Organ-preservation surgery following failed radiotherapy for laryngeal cancer. Evaluation, patient selection, functional outcome and survival

Abstract

Although radiotherapy is a well codified treatment for laryngeal carcinomas, the management of local recurrence after failed radiotherapy remains controversial. Total laryngectomy is the classical salvage surgical approach. Recent evidence showed that selected laryngeal recurrences may be successfully treated with partial laryngectomies with comparable survival rates, acceptable morbidity, tracheostomy closure, effective swallowing, and satisfactory voice intelligibility. Recurrent laryngeal carcinoma after radiotherapy failure requires a comprehensive clinical, radiological and pathological restaging. Strict selection criteria are mandatory for the identification of radiotherapy failure cases amenable to conservative laryngeal surgery. Although larger series confirmation is necessary, conservative salvage surgery seems definitely promising. Salvage endolaryngeal laser surgery after irradiation failure allows in selected cases a mean local control rate of 65%. Selectively, supracricoid laryngectomy can be a flexible alternative to salvage total laryngectomy being conservative of laryngeal functions (mean local control rate of 85%). Selected laryngeal recurrences can be correctly treated also with vertical or horizontal supraglottic laryngectomies. In partial laryngectomies, intraoperative frozen sections are mandatory: postoperatively permanent sections have to confirm all margins. When proper selection criteria for conservative salvage laryngeal surgery are used, laryngeal function can be preserved with oncological efficacy also after radiotherapy failure.