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Organ preservation strategies in the treatment of laryngeal cancer

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Opinion statement

For most patients, a total laryngectomy should not be used as the initial treatment for any stage laryngeal tumor. The goal in treating a patient with laryngeal cancer must be not only to cure but also to provide the best functional outcome for the patient. In the United States, the treatment of laryngeal cancer has moved from radical surgery toward a more conservative approach involving definitive radiotherapy and chemotherapy, with extirpative surgery held in reserve for salvage. In Europe, there has been increasing reliance on limited endoscopic cordectomy procedures for early tumors and the use of function-preserving surgical approaches for more advanced lesions. Careful monitoring of the conservatively treated patient is mandatory to allow for early salvage of failures to the original therapy. Because of the high costs of hospitalization, the direct medical costs attributable to conservative approaches are equal to or less than the costs for more radical surgical resections. Even if survivals are only equivalent, organ preservation approaches should be the treatment of choice for most patients.

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References and Recommended Reading

  1. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer: the Department of Veterans Affairs Laryngeal Cancer Study Group. N Engl J Med 1991, 324:1685–1690.

  2. Wolf G, Hong WK, Fisher SG: Neoadjuvant chemotherapy for organ preservation: current status. In Proceedings of 4th International Conference on Head and Neck Cancer. Edited by Shah JP, Johnson JT. Arlington: Society of Head and Neck Surgeons; 1996:89–97.

    Google Scholar 

  3. Hillman RE, Walsh MJ, Wolf GT, et al.: Functional outcomes following treatment for advanced laryngeal cancer. Part I-voice preservation in advanced laryngeal cancer. Part II-laryngectomy rehabilitation: the state of the art in the VA system? Ann Otol Rhinol Laryngol 1998, 172:2–27. This is the definitive report on the secondary functional outcomes of speech and swallowing for the VA Laryngeal Cancer study.

    Google Scholar 

  4. Forastiere AA, Berkey G, Maor M, et al.: Phase III trial to preserve the larynx: induction chemotherapy and radiotherapy versus concomitant chemotherapy versus radiotherapy alone [abstract]. Intergroup trial R91-11? Proc Annu Meet Am Soc Clin Oncol 2001, 20:2a. This is the first large-scale study comparing neoadjuvant chemotherapy and radiotherapy to standard radiotherapy and to concomitant chemotherapy for a well-defined patient population.

    Google Scholar 

  5. Jemal A, Thomas A, Murray T, et al.: Cancer statistics 2002? CA Cancer J Clin 2002, 52:23–47.

    Article  PubMed  Google Scholar 

  6. Wynder EL, Covey LS, Mauchi K, et al.: Environmental factors in cancer of the larynx: a second look? Cancer 1976, 38:1591–1601.

    Article  PubMed  CAS  Google Scholar 

  7. Nelson NJ: “Big smoke” has big risks: daily cigar use causes cancer and heart disease? J Natl Cancer Inst 1998, 90:562–564.

    Article  PubMed  CAS  Google Scholar 

  8. Blot WJ, McLaughin JK, Winn DM, et al.: Smoking and drinking in relation to oral and pharyngeal cancer? Cancer Res 1988, 48:3282–3287.

    PubMed  CAS  Google Scholar 

  9. Cooper JS, Pajak TF, Rubin P, et al.: Second malignancies in patients who have head and neck cancers: incidence, effect on survival, and implications for chemoprevention based upon the RTOG experience? Int J Radiat Oncol Biol Phys 1989, 17:449–456.

    PubMed  CAS  Google Scholar 

  10. Day GL, Blot WJ, Shore RE, et al.: Second cancers following oral and pharyngeal cancers: role of tobacco and alcohol? J Natl Cancer Inst 1994, 86:131–137. This study illustrates the role of tobacco and alcohol use in increasing the risk of second malignancies in patients who are considered cured of head and neck cancer.

    Article  PubMed  CAS  Google Scholar 

  11. Donald PJ: Marijuana smoking: possible cause of head and neck carcinoma in young patients? Otolaryngol Head Neck Surg 1986, 94:517–521.

    PubMed  CAS  Google Scholar 

  12. Kashina HK: Epidemiology and carcinogens in head and neck cancer. In Head and Neck Cancer. Edited by Fee WE, Goepfert H, Johns ME, et al. Philadelphia: BC Decker; 1990:39–43.

    Google Scholar 

  13. Brandsma JL, Steinberg BM, Abramson AL, et al.: Presence of human papillomavirus type 16 related sequences in verrucous carcinoma of the larynx? Cancer Res 1986, 46:2185–2188.

    PubMed  CAS  Google Scholar 

  14. DeSanto LW, Olsen KD, Perry WC, et al.: Quality of life after surgical treatment of cancer of the larynx? Ann Otol Rhinol Laryngol 1995, 104:763–769.

    PubMed  CAS  Google Scholar 

  15. Weinstein GS, Laccourreye O, Brasnu D, et al.: Organ Preservation Surgery for Laryngeal Cancer. San Diego: Singular Publishing Group; 2000. This text provides an excellent description of surgical approaches relevant to organ preservation.

    Google Scholar 

  16. Wagenfeld DJ, Harwood AR, Bryce DP, et al.: Second primary respiratory tract malignant neoplasms in supraglottic carcinoma? Arch Otolaryngol 1981, 107:135–137.

    PubMed  CAS  Google Scholar 

  17. Brasnu D, Laccourreye H, Dulmet E, et al.: Mobility of the vocal cord and arytenoid in squamous cell carcinoma of the larynx and hypopharynx: an anatomical and clinical comparative study? Ear Nose Throat J 1990, 69:324–330.

    PubMed  CAS  Google Scholar 

  18. Piquet JJ, Desaulty A, Decroix G: Crico-hyoido-epiglotto-pexie: technique operatoire et resultats fonctionnels? Ann Otolaryngol Chir Cervicofac 1974, 91:681–686.

    PubMed  CAS  Google Scholar 

  19. 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.

    PubMed  CAS  Google Scholar 

  20. Bocca E: Sixteenth Daniel C. Baker, Jr, Memorial Lecture. Surgical management of supraglottic cancer and its lymph node metastases in a conservative perspective? Ann Otol Rhinol Laryngol 1991, 100:261–267.

    PubMed  CAS  Google Scholar 

  21. Timon CI, Gullane PJ, Brown D, et al.: Hyoid bone involvement by squamous cell carcinoma: clinical and pathological features? Laryngoscope 1992, 102:515–520.

    Article  PubMed  CAS  Google Scholar 

  22. Iro H, Waldfahrer F, Altendorf-Hofmann A, et al.: Transoral laser surgery of supraglottic cancer: followup of 141 patients? Arch Otolaryngol Head Neck Surg 1998, 124:1245–1250.

    PubMed  CAS  Google Scholar 

  23. Laramore GE: Larynx. In Radiation Therapy of Head and Neck Cancer. Edited by Laramore GE. Berlin: Springer-Verlag; 1989:125–143.

    Google Scholar 

  24. Spayne JA, Warde P, O’Sullivan B, et al.: Carcinoma in-situ of the glottic larynx: results of treatment with radiation therapy? Int J Radiat Oncol Biol Phys 2001, 49:1235–1238.

    Article  PubMed  CAS  Google Scholar 

  25. Kim RY, Marks ME, Salter MM, et al.: Early stage glottic cancer: importance of dose fractionation in radiation therapy? Radiology 1992, 182:273–275.

    PubMed  CAS  Google Scholar 

  26. Ricciardelli EJ, Weymuller EA, Koh WJ, et al.: Effect of radiation fraction size on local control rates for early glottic cancer? Arch Otolaryngol Head Neck Surg 1994, 120:737–742.

    PubMed  CAS  Google Scholar 

  27. Franchin G, Minatel E, Gobbitti C, et al.: Radiation treatment of glottic squamous cell carcinoma, stage I and II: analysis of factors affecting prognosis? Int J Radiat Oncol Biol Phys 1998, 40:541–548. This article discusses the importance of prognostic factors, other than tumor stage, which effect treatment outcome.

    Article  PubMed  CAS  Google Scholar 

  28. Ostwald PM, Kron T, Hamilton CS, et al.: Assessment of mucosal underdosing in larynx irradiation? Int J Radiat Oncol Biol Phys 1996, 36:181–187.

    Article  PubMed  CAS  Google Scholar 

  29. Wiggenraad RG, Terhaard CH, Hordijk GJ, et al.: The importance of vocal cord mobility in T2 laryngeal cancer? Radiother Oncol 1990, 18:321–327.

    Article  PubMed  CAS  Google Scholar 

  30. Van der Voet JCM, Keus RB, Hart AAM, et al.: The impact of treatment time and smoking on local control and complications in T1 glottic cancer? Int J Radiat Oncol Biol Phys 1998, 42:247–255.

    Article  PubMed  Google Scholar 

  31. Esibruch A, Lyden T, Bradford CR, et al.: Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head and neck cancer? Int J Radiat Oncol Biol Phys 2002, 53:23–28.

    Article  Google Scholar 

  32. Fu KK, Pajak TF, Trotti A, et al.: A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003? Int J Radiat Oncol Biol Phys 2000, 48:7–16.

    Article  PubMed  CAS  Google Scholar 

  33. Laramore GE: T3N0M0 glottic cancer: Are more treatment modalities necessarily better? Int J Radiat Oncol Biol Phys 1995, 31:423–425.

    Article  PubMed  CAS  Google Scholar 

  34. Savoye C, Swenberg C, Hugot S, et al.: Thiol WR-1065 and disulphide WR-33278, two metabolites of the drug ethyol (WR-2721), protect DNA against fast neutron-induced strand breakage? Int J Radiat Oncol Biol Phys 1997, 71:193–202.

    CAS  Google Scholar 

  35. Tannehill SP, Mehta MP: Amifostine and radiation therapy: past, present, and future? Semin Oncol 1996, 23:69–77.

    PubMed  CAS  Google Scholar 

  36. Johnson JT, Ferretti GA, Nethery WJ, et al.: Oral pilocarpine for post-irradiation xerostomia in patients with head and neck cancer? N Engl J Med 1993, 329:390–395.

    Article  PubMed  CAS  Google Scholar 

  37. Rieke JW, Hafermann MD, Johnson JT, et al.: Oral pilocarpine for radiation-induced xerostomia: integrated efficacy and safety results from two prospective randomized clinical trials? Int J Radiat Oncol Biol Phys 1995, 31:661–669.

    Article  PubMed  CAS  Google Scholar 

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Laramore, G.E., Coltrera, M.D. Organ preservation strategies in the treatment of laryngeal cancer. Curr. Treat. Options in Oncol. 4, 15–25 (2003). https://doi.org/10.1007/s11864-003-0028-5

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