Comparison of the therapeutic effects of total laryngectomy and a larynx-preservation approach in patients with T4a laryngeal cancer and thyroid cartilage invasion: A multicenter retrospective review

Head & Neck ◽  
2016 ◽  
Vol 38 (8) ◽  
pp. 1271-1277 ◽  
Author(s):  
Yoon Seok Choi ◽  
Sang Gon Park ◽  
Eun-Kee Song ◽  
Sang-Hee Cho ◽  
Moo-Rim Park ◽  
...  
Keyword(s):  
Laryngeal Cancer ◽  
Retrospective Review ◽  
Total Laryngectomy ◽  
Thyroid Cartilage ◽  
Therapeutic Effects ◽  
Larynx Preservation ◽  
Cartilage Invasion ◽  
Multicenter Retrospective Review

Thyroid cartilage invasion in laryngeal and hypopharyngeal squamous cell carcinoma treated with total laryngectomy

2016 ◽  
Vol 273 (11) ◽  
pp. 3789-3794 ◽  
Author(s):  
Mario Koopmann ◽  
Daniel Weiss ◽  
Matthias Steiger ◽  
Sandra Elges ◽  
Claudia Rudack ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Total Laryngectomy ◽  
Thyroid Cartilage ◽  
Hypopharyngeal Squamous Cell Carcinoma ◽  
Cartilage Invasion

Outcomes Following Transoral Laser Microsurgery With Resection of Cartilage for Laryngeal Cancer

2019 ◽  
Vol 128 (10) ◽  
pp. 978-982 ◽  
Author(s):  
Brent A. Chang ◽  
David G. Lott ◽  
Thomas H. Nagel ◽  
Brittany E. Howard ◽  
Richard E. Hayden ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Laryngeal Cancer ◽  
Total Laryngectomy ◽  
Thyroid Cartilage ◽  
Preoperative Staging ◽  
Disease Free Survival ◽  
Transoral Laser Microsurgery ◽  
Laser Microsurgery ◽  
Select Group ◽  
Close Proximity

Introduction:The ability to treat more advanced laryngeal cancers by transoral approaches has expanded significantly in the past several decades. Transoral management of laryngeal cancers that require removal of the laryngeal framework is controversial. Resecting cartilage through endoscopic means carries inherent technical challenges and the question of oncologic safety.Methods:We describe a retrospective review of patients undergoing resection of the thyroid cartilage during transoral laser microsurgery (TLM) for laryngeal cancer over a 10-year period. Only patients with 5-year follow-up were included.Results:Fourteen patients were identified that underwent attempted endoscopic resection of the thyroid cartilage. Preoperative staging ranged from T1 to T4 laryngeal cancers. Most patients underwent resection of the thyroid cartilage either for close proximity of the tumor to cartilage or microscopic involvement of the inner perichondrium, although 6 patients had gross invasion of the cartilage. Twelve patients underwent successful endoscopic clearance. Two patients were converted to total laryngectomy either at the time of surgery or shortly after due to extent of disease that was deemed not amenable to endoscopic resection. Overall 5-year survival was 71%. Disease-free survival was 62% at 5 years. The majority of patients avoided gastrostomy and tracheostomy tube dependence. One patient underwent total laryngectomy following initial TLM for chronic aspiration.Conclusion:We conclude that TLM for laryngeal cancer performed with removal of thyroid cartilage is feasible. Both oncologic and functional outcomes are reasonable in a select group of patients. This paper describes that cartilage can be resected endoscopically in the appropriate setting and not necessarily that cartilage invasion should routinely be treated with TLM.

scholarly journals Pretherapeutic assessment by multidetector computed tomography for thyroid cartilage invasion in laryngeal cancer: A double-edged sword

2018 ◽  
Vol 39 (2) ◽  
pp. 196 ◽  
Author(s):  
VishalD Thakker ◽  
Manali Arora ◽  
Geetika Sindhwani ◽  
Jayesh Bhatt ◽  
Monica Gupta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multidetector Computed Tomography ◽  
Laryngeal Cancer ◽  
Thyroid Cartilage ◽  
Cartilage Invasion

ULTRASONOGRAPHY AND COMPUTED TOMOGRAPHY COMPARISON IN ASSESSING THYROID CARTILAGE INVASION IN LARYNGEAL CANCER IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 56-58
Author(s):  
Shankhashubhra Ghosh ◽  
Swadhapriya Basu ◽  
Raj Saha ◽  
Uddalok Mondal ◽  
Debarshi Jana
Keyword(s):  
Computed Tomography ◽  
Laryngeal Cancer ◽  
Management Strategy ◽  
Tertiary Care Hospital ◽  
Thyroid Cartilage ◽  
Tertiary Care ◽  
Care Hospital ◽  
Cartilage Invasion ◽  
Ct Finding

Objective:To study the efcacy of ultrasonography (US) in the assessment of Laryngeal Cancers along with computed tomography (CT). Materials and methods: 30 consecutive patients were undergoing US and CT to stage laryngeal cancer in this study. Two radiologists, who were blinded to the patients' clinical histories and histopathology, evaluated thyroid cartilage invasion on US and CT separately and independently. Result:CT achieved a sensitivity of 86.2% anda specicity of 100%, while USG attained a sensitivity of 62.1%and a specicity of 100%.Association of US ndings vs. HPE was not statistically signicant (p=0.2128).Association of CT Finding vs. HPE was not statistically signicant (p=0.0229). USG and CT compare pretherapeutic stagingaccuracy of laryngeal ca Conclusion: ncers and thereby impacting the management strategy.

Therapeutic strategies for locally advanced laryngeal cancer. Part 1: Radical treatment

ORL ro ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 32-38
Author(s):  
Corina Pitiu ◽  
Ciprian Enăchescu ◽  
Sena Yossi ◽  
Gianina Elena Crismariu
Keyword(s):  
Laryngeal Cancer ◽  
Total Laryngectomy ◽  
Locally Advanced ◽  
Therapeutic Strategies ◽  
Stage Iii ◽  
Tumor Board ◽  
Patient Specific ◽  
Cervical Lymph Nodes ◽  
Airway Patency ◽  
Larynx Preservation

According to the Union for International Cancer Control (UICC)/ American Joint Committee on Cancer (AJCC), staging system for the locally advanced laryngeal cancer generally denotes stage III or IV, stage III being represented by T3 or N1 tumors and the non-metastatic stage IV including N2-N3 or T4 tumors. The main therapeutic goals are local control and survival, but also the functional organ preservation (speech, swallowing and airway patency), if possible. To achieve these objectives, the management should be established by a multidisciplinary tumor board, based on the analysis of patient-specific factors (age, performance status, comorbidities, and psychosocial support), cancer topography and staging, but also the physician expertise and the availability of rehabilitation services. Regarding the larynx preservation, there are two major therapeutic strategies: total laryngectomy (associated with adjuvant radio- and chemotherapy) and larynx preservation strategy, which includes neoadjuvant chemotherapy followed by exclusive radiotherapy or concurrent radio-chemotherapy or radio-biotherapy. Total laryngectomy can be performed by open surgery or, in order to avoid a wide surgical field and reduce the local morbidity, by transoral techniques. After laryngectomy, the recurrence can be local, at the resection site, nodal, at cervical lymph nodes, or distal, the lung being the most common site of recurrence as a distant metastasis. To improve locoregional control and survival, adjuvant treatments are proposed, including radiotherapy, chemo- and biotherapy.  

The incidence of thyroid cartilage invasion through the anterior commissure in clinically early-staged laryngeal cancer

2015 ◽  
Vol 273 (2) ◽  
pp. 447-453 ◽  
Author(s):  
Murat Ulusan ◽  
Selin Unsaler ◽  
Bora Basaran ◽  
Dilek Yılmazbayhan ◽  
Ismet Aslan
Keyword(s):  
Laryngeal Cancer ◽  
Anterior Commissure ◽  
Thyroid Cartilage ◽  
Cartilage Invasion

scholarly journals Current Role of Total Laryngectomy in the Era of Organ Preservation

Cancers ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 584 ◽  
Author(s):  
Alexandre Bozec ◽  
Dorian Culié ◽  
Gilles Poissonnet ◽  
Olivier Dassonville
Keyword(s):  
Total Laryngectomy ◽  
Organ Preservation ◽  
Therapeutic Option ◽  
Thyroid Cartilage ◽  
Locally Advanced ◽  
Concurrent Chemotherapy ◽  
Tumor Extension ◽  
Laryngeal Function ◽  
Larynx Preservation

In this article, we aimed to discuss the role of total laryngectomy (TL) in the management of patients with larynx cancer (LC) in the era of organ preservation. Before the 1990s, TL followed by radiotherapy (RT) was the standard treatment for patients with locally advanced LC. Over the last 30 years, various types of larynx preservation (LP) programs associating induction or concurrent chemotherapy (CT) with RT have been developed, with the aim of treating locally advanced LC patients while preserving the larynx and its functions. Overall, more than two-thirds of patients included in a LP program will not require total laryngectomy (TL) and will preserve a functional larynx. However, despite these advances, the larynx is the only tumor site in the upper aero-digestive tract for which prognosis has not improved during recent decades. Indeed, none of these LP protocols have shown any survival advantage compared to primary radical surgery, and it appears that certain LC patients do not benefit from an LP program. This is the case for patients with T4a LC (extra-laryngeal tumor extension through the thyroid cartilage) or with poor pretreatment laryngeal function and for whom primary TL is still the preferred therapeutic option. Moreover, TL is the standard salvage therapy for patients with recurrent tumor after an LP protocol.

scholarly journals American Society of Clinical Oncology Clinical Practice Guideline for the Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer

2006 ◽  
Vol 24 (22) ◽  
pp. 3693-3704 ◽  
Author(s):  
David G. Pfister ◽  
Scott A. Laurie ◽  
Gregory S. Weinstein ◽  
William M. Mendenhall ◽  
David J. Adelstein ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Oncology ◽  
Laryngeal Cancer ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Total Laryngectomy ◽  
Soft Tissues ◽  
Larynx Preservation ◽  
Advantages And Disadvantages ◽  
American Society

Purpose To develop a clinical practice guideline for treatment of laryngeal cancer with the intent of preserving the larynx (either the organ itself or its function). This guideline is intended for use by oncologists in the care of patients outside of clinical trials. Methods A multidisciplinary Expert Panel determined the clinical management questions to be addressed and reviewed the literature available through November 2005, with emphasis given to randomized controlled trials of site-specific disease. Survival, rate of larynx preservation, and toxicities were the principal outcomes assessed. The guideline underwent internal review and approval by the Panel, as well as external review by additional experts, members of the American Society of Clinical Oncology (ASCO) Health Services Committee, and the ASCO Board of Directors. Results Evidence supports the use of larynx-preservation approaches for appropriately selected patients without a compromise in survival; however, no larynx-preservation approach offers a survival advantage compared with total laryngectomy and adjuvant therapy with rehabilitation as indicated. Recommendations All patients with T1 or T2 laryngeal cancer, with rare exception, should be treated initially with intent to preserve the larynx. For most patients with T3 or T4 disease without tumor invasion through cartilage into soft tissues, a larynx-preservation approach is an appropriate, standard treatment option, and concurrent chemoradiotherapy therapy is the most widely applicable approach. To ensure an optimum outcome, special expertise and a multidisciplinary team are necessary, and the team should fully discuss with the patient the advantages and disadvantages of larynx-preservation options compared with treatments that include total laryngectomy.

Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

2018 ◽  
Vol 36 (11) ◽  
pp. 1143-1169 ◽  
Author(s):  
Arlene A. Forastiere ◽  
Nofisat Ismaila ◽  
Jan S. Lewin ◽  
Cherie Ann Nathan ◽  
David J. Adelstein ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Laryngeal Cancer ◽  
Total Laryngectomy ◽  
Locally Advanced ◽  
Elective Neck Dissection ◽  
Head Neck Cancer ◽  
Swallowing Function ◽  
Laryngeal Function ◽  
Larynx Preservation

Purpose To update the guideline recommendations on the use of larynx-preservation strategies in the treatment of laryngeal cancer. Methods An Expert Panel updated the systematic review of the literature for the period from January 2005 to May 2017. Results The panel confirmed that the use of a larynx-preservation approach for appropriately selected patients does not compromise survival. No larynx-preservation approach offered a survival advantage compared with total laryngectomy and adjuvant therapy as indicated. Changes were supported for the use of endoscopic surgical resection in patients with limited disease (T1, T2) and for initial total laryngectomy in patients with T4a disease or with severe pretreatment laryngeal dysfunction. New recommendations for positron emission tomography imaging for the evaluation of regional nodes after treatment and best measures for evaluating voice and swallowing function were added. Recommendations Patients with T1, T2 laryngeal cancer should be treated initially with intent to preserve the larynx by using endoscopic resection or radiation therapy, with either leading to similar outcomes. For patients with locally advanced (T3, T4) disease, organ-preservation surgery, combined chemotherapy and radiation, or radiation alone offer the potential for larynx preservation without compromising overall survival. For selected patients with extensive T3 or large T4a lesions and/or poor pretreatment laryngeal function, better survival rates and quality of life may be achieved with total laryngectomy. Patients with clinically involved regional cervical nodes (N+) who have a complete clinical and radiologic imaging response after chemoradiation do not require elective neck dissection. All patients should undergo a pretreatment baseline assessment of voice and swallowing function and receive counseling with regard to the potential impact of treatment options on voice, swallowing, and quality of life. Additional information is available at www.asco.org/head-neck-cancer-guidelines and www.asco.org/guidelineswiki .

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