NEW YORK (Reuters Health) Oct 09 - Supracricoid partial laryngectomy (SCPL) produced excellent local control and functional outcomes in a retrospective series.
In 96 patients with primary or recurrent squamous cell carcinoma of the larynx, the five-year local control rate was 94% overall and 89% in patients who had already undergone radiotherapy, according to Dr. Gregory S. Weinstein of the University of Pennsylvania in Philadelphia and colleagues.
In the medical literature, by contrast, the five-year local control rate for patients with T2 primary tumors treated with radiation ranges from 50% to 85%, the investigators say. Five-year survival is less than 50% for patients who must undergo laryngectomy after radiation failure, they add.
"This surgery offers the best cure rate for intermediate-sized larynx cancers, compared to any other treatment, with an outstanding functional outcome, with the caveat that the patients ended up very hoarse," Dr. Weinstein told Reuters Health.
SCPL is an alternative to total laryngectomy, offering the advantage of preserving lung-powered speech and swallowing, Dr. Weinstein and his team wrote in JAMA Otolaryngology-Head and Neck Surgery.
Several studies have found that SCPL produces better results than radiation plus chemotherapy and other types of partial laryngectomy surgery, they say. They also point out that just one of three patients who fail radiation treatment are candidates for SCPL.
For the current report, the investigators analyzed consecutive patients with primary or recurrent squamous cell carcinoma of the larynx treated with SCPL between 1992 and 2010. Dr. Weinstein performed all of the surgeries.
The series included 54 primary tumors and 42 that had been treated previously with radiation. The five-year local control rate was 100% for T2 primary tumors and 96% for T3 primary tumors. Among patients previously treated with radiation, five-year local control and the rate of laryngeal preservation were both 89%. For patients with stage III or IV primary tumors, five-year rates of local and locoregional control were 96% and 83%, respectively, with a 91% rate of larynx preservation.
Eighteen patients developed postoperative complications requiring hospitalization or additional treatment, including one who died of anesthesia-related causes.
About 1,000 patients are diagnosed with laryngeal cancer in the US each year, Dr. Weinstein said in an interview, and the vast majority are likely to be candidates for the surgery. The primary gatekeepers in determining what type of treatment these patients receive is usually an ear, nose and throat specialist, he added, who may then refer the patient to the local tumor board. Given the rarity of the cancer, Dr. Weinstein pointed out, these surgeons may not have the expertise to perform SCPL. Nevertheless, he added, "there are plenty of surgeons around the country who do it."
"Patients sometimes feel like they can't travel to get care, it's too inconvenient," he added. "But the reality is I'm quite certain within driving distance of every patient there's a surgeon who does this operation well."
He and his colleagues conclude: "In appropriately staged and selected patients with T2 or T3 primary laryngeal tumors, or early to moderately advanced laryngeal tumors following prior radiation treatment, SCPL should be discussed in the treatment algorithm for organ-preserving laryngeal treatment."
SOURCE: http://bit.ly/19imRd7
JAMA Otolaryngol Head Neck Surg 2013.
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