Management of locally advanced laryngeal cancer

Abstract

BackgroundManagement of advanced laryngeal cancer is complex and ideal strategy is yet to be defined. This study evaluates the experience of a single head and neck oncologic centre in the management of T4 laryngeal cancer.MethodsRetrospective assessment of cases primarily treated for T4a squamous cell carcinoma of the larynx, between 1980 and 2007, at a tertiary referral center.ResultsA total of 384 cases were studied. Five-year disease specific survival was 56.2% and local control 87.4%. Regional and distal control estimates were 90.3% and 88.3% respectively. Prognosis was significantly superior for cases treated with primary surgery compared to cases solely managed with non-surgical modalities. Positive surgical margins and regional disease worsened prognosis.ConclusionThis study suggests that primary surgery remains a key element in the treatment of advanced laryngeal cancer. The need for well-designed, prospective, randomised studies in order to further evaluate the remaining role of primary surgery in the modern management of locally advanced laryngeal lesions is emphasized.

Treatment Selection for T3/T4a Laryngeal Cancer

“…11 Other reports have also found significant survival improvement in T4a tumors when treating with surgery over radiation or chemoradiation. 12,13 It is unclear why the results of these studies differ from our own experience, particularly for patients with T4a disease. In the reports, it is not stated whether each patient treated had received the benefit of multidisciplinary prospective treatment planning.…”

Evidence and evidence gaps of laryngeal cancer surgery

“…This aspect was meanwhile confirmed by numerous retrospective studies. Karatzanis et al [139] analyzed 384 patients who were treated between 1980 and 2007 for T4a laryngeal cancer. In the group of primarily surgically treated patients a disease-specific 5-year survival of 62.2% was found while in the group that was treated with primary radio(chemo)therapy the disease-specific survival amounted to 24.5% and the overall survival after 5 years was 16.7%.…”

“…In the group of primarily surgically treated patients a disease-specific 5-year survival of 62.2% was found while in the group that was treated with primary radio(chemo)therapy the disease-specific survival amounted to 24.5% and the overall survival after 5 years was 16.7%. Those differences were statistically significant [139]. In a study of Gourin et al [140] of 451 patients with laryngeal carcinomas who were treated between 1985 and 2002, patients with T4 carcinomas had a significantly better survival after surgery (55%) in comparison to radiochemotherapy (25%) or radiotherapy alone (0%).…”

Expression of Th1- Th2- and Th17-associated cytokines in laryngeal carcinoma

“…The vast majority of tumors are squamous cell carcinomas (19 the important physiological functions of the larynx, advanced laryngeal lesions are associated with significant morbidity and mortality for the patient and increased financial costs for society (20,21). When patients experience postoperative recurrence and/or distant metastasis, it is not sensitive to radiation and chemotherapy.…”