Abstract
PurposeAccurate therapeutic management of the neck is a challenge in patients with supraglottic laryngeal cancer. Nodal metastasis is common at all disease stages, and treatment planning relies on clinical staging of the neck, for both surgical and non-surgical treatment. Here, we compared clinical and surgical staging results in supraglottic carcinoma patients treated with primary surgery to assess the accuracy of pre-therapeutic clinical staging and guide future treatment decisions.MethodsRetrospective analysis of clinical, pathological, and oncologic outcome data of 70 patients treated with primary surgery and bilateral neck dissection for supraglottic laryngeal cancer. Patients where clinical and pathological neck staging results differed, were identified and analyzed in detail.ResultsOn pathologic assessment, patients with early stage (pT1/2) primaries showed cervical lymph node metastases in 55% (n = 17/31) of cases, compared to 67% (n = 26/39) of patients with pT3/4 tumors. In 24% (n = 17/70) of all patients, cN status differed from pN status, resulting in an upstaging in 16% of cases (n = 11/70) and a downstaging in 9% (n = 6/70) of cases. 14% of patients with cN0 status had occult metastases (n = 5/30). As assessed by a retrospective tumor board, in case of a non-surgical treatment approach, the inaccurate clinical staging of the neck would have led to an over- or undertreatment of the neck in 20% (n = 14/70) of all patients.ConclusionOur data re-emphasize the high cervical metastasis rates of supraglottic laryngeal cancer across all stages. Inaccurate clinical staging of the neck is common and should be taken into consideration when planning treatment.
Highlights
Due to the extensive regional lymphatic network, supraglottic laryngeal carcinomas have a tendency to develop neck metastases at all disease stages, hereby negatively impacting patients’ prognosis and influencing treatment decisions [1, 2]
For patients treated with a primary surgical approach, nodal metastasis is routinely managed by neck dissection
Our data confirm the notion that supraglottic laryngeal cancers show a pronounced tendency to spread to regional lymph nodes of the neck at every disease stage
Summary
Due to the extensive regional lymphatic network, supraglottic laryngeal carcinomas have a tendency to develop neck metastases at all disease stages, hereby negatively impacting patients’ prognosis and influencing treatment decisions [1, 2]. For patients treated with a primary surgical approach, nodal metastasis is routinely managed by neck dissection,. In anticipation of high rates of occult nodal metastasis, all patients undergoing primary surgery for supraglottic laryngeal carcinomas routinely underwent bilateral neck dissection. Patients undergoing a primary surgical approach including bilateral neck dissection have the benefit of a definitive pathological nodal status after surgery which guides adjuvant treatment planning, [11] i.e., the addition of radiotherapy if nodal involvement is shown [12], and radiochemotherapy with the inclusion of cisplatin if extracapsular spread is established, or the resection is incomplete [13]. In patients undergoing a primary non-surgical treatment approach, clinical nodal staging determines the entire therapeutic regimen and is, of particular interest. Potential discrepancy rates between clinical and pathological staging results must be kept in mind during therapy planning to avoid over/undertreatment
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
