Larynx organ preservation in subjects with hypopharynx-larynx cancer

Background

Till not many years ago, the recommended treatment for advanced laryngeal cancer was a total laryngectomy followed by adjuvant radiation therapy. Studies conducted from 1980’s have broadened the therapeutic options, in the attempt to cure the cancer while sparing laryngeal functions. Functional surgery and a combination of chemotherapy (CT) and radiotherapy (RT) appears to be able to reach these objectives. We analyzed the case series of patients with laryngeal-hypopharyngeal cancer observed in the period 1999-2006 to evaluate the results on the basis of the treatment offered, focusing in particular on advanced-stage cancer.

Materials and methods

146 patients were observed, of which 137 were analyzed; 113 patients were operated, while 24 had non-surgical treatment: 12 of these had a CT-RT protocol with induction CT followed by concomitant CT-RT.

Results

After surgery in advanced-stage laryngeal cancer survival was 82% at 18 months, and 36% at 5 years, while after CT-RT protocol was 60% at 18 months. There was a statistically relevant advantage in the surgery group (P=0.02). For what concerns advanced-stage hypopharyngeal cancer, survival observed was 60% at 3 years (48% at 5 years) in the surgery group, and 62% at 3 years in the CT-RT group, without difference at the log-rank test (P=0.79).

Conclusions

In our case history, surgery had a better outcome than CT-RT in advanced-stage larynx cancer, even if we analyzed small groups of patients. These data need to be confirmed by larger case series; the advancements in surgery, chemotherapy and radiotherapy have furthermore to be held in due consideration, since they are opening interesting perspectives in the treatment of advanced-stage larynx cancer.