Combined modality treatment of laryngeal squamous cell carcinoma.
Squamous cell carcinoma of the larynx is a major public health concern; it causes substantial morbidity and mortality, and arises chiefly as a result of tobacco and alcohol consumption. Early stage disease is best treated with radiation or surgery alone, but for patients with more locally advanced squamous cell carcinoma of the larynx, combined modality treatment has been shown to benefit selected patients, particularly when cisplatin-based chemotherapy and concurrent radiation therapy are employed, with or without altered fractionated radiation therapy. Substantial laryngectomy-associated quality-of-life decrements can be avoided in selected, potentially resectable patients with organ-sparing approaches, without sacrificing survival. Recently, trials have addressed the role of targeted systemic agents to the epidermal growth factor receptor, and other targets are under investigation. The addition of induction chemotherapy to concurrent chemoradiotherapy is a promising treatment strategy that warrants further evaluation, but has not yet emerged as a standard of care; the toxicity of such regimens must be balanced with the potential benefits on a case-by-case basis, and functional outcomes are often quite variable. Treatment planning, management and follow-up are complex, and thus should ideally be performed in a comprehensive, multidisciplinary fashion, in a center accustomed to a high volume of such cases. Future research directions are described herein.
Devlin
John G
JG
Fox Chase Cancer Center, Thoracic & Head & Neck Oncology, Medical Oncology, 333 Cottman Avenue, PA 19111, USA. john.devlin@fccc.edu
Langer
Corey J
CJ
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D002455:Cell Division / Q000528:radiation effects; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D019468:Disease Management; D005931:Glottis / Q000473:pathology; D006801:Humans; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D007825:Laryngectomy / Q000009:adverse effects; D015201:Meta-Analysis as Topic; D037981:Neck Dissection; D009363:Neoplasm Proteins / Q000037:antagonists & inhibitors; D009367:Neoplasm Staging; D010166:Palliative Care; D049268:Positron-Emission Tomography; D011788:Quality of Life; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014832:Voice Disorders / Q000209:etiology / Q000517:prevention & control
D009363:Neoplasm Proteins; D011838:Radiation-Sensitizing Agents