What is the price of functional surgical organ preservation in local-regionally advanced supraglottic cancer? Long-term outcome for partial laryngectomy followed by radiotherapy in 32 patients

Abstract

We confirmed literature data on the feasibility and efficacy of a surgical organ preservation strategy. However, the high incidence of severe late toxicity requires further studies to improve patient selection and to reduce side effects.

Management of primary T1–T4 glottic squamous cell carcinoma by transoral laser microsurgery

“…Although consensus is lacking, several studies have previously highlighted the morbidity of adjuvant RT following conservation laryngeal surgery . In these studies, severe laryngeal complications (including but not limited to severe laryngeal edema, severe chondritis, radionecrosis, laryngeal stenosis, esophageal stenosis, pneumonia secondary to aspiration, tracheostomy dependence, or gastrostomy tube dependence) were described in 17% (n = 90), 34% (n = 32), and at least 35% (n = 17) of treated patients . A dose‐dependent relationship has been described, as fewer complications have been reported for patients receiving not more than 50 Gy .…”

“…56,57 In these studies, severe laryngeal complications (including but not limited to severe laryngeal edema, severe chondritis, radionecrosis, laryngeal stenosis, esophageal stenosis, pneumonia secondary to aspiration, tracheostomy dependence, or gastrostomy tube dependence) were described in 17% (n 5 90), 34% (n 5 32), and at least 35% (n 5 17) of treated patients. [58][59][60] A dose-dependent relationship has been described, as fewer complications have been reported for patients receiving not more than 50 Gy. 57,58 Canis et al administered adjuvant RT for 10.7% (for N 1 disease) of patients with T3Nx glottic disease.…”

Open partial horizontal laryngectomy and adjuvant (chemo)radiotherapy for laryngeal squamous cell carcinoma: results from a multicenter Italian experience

“…In particular, Laccourreye et al reported a rate of permanent gastrostomy and tracheostomy of 16.6% and 1.1%, respectively, after a minimum follow-up of 10 years [17]. Alterio and coworkers [18] found late severe laryngeal toxicity in 34% of patients, although with laryngeal and function preservation obtained in 93% and 81%, respectively. Buglione et al [19] compared the outcomes of early supraglottic cancer treated by curative RT (N = 132) with those of a smaller group of 30 patients submitted to conservative surgery and postoperative RT, finding no difference in functional and oncologic outcomes.…”

The Effect of Arytenoidectomy on Functional and Oncologic Results of Supracricoid Partial Laryngectomy

“…However, laryngeal edema induced by RT narrows the airway in the early period, and the obstruction can become persistent due to fibrosis of the soft tissues, or immobility of the arytenoid caused by ancylosis of the cricoarytenoid joint, or cranial neuropathy. [20][21][22] The patients who received postoperative RT in the OASCPL group seemed to have the advantage of a larger laryngeal airway because their mean decannulation time (61 days) was shorter than that of the irradiated patients in the BASCL group. An airway problem encountered in some patients who undergo arytenoidectomy is that the mucosa of the aryepiglottic fold and pyriform sinus on the side of the arytenoidectomy becomes hypertrophic and prolapses into the neolarynx during inspiration.…”