scholarly journals Locally advanced laryngeal cancer: Total laryngectomy or primary non-surgical treatment?

2018 ◽  
Author(s):  
Aleš Čoček ◽  
Miloslav Ambruš ◽  
Alena Dohnalov� ◽  
Martin Chovanec ◽  
Martina Kubecov� ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Laryngeal Cancer ◽  
Total Laryngectomy ◽  
Locally Advanced ◽  
Non Surgical Treatment

Supracricoid partial laryngectomy: an alternative to total laryngectomy for locally advanced laryngeal cancers

2008 ◽  
Vol 122 (11) ◽  
pp. 1219-1223 ◽  
Author(s):  
E Soudry ◽  
Y Marmor ◽  
A Hazan ◽  
S Marx ◽  
R Sadov ◽  
...  
Keyword(s):  
Laryngeal Cancer ◽  
Medical Records ◽  
Total Laryngectomy ◽  
Locally Advanced ◽  
Partial Laryngectomy ◽  
Oncological Safety ◽  
Supracricoid Partial Laryngectomy ◽  
Laryngeal Tumours ◽  
Feasible Option

AbstractObjectives:The management of advanced laryngeal cancer has evolved in the last century, from total laryngectomy to chemoradiation. The aim of this study was to examine our experience with supracricoid partial laryngectomy as a possible solution for patients with advanced laryngeal tumours, with a focus on the oncological safety of the procedure and the functionality of the preserved larynges.Study design:We reviewed the medical records of patients with laryngeal cancer who had undergone primary or salvage supracricoid partial laryngectomy at our department between 1998 and 2004.Results:Twenty-three patients treated with supracricoid partial laryngectomy for endolaryngeal squamous cell carcinoma were identified. Median follow-up time was 35 months. Twelve patients had advanced laryngeal tumours. Eight patients were radiation failures. These factors were not associated with increased local recurrence or with decreased survival.Conclusion:Supracricoid partial laryngectomy appears to be a feasible option for the treatment of laryngeal tumours, even in the advanced stage or after failure of radiation therapy.

scholarly journals Comparison of Current Surgical and Non-Surgical Treatment Strategies for Early and Locally Advanced Stage Glottic Laryngeal Cancer and Their Outcome

Cancers ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 732 ◽  
Author(s):  
Olgun Elicin ◽  
Roland Giger
Keyword(s):  
Decision Making ◽  
Functional Outcome ◽  
Shared Decision Making ◽  
Laryngeal Cancer ◽  
Total Laryngectomy ◽  
Locally Advanced ◽  
Treatment Strategies ◽  
Current Evidence ◽  
Shared Decision ◽  
Cancer Multiple

For the treatment of early and locally advanced glottic laryngeal cancer, multiple strategies are available. These are pursued and supported by different levels of evidence, but also by national and institutional traditions. The purpose of this review article is to compare and discuss the current evidence supporting different loco-regional treatment approaches in early and locally advanced glottic laryngeal cancer. The focus is kept on randomized controlled trials, meta-analyses, and comparative retrospective studies including the treatment period within the last twenty years (≥ 1999) with at least one reported five-year oncologic and/or functional outcome measure. Based on the equipoise in oncologic and functional outcome after transoral laser surgery and radiotherapy, informed and shared decision-making with and not just about the patient poses a paramount importance for T1-2N0M0 glottic laryngeal cancer. For T3-4aN0-3M0 glottic laryngeal cancer, there is an equipoise regarding the partial/total laryngectomy and non-surgical modalities for T3 glottic laryngeal cancer. Patients with extensive and/or poorly functioning T4a laryngeal cancer should not be offered organ-preserving chemoradiotherapy with salvage surgery as a back-up plan, but total laryngectomy and adjuvant (chemo) radiation. The lack of high-level evidence comparing contemporary open or transoral robotic organ-preserving surgical and non-surgical modalities does not allow any concrete conclusions in terms of oncological and functional outcome. Unnecessary tri-modality treatments should be avoided. Instead of offering one-size-fits-all approaches and over-standardized rigid institutional strategies, patient-centered informed and shared decision-making should be favored.

A retrospective review of treatment outcomes following definitive chemoradiotherapy or single modality radical radiotherapy among patients with locally advanced esophageal cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 196-196
Author(s):  
Ben A Fulton ◽  
Joanna Gray ◽  
Vivienne MacLaren ◽  
David McIntosh ◽  
Alexander McDonald ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Retrospective Analysis ◽  
Oesophageal Cancer ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Radical Radiotherapy ◽  
Tumour Staging ◽  
Definitive Chemoradiotherapy ◽  
Non Surgical Treatment ◽  
Single Modality

196 Background: Definitive chemoradiotherapy (CRT) has been advocated as an alternative to surgical resection for the treatment of locally advanced oesophageal cancer (OC). We have retrospectively reviewed 4 years experience of patients (pts) who underwent contemporary staging and were treated with concurrent chemoradiotherapy (CRT) or single modality radical radiotherapy (RT) with curative intent. Methods: Retrospective analysis permitted identification of consecutive pts who underwent contemporary staging prior to non-surgical treatment for oesophageal carcinoma. The primary outcomes were overall (OS) and disease-free survival (DFS), adjusted for baseline differences in age, tumour staging and histological cell type. All patients were treated with either definitive CRT or single modality RT within a single centre treated between 2009 and 2012. Results: We identified 135 pts in total (median age 69.8 yrs, male=130pts, female=105pts, Adenocarcinoma=85pts, Squamous=150pts). 190 pts received CRT and 45pts were treated with RT. All pts were staged with CT of chest, abdomen and pelvis, 226 pts underwent Endoscopic ultrasound (EUS) and 183 pts had PET-CT. Patients treated with CRT demonstrated longer OS (37 versus 25 months, p=0.02) and DFS (31 versus 16 months, p=0.01) compared to those treated with RT. More advanced tumour stage (stage 3 v stage 1-2) at presentation conferred poorer OS (32 versus 38.2 months) and DFS (11 versus 28 months, p=0.013). We demonstrated an acceptable toxicity profile with only 77 pts (32.8%) and 9 pts (4.2%) experiencing grade III or IV CTC toxicities respectively. Conclusions: This retrospective analysis is in keeping with current treatment paradigms emphasising the importance and safety of concurrent CRT in maximising curative potential for pts undergoing non-surgical treatment of oesophageal cancer. Although retrospective, in comparison to similar retrospective series from our centre, our data suggest improvements in OS and DFS, possibly due to improved patient selection through the use of more effective tumour staging.

scholarly journals Comparing surgical and nonsurgical larynx‐preserving treatments with total laryngectomy for locally advanced laryngeal cancer

Cancer ◽  
2019 ◽  
Vol 125 (19) ◽  
pp. 3367-3377 ◽  
Author(s):  
Sagar A. Patel ◽  
Muhammad M. Qureshi ◽  
Michael A. Dyer ◽  
Scharukh Jalisi ◽  
Gregory Grillone ◽  
...  
Keyword(s):  
Laryngeal Cancer ◽  
Total Laryngectomy ◽  
Locally Advanced

scholarly journals Patterns of cervical lymph node metastasis in supraglottic laryngeal cancer and therapeutic implications of surgical staging of the neck

2021 ◽  
Author(s):  
Cornelius H. L. Kürten ◽  
Eleni Zioga ◽  
Thomas Gauler ◽  
Martin Stuschke ◽  
Maja Guberina ◽  
...  
Keyword(s):  
Lymph Node ◽  
Surgical Treatment ◽  
Laryngeal Cancer ◽  
Cervical Lymph Node ◽  
Early Stage ◽  
Surgical Staging ◽  
Clinical Staging ◽  
Tumor Board ◽  
Primary Surgery ◽  
Non Surgical Treatment

Abstract Purpose Accurate therapeutic management of the neck is a challenge in patients with supraglottic laryngeal cancer. Nodal metastasis is common at all disease stages, and treatment planning relies on clinical staging of the neck, for both surgical and non-surgical treatment. Here, we compared clinical and surgical staging results in supraglottic carcinoma patients treated with primary surgery to assess the accuracy of pre-therapeutic clinical staging and guide future treatment decisions. Methods Retrospective analysis of clinical, pathological, and oncologic outcome data of 70 patients treated with primary surgery and bilateral neck dissection for supraglottic laryngeal cancer. Patients where clinical and pathological neck staging results differed, were identified and analyzed in detail. Results On pathologic assessment, patients with early stage (pT1/2) primaries showed cervical lymph node metastases in 55% (n = 17/31) of cases, compared to 67% (n = 26/39) of patients with pT3/4 tumors. In 24% (n = 17/70) of all patients, cN status differed from pN status, resulting in an upstaging in 16% of cases (n = 11/70) and a downstaging in 9% (n = 6/70) of cases. 14% of patients with cN0 status had occult metastases (n = 5/30). As assessed by a retrospective tumor board, in case of a non-surgical treatment approach, the inaccurate clinical staging of the neck would have led to an over- or undertreatment of the neck in 20% (n = 14/70) of all patients. Conclusion Our data re-emphasize the high cervical metastasis rates of supraglottic laryngeal cancer across all stages. Inaccurate clinical staging of the neck is common and should be taken into consideration when planning treatment.

scholarly journals Non-Surgical Strategies for Assisting Closure of Pharyngocutaneous Fistula after Total Laryngectomy: A Systematic Review of the Literature

2021 ◽  
Vol 11 (1) ◽  
pp. 100
Author(s):  
Luca Giovanni Locatello ◽  
Giuseppe Licci ◽  
Giandomenico Maggiore ◽  
Oreste Gallo
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Total Laryngectomy ◽  
Case Series ◽  
Present Review ◽  
Standard Group ◽  
Pharyngocutaneous Fistula ◽  
Small Series ◽  
Botulinum Toxin Therapy ◽  
Non Surgical Treatment

Background: Pharyngocutaneous fistula (PCF) is a frequent complication after total laryngectomy, with an incidence of up to 65%. Many conservative or invasive approaches are available and the choice among them is usually made on a case-by-case basis. The aim of the present review is to critically summarize the available evidence of the effectiveness of the non-surgical management of PCF. Methods: A systematic review and a meta-analysis of the literature were conducted, according to the PRISMA guidelines. Studies investigating botulinum toxin therapy, scopolamine transdermal patch, hyperbaric oxygen therapy (HBOT), and negative pressure wound therapy (NPWT) were assessed. Complete fistula closure after the initiation of non-surgical treatment was the main outcome. Results: After the application of selection criteria, a total of seven articles and 27 patients were included in the present review. All the eligible studies were descriptive case series, while only one article used a standard group as a comparison. The mean age was 63.3 and 14 patients (51.9%) had previously received RT. The reported comorbidities were diabetes, ischemic heart disease, hypertension, dyslipidemia, COPD, and atrial fibrillation. With a mean healing time of 25.0 days, the overall success rate was 92.6%. Conclusions: Non-surgical treatment of PCF is only based on the experience of small series. Although success rates seem promising, the absence of properly designed comparative studies does not allow us, at present, to identify ideal candidates for these non-invasive management strategies for PCF.

scholarly journals Outcome comparison between radiochemotherapy and surgery in the management of locally advanced non-metastatic laryngeal cancer a single institution experience

2021 ◽  
Vol 13 (2) ◽  
pp. 34-41
Author(s):  
Nimubona Désiré ◽  
Benyouness Leilla ◽  
El Lanigri Merriam ◽  
Diouf Kady ◽  
Bounid Oumaima ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Laryngeal Cancer ◽  
Total Laryngectomy ◽  
Locally Advanced ◽  
Node Dissection ◽  
Free Survival ◽  
Surgery Group ◽  
Radio Chemotherapy

he treatment of locally advanced non-metastatic laryngeal squamous cell carcinoma is very controversial. Total laryngectomy associated with lymph node dissection and adjuvant radiotherapy with or without chemotherapy is considered the gold standard treatment. The functional impairment on voice and breathing that result from this approach called for discussion of preservation of this organ. Since the publication of the Veterans' Study in 1991 on laryngeal cancer and the confirmation by subsequent randomized trials of an equivalent survival, treatment strategies for advanced laryngeal carcinoma have shown significant changes in favour of an organ-sparing approach by chemoradiotherapy. Purpose: We aim to assess the outcome of locally advanced non-metastatic laryngeal cancer classified as (T3NxM0 -T4NxM0) by comparing the carcinological results and the survival at one and three years between two cohorts of patients, one treated by surgery and the other by organ preservation protocols. Between the two series, we will analyze the carcinological outcomes, local control, local and lymph node recurrence, distant metastases, overall survival, and recurrence-free survival, lymph Node-free survival, and metastatic evolution. Results: 106 patients were treated for locally advanced squamous cell laryngeal carcinoma of the ENT department and radiation Oncology department of Mohamed VI University hospital between January 2014 and December 2018; Sixty-three patients in surgery group I and forty-three patients in group II went on organ sparing approach by radiochemotherapy. The two groups were compared according to local tumor control, local recurrence, lymph node recurrence, and distant metastasis. Early deaths and patients who were lost to follow-up were excluded from this analysis. The average age was 61 years in the surgery group versus 60 years in the RCC. The male predominance was marked in both treatment groups, 102 were male (96.23%) and only 4 female (3.77 %.).88.7% were smokers with an average consumption of 26.4 package-years. Only 15% of our smoking patients reported a withdrawal period estimated at two months on average. Alcohol-smoking synergy was observed in 19% of cases. In the surgery group, 47 patients or 83.9% had local tumor control compared to 12 patients or 41.4% in the radio-chemotherapy group with a statistically significant difference p<0.0001. Local recurrence was observed in 8 patients (14.5%) in the surgery group against 6 patients (46.2%) in the radio-chemotherapy cohort with a p= 0.02. We noted that there was a large number of missing data (30 patients) in the radio-chemotherapy group due to the large number of patients who were lost to follow-up, early deaths, and patients who did not progress well after treatment. There was no statistically significant difference between the two groups in terms of lymph node recurrence and metastatic progression. At 1 year, Overall survival was 87.9% of patients were alive (n=51 out of 58) in the surgery arm versus 60.6% (n=20 out of 33) in the radio-chemotherapy arm. At 3 years overall survival was 77.5% for surgery versus 48.4% for radiotherapy (p= 0.005).Lymph node free recurrence and metastatic free progression at 1 year was 94.5% in the surgery group compared with 84.6% for radio-chemotherapy. Survival at 3 years was 85.4% versus 53.8% respectively (p=0.05).In the chemoradiation therapy group, there were 30 missing data due to a large number of deaths and loss of the follow-up during the first year without any indication of the presence or absence of recurrence, compared to 8 missing data for the radio-chemotherapy group. Conclusion: The optimal treatment for advanced squamous cell carcinoma of the larynx is highly controversial. Total laryngectomy associated with cervical lymph node dissection remains the gold standard of treatment but organ-sparing protocols are as effective as surgical therapy. However, in our study, total laryngectomy plus lymph node dissection showed better survival outcomes in terms of locoregional control and significantly increased overall survival and recurrence-free survival. This makes surgery the treatment of choice in the management of locally advanced non-metastatic laryngeal cancer in our single institutional Moroccan setting. Possible reasons for these results may be poor patient selection, inadequate follow-up, incomplete treatment, and interrupted treatment sessions but also the long delay in consultation. Patients and professionals should be made aware of the small but significant disadvantage of the non-surgical therapy approach as part of the shared decision-making process when selecting treatment. Both surgery and radio-chemotherapy can be effective if the treatment indications are well directed. These indications depend on several many several parameters and should be considered at the multidisciplinary consultation meetings and adapted on a case-by-case basis.

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