Management of Stage IV Glottic Carcinoma: Therapeutic Outcomes

Abstract

The five treatment modalities had statistically similar survival, recurrence, and complication rates. The overall 5-year DSS for patients with stage IV glottic carcinoma was 45%, and the OS was 39%. The cumulative disease-specific survival (CDSS) was 0.4770 with a mean survival of 10.1 years and a median survival of 3.9 years. Patients younger than age 55 years had better survival (DSS) than patients 56 years of age or older (P =.0002). Patients with early T stage had better survival than patients with more advanced T stage (P =.04). Tumor recurrence at the primary site (P =.0001) and in the neck (P =.014) and distant metastasis (P =.0001) had a deleterious effect on survival. Tumor recurrence was not related to treatment modality. Patients with clear margins of resection had a statistically significant improved survival (DSS and CDSS) compared with patients with close or involved margins (P =.0001). Post-treatment quality of life was not significantly related to treatment modality. Patients whose N0 neck was treated with observation and appropriate treatment for subsequent neck disease had statistically similar survival compared with patients whose N0 neck was treated prophylactically at the time of treatment of the primary. A minimum of 7 years of follow-up is recommended for early identification of recurrent disease, second primary tumors, and distant metastasis. None of the standard treatment modalities currently employed has a statistical advantage regarding survival, recurrence, complications, or quality of life.

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

“…Radical treatment, associated or not to radiation therapy for advanced tumors has brought similar results in regards to survival in the literature. 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.…”

“…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.…”

The frequency and characteristics of regional metastases and their impact on the survival of patients with T1 and T2 laryngeal cancer

“…Spector nalazi u studiji od 2550 ispitanika prose nu starost 59.8 godina gde je najmla i imao 21 a najstariji 94 godina. [12] Laringealni karcinom je bolest 6. i 7. decenije života (citat Jovi ). [10] Lokalna uzapredovalost tumorskog procesa ali i njegova regionalna uznapredovalost i prisustvo udaljenih metastaza uti u na pristup le enju i kona ni ishod.…”

“…Spector navodi 67% glotisnih, 31% su-praglotisnih i 1.7% subglotisnih karcinoma. [12] Razlika u rezultatima je posledica analize samo ranih laringealnih karcinoma. Kako je prvi znak bolesti glotisnih karcinoma promuklost, isti se dijagnostikuju u ranoj fazi i esto u kategoriji T1 ili T2.…”

Laringectomía total ampliada en carcinoma laríngeo avanzado T4a

“…En casos con extensión importante a hipofaringe o a esófago cervical puede realizarse una laringofaringectomía. La radioterapia postoperatoria es parte del tratamiento en pacientes con cáncer laríngeo avanzado, es decir, pacientes con extensión supra o subglótica o en aquellos pacientes que presentan compromiso extralaríngeo; también está indicada resecciones con márgenes positivos, linfonodos positivos múltiples y pacientes que requirieron traqueostomía prelaringectomía por el mayor riesgo de recurrencia en el estoma 10,11 .…”