Supracricoid partial laryngectomy as salvage surgery for radiation therapy failure

Abstract

Background. The main concern in the treatment of laryngeal carcinomas is tumor control with preservation of laryngeal functions. We believe that salvage supracricoid partial laryngectomy (SPL) should be carefully considered in selected cases of radiotherapy failure, because it can offer the possibility of achieving adequate tumor control with preservation of laryngeal functions.Methods. A series of 31 patients who underwent an SPL as salvage procedure after radiotherapy failure was reviewed.Results. Locoregional control rate was 75%, with 60% 5-year overall survival; no patients were lost to follow-up, and a death-from-disease rate of 19.35% was recorded. Restoration of laryngeal functions was achieved in 89.29% of the patients. No statistically significant differences were found in locoregional control regarding anterior commissure involvement, elective neck dissection versus wait-and-see policy, pathologic positive neck disease, and restage I-II versus restage III-IV.Conclusion. The oncologic and functional results indicate the consistency of salvage SPL, proposing this type of operation as a serious alternative to total laryngectomy in carefully selected cases. Keywords: partial laryngectomy; salvage surgery; larynx carcinoma; radiation failure; neck dissectionThe main concern in the treatment of laryngeal carcinomas is tumor control with preservation of whole laryngeal functions.Early laryngeal cancer can be effectively treated either by larynx preserving surgery or with external beam radiation therapy; results in terms of tumor control and preservation of function for both modalities are satisfactory with reported rates of recurrence or persistence of tumor varying from 10% to 35%.

Elective neck dissection during salvage laryngectomy: A systematic review and meta‐analysis

“…Despite contacting and receiving replies from most of the authors, multiple studies did not have the individual data points required to calculate OS and DFS for meta‐analysis. As a result, only three studies (including 103 elective necks and 52 observed) were used for the meta‐analysis for OS . Meaningful DFS could not be calculated due to insufficient data.…”

“…The available data were limited, heterogeneous, and inconsistently reported, but these patients did tend to die from their disease recurrence and could not be salvaged. Of the four included studies with these data, only one of 14 patients with a regional recurrence after an observed neck had long‐term survival (5‐year OS = 7%) . Other included studies showed equivalent rates of regional recurrence between END and observed necks, or even greater rates in END patients, without report of their survival …”

Salvage Conservation Laryngeal Surgery After Radiation Therapy Failure

“…22 Laryngeal preservation rates for SCPL in the salvage setting have been shown to be around 90%. 23 TLM is well established in the primary management of early-stage larynx cancer. 24 The 5-year disease-free survival rate in early-stage glottic cancer treated primarily by TLM is 81% to 93%.…”

Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

“…Previous reports indicate an incidence of 10-28 per cent occult neck metastasis in persistent and recurrent laryngeal disease after primary RT. [6][7][8][9] Accurate restaging with scrupulous reassessment of the nodal status cannot completely rule out the presence of occult neck disease. [10][11][12] Small nodal metastases are still a diagnostic challenge despite continuing improvements in imaging techniques.…”