CONTROVERSIES AND UPDATE IN OTOLARYNGOLOGY IN 2011 

Otorinolaringologia 2011 September;61(3):57-70

Copyright © 2011 EDIZIONI MINERVA MEDICA

language: English

Current management of advanced laryngeal cancer: a multidisciplinary review

Raza S. N. ¹, Worden F. P. ²

¹ Department of Otolaryngology Head & Neck, Surgery, University of Michigan, Ann Arbor, MI, USA; ² Division of Hematology-Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

Treatment of advanced laryngeal cancer has changed dramatically over the last two decades, with increasing interest in organ preservation therapy. Chemoradiation has become a mainstay in this therapy, but questions remain with respect to specific chemotherapy and radiotherapy regimens. The role for surgery in both a primary and salvage setting should also be re-evaluated given this. This review will attempt to demystify much of the current literature on advanced laryngeal cancer and provide a multidisciplinary perspective on its management.
Concurrent chemoradiation continues to provide good results with respect to laryngeal preservation, but there continues to be a lack of evidence of it impacting overall survival when compared to surgery. Chemoselection prior to chemoradiation is showing promise in helping select out patients that are more likely to succeed from treatment. Surgical salvage of these patients remain challenging with increased risk of fistula formation and wound complications . Elective neck dissection for N0 necks in salvage surgery shows no survival advantage if
necks were included in initial treatment. Organ preservation protocols need continued work looking at the role of chemoselection, as well as multiagent chemoradiation. There continues to lack consistent end points with respect to the organ preservation literature, though there is increasing emphasis on laryngeal function as well as preservation. Surgical treatment primarily and via salvage continue to be viable options in patients, particularly if laryngeal function will be lost if preserved.