Which is the most reliable diagnostic modality for detecting locally residual or recurrent laryngeal squamous cell carcinoma after (chemo)radiotherapy?

Abstract

Radiotherapy and, more recently, chemoradiotherapy have become important treatment modalities in the treatment of laryngeal squamous cell carcinoma (LSCC). In early stage LSCC, it is an alternative to minimally invasive (microscopic laser) surgery or partial laryngectomy and in advanced stage disease chemoradiotherapy is an organpreserving alternative for laryngectomy [1–4]. Therefore, the head and neck surgeon must frequently deal with recurrent or residual LSCC. The recurrence rate in T2–T4 LSCC after (chemo)radiotherapy is reported between 25 and 50 % [5]. The identification of recurrent or residual disease may be difficult. Clinical symptoms and signs secondary to radiation toxicity such as hoarseness, dysphagia, respiratory distress and pain are quite similar to those of recurrent carcinoma. Moreover, the growth pattern of recurrent LSCCs is different from that of primary carcinomas [6]. Many recurrences, even after initial T1 or T2 carcinomas, present with multicentric tumor foci, localized below an intact mucosa. The distinction between recurrent or residual carcinoma and radiotherapeutic sequelae such as fibrosis, edema, soft tissue necrosis, perichondritis and cartilage necrosis can be challenging either by endoscopy with biopsies or by imaging studies. The focus of this Editorial is on (1) which is the appropriate diagnostic modality to distinguish recurrent or residual disease from post-(chemo)radiotherapy changes and (2) recurrent tumor assessment and cr-T-classification, which is a prerequisite for voice-preserving salvage surgery.