Uncommon Surgical Technique Can Preserve Function after Throat Cancer Surgery

Subsequently, RTOG 91–11, a definitive study published in 2003, confirmed that chemotherapy plus radiotherapy RTX achieved a long-term 84% control rate in patients with laryngeal cancer. This therapy allowed organ preservation, and the notion of organ preservation gained prominence as a treatment goal. However, over time it became clear that organ preservation did not necessarily equate to functional preservation, Dr. Holsinger explained. Dr. Weinstein noted that at two years, 15% of patients who underwent concurrent chemotherapy and radiation have swallowing difficulties and it is not clear from the study what percentage of those patients required a permanent gastrostomy tube.

More well-designed scientific studies are needed to explore which patients should receive chemotherapy and radiotherapy versus SCPL.

With greater experience using this nonsurgical approach, it became clear that despite preservation of the larynx with chemotherapy and radiotherapy, some patients had poor functional outcomes, requiring gastrostomy tubes and in some cases even a tracheotomy. Also, some patients treated with chemotherapy and radiotherapy developed disease progression.

More well-designed scientific studies are needed to explore which patients should receive chemotherapy and radiotherapy versus SCPL.

“We began to realize that while there is a role for radiotherapy and chemotherapy, preservation of function is as important as organ preservation. If the group with poor functional outcomes and/or tumor failure had received SCPL, functional outcomes might have been superior. This includes bulky T2-T3 glottic and supraglottic laryngeal cancers,” Dr. Holsinger said.

Patient Selection

Right now, there are no prospective randomized data to guide patient selection, Dr. Sturgis said. However, SCPL is a reasonable option for advanced or intermediate vocal cord cancers where the cricoarytenoid joint is still mobile.

According to Dr. Weinstein, SCPL is suitable for patients with selected T2, T3, or T4 cancers of the larynx and for selected patients who have failed radiation.

Dr. Sturgis said that recurrent vocal cord cancers with involvement of the anterior commissure but without significant supraglottic extension are probably the easiest radiation failure cases to justify the use of SCPL. He noted that patients selected for SCPL must be reasonably healthy with good pulmonary function to be able to clear secretions.

Despite the advantages of SCPL, a confluence of factors has kept this procedure from enjoying more widespread use in the United States.

Indications and Contraindications for SCPL with CHP and with CHEP

Dr. Weinstein said that indications for SCPL with CHP include (1) supraglottic carcinomas with glottic extension; (2) supraglottic carcinomas with preepiglottic space invasion; (3) transglottic carcinomas; and (4) selected supraglottic carcinoma with limited thyroid cartilage invasion.