Outcome of multidisciplinary treatment in laryngeal cancer. Retrospective study with 10-years follow-up

Background

In laryngeal cancer, multidisciplinary treatment improves the patient's quality of life and the possibility of preserving the larynx. Most cases occur in a locally advanced stage. The aim is to present the results according to the stage.

Method

A retrospective study which analyzed the clinical stage, type of primary treatment, outcomes, and survival were analyzed.

Results

451 patients were included. The median age was 66 years. The majority of the tumors presented in advanced stage (72%) and the most affected subsite was the glottis (84.5%). In the early stage the most frequent treatment was radiotherapy as the only treatment modality. In stages III and IVA, 65% were resectable. In stage IVB the management was non-surgical, with control in 26% of the cases. Survival at 10 years was related to the clinical stage: 81.7% for stage I and 0% for stages IVB and IVC.

Conclusions

Patients with laryngeal cancer should be treated according to the clinical stage, through a multidisciplinary approach. Long-term follow-up showed a worse prognosis for advanced clinical stages.

[Evaluación funcional de deglución-aspiración en pacientes sometidos a laringectomía subtotal supracricoidea con cricohioidoepiglotopexia]

Introduction

Cardiovascular disease is the main cause of mortality worldwide. In women, its incidence increases at the sixth decade of life, coinciding with postmenopause. Whether this effect is due to menopause-related hormonal changes is not known.

Objective

To evaluate the differences in cardiovascular risk in pre- and postmenopausal women by means of the Globorisk risk scale, the triglyceride/high-density lipoproteinsHDL cholesterol (Tg/HDL-C) ratio and metabolic syndrome (MS) criteria.

Method

Cross-sectional study that included 408 women from 40 to 60 years of age; anthropometric measurements and biochemical determinations were performed. The participants were classified as premenopausal and postmenopausal. Cardiovascular risk was assessed using the MS criteria, the Globorisk risk calculator and the Tg/HDL-C ratio.

Results

Postmenopausal women showed a significant increase in waist circumference, total cholesterol and triglycerides Tg in comparison with premenopausal women. Significant associations were found between hormonal state and Globorisk-measured cardiovascular risk (OR = 2.50; 95 % CI = 1.67-3.74) and the Tgtriglyceride/HDL-C ratio (OR = 1.66; 95 % CI = 1.09-2.52).

Conclusion

Cardiovascular risk factors have a higher prevalence in postmenopause. The Globorisk scale and Tg/HDL-C ratio identify cardiovascular risk in postmenopausal women.

Rehabilitation of the laryngectomised patient. Recommendations of the Spanish Society of Otolaryngology and Head and Neck Surgery

Total laryngectomy remains essential treatment for locally advanced laryngeal carcinoma, related to better survival rates. However, it involves changes for the patient, such as the inability to communicate verbally, breathing or aesthetic changes, which affect their quality of life and require comprehensive rehabilitation. This paper was written by the total laryngectomy rehabilitation workgroup of the National Head and Neck and Skull Base working committee of the Spanish Society of Otolaryngology and Head and Neck Surgery. The purpose of the article is to combine materials, surgical procedures and means towards the comprehensive rehabilitation of total laryngectomy patients, so that they can achieve a good quality of life. This paper is aimed at all health care professionals caring for total laryngectomy patients. It is also aimed at the patients themselves, as well as ENT surgeons. We have considered staffing and material needs, all procedures before, during and after surgery and after hospital discharge. There are also detailed recommendations about types of rehabilitation and follow-up, and the need for recording these events. The comprehensive rehabilitation total laryngectomy patients is very important if we want to improve their quality of life. The recommendations we mention aim to help the healthcare professionals involved in the treatment of total laryngectomy patients to help them achieve a good quality of life, as similar as possible to the life they led before surgery.

Treatment of advanced laryngeal cancer and quality of life. Systematic review

INTRODUCTION AND OBJECTIVES

The objective was the comparison of the quality of life in patients with advanced laryngeal cancer treated with organ preservation versus surgical treatment.

METHODS

We performed a systematic review in the databases MedLine, EMBASE, and PubMed (2014 1991) and Web of Science (2012 - 2014). The search terms were: Laryngeal cancer, organ preservation, chemotherapy, laryngectomy, treatment outcomes and quality of life. Systematic reviews, meta-analysis, reports of health technology assessment and comparative studies with control group, published in Spanish, French or English were included. The selection and quality assessment was made by two researchers. The criteria of the Cochrane Collaboration were used to assess the risk of bias and Scottish Intercollegiate Guidelines Network (SIGN) for the level of evidence.

RESULTS

Of the 208 studies identified in the search, three were included a clinical trial and two observational studies, with a total of 211 patients. Quality and level of evidence was low. The results were contradictory, on occasion they favoured surgery, and on other occasions chemotherapy, but in general there were no statistical differences between the treatments. The studies were heterogeneous, with different methodology, undersized, limitations in quality with high risk of bias and use of different measurement scales.

CONCLUSIONS

There are not enough studies of quality to establish differences in the quality of life in patients with advanced laryngeal cancer according to the treatment received.

[Histopathological evaluation of the subtotal laryngectomy specimen]

INTRODUCTION

The goal of conservative surgical treatment of laryngeal cancer is to obtain oncological control with preservation of laryngeal function. The concept of laryngeal function preservation should be understood as the preservation of the patient's ability to breathe normally with neither tracheostomy nor aspiration, and maintaining intelligible speech. This can be achieved by a balance between two fundamental aspects, proper patient selection (based on tumour extension and preoperative laryngeal function), and an adequate histopathological analysis of the surgical specimen. Supracricoid subtotal laryngectomy is the voice conservative surgical technique that offers the best possibility of control in patients with locally advanced laryngeal cancer. The proper histopathological analysis allows staging and selecting patients for adjuvant therapy, avoiding unnecessary ones as well as designing monitoring and surveillance programs based on risk factors.

OBJECTIVE

To highlight key points in the histopathological evaluation of the surgical specimen of a subtotal laryngectomy.

CONCLUSION

The proper communication between the surgeon and pathologist, offering complete information on preoperative clinical evaluation and the knowledge of the key points in the evaluation of the surgical specimen (sites of tumour leakage and surgical resection margins) are fundamental parameters to achieve a proper histopathological evaluation of the surgical specimen.