Open partial horizontal laryngectomy and adjuvant (chemo)radiotherapy for laryngeal squamous cell carcinoma: results from a multicenter Italian experience

Abstract

Purpose To evaluate the functional and oncologic outcomes of adjuvant (chemo)radiation [(C)RT] after open partial horizontal laryngectomies (OPHLs). Methods Multicenter retrospective evaluation of 130 patients (116 males, 14 females) submitted between 1995 and 2017 to OPHL Types II and III for laryngeal cancer and receiving adjuvant (C)RT for one or more of the following risk factors at histopathologic examination of the surgical specimen: pT4a and/or > pN2a categories, close/positive resection margins, or presence of both perineural (PNI) and lympho-vascular invasion (LVI). The primary study endpoints were evaluation of the presence of tracheostomy and/or gastrostomy at last follow-up, and calculation of laryngo-esophageal dysfunction-free survival (LEDFS). Results Mean age of the study cohort was 60.8 ± 8.9 years (median, 62; interquartile range [IQR], 13). Mean follow-up was 50.7 ± 39.4 months (range 24-188; median, 38; IQR, 51). Adjuvant therapy consisted of CRT in 53 (41%) patients, and RT alone in 77 (59%). Five-year LEDFS was 85%. Overall survival was 71.5%, while 13% of patients remained tracheostomy-and 3% gastrostomy-dependent at the last follow-up. The only significant variable in predicting survival (p = 0.020) was tracheostomy dependence: it was maintained in 7.5% of subjects after OPHL Type II and in 34% of those submitted to OHPL Type III (p < 0.001). Conclusions In selected patients affected by advanced laryngeal cancer, OPHLs Type II and III have a relatively good laryngeal safety profile and provide favorable oncologic outcomes even in case of need for adjuvant (C)RT.

Current Status of Partial Laryngeal Surgery for Advanced Laryngeal Cancer: When and Why?

“…The controversies surrounding adjuvant therapies for advanced pT-stage tumors, with post-operative radiotherapy potentially negatively impacting functional results and without a clear oncological benefit in cases with positive margins, are significant [ 76 ]•.…”

“…Functional results show that most patients achieve efficient swallowing, though some may need gastrostomy. Phonatory outcomes vary, with some patients experiencing significantly altered voice quality [ 76 •].…”

Twenty questions from the surgeon to the radiologist to better plan an open partial horizontal laryngectomy

“…an increased N category is associated with a higher rate of regional failure and the need for postoperative (C)RT, which, in the case of central compartment metastases, must also include the neolarynx within the irradiation field. This often results in chronic edema of the neoglottis with an inability to decannulate the patient ( 47 ). ENE itself is a negative prognostic factor that requires postoperative CRT.…”

Machine learning in laryngeal cancer: A pilot study to predict oncological outcomes and the role of adverse features

“…4 Due to this discrepancy, many efforts have been made to stratify patients into high-or low-risk groups and to plan patient-specific optimal treatments. [5][6][7][8] The collaboration between biomedicals and bioinformatics has led to develop the Artificial Intelligence (AI) algorithms, which have consistently improved the cancer's analysis compared with conventional statistical tools. [9][10][11] Machine learning (ML) is a branch of AI that deals with predictions in unknown situations from previous observations that have been "learnt."…”

“…Tumor stage at diagnosis impacts on OS and it largely varies from 85% at early‐stage to 40% in stage IV disease 4 . Due to this discrepancy, many efforts have been made to stratify patients into high‐ or low‐risk groups and to plan patient‐specific optimal treatments 5–8 …”