Current Oncology Reports

, Volume 10, Issue 2, pp 170–175

Swing of the pendulum: Optimizing functional outcomes in larynx cancer



For years, total laryngectomy was the only treatment option for patients with intermediate to advanced laryngeal cancer. Over the past two decades, great progress has been made in the management of this disease, with multimodality approaches aimed at laryngeal preservation reshaping the treatment landscape. In the era of chemoradiation, greater focus and attention are now directed toward functional laryngeal preservation—not simply “organ preservation.” The continued development and integration of new treatment approaches, including organ preservation surgery (eg, transoral minimally invasive surgery of the head and neck, supracricoid partial laryngectomy), intensity-modulated radiotherapy, and targeted molecular therapies, offer the potential to improve clinical outcomes, function, and quality of life. Incorporation of these new approaches advances the concept of personalized medicine, with treatment strategies tailored to the circumstances and future of each patient.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    The Department of Veterans Affairs Laryngeal Study Group: Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991, 324:1685–1690.CrossRefGoogle Scholar
  2. 2.
    Forastiere AA, Goepfert H, Maor M, et al.: Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003, 349:2091–2098.PubMedCrossRefGoogle Scholar
  3. 3.
    Pignon JP, Bourhis J, Domenge C, Designé L: Chemotherapy added to locoregional treatment for head and neck squamouscell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 2000, 355:949–955.PubMedGoogle Scholar
  4. 4.
    Bourhis J, Amand C, Pignon JP; MACH-NC Collaborative Group: Update of MACH-NC (Meta-Analysis of Chemotherapy in Head and Neck Cancer) database focused on concomitant chemotherapy [ASCO abstract]. J Clin Oncol 2004, 22(14S):abstract 5505.Google Scholar
  5. 5.
    National Comprehensive Cancer Center Network: Clinical practice guidelines in oncology — v.1.2007: head and neck cancer. Accessed December 2007.
  6. 6.
    Pfister DG, Laurie SA, Weinstein GS, et al.: American Society of Clinical Oncology clinical practice guideline for the use of larynx-preservation strategies in the treatment of laryngeal cancer. J Clin Oncol 2006, 24:3693–3704.PubMedCrossRefGoogle Scholar
  7. 7.
    Rosenthal DI, Lewin JS, Eisbruch A: Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol 2006, 24:2636–2643.PubMedCrossRefGoogle Scholar
  8. 8.
    Kotz T, Costello R, Li Y, Posner MR: Swallowing dysfunction after chemoradiation for advanced squamous cell carcinoma of the head and neck. Head Neck 2004, 26:365–372.PubMedCrossRefGoogle Scholar
  9. 9.
    Rademaker AW, Vonesh EF, Logemann JA, et al.: Eating ability in head and neck cancer patients after treatment with chemoradiation: a 12-month follow-up study accounting for dropout. Head Neck 2003, 25:1034–1041.PubMedCrossRefGoogle Scholar
  10. 10.
    Roh JL, Kim AY, Cho MJ: Xerostomia following radiotherapy of the head and neck. J Clin Oncol 2005, 23:3016–3023.PubMedCrossRefGoogle Scholar
  11. 11.
    Campbell BH, Spinelly K, Marbella AM, et al.: Aspiration, weight loss, and quality of life in head and neck survivors. Arch Otolaryngol Head Neck Surg 2004, 130:1100–1103.PubMedCrossRefGoogle Scholar
  12. 12.
    Holsinger FC, Weber RS: Swing of surgical pendulum: a return to surgery for treatment of head-and-neck cancer in 21st century? Int J Radiat Oncol Biol Phys 2007, 69(Suppl):S129–S131.PubMedGoogle Scholar
  13. 13.
    Strong MS, Jako GJ: Laser surgery in the larynx: early clinical experience with continuous CO2 laser. Ann Otol Rhinol Laryngol 1972, 81:791–798.PubMedGoogle Scholar
  14. 14.
    Steiner W, Ambrosch P: Endoscopic Laser Surgery of the Upper Aerodigestive Tract with Special Emphasis on Cancer Surgery. Translated by Knappe MV. Stuttgart, Germany; New York, NY: Georg Thieme Verlag; 2000.Google Scholar
  15. 15.
    Hockstein NG, Nolan JP, O’Malley BW, Jr, et al.: Robotic microlaryngeal surgery: a technical feasibility study using the daVinci surgical robot and an airway mannequin. Laryngoscope 2005, 115:780–785.PubMedCrossRefGoogle Scholar
  16. 16.
    Weinstein GS, O’Malley BW, Jr, Snyder W, et al.: Transoral robotic surgery: supraglottic partial laryngectomy. Ann Otol Rhinol Laryngol 2007, 116:19–23.PubMedGoogle Scholar
  17. 17.
    McWhorter AJ, Hoffman HT: Transoral laser microsurgery for laryngeal malignancies. Curr Probl Cancer 2005, 29:180–189.PubMedCrossRefGoogle Scholar
  18. 18.
    Pearson BW, Salassa JR: Transoral laser microresection for cancer of the larynx involving the anterior commissure. Laryngoscope 2003, 113:1104–1112.PubMedCrossRefGoogle Scholar
  19. 19.
    Steiner W, Martin A, Ambrosch P, et al.: Laser microsurgical treatment of pT2/#N0 carcinoma of the glottis: results of 301 cases. Presented at the 85th Annual Meeting of the American Broncho-Esophageal Association. May 14, 2005; Boca Raton, FL.Google Scholar
  20. 20.
    Hinni ML, Salassa JR, Grant DG, et al.: Transoral laser microsurgery for advanced laryngeal cancer. Arch Otolaryngol Head Neck Surg 2007, 133:1198–1204.PubMedCrossRefGoogle Scholar
  21. 21.
    Iro H, Waldfahrer F, Attendorf-Hofmann A, et al.: Transoral laser surgery of supraglottic cancer. Arch Otolaryngol Head Neck Surg 1998, 124:1245–1250.PubMedGoogle Scholar
  22. 22.
    Davis RK, Kriskovich MD, Galloway EB III, et al.: Endoscopic supraglottic laryngectomy with postoperative irradiation. Ann Otol Rhinol Laryngol 2004, 113:132–138.PubMedGoogle Scholar
  23. 23.
    Zeitels SM, Hillman RE, Franco RA, Bunting GW: Voice and treatment outcome for phonosurgical management of early glottic cancer. Ann Otol Rhinol Laryngol 2002, 190(Suppl):3–20.Google Scholar
  24. 24.
    Weinstein GS, Laccourreye O, Brasnu D, Laccourreye H: Organ Preservation Surgery for Laryngeal Cancer. San Diego, CA: Singular; 2000.Google Scholar
  25. 25.
    Holsinger FC, Laccourreye O, Weinstein GS, et al.: Technical refinements in the supracricoid partial laryngectomy to optimize functional outcomes. J Am Coll Surg 2005, 201:809–820.PubMedCrossRefGoogle Scholar
  26. 26.
    Chevalier D, Laccourreye O, Brasnu D, et al.: Cricohyoidoepiglottopexy for glottic carcinoma with fixation or impaired motion of the true vocal cord: 5-year oncologic results with 112 patients. Ann Otol Rhinol Laryngol 1997, 106:364–369.PubMedGoogle Scholar
  27. 27.
    Dufour X, Hans S, De Mones E, et al.: Local control after supracricoid partial laryngectomy for “advanced” endolaryngeal squamous cell carcinoma classified as T3. Arch Otolaryngol Head Neck Surg 2004, 130:1092–1099.PubMedCrossRefGoogle Scholar
  28. 28.
    Naudo P, Laccourreye O, Weinstein G, et al.: Functional outcome and prognosis factors after supracricoid partial laryngectomy with cricohyoidopexy. Ann Otol Rhinol Laryngol 1997, 106:291–296.PubMedGoogle Scholar
  29. 29.
    Laccourreye O, Weinstein G, Naudo P, et al.: Supracricoid partial laryngectomy after failed laryngeal radiation therapy. Laryngoscope 1996, 106:495–498.PubMedCrossRefGoogle Scholar
  30. 30.
    Mendenhall WM, Amdur RJ, Palta JR: Intensity-modulated radiotherapy in the standard management of head and neck cancer: promises and pitfalls. J Clin Oncol 2006, 24:2618–2623.PubMedCrossRefGoogle Scholar
  31. 31.
    Chao KS, Ozyigit G, Tran BN, et al.: Patterns of failure in patients receiving definitive and postoperative IMRT for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2003, 55:312–321.PubMedGoogle Scholar
  32. 32.
    Lee N, Xia P, Fischbein NJ, et al.: Intensity-modulated radiation therapy for head-and-neck cancer: the UCSF experience focusing on target volume delineation. Int J Radiat Oncol Biol Phys 2003, 57:49–60.PubMedCrossRefGoogle Scholar
  33. 33.
    Yao M, Dornfeld KJ, Buatti JM, et al.: Intensity-modulated radiation treatment for head-and-neck squamous cell carcinoma-the University of Iowa experience. Int J Radiat Oncol Biol Phys 2005, 63:410–421.PubMedGoogle Scholar
  34. 34.
    Grandis JR, Melhem MF, Barnes EL, Tweardy DJ: Quantitative immunohistochemical analysis of transforming growth factor-alpha and epidermal growth factor receptor in patients with squamous cell carcinoma of the head and neck. Cancer 1996, 78:1304–1292.CrossRefGoogle Scholar
  35. 35.
    Ang KK, Berkey BA, Tu X, et al.: Impact of epidermal growth factor receptor expression on survival and pattern of relapse in patients with advanced head and neck carcinoma. Cancer Res 2002, 62:7350–7356.PubMedGoogle Scholar
  36. 36.
    Bonner JA, Harari PM, Giralt J, et al.: Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 2006, 354:567–578.PubMedCrossRefGoogle Scholar
  37. 37.
    Bonner J, Harari P, Giralt J, et al.: Improved preservation of larynx with the addition of cetuximab to radiation for cancers of the larynx and hypopharynx [abstract]. J Clin Oncol 2005, 23(16S):abstract 5533.Google Scholar
  38. 38.
    Rogers SN, Gwanne S, Lowe D, et al.: The addition of mood and anxiety domains to the University of Washington quality of life scale. Head Neck 2002, 24:521–529.PubMedCrossRefGoogle Scholar
  39. 39.
    Cella DF: Manual for the Functional Assessment of Cancer Therapy (FACT) Measurement System (v.3). Chicago, IL: Rush Medical Center; 1994.Google Scholar
  40. 40.
    Bjordal K, Hammerlid E, Ahlner-Elmqvist M, et al.: Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35. J Clin Oncol 1999, 17:1008–1019.PubMedGoogle Scholar
  41. 41.
    List MA, D’Antonio LL, Cella DF, et al.: The Performance Status Scale for Head and Neck Cancer Patients and the Functional Assessment of Cancer Therapy-Head and Neck Scale. A study of utility and validity. Cancer 1996, 77:2294–2301.PubMedCrossRefGoogle Scholar
  42. 42.
    Chen AY, Frankowski R, Bishop-Leone J, et al.: The development and validation of a dysphagia-specific qualityof-life questionnaire for patients with head and neck cancer: the M.D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg 2001, 127:870–876.PubMedGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Department of Head and Neck SurgeryThe University of Texas M.D. Anderson Cancer CenterHoustonUSA

Personalised recommendations