Recent changes in the treatment of patients with advanced laryngeal cancer.
Since the original data from the Department of Veterans Affairs Laryngeal Cancer Study Group demonstrated that nonsurgical therapy could achieve survival rates comparable to total laryngectomy in selected cases, there has been a progressive increase in employment of nonsurgical therapy for the management of advanced laryngeal cancer. Both neoadjuvant chemotherapy followed by conventionally fractionated or hyperfractioned radiotherapy for chemotherapy responders, or simultaneously administered chemoradiation has resulted in a significant number of patients who achieved cure while preserving their larynges. Nevertheless, combined chemotherapy and external beam radiation is associated with a variety of acute and chronic sequelae that can have a debilitating impact on function and quality of life. Although no therapeutic option is without risk, the decision regarding the modality of therapy for a patient with advanced laryngeal cancer should prompt a careful review of the current surgical techniques available for treatment. Data on quality of life and aging, as well as advances in minimally invasive surgical techniques, are available today that were not available at the time of the Veterans study. Selection of optimal therapy is often complex and raises the question whether the pendulum may have swung too far in the direction of nonsurgical therapy for advanced laryngeal cancer. This article reviews the current options available for a patient with advanced laryngeal cancer and discusses the impact of therapy.
Genden
Eric M
EM
Department of Otolaryngology-Head and Neck Surgery, The Mount Sinai Medical Center, New York, NY, USA.
Ferlito
Alfio
A
Rinaldo
Alessandra
A
Silver
Carl E
CE
Fagan
Johannes J
JJ
Suárez
Carlos
C
Langendijk
Johannes A
JA
Lefebvre
Jean Louis
JL
Bradley
Patrick J
PJ
Leemans
C René
CR
Chen
Amy Y
AY
Jose
Jemy
J
Wolf
Gregory T
GT
D000367:Age Factors; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D003680:Deglutition Disorders / Q000523:psychology; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D007825:Laryngectomy / Q000191:economics; D020360:Neoadjuvant Therapy / Q000191:economics; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D014987:Xerostomia / Q000523:psychology
D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D066246:ErbB Receptors