Abstract
Background
The oncological and functional role of postoperative radiotherapy (PORT) after open partial laryngeal surgery (OPLS) remains debatable.
Methods
A systematic review and a meta-analysis of the literature were conducted according to the PRISMA guidelines. Outcomes of patients receiving OPLS with and without PORT for laryngeal cancer were summarized.
Results
In the 10 studies that were included in the meta-analysis, no significant difference emerged in terms of pooled overall survival between OPLS patients who did and who did not receive PORT (− 0.3%, 95% CI − 5.4 to 4.9%, p = 0.922). Only one study showed a significantly higher incidence of complications in the PORT cohort.
Conclusions
PORT may apparently be performed after OPLS in face of adverse postoperative features without an increased risk of toxicities affecting the neolarynx. Because of the limitations in the available literature, the oncological and functional effects of PORT in this setting needs to be prospectively assessed to strengthen the evidence of this treatment strategy for laryngeal cancer.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Introduction
Laryngeal cancer (LC) remains a protean disease in terms of biological behavior and its many patterns of diffusion depending on the anatomical location [1]. Traditionally, for early-stage LC (T1-T2 N0) a single-modality strategy is recommended, either with surgery or radiotherapy (RT), thus leaving other treatment options open in case of recurrence [2]; on the other hand, resectable, advanced-stage LC (T3-T4 N +) is usually managed with a multi-modality approach, either a combination of chemotherapy (CHT) and RT (chemoradiation, CRT), or surgical resection followed by adjuvant RT and/or CHT [3].
Open partial laryngeal surgery (OPLS) consists of a large array of surgical procedures that are meant to eradicate LC, while preserving laryngeal functions (breathing without a tracheostomy, speaking, etc.). OPLS has very specific indications and, only in this particular subset of patients, the oncological outcomes may be considered non-inferior to transoral laryngeal surgery or total laryngectomy (TL); this holds true also in the salvage setting, albeit with lower evidence [1, 4]. Unfortunately, OPLS often comes at the cost of persistent voice and swallowing functional impairments that can affect up to 50% of these patients depending on their definition [5, 6]. In this regard, because of preoperative incorrect staging or unexpected pathological features (positive surgical margins, extranodal extension, etc.), a non-negligible proportion of patients receiving OPLS is faced with the need to receive adjuvant RT and/or CHT to improve locoregional control and survival [7,8,9]. However, the benefits of adjuvant treatments were never specifically investigated in the OPLS population while there is conflicting evidence regarding a higher risk of both short-term (e.g., chondronecrosis) and long-term (e.g., chronic aspiration, neolaryngeal stenosis, etc.) RT-related complications [10,11,12].
The aim of the present review is to summarize the currently available evidence on the oncological and functional impact of adjuvant RT ± CHT after OPLS while highlighting the unmet needs in this context.
Materials and methods
Searching strategy and selection criteria
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [13], we conducted a literature search on articles published from January 1980 up to December 2021, using PubMed and Scopus databases to identify the relevant studies. This study was conducted by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and it was registered in the International Prospective Register of Systematic Reviews (PROSPERO, University of York, UK; registration number CRD42021247403).
The following keywords were used: ((adjuvant radiotherapy OR postoperative radiotherapy) AND laryngeal cancer) OR (postoperative radiotherapy AND ( laryngeal tumor OR laryngeal cancer)) OR (partial laryngectomy AND (postoperative radiotherapy OR postoperative radiation therapy)) OR (conservative laryngeal surgery AND postoperative radiotherapy) OR (larynx salvage radiotherapy).
Only studies describing the clinical outcomes of patients with laryngeal squamous cell carcinoma treated with OPLS and, at least in a subgroup, with PORT were included. Articles were excluded based on the following criteria: studies with less than 10 patients or case reports; treatment modalities that involved neoadjuvant CRT, TL, or transoral laryngeal surgery; data not clearly stating the oncological and functional results of the group/subgroup of patients who received adjuvant RT; articles not written in English, French, Italian, or Chinese.
Data collection
The title and abstract of the selected papers were carefully read according to the inclusion and exclusion criteria and duplicates were removed. Three reviewers (SJ, LXC, and LGL) independently extracted data from each study, which were reviewed for consistency among the authors, and any discrepancies were resolved by consensus. The full text of the included studies was then read to extract the following data:
-
Reference: first author, year of publication, and country;
-
Recruitment time span;
-
Time from surgery to adjuvant RT (weeks);
-
Study size and number of patients receiving PORT;
-
TNM stage;
-
Type of OPLS;
-
The mean radiation dose delivered (Gy);
-
Complications related to PORT;
-
Mean and/or median follow-up time (months);
-
Survival outcomes.
Definition of the outcomes, synthesis of the literature, and meta-analysis
Our initial aim was to compare the oncological outcomes (by all possibly available endpoints such as Overall Survival-OS, Disease-Specific Survival-DSS, and Disease-Free Survival-DFS) between the group receiving only OPLS (i.e., excluding any possible case of salvage procedure) versus OPLS and PORT. After the extraction of all relevant articles, however, we noticed that only a very limited proportion of articles reported these figures separately for the two groups. It was thus decided to critically discuss all the articles qualitatively and to meta-analyze only these latter papers.
Regarding the functional outcomes, we decided to extract all available data about the complications affecting the neolaryngeal function that were attributable only to PORT. We have thus annotated the rates of neolaryngeal dysfunction (i.e., chronic aspiration, aspiration pneumonia, time to and proportion of decannulated patients) in the two groups, to extrapolate the functional parameters after PORT such as the rate of patients that have a sufficient oral intake, time until PEG or nasogastric tube removal, and the proportion of patients requiring them in a permanent manner.
When an open partial horizontal laryngectomy (OPHL) was performed, it was classified according to the nomenclature system introduced in 2014 by the European Laryngological Society (ELS): Type I (supraglottic), Type II (supracricoid), and Type III (supratracheal) with the conservation (a) or sacrifice (b) of the epiglottis and/or the resection of one arytenoid, the base of the tongue, or pyriform sinus (+ ARY, + BOT, + PIR) [14].
Quality assessment and statistical methods
The quality and the risk of bias of the articles included in the meta-analysis were evaluated by the Quality In Prognosis Studies (QUIPS) tool with any discrepancies resolved by consensus by the first two authors. Visualization of the risk-of-bias assessments was performed by creating a traffic lights plot and a weighted bar plot using the robvis tool [15].
The study-specific differences in % OS between patients treated with surgery + PORT vs. patients treated with surgery only (taken as the reference group) were pooled into a summary OS difference by fitting meta-analysis models. A positive % difference meant that the OS was better among patients treated with surgery vs. PORT, and vice versa when the % difference was negative. The between-studies heterogeneity was quantified using the I2 statistics, which can be interpreted as the proportion of the total variability across studies that is attributable to actual heterogeneity rather than chance. In the case of large heterogeneity (I2 ≥ 50), random-effect models were fitted, while fixed-effect models were preferred in absence of large heterogeneity. All statistical tests were performed using Stata (command metan, Stata Statistical Software: Release 15. College Station, TX, USA: StataCorp LLC) and R (Version 4.1.0, R Foundation for Statistical Computing, Vienna, Austria).
Results
4913 records for laryngeal cancer and adjuvant PORT were identified from a primary literature search: after the removal of duplicates and by applying the aforementioned criteria, a total of 1627 publications were selected. Papers were then screened by reading the titles and abstracts, and 35 manuscripts were deemed eligible for possible inclusion. After reading the full texts, 14 articles were excluded because of insufficient or incomplete data regarding the surgical and non-surgical treatments received, the survival and functional outcomes, or for histology other than squamous cell carcinoma; only 21 studies eventually met the inclusion criteria. The flowchart presenting our literature search strategy is shown in Fig. 1.
6 studies were carried out in Italy, 6 in China, 1 in Turkey, 1 in Switzerland, 1 in France, 3 in the USA, 1 in Spain, and 2 in Greece. A total of 1959 patients undergoing OPLS were considered, and 970 of them (49.5%) received PORT: a detailed description of their clinical features and oncological outcomes is given in Table 1.
The treatment period ranges from 1969 to the beginning of 2010 and supraglottic surgery (OPHL I) was the most frequent type of OPLS performed. Indications for PORT on the neolarynx mostly included positive or close surgical margins, and high nodal burden (pN2 or pN3). Only a total of ten articles for a total of 1198 patients reported sufficient information regarding survival separately for those with (491, 40.9%) and without PORT (707, 59.1%). Five-year OS rates greatly differ between these studies, however, no significant difference was found comparing OS for patients receiving or not receiving PORT (pooled %OS = − 0.3%, 95% CI − 5.4 to 4.9%, p = 0.922). No heterogeneity was present (I2 = 0%) and the resulting forest plot is shown in Fig. 2. Their overall risk of bias was judged to be low to moderate and the traffic lights plot and the weighted bar plot for each domain considered in the QUIPS tool are given in Figs. 3 and 4, respectively.
The collected data about the complications related only to PORT were collected from a total of 14 articles, for a total of 548 patients. They are summarized in Table 2, and exclusively in five articles, a comparison in terms of incidence of complications between the two groups was given. Only in one paper, differences were significant even though outcomes measurements and their definitions largely differed among them.
Discussion
OPLS represents an effective function-preserving treatment for both early and advanced laryngeal cancer but, despite the recent improvements in both endoscopic and imaging techniques, incorrect staging may occur in around 15–20% of patients [40]. It has been demonstrated that PORT with or without concurrent CHT significantly improves survival and reduces the risk of locoregional recurrence when adverse features such as positive margins, high tumoral (pT3-T4), or nodal stage (pN2-N3) are found after surgical resection [8, 9]. However, these results were based on a quite heterogeneous population of head and neck cancer patients [9]. In the context of OPLS, the oncological evidence of the role of PORT remains weak: while some authors showed that PORT can effectively reduce the postoperative loco-regional failure rates to around 8–10% [41], in a retrospective analysis of the US National Cancer Database on 1460 surgically treated LC patients (where only 90 underwent OPLS and 23 OPLS + PORT), in pT3N0R0 LC cases no survival benefit was found with adjuvant treatments (adjusted HR, 0.88; 95% CI 0.64–1.21) [42]. In the present work, we found no difference in terms of OS for patients receiving or not receiving RT, but we must recall that patients treated with PORT likely show a more advanced disease (i.e., they are considered to have a worse prognosis) compared to those treated with surgery alone. Therefore, since in the meta-analyzed studies it was not possible to obtain separate data on patients' characteristics or other relevant prognostic factors, our result might be indirectly interpreted in favor of PORT as a positive prognostic factor for OPLS patients.
There are some conflicting issues, which are specific to this combined “surgical preserving” plus RT strategy [43,44,45,46,47,48]. When OPLS is applied in improperly selected patients, achieving a R0 resection may become very difficult without converting to TL, and this explains the frequent encounter of close/positive surgical margins. [44]
Intriguingly, an American study where PORT was deliberately avoided in favor of a wait-and-see approach for R1 cases revealed that, despite a higher local recurrence rate in the former compared to the R0 cases, survival outcomes were notably the same in the two groups [45]. Then PORT is often requested after OPLS because of the postoperative finding of microscopic extracapsular extension in the excised lymph nodes which is a well-established adverse prognostic factor [46] and whose incorporation into the latest AJCC/UICC TNM edition has inevitably led to rising in the pathological stage [48]. On the contrary, it is known that adjuvant RT should ideally be started within 6 weeks, [9] but OPLS patients are typically characterized by the need for a long postoperative functional rehabilitation (for OPHL II, the mean reported length of hospital stay ranges from 5 to 104 days) [43]. Besides the need for proper recovery of the neolarynx, another reason not to irradiate these patients is given by the worsening of persistent laryngeal edema that was shown to increase the clinical difficulties in detecting recurrence in a large cohort of OPLS + PORT [20], even though the prognostic significance of this aspect remains understudied.
In the present paper, and in accordance with other authors [10, 34], we think that concerns about the potentially deleterious effects of PORT in OPLS might have been overemphasized. While it is true that in some series a worsening of neolaryngeal function was demonstrated after RT (longer tracheostomy dependence [4, 27], the longer time to resume oral intake/more frequent need to place a PEG [38, 41, 48], etc.), the exact contribution of PORT to these adverse events remains hardly discernible. It is well established that functional recovery depends on several factors, including age and the type of OPLS with vertical/hemilaryngectomy showing better swallowing outcomes compared to OPHL, while the removal of one cricoarytenoid unit significantly increases the postoperative hospital stay [43, 48]. On the other hand, some complications could be undoubtedly attributed to PORT such as cricopharyngeal stenosis [12], laryngeal stenosis [26, 39], or chondronecrosis [11]. It must be remembered, however, that these events can occur even in non-irradiated OPLS patients: for example, laryngeal stenosis can be attributed to arytenoid edema, posterior prolapse of the epiglottis, mucosal webs, and cicatricial narrowing of the pexy [49,50,51,52].
If a major strength of our study is the comprehensive evaluation of the literature, without limiting it to the Western surgical series, limitations in the included articles have substantially hindered our research because of several reasons. Underreporting of data was a common finding given that most of the works are retrospective analyses of OPLS series where a variable proportion of patients received PORT. An unavoidable obstacle was also represented by the many technical variations that go under the OPLS definition: though these operations can be ultimately tailored to the single case, the impact of neolaryngeal reconstruction on the incidence of complications after PORT could not be ascertained. Another critical issue was the heterogeneity of the included population with different treatment protocols, anatomical subsites involved, and follow-up protocols. Finally, in the recent decades, the evolution of RT techniques must be accounted for as the latest dose-delivery protocols have substantially changed to spare in a more precise manner the non-involved tissues: this indeed represents a limit in the analysis of PORT toxicities [50,51,52]. In summary, though a direct perspective comparison does not yet exist in terms of survival, an indirect benefit for PORT may be derived from our results. However, the many unreported factors in the available literature (poor performance status of patients making them unfit for PORT, the surgical quality declined as number of OPLS procedures performed annually, etc.) strongly limit a sound retrospective comparison for these two groups of patients.
Conclusions
In the treatment of laryngeal squamous cell carcinoma, from the present meta-analysis, it appears that PORT can be effectively performed after OPLS in face of adverse postoperative features, and without an increased risk of toxicities affecting the neolarynx. Unfortunately, the level of evidence regarding the oncological role of PORT in this setting remains low because of the limitations in the available literature and this holds also true for the functional complications of RT, whose techniques have greatly evolved in the latest years. Only specifically designed clinical trials investigating the role of PORT after OPLS will ultimately define the strengths and the drawbacks of this combined strategy in the management of intermediate- and advanced-stage LC.
Data availability
Data of the present research are available upon reasonable request to the Corresponding Author.
References
Elicin O, Giger R (2020) Comparison of current surgical and non-surgical treatment strategies for early and locally advanced stage glottic laryngeal cancer and their outcome. Cancers 12(3):732. https://doi.org/10.3390/cancers12030732
Baird BJ, Sung CK, Beadle BM, Divi V (2018) Treatment of early-stage laryngeal cancer: a comparison of treatment options. Oral Oncol 87:8–16. https://doi.org/10.1016/j.oraloncology.2018.09.012. (Epub 2018 Oct 16 PMID: 30527248)
Eskander A, Blakaj DM, Dziegielewski PT (2018) Decision making in advanced larynx cancer: an evidenced based review. Oral Oncol 86:195–199. https://doi.org/10.1016/j.oraloncology.2018.09.019. (Epub 2018 Oct 1 PMID: 30409301)
Guzzo M, Ferraro L, Rezzonico S, Ibba T, Bianchi R, Fontanella W, Scaramellini G (2011) Open organ preservation surgery of the larynx: experience of Istituto Nazionale Tumori of Milan. Head Neck 33(5):673–678. https://doi.org/10.1002/hed.21519. (Epub 2010 Aug 4 PMID: 20687166)
Benito J, Holsinger FC, Pérez-Martín A, Garcia D, Weinstein GS, Laccourreye O (2011) Aspiration after supracricoid partial laryngectomy: Incidence, risk factors, management, and outcomes. Head Neck 33(5):679–685. https://doi.org/10.1002/hed.21521. (Epub 2010 Aug 24 PMID: 20737502)
Lips M, Speyer R, Zumach A, Kross KW, Kremer B (2015) Supracricoid laryngectomy and dysphagia: a systematic literature review. Laryngoscope 125(9):2143–2156. https://doi.org/10.1002/lary.25341. (Epub 2015 May 25 PMID: 26013745)
Chow LQM (2020) Head and neck cancer. N Engl J Med 382(1):60–72. https://doi.org/10.1056/NEJMra1715715. (PMID: 31893516)
Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, Ozsahin EM, Jacobs JR, Jassem J, Ang KK, Lefèbvre JL (2005) Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 27(10):843–850. https://doi.org/10.1002/hed.20279. (PMID: 16161069)
National Comprehensive Cancer Network. NCCN Guidelines for Head and Neck Cancers V. 3.2021. https://www.nccn.org/professionals/physician_gls/pdf/headand-neck.pdf. Accessed 22 Dec 2021
Dragan T, Beauvois S, Moreau M, Paesmans M, Vandekerkhove C, Cordier L, Van Gestel D (2019) Clinical outcome and toxicity after simultaneous integrated boost IMRT in head and neck squamous cell cancer patients. Oral Oncol 98:132–140. https://doi.org/10.1016/j.oraloncology.2019.09.012. (Epub 2019 Oct 3 PMID: 31586895)
Spriano G, Antognoni P, Sanguineti G, Sormani M, Richetti A, Ameli F, Piantanida R, Luraghi R, Magli A, Corvo R, Tordiglione M, Vitale V (2000) Laryngeal long-term morbidity after supraglottic laryngectomy and postoperative radiation therapy. Am J Otolaryngol 21(1):14–21. https://doi.org/10.1016/s0196-0709(00)80119-2. (PMID: 10668672)
Bron L, Pasche P, Brossard E, Monnier P, Schweizer V (2002) Functional analysis after supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Laryngoscope 112(7 Pt 1):1289–1293. https://doi.org/10.1097/00005537-200207000-00027. (PMID: 12169915)
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62(10):e1-34. https://doi.org/10.1016/j.jclinepi.2009.06.006. (Epub 2009 Jul 23 PMID: 19631507)
Succo G, Peretti G, Piazza C, Remacle M, Eckel HE, Chevalier D, Simo R, Hantzakos AG, Rizzotto G, Lucioni M, Crosetti E, Antonelli AR (2014) Open partial horizontal laryngectomies: a proposal for classification by the working committee on nomenclature of the European Laryngological Society. Eur Arch Otorhinolaryngol 271(9):2489–2496. https://doi.org/10.1007/s00405-014-3024-4. (Epub 2014 Apr 2 PMID: 24691854)
McGuinness LA, Higgins JPT (2021) Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 12(1):55–61. https://doi.org/10.1002/jrsm.1411. (Epub 2020 May 6 PMID: 32336025)
Costa L, Pedretti S, Foscarini F, Maddalo M, Pegurri L, Pasinetti N, Cavagnini R, Ciccarelli S, Tonoli S, Magrini SM, Buglione M (2016) Clinical outcomes and toxicity after exclusive versus postoperative radiotherapy in supraglottic cancer: new solutions for old problems? The case of stage III and IV disease. Radiol Med 121(1):70–79. https://doi.org/10.1007/s11547-015-0565-6. (Epub 2015 Aug 1 PMID: 26231252)
Buglione M, Pedretti S, Costa L, Foscarini F, Maddalo M, Pegurri L, Pasinetti N, Ciccarelli S, Tonoli S, Magrini SM (2015) Clinical outcomes and toxicity after exclusive versus postoperative radiotherapy in supraglottic cancer: new solutions for old problems? The case of stage I and II disease. Radiol Med 120(11):1071–1077. https://doi.org/10.1007/s11547-015-0533-1. (Epub 2015 Mar 28 PMID: 25820354)
Lai Q, Li H (2013) The treatment and clinical therapeutic effect analysis in 59 cases of advanced supraglottic laryngeal squamous cell carcinoma. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 27(24):1366–1369 (Chinese PMID: 24669687)
Liu TR, Yang AK, Chen FJ, Zeng MS, Song M, Guo ZM, Chen WK, Ouyang D, Li QL, Chen YF, Zhang Q, Zeng ZY (2009) Survival and prognostic analysis of 221 patients with advanced laryngeal squamous cell carcinoma treated by surgery. Ai Zheng 28(3):297–302 (Chinese PMID: 19619446)
Oksüz DC, Uzel O, Yildirim A, Yetmen O, Sahinler I, Turkan S (2008) Significance of laryngeal edema after partial laryngectomy and radiotherapy in supraglottic cancer. J Otolaryngol Head Neck Surg 37(5):681–688 (PMID: 19128676)
Yu WB, Zeng ZY, Chen FJ, Peng HW (2006) Treatment and prognosis of stage T3 glottic laryngeal cancer—a report of 65 cases. Ai Zheng 25(1):85–87 (Chinese PMID: 16405757)
Tian WD, Zeng ZY, Chen FJ, Wu GH, Guo ZM, Zhang Q (2006) Treatment and prognosis of stage III-IV laryngeal squamous cell carcinoma. Ai Zheng 25(1):80–84 (Chinese PMID: 16405756)
Esposito E, Motta S, Motta G (2002) Exclusive surgery versus postoperative radiotherapy for supraglottic cancer. ORL J Otorhinolaryngol Relat Spec 64(3):213–218. https://doi.org/10.1159/000058027. (PMID: 12037389)
Zeng Z, Xia L, Chen F, Xu G, Zhang Q (2001) Value of surgical margin in directing the treatment of early laryngeal carcinoma after partial laryngectomy. Zhonghua Er Bi Yan Hou Ke Za Zhi 36(4):250–253 (Chinese PMID: 12761988)
Zeng Z, Chen F, Zhang Q, Yang A, Zeng X, Cheng W, Guo Z, Xu G (2000) Partial laryngectomy plus radiotherapy versus partial laryngectomy alone for laryngeal carcinoma. Zhonghua Er Bi Yan Hou Ke Za Zhi 35(1):32–34 (Chinese PMID: 12768686)
Laccourreye O, Hans S, Borzog-Grayeli A, Maulard-Durdux C, Brasnu D, Housset M (2000) Complications of postoperative radiation therapy after partial laryngectomy in supraglottic cancer: a long-term evaluation. Otolaryngol Head Neck Surg 122(5):752–757. https://doi.org/10.1067/mhn.2000.98756. (PMID: 10793360)
Steiniger JR, Parnes SM, Gardner GM (1997) Morbidity of combined therapy for the treatment of supraglottic carcinoma: supraglottic laryngectomy and radiotherapy. Ann Otol Rhinol Laryngol 106(2):151–158. https://doi.org/10.1177/000348949710600211. (PMID: 9041821)
Suárez C, Rodrigo JP, Herranz J, Llorente JL, Martínez JA (1995) Supraglottic laryngectomy with or without postoperative radiotherapy in supraglottic carcinomas. Ann Otol Rhinol Laryngol 104(5):358–363. https://doi.org/10.1177/000348949510400504. (PMID: 7747905)
Nikolaou A, Daniilidis J, Fountzilas G, Kouloulas A, Sombolos K, Velegrakis G (1993) Supraglottic laryngectomy: experience with 66 patients over 20 years. J Laryngol Otol 107(9):813–816. https://doi.org/10.1017/s0022215100124491. (PMID: 8228596)
Daniilidis J, Nikolaou A, Fountzilas G, Sombolos K (1992) Vertical partial laryngectomy: our results after treating 81 cases of T2 and T3 laryngeal carcinomas. J Laryngol Otol 106(4):349–352. https://doi.org/10.1017/s0022215100119462. (PMID: 1613349)
Wang MB, Lavey RS, Calcaterra TC (1990) Efficacy and morbidity of partial laryngectomy and postoperative radiation therapy. Laryngoscope 100(11):1146–1151. https://doi.org/10.1288/00005537-199011000-00002. (PMID: 2233073)
Bocca E, Pignataro O, Oldini C, Sambataro G, Cappa C (1987) Extended supraglottic laryngectomy. Review of 84 cases. Ann Otol Rhinol Laryngol 96(4):384–386. https://doi.org/10.1177/000348948709600406. (PMID: 3619281)
Burstein FD, Calcaterra TC (1985) Supraglottic laryngectomy: series report and analysis of results. Laryngoscope 95(7 Pt 1):833–836 (PMID: 4010424)
Sessions DG, Lenox J, Spector GJ (2005) Supraglottic laryngeal cancer: analysis of treatment results. Laryngoscope 115(8):1402–1410. https://doi.org/10.1097/01.MLG.0000166896.67924.B7. (PMID: 16094113)
Naudo P, Laccourreye O, Weinstein G, Hans S, Laccourreye H, Brasnu D (1997) Functional outcome and prognosis factors after supracricoid partial laryngectomy with cricohyoidopexy. Ann Otol Rhinol Laryngol 106(4):291–296. https://doi.org/10.1177/000348949710600405. (PMID: 9109718)
Gregor RT, Oei SS, Baris G, Keus RB, Balm AJ, Hilgers FJ (1996) Supraglottic laryngectomy with postoperative radiation versus primary radiation in the management of supraglottic laryngeal cancer. Am J Otolaryngol 17(5):316–321. https://doi.org/10.1016/s0196-0709(96)90018-6. (PMID: 8870937)
Spaulding CA, Constable WC, Levine PA, Cantrell RW (1989) Partial laryngectomy and radiotherapy for supraglottic cancer: a conservative approach. Ann Otol Rhinol Laryngol 98(2):125–129. https://doi.org/10.1177/000348948909800208. (PMID: 2916823)
Robbins KT, Davidson W, Peters LJ, Goepfert H (1988) Conservation surgery for T2 and T3 carcinomas of the supraglottic larynx. Arch Otolaryngol Head Neck Surg 114(4):421–426. https://doi.org/10.1001/archotol.1988.01860160065023. (PMID: 3348897)
Thawley SE (1981) Complications of combined radiation therapy and surgery for carcinoma of the larynx and inferior hypopharynx. Laryngoscope 91(5):677–700 (PMID: 7231019)
Cho KJ, Sun DI, Joo YH, Kim MS (2011) Analysis of clinicopathological stage in supracricoid partial laryngectomy patients: Need for adjuvant therapy in clinically understaged cases. Auris Nasus Larynx 38(2):255–260. https://doi.org/10.1016/j.anl.2010.07.002. (Epub 2010 Aug 19 PMID: 20727697)
Lee NK, Goepfert H, Wendt CD (1990) Supraglottic laryngectomy for intermediate-stage cancer: U.T. M.D. Anderson Cancer Center experience with combined therapy. Laryngoscope 100(8):831–836. https://doi.org/10.1288/00005537-199008000-00007. (PMID: 2381259)
Graboyes EM, Zhan KY, Garrett-Mayer E, Lentsch EJ, Sharma AK, Day TA (2017) Effect of postoperative radiotherapy on survival for surgically managed pT3N0 and pT4aN0 laryngeal cancer: Analysis of the National Cancer DataBase. Cancer 123(12):2248–2257. https://doi.org/10.1002/cncr.30586. (Epub 2017 Feb 9 PMID: 28182267)
Schindler A, Pizzorni N, Mozzanica F, Fantini M, Ginocchio D, Bertolin A, Crosetti E, Succo G (2016) Functional outcomes after supracricoid laryngectomy: what do we not know and what do we need to know? Eur Arch Otorhinolaryngol 273(11):3459–3475. https://doi.org/10.1007/s00405-015-3822-3. (Epub 2015 Nov 6 PMID: 26545378)
Horn S, Ozsahin M, Lefèbvre JL, Horiot JC, Lartigau E (2012) Association of Radiotherapy and Oncology of the Mediterranean Area (AROME) Larynx preservation: what is the standard treatment? Crit Rev Oncol Hematol 84(Suppl 1):e97–e105. https://doi.org/10.1016/j.critrevonc.2010.11. (Epub 2010 Dec 23. PMID: 21185198)
Wenig BL, Berry BW Jr (1995) Management of patients with positive surgical margins after vertical hemilaryngectomy. Arch Otolaryngol Head Neck Surg 121(2):172–175. https://doi.org/10.1001/archotol.1995.01890020034008. (PMID: 7840925)
Ho AS, Kim S, Tighiouart M, Gudino C, Mita A, Scher KS, Laury A, Prasad R, Shiao SL, Ali N, Patio C, Mallen-St Clair J, Van Eyk JE, Zumsteg ZS (2018) Association of quantitative metastatic lymph node burden with survival in hypopharyngeal and laryngeal cancer. JAMA Oncol 4(7):985–989. https://doi.org/10.1001/jamaoncol.2017.3852.PMID:29192305;PMCID:PMC6584272
Mermod M, Tolstonog G, Simon C, Monnier Y (2016) Extracapsular spread in head and neck squamous cell carcinoma: a systematic review and meta-analysis. Oral Oncol 62:60–71. https://doi.org/10.1016/j.oraloncology.2016.10.003. (Epub 2016 Oct 18 PMID: 27865373)
Rademaker AW, Logemann JA, Pauloski BR, Bowman JB, Lazarus CL, Sisson GA, Milianti FJ, Graner D, Cook BS, Collins SL et al (1993) Recovery of postoperative swallowing in patients undergoing partial laryngectomy. Head Neck 15(4):325–334. https://doi.org/10.1002/hed.2880150410. (PMID: 8360055)
Pinar E, Imre A, Calli C, Oncel S, Katilmis H (2012) Supracricoid partial laryngectomy: analyses of oncologic and functional outcomes. Otolaryngol Head Neck Surg 147(6):1093–1098. https://doi.org/10.1177/0194599812457334. (Epub 2012 Aug 11 PMID: 22886078)
Gallo O, Cannavicci A, Bruno C, Maggiore G, Locatello LG (2020) Survival outcomes and prognostic factors of open partial laryngeal surgery: a thirty years’ experience. Ann Otol Rhinol Laryngol 129(7):669–676. https://doi.org/10.1177/0003489420905616. (Epub 2020 Feb 6 PMID: 32028778)
Zorzi SF, Lazio MS, Pietrobon G, Chu F, Zurlo V, Bibiano D, De Benedetto L, Cattaneo A, De Berardinis R, Mossinelli C, Alterio D, Rocca MC, Gandini S, Gallo O, Chiocca S, Tagliabue M, Ansarin M (2022) Upfront surgical organ-preservation strategy in advanced-stage laryngeal cancer. Am J Otolaryngol 43(1):103272. https://doi.org/10.1016/j.amjoto.2021.103272. (Epub 2021 Oct 20. PMID: 34757315)
Gallo O, Locatello LG, Larotonda G, Napoleone V, Cannavicci A (2018) Nomograms for prediction of postoperative complications in open partial laryngeal surgery. J Surg Oncol 118(6):1050–1057. https://doi.org/10.1002/jso.25232. (Epub 2018 Sep 27 PMID: 30261103)
Funding
Open access funding provided by Università degli Studi di Firenze within the CRUI-CARE Agreement.
Author information
Authors and Affiliations
Contributions
LGL: data curation, formal analysis, investigation, methodology, validation, visualization, and writing—original draft. SJ: data curation, formal analysis, investigation, methodology, validation, visualization, and writing—original draft. LC: data curation, formal analysis, investigation, and visualization. SC: data curation, formal analysis, methodology, validation, visualization, and writing—original draft. GM: validation, visualization, supervision, and review and editing. PD: conceptualization, project administration, resources, supervision, and review and editing. OG: conceptualization, project administration, resources, supervision, and review and editing.
Corresponding author
Ethics declarations
Conflict of interest
All authors declare they have nothing to disclose.
Ethical approval
Not applicable.
Informed consent
Not applicable. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Locatello, L.G., Jiang, S., Chen, L. et al. Oncological and functional impact of adjuvant treatments after open partial laryngeal surgery: a systematic review of the literature and a meta-analysis. Eur Arch Otorhinolaryngol 280, 2911–2926 (2023). https://doi.org/10.1007/s00405-023-07871-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-023-07871-8