Organ Preservation for Adenoid Cystic Carcinoma of the Larynx

Abstract

Objectives. Two cases of adenoid cystic carcinoma (ACC) of the larynx were treated with chemoradiotherapy (CRT) for organ preservation. We reviewed case series and current literature to contrast the potential role of primary CRT as an organsparing modality with standard laryngectomy and radiotherapy in patients with laryngeal ACC. Methods. Two treatment-naïve patients with laryngeal ACC treated at Dana-Farber Cancer Institute between 2002 and 2007 were identified. Both patients were offered standard laryngectomy followed by adjuvant radiotherapy or organsparing treatment modality. Results. Both patients were males, aged 57 and 73. The patients completed a course of combined chemoradiotherapy with weekly carboplatin and paclitaxel and 7-8 weeks of radiotherapy to a total dose of 6,600 and 7,000 cGy over 50 and 57 days, respectively. There were no treatment breaks or delays because of toxicity. The major toxicities reported by both patients, as anticipated, were Grade 3 mucositis, desquamative dermatitis, and severe dysphagia, all of which resolved. Both patients are alive with local regional control and functional larynx; one at 112ϩ months with pulmonary metastases at 54 months, and the other disease free at 60ϩ months. Conclusions. Definitive chemoradiation with weekly carboplatin and paclitaxel may be a potential alternative to the current standard of surgery and radiation for patients with locally advanced laryngeal ACC who request an organ-sparing approach. In this group of patients, salvage laryngectomy may be reserved for those who are locally recurrent or chemoradiotherapy resistant. Although CRT provided long-term local regional control in our two patients, there are evident limitations in obtaining evidence for a determination of treatment of rare diseases. This report provides support for following an organ preservation plan in selected patients. The Oncologist 2013;18:579 -583 Implications for Practice: Concurrent chemoradiotherapy may be used for larynx preservation for selected patients with adenoid cystic carcinoma of the larynx when the functional outcome after surgery is expected to be unsatisfactory or when surgical expertise in such procedures is not available. Laryngeal preservation with concurrent chemoradiotherapy with surgery reserved for recurrent disease seems to offer potential for laryngeal preservation without compromising overall survival. Selection of a treatment option: surgery versus organ-sparing chemoradiotherapy will depend on patient choice of treatment, local expertise, and the availability of appropriate support and rehabilitation services.

Malignant Minor Salivary Gland Carcinomas of the Larynx

“…In our series, 5 patients (33%) had T3 and 7 patients (47%) had T4 disease, which are higher rates than those reported elsewhere [1,8]. Currently, surgery followed by adjuvant radiotherapy is the mainstay of treatment for malignant minor salivary gland tumours of the larynx; however, several case reports described the successful utilisation of chemoradiotherapy for ACC and radiotherapy for MEC [9,10,11]. In this study, 13 patients underwent various operations (9 TL, 2 VPL and 2 SCPL-CHEP) with curative intent, and 6 received adjuvant postoperative radiotherapy.…”

Laryngeal Adenoid Cystic Carcinoma

“…5 ACC is characterized by slow growth, multiple recurrences, and late distant metastasis, commonly to the lungs. 5-8 It is a rare entity in the larynx, representing <1% of all tumors occurring at this site. 2,4 It is thought to arise from submucosal glands present in a distinct anatomic distribution within the larynx.…”

Laryngeal Preservation in Managing Advanced Tracheal Adenoid Cystic Carcinoma

“…While negative margins were found to be associated with a trend towards longer survival (but no significant difference), resection and reconstruction with tumor positive margins provide a survival advantage compared to clinically defined unresectable tumors [ 20 ]. Both Haddad et al [ 21 ] and Misiukiewicz et al [ 22 ] report a case series highlighting the use of concurrent chemoradiation with no surgical intervention. This enabled the authors to achieve organ preservation with excellent long-term outcomes.…”