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 Role of Organ Preservation in Locally Advanced Hypopharyngeal Carcinoma

2021 ◽  
Author(s):  
Farida Nazeer ◽  
Rejnish Ravi Kumar ◽  
Malu Rafi ◽  
Lekha M. Nair ◽  
Kainickal Cessal Thommachan ◽  
...  
Keyword(s):  
Organ Preservation ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Response Assessment ◽  
Hypopharyngeal Carcinoma ◽  
Radical Radiotherapy ◽  
Postoperative Radiation ◽  
Larynx Preservation ◽  
Poor Treatment

Hypopharyngeal carcinoma is relatively rare and has the worst prognosis of all head and neck cancers. Initially, surgery followed by postoperative radiation was the standard of care for locally advanced disease. In the recent years, various organ sparing approaches have evolved. There are mainly two schools of thought regarding larynx preservation in hypopharyngeal cancers which include either induction chemotherapy followed by response assessment for radical radiotherapy or concurrent chemoradiation. An ongoing trial is comparing the effectiveness between these two established approaches. The role of anti-EGFR therapy and immunotherapy is still being evaluated. Despite all the advancements in treatment, hypopharyngeal cancers are still associated with poor treatment outcomes.

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 .

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.  

scholarly journals Organ preservation surgery in patients with locally advanced laryngeal cancer

2019 ◽  
Vol 100 (3) ◽  
pp. 511-515
Author(s):  
P V Svetitskiy ◽  
V L Volkova ◽  
I V Aedinova
Keyword(s):  
Laryngeal Cancer ◽  
Organ Preservation ◽  
Radiation Treatment ◽  
Skin Flap ◽  
Thyroid Cartilage ◽  
Locally Advanced ◽  
Cancer Stage ◽  
Antiseptic Solution ◽  
Results Of Treatment ◽  
Healthy Mucosa

Aim. To improve the results of treatment of patients with locally advanced laryngeal cancer by developing organ preservation surgery combined with radiation therapy. Methods. 20 patients with locally advanced laryngeal cancer stage III (T3N0-1M0) were examined. A surgery was developed that involves lateral resection of the larynx in conjunction with the underlying thyroid cartilage, preserving its upper 1/3-1/4 portion as a horizontal plate not affected by a tumor. On the affected side of the neck, a skin flap is preliminarily harvested, by 1.5-1.0 cm longer and wider than the resulting laryngeal defect. It is put over the fragment of thyroid cartilage left after resection and sutured to the healthy mucosa of the preserved part of the larynx. Laryngostomy and tracheostomy are formed. Tracheostomy tube is inserted. Formed laryngostomy is freely tamponed with two to three tampons with an antiseptic solution for up to 7 days. Naso-esophageal probe is inserted. Patients who did not receive radiation treatment before surgery, receive postoperative gamma-therapy after 14-20 days with cumulative dose up to 40 Gy. Plastic surgery of laryngostomy and tracheostomy is performed after 4-5 months after the intervention. Results. The developed method of surgery for patients with stage 3 of one half of the larynx allowed a radical removal of the tumor with the restoration of breathing, swallowing and speech. The event-free 5-year survival rate was 80±4.5%, and the total 3-year survival was 100%. Сonclusion. The developed technique of organ-preserving surgery in patients with locally advanced laryngeal cancer stage 3 involving its one half can provide oncological radical technique with the rehabilitation of the functions of the larynx.

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