Abstract
Squamous cell carcinoma of the larynx continues to be the commonest head and neck cancer in many Western countries. The larynx plays a key role for many essential functions, including breathing, voice production, airway protection, and swallowing. The goals of laryngeal cancer treatment are thus to provide best possible oncologic control, while optimizing functional outcomes.In recent decades, the treatment paradigm for advanced laryngeal cancer has shifted from one of primary surgery (total laryngectomy) as gold standard, toward non-surgical organ-preserving treatment using radiotherapy or chemoradiotherapy. However, concerns have emerged regarding functional outcomes after chemoradiotherapy, as well as possible decreased overall survival in patients with laryngeal cancer.The purpose of the present review is to review surgical and non-surgical options for treatment of advanced laryngeal cancer, as well as the evidence supporting each of these.
Highlights
Squamous cell carcinoma (SCC) of the larynx and neck in many Western countries
The major arguments in favor of consideration of total laryngectomy in such a cases include adverse characteristics of primary tumor which may increase the risk of persistence or local recurrence, including large size,[47] vocal cord fixation,[13,48] and transglottic tumor extent; the presence of pre-treatment laryngeal dysfunction which portends a higher risk of permanent laryngeal dysfunction after even successful non-surgical treatment; and good patient performance status, intelligence, motivation, and social support which predicts a better likelihood of good speech and other functional outcomes after total laryngectomy
Five-year overall survival rates for patients with advanced larynx cancer range from 48% to 54%.32,43,44. This does not appear to be affected by choice of treatment, with the increased local recurrence rate seen in nonsurgically treated patients offset by the ability of many of these patients to be salvaged by total laryngectomy at the time of recurrence
Summary
Squamous cell carcinoma (SCC) of the larynx and neck in many Western countries. Major risk continues to be the commonest cancer of the head factors include smoking[1,2] and alcohol consump-. Advanced Laryngeal Cancer tion.[1,2,3] Other risk factors include asbestos exposure,[4,5] industrial pollution,[6] history of larynx cancer in a first-degree relative,[7] and inadequate intake of anti-oxidant micronutrients found in fresh fruit and vegetables.[8,9,10] Males are more commonly affected, and most patients are aged over 40 years. Besides achieving tumor control, the other major aim of laryngeal cancer treatment is to optimize functional outcomes. This is usually possible in early larynx cancers, preserving laryngeal function in the setting of advanced cancer while still offering the optimum oncological outcome can be a difficult challenge
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