis of LSCC, the ENCORI database ( ) was used. It was predicted that LUCAT1 directly bound with miR-493, a miRNA previously reported to inhibit tumorigenesis occurred in the 3′-UTR ( 29 , 30 ) ( Fig. 5A ).…”

Predictors of Postoperative Radiation Following Laser Resection in Early‐Stage Glottic Cancer

“…[10][11][12][13] In a review of 477 patients with laryngeal cancer-the majority with glottic and early-stage disease-adjuvant therapy was required in 69 of 118 patients (58.5%) following primary surgical resection with curative intent. 10 TLM was the most frequent primary surgical modality, with a median total of 60 Gy among patients undergoing PORT. The addition of adjuvant RT may significantly affect long-term morbidity, as delayed severe laryngeal complications necessitating tracheostomy placement, gastrostomy dependence, or salvage laryngectomy remain possible.…”

“…1 PORT adds significant treatment toxicities and negatively affects quality of life. 6,[10][11][12][13] The primary objective of our study was to identify the incidence of PORT following laser resection for early-stage glottic cancer and to identify factors associated with its use.…”

Current Role of Total Laryngectomy in the Era of Organ Preservation

“…Interestingly, five of the eight feeding-tube insertions occurred beyond five years after CRT, thus highlighting the long-term side effects of CRT on larynx functions [41]. In a retrospective chart review of 477 patients undergoing curatively intended treatment for LC, Anschuetz et al found a 5% rate of feeding-tube dependence at the last follow-up in patients receiving primary CRT [42]. TL can be offered to these patients after adequate patient information in order to restore oral feeding if they accept the loss of laryngeal voice and definitive tracheostoma.…”