Conservative Surgery in T3–T4 Pharyngolaryngeal Squamous Cell Carcinoma: An Alternative to Radiation Therapy and to Total Laryngectomy for Good Responders to Induction Chemotherapy

Abstract

Objective: To evaluate the possibility of preservation of the larynx after neoadjuvant chemotherapy by performing a conservative surgery instead of total laryngectomy initially planned, in patients with previously untreated laryngeal and piriform sinus squamous cell carcinoma (SCC). Study Design: Retrospective study. Methods: A total of 115 patients treated at Tenon Hospital with induction chemotherapy from 1985 to 1995, all with initial indication of radical surgery, were available for the study. The clinical tumor response was evaluated after three cycles of chemotherapy. According to this response, to preserve laryngeal functions, some patients had a modification of the treatment initially planned: radiation therapy essentially for complete responders, and conservative surgery for some partial responders. Results: Of 69 patients with laryngeal cancer, 14 were treated by partial laryngectomy and 19 by radiation therapy; of 46 patients with piriform sinus cancer, 8 were treated by partial surgery and 12 by radiation therapy; the other patients were treated as was initially planned (total laryngectomy with partial pharyngectomy). Overall survival rates, estimated by the Kaplan-Meier method, were not statistically different between the three treatment groups. The laryngeal functions were preserved in 54% of the patients who were alive at 3 years. Conclusion: This report is a retrospective study, but these results suggest the possibility of using conservative surgery, instead of initially planned total laryngectomy, for good responders to induction chemotherapy with a small residual tumor.

Organ Preserving Transoral Laser Microsurgery for Cancer of the Hypopharynx

“…Beauvillain et al 12 observed 5‐year overall survival and 5‐year local control rates of 19% and 39% after chemotherapy followed by definitive radiotherapy. In a group of 34 patients, Urba et al reported a 35% rate for 3‐year overall survival, 13 a result that is similar to the 32% rate for 3‐year overall survival reported by Lecanu et al 14 Organ preservation rates have been similarly discouraging 12–14 …”

Local Control After Supracricoid Partial Laryngectomy for "Advanced" Endolaryngeal Squamous Cell Carcinoma Classified as T3

“…Furthermore, one must note that our main results, namely, a 91.4% 5-year actuarial local control estimate and an 89.8% overall laryngeal preservation rate, compare favorably with the overall 64% laryngeal preservation rate reported when induction chemotherapy and radiotherapy were used 6 and the 84% overall laryngeal preservation rate recently reported when a concurrent chemotherapy and radiotherapy protocol was used 7 in patients with advanced-stage squamous cell carcinoma of the larynx. From this perspective and from the results achieved in the current series, it appears clear to us and others [22][23][24] that (1) the response to induction chemotherapy regimen should be used for modification of the therapeutic strategy for pharyngolaryngeal carcinomas and (2) SCPL should be now completely integrated in the organ preservation strategies used worldwide in patients with advanced endolaryngeal invasive squamous cell carcinoma classified as T3.…”

Carcinoma of the supraglottic larynx: Treatment results with radiotherapy alone or with planned neck dissection

“…Varying opinions exist in the literature regarding the optimal treatment of supraglottic carcinoma 4, 6, 7, 14, 16, 19–22, 24, 26, 27, 36, 39, 57–60. Because there are no randomized data comparing radiotherapy with conservation surgery for early, “favorable” tumors, it is necessary to examine nonrandomized data.…”