Dr. Weinstein stated, “When patients with early or advanced laryngeal cancer are candidates for surgical approaches that preserve the larynx, it is the standard of care to discuss the surgical and nonsurgical organ-preserving options with the patient and allow the patient to participate in the choice of appropriate treatment.”
Explore This IssueJune 2006
In Dr. Holsinger’s opinion, the biology of the cancer should drive treatment. It is clear that some patients will respond well to radiotherapy, but other patients who have a tumor response to radiation may suffer impairment and poor functional outcome from radiation-induced scarring. Dr. Holsinger speculated that patients with this radioresistant aggressive disease might benefit from an upfront surgical approach (SCPL) to avoid the toxic effects of radiotherapy. He spoke of the need for future molecular studies that explore broader concepts, such as evaluating treatments based on tumor characteristics, such as genomic and proteomic studies—not on avoiding the perceived consequences of surgery.
“Chemoradiation isn’t a walk in the park either,” Dr. Holsinger commented.
Success of SCPL
Dr. Sturgis outlined several criteria that are required for successful SCPL procedures.
Patient selection is a critical factor, he noted, as is surgical experience in performing the procedure. Important technical aspects which ultimately result in limiting aspiration include preservation of laryngeal innervation and performing an adequate impaction (pexy) by pulling the base of the tongue and attaching it to the cricoid cartilage.
Patients who undergo SCPL must have adequate pulmonary function to clear secretions. It is also important for patients to be seen by an experienced speech pathologist after surgery for appropriate rehabilitation for swallowing. “It often takes time to learn how to swallow again after either chemoradiation or surgery,” Dr. Sturgis explained.
Although more research is needed to refine patient selection and to determine the relative benefits of procedures for treating intermediate to advanced laryngeal tumors, “SCPL should join the ranks of accepted procedures for T2 and T3 tumors,” Dr. Holsinger stated.
©2006 The Triological Society