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Cancers
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Larynx Cancer: From Diagnosis to Treatment and Rehabilitation
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Larynx Cancer: From Diagnosis to Treatment and Rehabilitation

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (15 June 2021) | Viewed by 18205

Special Issue Editor

Dr. Boban M. Erovic

E-Mail Website
Guest Editor
Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
Interests: microvascular surgical functional outcomes; outcome-based head and neck oncology research; thyroid surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The incidence of laryngeal carcinomas is increasing. The complexity of these tumors is manifested in their dual impact on patients: not only do they grow and metastasize like other cancers, but they also change patients’ voices and (when advanced) swallowing, resulting in clinical syndromes that significantly impact their quality of life.
The majority of patients present with an early-stage tumor that mostly is treated with Laser/TORS, but the treatment of patients with advanced tumors is still challenging. However, recent advances in our understanding of the genetic alterations provide novel approaches to their treatment, including targeted therapy. Because physicians´ responsibility does not end with the initial treatment, care of patients´ rehabilitation is key to providing the best treatment.
In this Special Issue, experts in this field will review the current approaches to the diagnosis, management, and rehabilitation of patients with the spectrum of laryngeal neoplasia.

Prof. Dr. Boban M. Erovic
Guest Editor

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Keywords

  • rare carcinomas of the larynx
  • epidemiology and outcome data
  • laser/TORS
  • systematic therapy
  • reconstructive options

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Published Papers (6 papers)

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Research

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18 pages, 1788 KiB  
Article
Chemoradiotherapy but Not Radiotherapy Alone for Larynx Preservation in T3. Considerations from a German Observational Cohort Study
by Gerhard Dyckhoff, Rolf Warta, Christel Herold-Mende, Volker Winkler, Peter K. Plinkert and Heribert Ramroth
Cancers 2021, 13(14), 3435; https://doi.org/10.3390/cancers13143435 - 8 Jul 2021
Cited by 3 | Viewed by 2277
Abstract
For advanced laryngeal cancers, after randomized prospective larynx preservation studies, nonsurgical therapy has been applied on a large scale as an alternative to laryngectomy. For T4 laryngeal cancer, poorer survival has been reported after nonsurgical treatment. Is there a need to fear worse [...] Read more.
For advanced laryngeal cancers, after randomized prospective larynx preservation studies, nonsurgical therapy has been applied on a large scale as an alternative to laryngectomy. For T4 laryngeal cancer, poorer survival has been reported after nonsurgical treatment. Is there a need to fear worse survival also in T3 tumors? The outcomes of 121 T3 cancers treated with pCRT, pRT alone, or surgery were evaluated in an observational cohort study in Germany. In a multivariate Cox regression of the T3 subgroup, no survival difference was noted between pCRT and total laryngectomy with risk-adopted adjuvant (chemo)radiotherapy (TL ± a(C)RT) (HR 1.20; 95%-CI: 0.57–2.53; p = 0.63). However, survival was significantly worse after pRT alone than after TL ± a(C)RT (HR 4.40; 95%-CI: 1.72–11.28, p = 0.002). A literature search shows that in cases of unfavorable prognostic markers (bulky tumors of 6–12 ccm, vocal cord fixation, minimal cartilage infiltration, or N2–3), pCRT instead of pRT is indicated. In cases of pretreatment dysphagia or aspiration requiring a feeding tube or tracheostomy, gross or multiple cartilage infiltration, or tumor volume > 12 ccm, outcomes after pCRT were significantly worse than those after TL. In these cases, and in cases where pCRT is indicated but the patient is not suitable for the addition of chemotherapy, upfront total laryngectomy with stage-appropriate aRT is recommended even in T3 laryngeal cancers. Full article
(This article belongs to the Special Issue Larynx Cancer: From Diagnosis to Treatment and Rehabilitation)
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20 pages, 683 KiB  
Article
Could Primary Chemoradiotherapy in T2 Glottic Cancers Yield Results Comparable to Primary Radiotherapy in T1? Considerations from 531 German Early Stage Patients
by Gerhard Dyckhoff, Rolf Warta, Christel Herold-Mende, Elisabeth Rudolph, Peter K. Plinkert and Heribert Ramroth
Cancers 2021, 13(7), 1601; https://doi.org/10.3390/cancers13071601 - 31 Mar 2021
Cited by 2 | Viewed by 2306
Abstract
T1 glottic cancer is a highly treatable disease with local control (LC) rates over 90% by either primary radiotherapy (pRT) or transoral laser microsurgery (TLM). LC of T2 glottic cancers is 15 percent points poorer on average. However, salvage after pRT entails more [...] Read more.
T1 glottic cancer is a highly treatable disease with local control (LC) rates over 90% by either primary radiotherapy (pRT) or transoral laser microsurgery (TLM). LC of T2 glottic cancers is 15 percent points poorer on average. However, salvage after pRT entails more than 50% total laryngectomy. Therefore, there is a need for enhanced LC. Altered fractionation regimens improved LC in T1 but not in T2. For this reason, for T2, alternative strategies must be considered. In a large observational cohort study including 531 early-stage laryngeal cancers, a small number of patients were treated with primary chemoradiotherapy (pCRT). In multivariable analysis, factors associated with significantly poorer outcomes included age, comorbidities, supraglottic localization, and T category. While there was a significant difference between pRT and surgery (HR 1.79; 95%-CI: 1.15–2.79), there was none between pCRT and surgery (HR 0.70; 95%-CI: 0.33–1.51). There is evidence from the literature that pCRT in early glottic cancers could yield results that surpass the limits so far experienced in radiotherapy alone with acceptable toxicity. Thus, prospective randomized studies with larger numbers of patients are warranted. Full article
(This article belongs to the Special Issue Larynx Cancer: From Diagnosis to Treatment and Rehabilitation)
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15 pages, 2918 KiB  
Article
A New Classification System to Predict Functional Outcome after Laryngectomy and Laryngopharyngectomy
by Stefan Grasl, Elisabeth Schmid, Gregor Heiduschka, Markus Brunner, Blažen Marijić, Matthaeus Ch. Grasl, Muhammad Faisal, Boban M. Erovic and Stefan Janik
Cancers 2021, 13(6), 1474; https://doi.org/10.3390/cancers13061474 - 23 Mar 2021
Cited by 11 | Viewed by 2600
Abstract
(1) Objective: To evaluate long-term functional outcome in patients who underwent primary or salvage total laryngectomy (TL), TL with partial (TLPP), or total pharyngectomy (TLTP), and to establish a new scoring system to predict complication rate and long-term functional outcome; (2) Material and [...] Read more.
(1) Objective: To evaluate long-term functional outcome in patients who underwent primary or salvage total laryngectomy (TL), TL with partial (TLPP), or total pharyngectomy (TLTP), and to establish a new scoring system to predict complication rate and long-term functional outcome; (2) Material and Methods: Between 1993 and 2019, 258 patients underwent TL (n = 85), TLPP (n = 101), or TLTP (n = 72). Based on the extent of tumor resection, all patients were stratified to (i) localization I: TL; II: TLPP; III: TLTP and (ii) surgical treatment (A: primary resection; B: salvage surgery). Type and rate of complication and functional outcome, including oral nutrition, G-tube dependence, pharyngeal stenosis, and voice rehabilitation were evaluated in 163 patients with a follow-up ≥ 12 months and absence of recurrent disease; (3) Results: We found 61 IA, 24 IB, 63 IIA, 38 IIB, 37 IIIA, and 35 IIIA patients. Complications and subsequently revision surgeries occurred most frequently in IIIB cases but rarely in IA patients (57.1% vs. 18%; p = 0.001 and 51.4% vs. 14.8%; p = 0.002), respectively. Pharyngocutaneous fistula (PCF) was the most common complication (33%), although it did not significantly differ among cohorts (p = 0.345). Pharyngeal stenosis was found in 27% of cases, with the highest incidence in IIIA (45.5%) and IIIB (72.7%) patients (p < 0.001). Most (91.1%) IA patients achieved complete oral nutrition compared to only 41.7% in class IIIB patients (p < 0.001). Absence of PCF (odds ratio (OR) 3.29; p = 0.003), presence of complications (OR 3.47; p = 0.004), and no need for pharyngeal reconstruction (OR 4.44; p = 0.042) represented independent favorable factors for oral nutrition. Verbal communication was achieved in 69.3% of patients and was accomplished by the insertion of voice prosthesis in 37.4%. Acquisition of esophageal speech was reached in 31.9% of cases. Based on these data, we stratified patients regarding the extent of surgery and previous treatment into subgroups reflecting risk profiles and expectable functional outcome; (4) Conclusions: The extent of resection accompanied by the need for reconstruction and salvage surgery both carry a higher risk of complications and subsequently worse functional outcome. Both factors are reflected in our classification system that can be helpful to better predict patients’ functional outcome. Full article
(This article belongs to the Special Issue Larynx Cancer: From Diagnosis to Treatment and Rehabilitation)
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14 pages, 938 KiB  
Article
An Observational Cohort Study on 194 Supraglottic Cancer Patients: Implications for Laser Surgery and Adjuvant Treatment
by Gerhard Dyckhoff, Rolf Warta, Christel Herold-Mende, Elisabeth Rudolph, Peter K. Plinkert and Heribert Ramroth
Cancers 2021, 13(3), 568; https://doi.org/10.3390/cancers13030568 - 2 Feb 2021
Cited by 8 | Viewed by 2137
Abstract
Supraglottic laryngeal cancer is characterized by poor prognosis. In contrast, excellent outcomes have been published in early-stage supraglottic cancers after laser surgery in single-institutional series in centers of excellence. Are these results reproducible in the normal clinical practice of less specialized facilities? As [...] Read more.
Supraglottic laryngeal cancer is characterized by poor prognosis. In contrast, excellent outcomes have been published in early-stage supraglottic cancers after laser surgery in single-institutional series in centers of excellence. Are these results reproducible in the normal clinical practice of less specialized facilities? As part of an observational cohort study, the outcomes of 194 supraglottic cancer patients were assessed after treatment by larynx-preserving surgery (transoral laser microsurgery [TLM] or open partial laryngectomy [OPL]) or total laryngectomy (TL), with each having risk-adopted adjuvant treatment, or primary (chemo-)radiotherapy (pCRT or pRT). In early-stage supraglottic cancers, TLM achieved a 5-year overall survival (5-year OS) of 62.0%. No significant survival difference could be discerned between patients with and without adjuvant treatment (HR 1.47; 95% CI: 0.80 2.69). The comparison between pCRT and pRT patients suggests that CRT is more effective in supraglottic cancer. The 5-year OS rate achieved in our multiinstitutional setting is comparable to that reached in laser surgery centers of excellence (59.4–76.0%). According to our data and supported by the literature, adjuvant RT (aRT) is not sufficiently effective in supraglottic cancers. In case adjuvant therapy is indicated, adjuvant chemoradiation (aCRT) could be recommended. Full article
(This article belongs to the Special Issue Larynx Cancer: From Diagnosis to Treatment and Rehabilitation)
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Review

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14 pages, 3905 KiB  
Review
Lymphoepithelial Carcinoma of Larynx and Hypopharynx: A Rare Clinicopathological Entity
by Muhammad Faisal, Sabrina Hartenbach, Annemarie Schratter, Wolfgang J. Köstler, Hannes Kaufmann, Rudolf Seemann, Claudia Lill, Sasan Hamzavi, Arno Wutzl and Boban M. Erovic
Cancers 2020, 12(9), 2431; https://doi.org/10.3390/cancers12092431 - 27 Aug 2020
Cited by 14 | Viewed by 4206
Abstract
(1) Background: Lymphoepithelial carcinoma of the hypopharynx and larynx is a rare tumor with fewer than 50 cases in the published literature. We present a literature review to discuss the clinical findings, viral or genetic associations, diagnostic challenges, histopathological findings and therapeutic aspects [...] Read more.
(1) Background: Lymphoepithelial carcinoma of the hypopharynx and larynx is a rare tumor with fewer than 50 cases in the published literature. We present a literature review to discuss the clinical findings, viral or genetic associations, diagnostic challenges, histopathological findings and therapeutic aspects of the disease. (2) Methods: A comprehensive literature review was performed through MEDLINE/PubMed from 1968 to 2018. We identified 21 studies comprising 46 patients. Data on all the clinicopathological features, diagnostic modalities, treatment options and viral or genetic etiology were extracted and analyzed using SPSS. (3) Results: The mean age of presentation was 64 years (range 40–82 years) and mostly involved males. The supraglottis and pyriform sinus were the most commonly involved sub-sites, with surgery as the preferred treatment modality. The presence of the Epstein–Barr virus possibly directs a viral etiology. The incidence of cervical and distant metastasis was 54% and 21%, respectively. The median survival time was 30 months. (4) Conclusions: Lymphoepithelial carcinoma of the hypopharynx is an aggressive tumor with a strong predilection for regional and distant metastasis. Surgery, in combination with adjuvant therapy, provides promising results. Immunohistochemistry helps in differentiating LEC from other pathologies. Full article
(This article belongs to the Special Issue Larynx Cancer: From Diagnosis to Treatment and Rehabilitation)
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Other

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12 pages, 963 KiB  
Systematic Review
Do Salivary Bypass Tubes Reduce the Risk of Pharyngocutaneous Fistula after Laryngopharyngectomy—A Systematic Review and Meta-Analysis
by Blažen Marijić, Stefan Grasl, Matthaeus Ch. Grasl, Muhammad Faisal, Boban M. Erovic and Stefan Janik
Cancers 2021, 13(11), 2827; https://doi.org/10.3390/cancers13112827 - 6 Jun 2021
Cited by 6 | Viewed by 3388
Abstract
To evaluate the effect of salivary bypass tube (SBT) usage on the occurrence of pharyngocutaneous fistula (PCF) in patients after a laryngopharyngectomy, a total of 20 studies, published between 1988 and 2021, were identified including 2946 patients. We performed a meta-analysis assessing the [...] Read more.
To evaluate the effect of salivary bypass tube (SBT) usage on the occurrence of pharyngocutaneous fistula (PCF) in patients after a laryngopharyngectomy, a total of 20 studies, published between 1988 and 2021, were identified including 2946 patients. We performed a meta-analysis assessing the risk of PCF occurrence in patients after SBT application compared to those without. PCF occurred in 26.8% of cases (669/2496) and SBT was applied in 33.0% of patients (820/2483). There was an overall trend towards lower PCF rates when using SBTs (22.2% vs. 35.3%; p = 0.057). We further selected five studies, comprising 580 patients who underwent laryngopharyngectomies, for meta-analysis showing that application of SBT reduced the risk of PCF formation (OR 0.46; 95% CI 0.18–1.18; p = 0.11). The meta-analysis demonstrates a beneficial effect of SBT insertion on PCF formation in patients after laryngopharyngectomy. Full article
(This article belongs to the Special Issue Larynx Cancer: From Diagnosis to Treatment and Rehabilitation)
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