Systematic review on T3 laryngeal squamous cell carcinoma; still far from a consensus on the optimal organ preserving treatment

Riga, Maria; Chelis, Leonidas; Danielides, Vassilios; Vogiatzaki, Theodosia; Pantazis, Theodoros-Leonidas; Pantazis, D.

doi:10.1016/j.ejso.2016.05.030

Cited by 24 publications

(25 citation statements)

References 32 publications

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“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] In series with T1 midcord tumors the risk of local relapse is usually under 6%. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] In series with T1 midcord tumors the risk of local relapse is usually under 6%.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 For more advanced carcinomas, the best local control is achieved with open partial surgery, that otherwise is associated to important perioperative morbidity and mainly indicated in younger patients. 7 Many series have reported the outcomes of TLM in laryngeal cancer, pointing out some of the risks and complications of this type of surgery. [8][9][10] Between them, an increased risk of local relapse in intermediate and advanced cases, especially when compared to open approaches.…”

Section: Discussionmentioning

confidence: 99%

“…The local control after TLM for early laryngeal carcinoma is between 79% and 95%, depending on the area of the involved larynx and the T category of the tumor. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] In series with T1 midcord tumors the risk of local relapse is usually under 6%. 2 In other series that include early and advanced cases, with AC infiltration, the percentage of local relapse is increased up to 40%, 7 requiring in some cases a repeated surgery or other treatment approaches to cure the patient.…”

Section: Discussionmentioning

confidence: 99%

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Factors of local recurrence and organ preservation with transoral laser microsurgery in laryngeal carcinomas; CHAID decision‐tree analysis

et al. 2018

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Background Indications of transoral laser microsurgery (TLM) are conditioned by the risk of local relapse. Objective To evaluate prognostic factors of local relapse and local control with TLM (LC‐TLM). Methods Local relapse and LC‐TLM were evaluated in 1119 patients. Logistic regression and CHAID decision tree analysis were performed. Results Local relapse correlated to previous radiotherapy failure (8.45, CI 95%: 2.64‐27.03; P < .001), paraglottic involvement (2.42, CI: 1.41‐4.15; P = .001), anterior commissure involvement (2.12, CI: 1.43‐3.14; P < .001), grade of differentiation (1.74, CI: 1.18‐2.57; P = .005), and alcohol consumption (1.4, CI: 0.99‐1.98; P = .057). Local relapse tended to inversely correlate with experience (0.73, CI: 0.51‐1.03; P = .078). The most important factors for local relapse were previous radiotherapy failure and anterior commissure involvement. LC‐TLM inversely correlated with previous radiotherapy failure (0.09, CI: 0.03‐0.28; P < .001), paraglottic involvement (0.25, CI: 0.14‐0.43; P < .001), anterior commissure involvement (0.49, CI: 0.32‐0.77; P = .007), margins (0.56, CI: 0.30‐1.04; P = .068), and differentiation (0.68, CI: 0.44‐1.05; P = .087). LC‐TLM correlated with experience (1.71, CI: 1.13‐2.55; P = .010). The most important factors for LC‐TLM were previous radiotherapy failure and paraglottic involvement. Conclusion Previous radiotherapy failure is the most important factor for local relapse and LC‐TLM. In primary treatments, anterior commissure involvement and paraglottic involvement are the most important factors for local relapse and LC‐TLM, respectively.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Factors of local recurrence and organ preservation with transoral laser microsurgery in laryngeal carcinomas; CHAID decision‐tree analysis

et al. 2018

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“…Apart from its toxicity (different from the surgical one but not less dangerous in terms of potentially fatal complications and sequelae) [42,43], its application and success must rely on strict cooperation between different professional figures like surgeons (for diagnostic work-up, management of airway issues, and follow-up), radiation and medical oncologists, dieticians, and speech pathologists. However, even in the best MDT approach to CRT, it should always be made clear to the patient that such an organ preservation treatment sacrifices at least 20% of oncological outcome in the face of a higher chance of OP (at least compared to upfront TL) [44,45,46]. Moreover, in such a trade-off, it should always be quite clear to the MDT, as well as to the patient, that in case of oncological and/or functional failure, salvage surgery is still feasible but rarely by something less than TL [47,48,49,50,51].…”

Section: Discussionmentioning

confidence: 99%

A Multidisciplinary Team Guided Approach to the Management of cT3 Laryngeal Cancer: A Retrospective Analysis of 104 Cases

Marchi

Filauro

Missale

et al. 2019

Cancers

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The optimal treatment for T3 laryngeal carcinoma (LC) is still a matter of debate. Different therapeutic options are available: Transoral laser microsurgery (TLM), open partial horizontal laryngectomies (OPHLs), total laryngectomy (TL), and organ preservation protocols (radiation therapy (RT) or chemo-radiation (CRT)). This study aimed to retrospectively evaluate oncologic outcomes of 104 T3 LCs treated by surgery or non-surgical approaches from January 2011 to December 2016 at a single academic tertiary referral center. Each case was evaluated by a multidisciplinary team (MDT) devoted to the management of head and neck cancers. We divided the cohort into two subgroups: Group A, surgical treatment (TLM, OPHLs, TL) and Group B, non-surgical treatment (RT, CRT). For the entire cohort, two- and five-year overall survival (OS) rates were 83% and 56%, respectively. The two- and five-year disease-free survival (DFS) rates were 75% and 65%, and disease-specific survival rates were 93% and 70%, respectively. The N category was a significant independent prognosticator for OS (p = 0.02), whereas Group B was significantly and independently associated with DFS (HR 4.10, p = 0.006). Analyzing laryngo-esophageal dysfunction-free survival as an outcome, it was found that this was significantly lower in higher N categories (p = 0.04) and in cases that underwent non-surgical treatments (p = 0.002). Optimization of oncologic outcomes in T3 LCs may be obtained only by a comprehensive MDT approach, considering that different treatment options have heterogenous toxicity profiles and indications.

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“…Nonetheless, functional outcomes in terms of quality of life, residual voice, and swallowing may be significantly different. However, prospective studies comparing different treatment strategies are still lacking and difficult to implement in the near future [1,2,3].…”

Section: Introductionmentioning

confidence: 99%

Open Partial Horizontal Laryngectomies for T3–T4 Laryngeal Cancer: Prognostic Impact of Anterior vs. Posterior Laryngeal Compartmentalization

Bon

Piazza

Lancini

et al. 2019

Cancers

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Open partial horizontal laryngectomies (OPHLs) are well-established and oncologically safe procedures for intermediate–advanced laryngeal cancers (LC). T–N categories are well-known prognosticators: herein we tested if “anterior” vs. “posterior” tumor location (as defined in respect to the paraglottic space divided according to a plane passing through the arytenoid vocal process, perpendicular to the ipsilateral thyroid lamina) may represent an additional prognostic factor. We analyzed a retrospective cohort of 85 T3–4a glottic LCs, treated by Type II or III OPHL (according to the European Laryngological Society classification) from 2005 to 2017 at two academic institutions. Five-year overall survival (OS), disease-specific survivals (DSS), and recurrence-free survivals (RFS) were compared according to tumor location and pT category. Anterior and posterior tumors were 43.5% and 56.5%, respectively, 78.8% of lesions were T3 and 21.2% were T4a. Five-year OS, DSS, and RFS for T3 were 74.1%, 80.5%, and 63.4%, respectively, and for T4a 71.8%, 71.8%, and 43%, respectively (p not significant). In relation to tumor location, the survival outcomes were 91%, 94.1%, and 72.6%, respectively, for anterior tumors, and 60.3%, 66.3%, and 49.1%, respectively, for posterior lesions (statistically significant differences). These data provide evidence that laryngeal compartmentalization is a valid prognosticator, even more powerful than the pT category.

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Systematic review on T3 laryngeal squamous cell carcinoma; still far from a consensus on the optimal organ preserving treatment

Cited by 24 publications

References 32 publications

Factors of local recurrence and organ preservation with transoral laser microsurgery in laryngeal carcinomas; CHAID decision‐tree analysis

Factors of local recurrence and organ preservation with transoral laser microsurgery in laryngeal carcinomas; CHAID decision‐tree analysis

A Multidisciplinary Team Guided Approach to the Management of cT3 Laryngeal Cancer: A Retrospective Analysis of 104 Cases

Open Partial Horizontal Laryngectomies for T3–T4 Laryngeal Cancer: Prognostic Impact of Anterior vs. Posterior Laryngeal Compartmentalization

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