Organ Preservation Surgery for Laryngeal Cancer Following Failed Radiation Therapy Hedyeh Javidnia January 14 th , 2008 Grand Rounds University of Ottawa Department of Otolaryngology and Head and Neck Surgery
He is a >25 pack year smoker who quit smoking 14 yrs ago
FNL shows tumour involving the anterior 3/4 of the left vocal cord and crossing over to involve the anterior commissure and the very anterior part of the right vocal cord. Some degree of subglottic extension is apparent. Vocal cord mobility is normal.
Radiotherapy reported failure rates of 9% - 21% in T1 and 28% - 37% in T2. 2
Total Laryngectomy post radiation has survival rates of 78% - 81% in T1 and 64% - 67% in T2. 3
2. Grisen O et. al. Consecutive series of patients with laryngeal carcinoma treated by primary irradiation. Acta Oncol 1997; 36:279-282 3. Hawkins NV et al. The treatment of glottic carcinoma: an analysis of 800 cases. Laryngoscope 1975; 85:1485-93
Differentiation between cancer recurrence and sequelae of radiotherapy is often clinically and rediographically difficult. 4
Endoscopic evaluation followed by biopsies may exacerbate post-radiotherapy changes and initiate superimposed infection, perichondritis, healing failure, and further edema. 5
4. Zbaren P. et. al. Pretherapeutic staging of recurrent laryngeal carcinoma: clinical findings and imaging studies compared with histopathology. Otolaryngol Head and Neck Surg. 2007; 137:487-491. 5. De Bree R, et. al. A randomized trial of PET scanning to improve diagonostic yield of direct laryngoscopy in pateints with suspicion of recurrent laryngeal carcinoma after radiotherapy. Contemp Clin Trials 2007; 28:705-712
9. Piazza C, et. al. Salvage surgery after radiotherapy for laryngeal cancer: from endoscopic resections to open-neck partial and total laryngectomies. Arch Otolaryngol Head and Neck Surg 2007; 133:1037-1043
Neck dissection must be performed in all cases of laryngeal carcinoma recurrence with clinical/cytological evidence of regional matastasis 17
Elective neck dissection in patients with N0 prior to salvage laryngeal surgery is controversial 18
The decision for elective neck dissection must be based on T staging, supraglottic or subglittic extension, and extralaryngeal involvement of recurrence.
Farrang et. al. Neck management in patients undergoing postradiotherapy slavage laryngeal surgery for recurrenc/persistent laryngeal cancer. Laryngoscope 2006; 116:1864-1866
Ganly I. et. al. Results of surgical salvage after failure of definitive radiation therapy for early stage squamous cell carcinoma of the glottic larynx. Arch otolaryngol Head and Neck Surg 2006; 132:59-66