1
Laryngology Seminar
Organ Preservation Therapy for Laryngeal Cancer
R3 黃俊棋 2005/07/13
1.

Introduction:
Anatomy: site & subsite
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Stage
Stage 0
Tis
N0
M0
Stage I
T1
N0
M0
Stage II
T2
N0
M0
Stage III
T3
N0
M0
T1-3
N1
M0
T4
N0-1
M0
Any T
N2
M0
Stage IVB
Any T
N3
M0
Stage IVC
Any T
Any N
M1
Stage IVA
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1866 Patrick Waltson (Edinberg): Total laryngectomy
1869 Solis-Cohen (New York): vertical partial laryngectomy
1874 Billroth (Germany): Hemilaryngectomy
1938 Huet (French): Supraglottic laryngectomy
1959 Majer & Reider (Australia): Supracricoid laryngectomy
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Department of Veterans Affairs Laryngeal Cancer Study Group (1991)
332 advanced (Stage III or IV) laryngeal SCC F/U 33 months, similar 2-year survival
rate (68%) between total laryngectomy then post-op R/T and induction C/T with at
least a partial response then R/T; 64% with larynx and 42% with functional larynx
2.
Definition: Treatment strategies maintain the physiology of speech and swallowing
without the need for permanent tracheostoma
2
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Medical organ preservation therapy
Radiation & Surgery for early laryngeal cancer (T1,T2): NCDB 1995
Stage
Management
I
Surgery
93
81
193
RT
90
73
678
surgery + RT
92
75
309
Surgery
82
57
70
RT
83
69
220
surgery + RT
87
70
75
II
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5y -survival%
Cases
NEJM 2003: 547 patients stage III or IV F/U 3.8years
Gr1: Induction CT + RT: local regional control 61%, laryngeal preservation 75%
Gr 2:CCRT: local regional control 78%, laryngeal preservation 88%
Gr3: RT alone=> local regional control 56%, laryngeal preservation 70%
Similar 2 and 5 years overall survival rate: 74-76% and 54-56 %
Surgical organ preservation therapy( Conservation laryngeal surgery)
Principle of surgical organ preservation
 local control: most important, only when resection of tumor can be
accomplished comfortably with local control rates approximating those of total
laryngectomy
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3.
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2y-survival%
predict extent of tumor: distinguish paraglottic space invasion caused fixed true
vocal fold from tumor involved cricoarytenoid joint
 cricoarytenoid unit: consist of arytenoid cartilage, cricoarytenoid joint, posterior
and lateral cricoarytenoid muscles, recurrent and superior laryngeal nerve
 eligibility for organ preservation surgery is base on extent of tumor, not T stage:
T2 to cricoid level---no; T4 invade thyroid cartilage---yes
Procedure
Endoscopic cordectomy
3
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carcinoma in situ or T1 without anterior commissure of glottis
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T1 glottic tumor: 142 cases, local control rate: 87.3%
laser salvage: 6 (4.2%), total laryngectomy:3 (2.1%), RT:9 (6.3%)
 T1 glottic carcinoma: 34 cases
local control rates 87.3% in laser therapy and 85.7% in radiotherapy
 141 stage I supraglottic cancer: 5-year survival rate 85%
Vertical partial laryngectomy(VPL)
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 T1 glottic cancer without anterior commissure involvement
 T1a 5-years local failure rate: 0%~11%
 T2 5-years local failure rate: 4~26%
 T3 5-years local failure rate: > 30%
Supraglottic laryngectomy ( SGL)
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T1 and T2 supraglottic cancer
4
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19% survivors experienced a second respiratory tract primary within 5 years
 T1 and T2 5-years local filure rate: 0-15%
Supracricoid laryngectomy (SCL)
Cricohyoidoepiglottopexy (CHEP)
cricohyoidopexy (CHP)
 selected T1b, T2, T3 and T4 laryngeal carcinoma and selected T1b and T2
radiation failures without subglottic extension (1mm)
 62 T1b, T2 laryngeal cancer 5-years local control rates: 98.2%
 112 T2, T3 laryngeal cancer 5-years local control rates: 94.6%
 overall local control rates: 66-100%
4.
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 23 T1/T2 recurrent irradiated glottic carcinoma 5-year local control rate: 66.6%
Did the preserved organ really have function?
Arch Otolaryngol Head And Neck Surg (1998)
Stage III or IV, surgery + RT: 25 patients, CT + RT: 21 patients, 10.4 years
5
HNQOL
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Arch Otolaryngol Head And Neck Surg (2004)
Stage III or IV, surgery + RT: 23 patients, CCRT: 19 patients, 15 months
5.
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Conclusion:
Selection of eligible patients for which procedures is an art
Balance between oncologic and functional outcome
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6.
Reference
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Tufano RP. Organ preservation surgery for laryngeal cancer. Otolaryngol Clin
North Am. 2002 Oct;35(5):1067-80.
The Department of Veterans Affairs Laryngeal Cancer Study Group. Induction
chemotherapy plus radiation compared with surgery plus radiation in patients
with advanced laryngeal cancer. N Engl J Med. 1991 Jun 13;324(24):1685-90.
Forastiere AA, et al. Concurrent chemotherapy and radiotherapy for organ
preservation in advanced laryngeal cancer. N Engl J Med. 2003 Nov
27;349(22):2091-8.
Close LG. Cancer of the larynx: new approaches for organ preservation. Curr
Surg. 2004 Sep-Oct;61(5):414-6.
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Moyer JS, et al. Current thoughts on the role of chemotherapy and radiation in
advanced head and neck cancer. Curr Opin Otolaryngol Head Neck Surg. 2004
Apr;12(2):82-7.
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Yeager LB, et al. Organ preservation surgery for intermediate size (T2 and T3)
laryngeal cancer. Otolaryngol Clin North Am. 2005 Feb;38(1):11-20, vii.
Koch WM. Head and neck surgery in the era of organ preservation therapy.
Semin Oncol. 2000 Aug;27(4 Suppl 8):5-12.
Makeieff M, et al. Supracricoid partial laryngectomies after failure of radiation
therapy. Laryngoscope. 2005 Feb;115(2):353-7.
Terrell JE, et al. Long-term quality of life after treatment of laryngeal cancer.
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The Veterans Affairs Laryngeal Cancer Study Group. Arch Otolaryngol Head
Neck Surg. 1998 Sep;124(9):964-71.
Hanna E, et al. Quality of life for patients following total laryngectomy vs
chemoradiation for laryngeal preservation. Arch Otolaryngol Head Neck Surg.
2004 Jul;130(7):875-9.
Commings otolaryngology H&N Surg 3th edition chapter 114-115