Neck Management with Total Laryngectomy and Adjuvant Radiotherapy in Locally Advanced Larynx Cancer

Abstract

Background: The aim of this study was to determine whether patients with clinically node-negative (cN0) locally advanced squamous cell carcinoma (SCC) of the larynx who receive total laryngectomy (TL) benefit from elective neck dissection (END) before adjuvant postoperative radiotherapy (RT). Methods: A retrospective review of 36 patients who received TL and adjuvant postoperative RT for laryngeal SCC between 1988 and 2013 was carried out. Patients had either T3 (n = 7; 19%) or T4a (n = 29; 81%) primaries, and all had clinically node-negative disease. All patients underwent TL and adjuvant RT. Patients underwent either a planned unilateral END, a bilateral END, or no END. Results: Median follow-up was 3.3 years (range, 0.3-18.4 years). Occult nodal metastases were found in 9 (32%) of 28 patients receiving END. 5-year control and survival rates for all patients were: local-regional control, 92% (END 91% vs. no END 100%; p = 0.4922); cause-specific survival, 80%; distant metastasis-free survival, 88%; and overall survival, 52%. Local-regional control and survival were not influenced by END. 5 (14%) patients experienced grade 3 or 4 toxicities. Conclusion: In this patient population, those not receiving END at the time of TL had equivalent rates of local-regional control and survival as those receiving END, although our sample size not receiving END was relatively small.

Detection of hypopharyngeal cancer (Tis, T1 and T2) by ENT physicians vs gastrointestinal endoscopists

“…In ENT departments, pharyngeal cancer is typically detected by ENT physicians at an advanced stage, when the patient is suffering hoarseness, swallowing pain, swallowing dysfunction, swollen neck lymph nodes, and/or dyspnea [13]. Because pharyngeal cancer can invade surrounding structures, such as the larynx, esophagus, or muscle, advanced disease requires invasive treatment; i.e., resection of the entire larynx, leading to loss of phonatory function [14].…”

Rational surgical neck management in total laryngectomy for advanced stage laryngeal squamous cell carcinomas

“…This fact should not be underestimated and survival outcome should not be jeopardized when considering surgical refinement in terms of reducing the extent of dissection. In contrast, several previous retrospective studies showed no significant influence of elective neck dissection (END) on survival in advanced laryngeal cancers (Ketterer et al 2020;Shi et al 2019;Kennedy et al 2017;Djordjevic et al 2016;Canis et al 2012). For salvage TL cases, END is not generally recommended, because, although it reduces the rate of regional recurrence, it does not provide a survival benefit as stated in a recent meta-analysis (Davies-Husband et al 2020).…”

Neck metastasis in transglottic laryngeal carcinomas

“…Skora et al reported that adjuvant radiotherapy was given to 138 patients in the T3-4N0M0 stage, who underwent total laryngectomy and neck dissection; 34 patients experienced recurrence, and the five-year survival rate was 76% (22). Kennedy et al found a five-year local and regional control rate of 92% after adjuvant radiotherapy in their study consisting of 36 patients in the T3-T4aN0 stage (23). In the present research, adjuvant radiotherapy was applied to 20 patients with postoperative thyroid cartilage invasion, subglottic extension, and multiple or ECE metastatic lymphadenopathy.…”