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Review

Treatment of laryngeal cancer: the permanent challenge

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Pages 913-920 | Published online: 10 Jan 2014

References

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  • •References [2-16] provide detailed information on reliability of laser CO2 surgery in early supraglottic cancer [2-4], and early glottic cancer [5-11], providing both excellent local control rates [2-11], and functional results [2,10,11], with low morbidity. Laser CO2 surgery may also be offered to more advanced stages [3,4,16], but requires a strong selection of patients [3,4] and expertise [4,16]. Finally, this surgery is cost effective when compared with open surgery or irradiation [5,7,12,13], and may be proposed for salvage [14,15].
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  • •References [17-23] provide information on techniques and indications for supraglottic partial laryngectomies insuring good local control [17,18]. This surgery provides good functional results [19,20] and quality of life [21], and may be used for salvage [22,23].
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  • •References [24-28] support a better local control achieved by hyperfractionation and/or acceleration of definitive irradiation.
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  • •Large meta-analysis that assessed the impact of either induction, adjuvant, or concurrent chemotherapy. A 4% benefit in survival is obtained with chemotherapy. The only significant survival is provided by concurrent chemotherapy.
  • Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J. Merl 324,1685–1690 (1991).
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  • •References [30-32] are randomized trials based on the same concept of selection by induction chemotherapy of potentially good candidates for irradiation. A nonsignificant loss of 6% in survival was balanced by a 60% rate of larynx preservation in the experimental arms. This approach has been considered as acceptable and safe.
  • Laccourreye 0, Veivers D, Hans S, Menard M, Brasnu D, Laccourreye H. Chemotherapy alone with curative intent in patients with invasive squamous cell carcinoma of the pharyngolarynx classified as T1—T4NOMO complete clinical responders. Cancer 92(6), 1504–1511 (2001).
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  • •Preliminary analysis of this three-arm randomized trial has failed to find a difference in survival between the three approaches, but the estimate of larynx preservation was significantly higher in the concurrent arm. It must be underscored that two-thirds of the patients had supraglottic cancer and that only tumors defined as T4 on a CT scan (and not clinically) were considered eligible.
  • Mantz CA, Vokes EE, Kies MS et al. Sequential induction chemotherapy and concomitant chemoradiotherapy in the management of locoregionally advanced laryngeal cancer. Ann. Oncol 12 (3), 343–347 (2001).

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