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Iwai M, Ando S, Sato K. The process of reacquiring new vocalization in total laryngectomy patients with head and neck cancer: A qualitative study. Asia Pac J Oncol Nurs 2024; 11:100362. [PMID: 38433771 PMCID: PMC10904916 DOI: 10.1016/j.apjon.2023.100362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/03/2023] [Indexed: 03/05/2024] Open
Abstract
Objective Speech rehabilitation significantly contributes to the enhanced quality of life for patients who have undergone laryngectomy due to head and neck cancer. The initiation of tracheoesophageal speech early in the rehabilitation process has been associated with improved speech quality. Despite this, voice changes can carry a stigma due to communication challenges, even after successful voice restoration, potentially limiting the overall improvement in quality of life. Thus, our aim was to gain a profound understanding of the transition process from the selection to the adaptation of tracheoesophageal speech in patients with head and neck cancer. Methods Participants, who had undergone laryngectomy for head and neck cancer, were recruited from peer support groups in Japan, resulting in the identification of thirteen tracheoesophageal speakers. The data were analyzed using grounded theory methodology, incorporating open, axial, and selective coding. Semi-structured interviews delved into tracheoesophageal speakers' perceptions of their voices and the adaptive strategies employed for their preferred alternative communication methods. Results During the adaptation process, participants underscored the importance of communicating with their own voices. However, they also experienced anxiety about losing their natural voice, confronted the reality of living without a voice, and coped with their new voice. Eventually, participants came to recognize the changed voice as their own. Conclusions The personal conviction associated with the notion of "communicating with one's own voice" is integral to the adaptation process for patients with head and neck cancer who undergo laryngectomies and utilize tracheoesophageal speech. Some aspects of tracheoesophageal speech can evoke feelings of hopelessness, emphasizing the importance of comprehensive support for professional speech rehabilitation.
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Affiliation(s)
- Miyoko Iwai
- Nursing for Advanced Practice, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya City, Aichi, Japan
| | - Shoko Ando
- Department of Nursing, Ichinomiya Kenshin College, Ichinomiya City, Aichi, Japan
| | - Kazuki Sato
- Nursing for Advanced Practice, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya City, Aichi, Japan
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List MA, Knackstedt M, Liu L, Kasabali A, Mansour J, Pang J, Asarkar AA, Nathan C. Enhanced recovery after surgery, current, and future considerations in head and neck cancer. Laryngoscope Investig Otolaryngol 2023; 8:1240-1256. [PMID: 37899849 PMCID: PMC10601592 DOI: 10.1002/lio2.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/15/2022] [Indexed: 10/31/2023] Open
Abstract
Objectives Review of the current and relevant literature to develop a list of evidence-based recommendations that can be implemented in head and neck surgical practices. To provide rationale for the multiple aspects of comprehensive care for head and neck surgical patients. To improve postsurgical outcomes for head and neck surgical patients. Methods Extensive review of the medical literature was performed and relevant studies in both the head and neck surgery and other surgical specialties were considered for inclusion. Results A total of 18 aspects of perioperative care were included in this review. The literature search included 276 publications considered to be the most relevant and up to date evidence. Each topic is concluded with recommendation grade and quality of evidence for the recommendation. Conclusion Since it's conception, enhanced recovery after surgery (ERAS) protocols have continued to push for comprehensive and evidence based postsurgical care to improve patient outcomes. Head and neck oncology is one of the newest fields to develop a protocol. Due to the complexity of this patient population and their postsurgical needs, a multidisciplinary approach is needed to facilitate recovery while minimizing complications. Current and future advances in head and neck cancer research will serve to strengthen and add new principles to a comprehensive ERAS protocol. Level of Evidence 2a.
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Affiliation(s)
- Marna A. List
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Mark Knackstedt
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Lucy Liu
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Ahmad Kasabali
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
- College of MedicineLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Jobran Mansour
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - John Pang
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Ameya A. Asarkar
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
- Feist‐Weiller Cancer CenterShreveportLouisianaUSA
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Gomes MIB, Duarte NMDFB, Aguiar PMV. Informação Clínica e sua Relação com a Qualidade de Vida em Pacientes com Câncer de Cabeça e Pescoço. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n2.1936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introdução: O tratamento do câncer de cabeça e pescoço tem grande impacto na qualidade de vida dos pacientes pelas sequelas físicas, psicológicas, estéticas, sociais e emocionais. A informação prestada pelos profissionais de saúde no continuum do processo clinico desses pacientes e tida como um fator-chave dos cuidados de saúde de qualidade e com múltiplos benefícios na sua qualidade de vida. Objetivo: Averiguar a percepção dos pacientes com câncer de cabeça e pescoço relativamente a informação prestada e a existência de correlação com a sua qualidade de vida. Método: Estudo transversal com amostra de 38 pacientes com câncer de cabeça e pescoço, selecionados por conveniência de amostra potencial de 347 pacientes. Recorreram-se aos questionários EORTC QLQ-C30 e EORTC QLQ-INFO25, aplicados dois a quatro meses após o termino das terapias oncológicas. Todos os cálculos foram efetuados com recurso ao SPSS, versão 24, utilizando-se a estatística descritiva para caracterização da amostra e testes não paramétricos para avaliar a possível correlação entre as variáveis em estudo. Resultados: A percepção dos pacientes, relativa a informação prestada e a sua qualidade de vida, e razoável, existindo correlação entre ambas. Conclusão: Os dados obtidos vão ao encontro dos referidos na literatura, podendo-se aferir que a informação prestada pelos profissionais de saúde e importante para a qualidade de vida dos pacientes. O conhecimento das necessidades informativas permite adequar as estratégias dos profissionais de saúde no sentido de uma melhor prestação de cuidados de saúde e, consequentemente, da qualidade de vida dos pacientes.
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Turkdogan S, Roy CF, Chartier G, Payne R, Mlynarek A, Forest VI, Hier M. Effect of Perioperative Patient Education via Animated Videos in Patients Undergoing Head and Neck Surgery: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2022; 148:173-179. [PMID: 34967863 PMCID: PMC8719273 DOI: 10.1001/jamaoto.2021.3765] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Patient education and engagement is a pivotal component of surgical recovery. Ensuring proper patient education involves a thorough understanding of one's diagnosis and recovery plan, while reducing language and learning barriers to help patients make informed decisions and improve their hospital experience. Objective To assess whether using an animated surgical guide will help patients who are undergoing head and neck surgery feel more satisfied with their surgery and recovery process. Design, Setting, and Participants A randomized clinical trial was conducted between January and August 2020 at a single tertiary care academic center in Montreal, Canada. A consecutive sample of individuals who were undergoing any of the following surgical procedures was recruited: head and neck cancer resection with or without reconstruction, parotidectomy, thyroidectomy, parathyroidectomy, laryngectomy, or transoral robotic resection. The treating team was masked to group allocation, while study participants in the nonintervention group were unaware of the multimedia platform to avoid introducing bias in their survey responses. Interventions Patients were randomly allocated to either the treatment arm, in which they obtained access to a multimedia patient education platform, or the control arm, in which they received traditional patient education methods via clinical visits. Main Outcomes and Measures Primary analysis compared patient satisfaction scores on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire INFO 25, a validated questionnaire on the perceived quality of information received by patients with cancer (possible scores ranging from 20 to 80). Results A total of 100 patients (50 in each arm; 63 women [63%]; 6 African American [6%, 12 Hispanic/Latino [12%], 11 Middle Eastern [11%], and 78 White [78%] individuals) completed the preintervention and postintervention questionnaires. In those who received access to the patient education platform, there was an 11.3-point (Cohen d = 1.02; control group score, 61.1 of 80; treatment group score, 72.4 of 80) difference of greater postoperative satisfaction scores at 1 month. While both groups felt that they received an adequate amount of information concerning their disease process, patients in the treatment arm had significantly better satisfaction with information concerning their medical tests, treatments, and other services. Conclusions and Relevance This randomized clinical trial of patients undergoing head and neck cancer treatment demonstrates that multimedia patient education platforms may enhance current traditional methods, providing complementary information on patients' treatment plans and recovery process, mental health, family life, and supplementary services. Further research is currently underway to confirm whether this platform will lead to decreased hospital stay, shorter complication rates, and long-term effects. Trial Registration ClinicalTrials.gov Identifier: NCT04048538.
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Affiliation(s)
- Sena Turkdogan
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Centre, Montreal, Québec, Canada
| | - Catherine F. Roy
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Centre, Montreal, Québec, Canada
| | - Gabrielle Chartier
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Centre, Montreal, Québec, Canada,Department of Nursing, Jewish General Hospital, Montreal, Québec, Canada
| | - Richard Payne
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Centre, Montreal, Québec, Canada,Department of Otolaryngology Head & Neck Surgery, Jewish General Hospital, Montreal, Québec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology Head & Neck Surgery, Jewish General Hospital, Montreal, Québec, Canada
| | | | - Michael Hier
- Department of Otolaryngology Head & Neck Surgery, Jewish General Hospital, Montreal, Québec, Canada
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Queirós SMM, Pinto IES, de Brito MAC, Santos CSVDB. Nursing interventions for the promotion of tracheostomy self-care: A scoping review. J Clin Nurs 2021; 30:3055-3071. [PMID: 34101275 DOI: 10.1111/jocn.15823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To map nursing interventions, their characteristics, and outcomes, in promoting self-care of the person with a tracheostomy. BACKGROUND The development of competencies in self-care of a person with a tracheostomy is recognised as one of the most significant nursing intervention areas for the promotion of autonomy, prevention of complications and adaptation. Identifying nursing interventions for the promotion of self-care of the person with a tracheostomy enables enhanced clinical practice knowledge within different care contexts and the identification of gaps in the available evidence. DESIGN The Joanna Briggs Institute (JBI) methodology was used to perform this scoping review. METHOD A search was conducted on the CINAHL, Scopus, Web of Science, PubMed, JBI Database of Systematic Reviews and Implementation Reports, and Cochrane Database of Systematic Reviews. The search for grey literature included Portugal´s Open Access Scientific Repository, OpenGrey, and ProQuest Dissertations and Theses. Studies published in Portuguese, English, Spanish and French were included. The PRISMA-ScR checklist was used. RESULTS From a total of 4,224 identified articles, 31 were included in this review. Multiple nursing interventions were identified and grouped into four types of action: informing, managing, determining and attending. Although most interventions are implemented with the face-to-face method, there is a growing interest in using technologies for this purpose. The dose is the characteristic most poorly described in interventions. Various results were obtained; however, valid assessment tools were not always used. CONCLUSIONS Designing and testing intervention programmes for the promotion of self-care of the person with a tracheostomy is necessary, based on available and robust evidence to guide clinical practice. RELEVANCE TO CLINICAL PRACTICE This review allowed to systematise nursing interventions to promote self-care of the person with a tracheostomy. The use of combined interventions and methodologies is likely to be more effective in care delivery.
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Affiliation(s)
- Sílvia Maria Moreira Queirós
- Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal.,Hospital Epidemiology Center, Centro Hospitalar Universitário de S. João, Porto, Portugal
| | - Igor Emanuel Soares Pinto
- Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal.,Surgery Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Portugal.,Nursing School of Porto, Porto, Portugal
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Bozec A, Boscagli M, Serris M, Chamorey E, Dassonville O, Poissonnet G, Culié D, Scheller B, Benezery K, Gal J. Long-term functional and quality of life outcomes in laryngectomized patients after successful voice restoration using tracheoesophageal prostheses. Surg Oncol 2021; 38:101580. [PMID: 33862577 DOI: 10.1016/j.suronc.2021.101580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess long-term functional and quality of life (QoL) outcomes and their predictive factors in laryngectomized patients after successful voice restoration using tracheoesophageal prostheses (TEP). METHODS This cross-sectional study was conducted in alive and disease-free patients at least 1 year after total laryngectomy ± partial pharyngectomy. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) Core (QLQ-C30) and Head and Neck Cancer (QLQ-H&N35) QoL questionnaires, the Voice Handicap Index (VHI-10) questionnaire and the Hospital Anxiety and Depression Scale (HADS). The level of dysphagia was evaluated using the Dysphagia Handicap Index (DHI) and the Dysphagia Outcomes and Severity Scale (DOSS). Predictive factors of these clinical outcomes were determined in univariate and multivariate analysis. RESULTS A total of 48 patients were included in this study. Long-term QoL and functioning scales scores were all superior to 70%. Main persistent symptoms were fatigue, dyspnea, senses, speech and coughing problems. A DOSS score ≥6, indicating normal/subnormal swallowing function, and a VHI-10 score ≤20, representing light to medium voice disorders, were found in at least 75% of patients. An anxiodepressive disorder (HADS global score ≥ 15) was reported by 15 (31%) patients and represented the main predictor of QoL and voice outcomes. A strong correlation was found between VHI-10 and global QoL scores. CONCLUSIONS After successful voice restoration, laryngectomized patients achieved satisfactory QoL and functional outcomes. Psychological distress was the main determinant of long-term QoL and is therefore of critical importance in the multidisciplinary management of laryngectomized patients.
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Affiliation(s)
- Alexandre Bozec
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France.
| | - Maxime Boscagli
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Marilou Serris
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Emmanuel Chamorey
- Department of Statistics, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Olivier Dassonville
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Gilles Poissonnet
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Dorian Culié
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Boris Scheller
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Jocelyn Gal
- Department of Statistics, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
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7
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Steinau P, Walter S, Hübner J, Büntzel J. [Subjective significance of olfactory dysfunction after laryngectomy : Let's ask our patients]. HNO 2020; 69:878-885. [PMID: 33052423 DOI: 10.1007/s00106-020-00956-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Laryngectomy is usually associated with olfactory dysfunction. How do laryngectomees personally experience and feel about this change? MATERIALS AND METHODS In cooperation with the Bundesverband der Kehlkopfoperierten (German Association of Throat Cancer Patients) and together with laryngectomized patients, a new questionnaire was created and distributed via the regional offices according to the population sizes of the federal states (n = 293) for the first time in spring 2018. The questionnaire covers patient characteristics and daily life without a larynx, as well as the specific areas of smell and taste, albeit without differentiation between ortho- and retronasal olfaction. The items were designed to be answered using patient-friendly visual rating scales, multiple-choice answers, and free text. RESULTS Return rate was 198/293 (67.6%). Median age of all participants was 69 years (48-88). Overall life situation was rated by 99/198 (50%) participants as "good" or "very good." The primary subjective impairment for the patients was loss of voice (137/198, 69.1%) and loss of olfaction (113/198, 59.1%). Adaption to life without a larynx has been completed within a maximum of 3 years for 161/198 (81.3%) patients. Principally, 127/198 (64.1%) affirmed being able to smell and 176 of 198 (88.9%) being able to taste; however, only 29/198 (14.6%) rated their sense of smell and 109/198 (55.1%) their sense of taste as "good" or "very good." Most frequently detected smell sensations were perfume (141), smoke (126), and feces (99). Univariate analysis showed a significant (p < 0.05) correlation between adaptation time <1 year and current subjective smell and taste. CONCLUSION Subjective loss of smell and taste after laryngectomy is a daily problem for patients in Germany, which should be focused on promptly and included in early rehabilitation strategies.
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Affiliation(s)
- P Steinau
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland
| | - S Walter
- Bundesverband der Kehlkopfoperierten e. V., Bonn, Deutschland
| | - J Hübner
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland
| | - J Büntzel
- Klinik für HNO-Erkrankungen, Kopf-Hals-Chirurgie, Südharz-Klinikum Nordhausen, Dr.-Robert-Koch-Str. 39, 99734, Nordhausen, Deutschland.
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Wulff NB, Højager A, Wessel I, Dalton SO, Homøe P. Health-Related Quality of Life Following Total Laryngectomy: A Systematic Review. Laryngoscope 2020; 131:820-831. [PMID: 32866284 DOI: 10.1002/lary.29027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/13/2020] [Accepted: 07/25/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Treatment of advanced laryngeal and hypopharyngeal cancer has shifted from total laryngectomy (TL) toward laryngeal-preserving therapies due to a general perception that TL has a significantly negative impact on the individual's life. However, whether the physical impairments related to TL translate to a reduced health-related quality of life (HRQoL) has not yet been determined. Therefore, the objective of this systematic review was to determine how HRQoL is affected following TL. METHODS Systematic searches were conducted in PubMed, Embase, and Cochrane. Inclusion criteria were original studies describing quality of life following TL after larynx/hypopharynx cancer using a formally developed patient-reported questionnaire. Study quality assessment was carried out with the tool developed by the National Heart, Lung, and Blood Institute. RESULTS Forty-six studies using 12 different questionnaires were included. The majority were cross-sectional (85%), and study quality was rated poor in 30%, fair in 30%, and good in 39% of studies. When comparing results from the four most frequently used questionnaires with normative data, we found that in more than 60% of studies, differences to the reference population were of clinical importance, with only few exceptions. CONCLUSIONS In general, we found that people who received TL have a worse HRQoL than the male normative reference population. However, even though TL patients experience a clinically important difference in many domains when compared with normative data, their burden of symptoms is generally mild. The current review also makes it evident that despite the relatively large number of studies conducted, the strength of evidence remains weak. Laryngoscope, 131:820-831, 2021.
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Affiliation(s)
- Nille B Wulff
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Anna Højager
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne O Dalton
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Bozec A, Culié D, Poissonnet G, Dassonville O. Current Role of Total Laryngectomy in the Era of Organ Preservation. Cancers (Basel) 2020; 12:cancers12030584. [PMID: 32138168 PMCID: PMC7139381 DOI: 10.3390/cancers12030584] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 01/02/2023] Open
Abstract
In this article, we aimed to discuss the role of total laryngectomy (TL) in the management of patients with larynx cancer (LC) in the era of organ preservation. Before the 1990s, TL followed by radiotherapy (RT) was the standard treatment for patients with locally advanced LC. Over the last 30 years, various types of larynx preservation (LP) programs associating induction or concurrent chemotherapy (CT) with RT have been developed, with the aim of treating locally advanced LC patients while preserving the larynx and its functions. Overall, more than two-thirds of patients included in a LP program will not require total laryngectomy (TL) and will preserve a functional larynx. However, despite these advances, the larynx is the only tumor site in the upper aero-digestive tract for which prognosis has not improved during recent decades. Indeed, none of these LP protocols have shown any survival advantage compared to primary radical surgery, and it appears that certain LC patients do not benefit from an LP program. This is the case for patients with T4a LC (extra-laryngeal tumor extension through the thyroid cartilage) or with poor pretreatment laryngeal function and for whom primary TL is still the preferred therapeutic option. Moreover, TL is the standard salvage therapy for patients with recurrent tumor after an LP protocol.
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Affiliation(s)
- Alexandre Bozec
- Correspondence: ; Tel.: +0033-4-92-03-17-66; Fax: +0033-4-92-03-17-64
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