Our Summary

This research paper discusses a study by the Department of Veterans Affairs on laryngeal cancer treatment. The study primarily focused on using a combination of chemotherapy and radiation therapy for advanced cases of laryngeal cancer. This strategy was effective at preserving the larynx in 84% of cases. However, over the past 30 years, some concerns have arisen about this approach. These include doubts about long-term survival rates and high rates of treatment failure, which required additional intervention. Also, additional surgery to remove the larynx, if needed after chemotherapy and radiation, can lead to further risks. These include wound complications, longer hospital stays, and a decrease in the patient’s quality of life.

FAQs

  1. What is the organ preservation rate in the treatment of locally advanced laryngeal cancer using chemotherapy and radiation therapy?
  2. What are the potential complications associated with salvage laryngectomy after chemoradiation therapy?
  3. How has the treatment of laryngeal cancer evolved over the past 30 years?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laryngectomy is to follow a strict post-operative care regimen to prevent complications such as wound infections or fistulas. This may include keeping the stoma clean and dry, avoiding smoking and alcohol, and attending regular follow-up appointments with healthcare providers. It is also important for patients to communicate any concerns or changes in symptoms to their healthcare team promptly.

Suitable For

Patients who are typically recommended for laryngectomy include those with locally advanced laryngeal cancer who have failed or are not candidates for organ preservation therapies such as chemotherapy and radiation therapy. These patients may have a high risk of recurrence or have experienced treatment failure, making laryngectomy a necessary option for disease control. Additionally, patients with extensive tumors that cannot be adequately treated with non-surgical approaches may also be recommended for laryngectomy. Other factors that may influence the recommendation for laryngectomy include the patient’s overall health status, comorbidities, and personal preferences.

Timeline

  • Before laryngectomy:
  1. Patient is diagnosed with locally advanced laryngeal cancer.
  2. Patient undergoes chemotherapy and radiation therapy to preserve the larynx.
  3. Concerns arise regarding long-term survival and high failure rates requiring salvage.
  4. Salvage laryngectomy is considered, if feasible, but is associated with increased morbidity and complications.
  • After laryngectomy:
  1. Patient undergoes surgery to remove the larynx.
  2. Patient may experience complications such as wound complications, fistula, and longer hospitalization.
  3. Patient may require additional procedures such as elective neck dissection.
  4. Patient may undergo reconstruction using techniques such as the pectoralis major myocutaneous/myofascial flap.
  5. Patient may need to undergo tracheal esophageal puncture to facilitate speech.
  6. Patient may experience reduced quality of life due to changes in speech and swallowing abilities.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a laryngectomy procedure?
  2. How will my ability to speak and swallow be affected after a laryngectomy?
  3. What post-operative care and rehabilitation will be necessary?
  4. What support resources are available for patients undergoing a laryngectomy?
  5. How will my quality of life be impacted after a laryngectomy?
  6. What are the potential long-term effects of a laryngectomy on my overall health?
  7. Are there alternative treatment options to consider before undergoing a laryngectomy?
  8. How can I best prepare for a laryngectomy procedure, both physically and emotionally?
  9. What is the success rate of laryngectomy procedures in terms of cancer recurrence and overall survival?
  10. Are there any clinical trials or new advancements in laryngectomy treatment that I should be aware of?

Reference

Authors: Okafor S, Awaonusi OO, Watts TL, Cannon TY. Journal: Otolaryngol Clin North Am. 2023 Apr;56(2):323-331. doi: 10.1016/j.otc.2022.12.002. PMID: 37030945