Clinically staged T₃N₀M₀ laryngeal cancer: how is it best treated? Definitive radiotherapy with salvage surgery v/s combined surgery and radiotherapy

Abstract

Controversy surrounds the optimum treatment of T3N0 cancer larynx. Curative radiotherapy with salvage surgery in reserve is an accepted methodology as is also a combined protocol of surgery and radiotherapy. A retrospective analysis of the survival results of 119 cases of clinically staged T3N0 cancer larynx treated over a 14-year period at a single centre with either of the above two modalities has been undertaken. The selection of the treatment modality for an individual patient was decided jointly by the patient and the clinicians at a combined cancer clinic. The combined surgery plus radiotherapy treatment group was comprised of a relatively greater number of transglottic tumours while the curative radiotherapy group had a higher proportion of glottic tumours. Actuarial four-year disease-free survival rates were significantly better with combined treatment (79.3 per cent) than with radical radiotherapy and surgical salvage (65.3 per cent)--p value = 0.024. In the radical radiotherapy group, failure was almost always at the primary site and the probability of surviving with an intact larynx was approximately half of the total survival. As per this study, a policy of radical radiotherapy (with salvage surgery for failure) for unselected clinically staged T3N0 cancer larynx, does not provide for comparable cure rates or for satisfactory laryngeal preservation.

Survival Outcomes in T3 Laryngeal Cancers: Primary Total Laryngectomy vs. Concurrent Chemoradiation or Radiation Therapy—A Meta-Analysis

“…However, upon review, 35 of these articles were identified as duplicates already found through the initial database search. The remaining two articles met the eligibility criteria and were included in the meta-analysis, bringing the total number of articles to sixteen [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] (including the two additional articles and the fourteen from the database search). Among these sixteen articles, six had provided data for both CRT and RT alone: two out of six articles had provided separate data for TL, CRT, and RT alone [ 18 , 21 ], while in four out of six articles, separate data for CRT and RT alone were not available and were therefore classified as “non-surgical organ preservation method not specified” [ 19 , 22 , 24 , 27 ].…”

“…Among these sixteen articles, six had provided data for both CRT and RT alone: two out of six articles had provided separate data for TL, CRT, and RT alone [ 18 , 21 ], while in four out of six articles, separate data for CRT and RT alone were not available and were therefore classified as “non-surgical organ preservation method not specified” [ 19 , 22 , 24 , 27 ]. Finally, seven articles had provided separate data for TL and CRT [ 16 , 18 , 20 , 21 , 23 , 25 , 26 ], seven articles for TL and RT alone [ 12 , 13 , 14 , 15 , 17 , 18 , 21 ], and in four articles, TL was compared with unspecified non-surgical methods of organ preservation [ 19 , 22 , 24 , 27 ] ( Figure 1 ). Unfortunately, the information on tumour extension inside the larynx and the reasons for T3 classification were not available for subset analyses.…”

Complications of Total Laryngectomy

“…The overall incidence of postoperative wound infection after major head & neck surgery is 23% & this becomes higher in those patients who have received preoperative radiotherapy. 27 The most important aetiologic factor is Methicillin Resistant Staphylococcus aureus (MRSA). 28 Administration of prophylactic antibiotics reduces the risk of postoperative infection.…”

Efficacy of Photosence Mediated Photodynamic Therapy in HeLa Cell Lines

“…Hindrance of various mitochondrial proteins the most crucial one is cytochrome-c end up leaded through PDT From direct PDT conveyed on cell absence of existe Hypoxic tumor have been covered, as 1 O2 arrangement is lacking with the helpful valuable guide of the way of O2 accessibility. Diverse dosed of HeLa portable strains and a total thereof to look at adequacy with interceded (Karamzadeh et al, 2001;Gallo et al, 2001;Thakar et al, 2000;Ullah et al, 2021c). These training of most diseases are malignancy of tissues or pores and skin that covers our inward organs like gut, bosom, colon, lungs, and prostate tumors are known as carcinomas (Kreuzer et al, 2000;Hinerman et al, 2002;Lee et al, 2007).…”