Strahlentherapie und Onkologie

, Volume 185, Issue 5, pp 303–309 | Cite as

Organ Function and Quality of Life after Transoral Laser Microsurgery and Adjuvant Radiotherapy for Locally Advanced Laryngeal Cancer

  • Arno Olthoff
  • Andreas Ewen
  • Hendrik Andreas Wolff
  • Robert Michael Hermann
  • Hilke Vorwerk
  • Andrea Hille
  • Ralph Rödel
  • Clemens F. Hess
  • Wolfgang Steiner
  • Olivier Pradier
  • Hans Christiansen
Original Article

Background and Purpose:

Transoral laser microsurgery (TLM) and adjuvant radiotherapy are an established therapy regimen for locally advanced laryngeal cancer at our institution. Aim of the present study was to assess value of quality of life (QoL) data with special regard to organ function under consideration of treatment efficacy in patients with locally advanced laryngeal cancer treated with larynx-preserving TLM and adjuvant radiotherapy.

Patients and Methods:

From 1994 to 2006, 39 patients (ten UICC stage III, 29 UICC stage IVA/B) with locally advanced laryngeal carcinomas were treated with TLM and adjuvant radiotherapy. Data concerning treatment efficacy, QoL (using the VHI [Voice Handicap Index], the EORTC QLQ-C30 and QLQ-H&N35 questionnaires) and organ function (respiration, deglutition, voice quality) were obtained for ten patients still alive after long-term follow-up. Correlations were determined using the Spearman rank test.

Results:

After a median follow-up of 80.8 months, the 5-year overall survival rate was 46.8% and the locoregional control rate 76.5%, respectively. The larynx preservation rate was 89.7% for all patients and 100% for patients still alive after follow-up. Despite some verifiable problems in respiration, speech and swallowing, patients showed a subjectively good QoL.

Conclusion:

TLM and adjuvant radiotherapy is a curative option for patients with locally advanced laryngeal cancer and an alternative to radical surgery. Even if functional deficits are unavoidable in the treatment of locally advanced laryngeal carcinomas, larynx preservation is associated with a subjectively good QoL.

Key Words:

Laser surgery Radiotherapy Locally advanced head-and-neck cancer Quality of life Organ preservation 

Objektive und subjektive funktionelle Einschränkungen nach organerhaltender lasermikrochirurgischer Resektion und adjuvanter Radiotherapie bei lokal fortgeschrittenen Larynxkarzinomen

Hintergrund und Ziel:

Lasermikrochirurgie und adjuvante Strahlentherapie sind in der Klinik der Autoren etablierte Behandlungsmethoden lokal fortgeschrittener Larynxkarzinome mit guten onkologischen Ergebnissen und einer hohe Rate an Organerhalt. Bei organerhaltender Therapie sind funktionelle Einschränkungen oft unvermeidbar. Neben den onkologischen Ergebnissen sollten in dieser Studie das objektive Ausmaß solcher Einschränkungen und deren subjektive Wertung durch die Patienten untersucht werden.

Patienten und Methodik:

Von 1994 bis 2006 wurden 39 Patienten (zehn UICC-Stadium III, 29 UICC-Stadium IVA/B) mit lokal fortgeschrittenen Larynxkarzinomen mittels Lasermikrochirurgie und adjuvanter Strahlentherapie behandelt. Bei zehn Patienten erfolgte im Rahmen der Nachsorge in den Jahren 2006/2007 eine Erhebung von Lebensqualitätsdaten. Die Schluckfunktion wurde flexibel endoskopisch überprüft, die Atmung durch eine Bodyplethysmographie. Die Objektivierung der Stimmqualität erfolgte durch das Göttinger Heiserkeitsdiagramm.

Ergebnisse:

Nach einer medianen Beobachtungsdauer von 80,8 Monaten betrugen die 5-Jahres-Überlebensrate 46,8% und die lokoregionale Kontrollrate 76,5%. Eine Salvage-Laryngektomie bei Lokalrezidiv erhielten vier Patienten, so dass im Verlauf eine 89,7%ige Rate an Larynxerhalt erreicht werden konnte. Bei der objektiven Untersuchung der Funktionseinschränkungen zeigte sich bei fünf Patienten eine gelegentliche Aspiration bei kräftigem Hustenreflex. Die übrigen fünf Patienten wiesen keine Schluckstörung auf. Eine Normalstimme lag bei keinem Patienten vor. Es bestand jedoch keine signifikante Korrelation der objektivierten Funktionsstörungen mit den Lebensqualitätsfunktionsskalen: Subjektiv schätzen die Patienten ihre Lebensqualität als gut ein.

Schlussfolgerung:

Lasermikrochirurgie und adjuvante Strahlentherapie sind eine Therapieoption für lokal fortgeschrittene Larynxkarzinome, die neben guten onkologischen Ergebnissen eine hohe Rate an Organerhalt ermöglicht. Die Patienten schätzen ihre Lebensqualität im weiteren Verlauf subjektiv als gut ein. Die tatsächlichen funktionellen Einschränkungen werden durch die Lebensqualitätsdaten allerdings nicht sicher abgebildet. Daher ist zur objektiven Beurteilung posttherapeutischer Funktionsergebnisse die klinische Erhebung funktioneller Befunde erforderlich.

Schlüsselwörter:

Laserchirurgie Radiotherapie Lokal fortgeschrittene Kopf-Hals-Tumoren Lebensqualität Organerhalt 

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Copyright information

© Urban & Vogel, Muenchen 2009

Authors and Affiliations

  • Arno Olthoff
    • 1
  • Andreas Ewen
    • 2
  • Hendrik Andreas Wolff
    • 2
  • Robert Michael Hermann
    • 2
  • Hilke Vorwerk
    • 2
  • Andrea Hille
    • 2
  • Ralph Rödel
    • 3
  • Clemens F. Hess
    • 1
  • Wolfgang Steiner
    • 3
  • Olivier Pradier
    • 4
  • Hans Christiansen
    • 2
    • 5
  1. 1.Department of Phoniatrics and PedaudiologyUniversity of GöttingenGöttingenGermany
  2. 2.Department of RadiotherapyUniversity of GöttingenGöttingenGermany
  3. 3.Department of OtorhinolaryngologyUniversity of GöttingenGöttingenGermany
  4. 4.Department of CancerologyCHU MorvanBrestFrance
  5. 5.Klinik und Poliklinik für Strahlentherapie und RadioonkologieUniversitätsmedizin GöttingenGöttingenGermany

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