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Lee MY, Belfiglio M, Zeng J, Fleming CW, Koyfman S, Joshi NP, Lamarre E, Prendes B, Scharpf J, Lorenz RR, Woody NM, Adelstein DJ, Geiger JL, Chute DJ, Ku JA. Primary Total Laryngectomy versus Organ Preservation for Locally Advanced T3/T4a Laryngeal Cancer. Laryngoscope 2022; 133:1122-1131. [PMID: 35754153 DOI: 10.1002/lary.30254] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/11/2022] [Accepted: 05/31/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Organ preservation (OP) treatment for advanced laryngeal cancer has increased compared to primary total laryngectomy. Our study compares oncologic and functional outcomes between these approaches. STUDY DESIGN Retrospective cohort study. SETTING Single tertiary care institution. METHODS Retrospective review of patients receiving primary total laryngectomy or OP for laryngeal cancer between 1/1/2000 and 12/31/2018. RESULTS A total of 118 patients received primary total laryngectomy and 119 received OP. Overall survival was similar between total laryngectomy and OP. When stratified by T stage, disease-free survival was worse among T3 patients receiving OP versus total laryngectomy. In T3 patients, 28 OP patients experienced local recurrence (28.9%) compared to 3 total laryngectomy patients (7.1%; p < 0.01). In total, 20 OP patients with local recurrence received salvage surgery. These patients had similar overall survival to patients who underwent initial total laryngectomy (TL). About 14 OP patients with local recurrence did not receive salvage surgery. About 89 (75.4%) TL patients achieved normal diet as compared to 64 (53.8%) OP patients (p < 0.001). In TL patients, 106 (89.8%) received primary or secondary tracheoesophageal-prosthesis, 82 (77.4%) of whom achieved completely understandable speech. CONCLUSIONS There was no difference in survival by treatment in T4 patients, possibly because of strict patient selection. However, disease-free survival was worse in T3 patients receiving OP, likely due to a high local recurrence rate. Approximately 40% of patients with local recurrence were not eligible for salvage laryngectomy. TL patients had comparable swallowing and speech outcomes with OP patients. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Maxwell Y Lee
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Mario Belfiglio
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Johnathan Zeng
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Christopher W Fleming
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Shlomo Koyfman
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Nikhil P Joshi
- Department of Radiation Oncology, Rush University Medical Center, Cleveland, Ohio, USA
| | - Eric Lamarre
- Head and Neck Cancer Program, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Brandon Prendes
- Head and Neck Cancer Program, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Joseph Scharpf
- Head and Neck Cancer Program, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Robert R Lorenz
- Head and Neck Cancer Program, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Neil M Woody
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - David J Adelstein
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Jessica L Geiger
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Deborah J Chute
- Department of Pathology, Cleveland Clinic Pathology and Laboratory Medicine Institute, Cleveland, Ohio, USA
| | - Jamie A Ku
- Head and Neck Cancer Program, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
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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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Raquel ACS, Buzaneli EP, Lima Silveira HS, Simões-Zenari M, Kulcsar MAV, Kowalski LP, Nemr K. Quality of life among total laryngectomized patients undergoing speech rehabilitation: correlation between several instruments. Clinics (Sao Paulo) 2020; 75:e2035. [PMID: 33206762 PMCID: PMC7603229 DOI: 10.6061/clinics/2020/e2035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of this study was to correlate several instruments currently used for the assessment of the quality of life of patients who underwent total laryngectomy and speech rehabilitation. METHODS A cross-sectional, observational study was conducted with 38 patients after total laryngectomy and speech therapy aiming to develop oesophageal speech. The patients were divided into the following two groups (19 participants each): speakers and non-speakers. The quality of life instruments used were as follows: visual analogue scale (VAS); Voice Handicap Index (VHI); Voice-Related Quality of Life (V-RQOL); Functional Assessment of Cancer Therapy - Head & Neck (FACT-H&N); European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck (EORTC QLQ-H&N35); and University of Washington Quality of Life (UW-QOL). RESULTS The V-RQOL global health domain exhibited a strong correlation with the VHI. The EORTC QLQ-C30 exhibited a moderate to strong correlation with the EORTC QLQ-H&N35 functional domain in both groups. The EORTC QLQ-C30 functional domain exhibited a strong to moderate correlation with all other instruments in both groups. The UW-QOL exhibited a moderate to strong correlation with the VHI and EORTC QLQ-C30 in both groups. CONCLUSION The EORTC QLQ-C30, EORTC QLQ-H&N35 and UW-QOL were the instruments that most correlated with the remaining instruments, indicating that any of the three can be used to assess the quality of life of the target population regardless of oesophageal voice development.
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Affiliation(s)
- Ana Carolina Soares Raquel
- Programa de pos-graduacao em Ciencias da reabilitacao, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Elaine Pires Buzaneli
- Programa de pos-graduacao em Ciencias da reabilitacao, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Hevely Saray Lima Silveira
- Programa de pos-graduacao em Ciencias da reabilitacao, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcia Simões-Zenari
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | | | - Luiz Paulo Kowalski
- Departamento de Cirurgia - Cirurgia de Cabeça e Pescoço, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Kátia Nemr
- Programa de pos-graduacao em Ciencias da reabilitacao, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
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