Organ Preservation for Advanced Larynx Cancer: Issues and Outcomes

被引:88
作者
Forastiere, Arlene A. [1 ,2 ]
Weber, Randal S. [3 ]
Trotti, Andy [4 ]
机构
[1] Johns Hopkins Univ, Baltimore, MD USA
[2] Sydney Kimmel Comprehens Canc Ctr, Baltimore, MD USA
[3] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA
[4] Univ S Florida, Coll Med, H Lee Moffitt Canc Ctr & Res Inst, Tampa, FL 33612 USA
关键词
SQUAMOUS-CELL CARCINOMA; TRANSORAL LASER MICROSURGERY; LOCALLY ADVANCED HEAD; INDUCTION CHEMOTHERAPY; GLOTTIC CANCER; NECK-CANCER; ALTERNATING CHEMOTHERAPY; RANDOMIZED-TRIAL; CLINICAL-TRIAL; UNITED-STATES;
D O I
10.1200/JCO.2015.61.2978
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose To provide a review of the clinical data, controversies, and limitations that underpin current recommendations for approaches to larynx preservation for locally advanced larynx cancer requiring total laryngectomy. Methods The key findings from pivotal randomized controlled trials are discussed, including quality of life, late effects, and function assessments. Trials investigating taxane inclusion in induction chemotherapy and trials of epidermal growth factor receptor inhibition for radiosensitization are put into perspective for larynx cancer. Controversies in the management of T4 primaries and the opportunities for conservation laryngeal surgery are reviewed. Results There are data from clinical trials to support induction chemotherapy, followed by radiotherapy (preferred approach in Europe) and concomitant cisplatin plus radiotherapy (preferred in North America) for nonsurgical preservation of the larynx. Treatment intensification by a sequential approach of induction, followed by concomitant treatment, is investigational. Transoral laryngeal microsurgery and transoral robotic partial laryngectomy have application in selected patients. Conclusion The management of locally advanced larynx cancer is challenging and requires an experienced multidisciplinary team for initial evaluation, response assessment, and support during and after treatment to achieve optimal function, quality of life, and overall survival. Patient expectations, in addition to tumor extent, pretreatment laryngeal function, and coexisting chronic disease, are critical factors in selecting surgical or nonsurgical primary treatment. (C) 2015 by American Society of Clinical Oncology
引用
收藏
页码:3262 / +
页数:8
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