New modalities to treat laryngeal cancer [Novi načini liječenje laringealnog karcinoma]

Prgomet, Drago (2012) New modalities to treat laryngeal cancer [Novi načini liječenje laringealnog karcinoma]. Collegium Antropologicum, 36 (S. 2). pp. 3-6. ISSN 0350-6134

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Abstract

Early laryngeal cancer comprises T1 and T2 stages of the disease. Open functional operations achieve local control of the disease in 90-95% of T1 patients and in 70-90% of T2 patients. Primary RT achieves local control in 85-94% of T1 tumors and in 70-80% of patients with T2 tumors. Introduction of endoscopic laser surgery resulted in further popularization of preservation laryngeal surgery, whereby equally successful treatment results are achieved with minimal invasiveness. Quality of voice is also better after RT and laser resection. In the last century a golden standard of treatment of advanced laryngeal cancer (T3/T4 stage) was total laryngectomy (TL) with neck dissection followed by adjuvant RT. Overall 5 year survival was around 50%. Due to impact of TL on quality of life, "Larynx preservation strategy" (LPS) was developed in the early '90 for advanced stages of the disease. Novel approach is an introduction of targeted therapy, such as anti-EGFR monoclonal antibody, cetuximab. Concomitant cetuximab with RT achieves higher survival, and better locoregional disease control in comparison to administration of single RT modality. Therefore non-surgical methods of treatment of advanced laryngeal carcinoma are constantly changing and improving as new chemotherapeutics are being introduced into protocols. Uncritical enthusiasm with non-surgical methods of treatment resulted in higher incidence of treatment toxicities, higher rates of "salvage surgery" with more frequent adverse effects. That resulted in a consensus attempt around "LPS" project with reevaluation of clinical studies and uniform recommendations for future studies. When choosing appropriate therapy for oncological patient, quality of life (QOL) is a special category to be taken into account besides complications, pain, duration of treatment and overall benefit for the patient.

Abstract in Croatian

Rani karcinomi larinksa uključuju stadije T1 i T2. Otvorene funkcijske operacije dostižu lokalnu kontrolu bolesti kod 90–95% T1 tumora te kod 70–90% T2 tumora. Primarna radioterapija postiže lokalnu kontrolu kod 85–94% T1 tumora te 70–80% kod T2 tumora. Uvođenje endoskopske laserske kirurgije je rezultiralo daljnom popularizacijom prezervacijske kirurgije, gdje se jednaki rezultati postižu na minimalno invazivni način. S druge strane, zlatni standard u liječenju uznapredovalog karcinoma je bila totalna laringektomija sa disekcijom vrata, praćena radioterapijom. Ukupno petogodišenje preživljenje je bilo oko 50%. Zbog utjecaja TL na kvalitetu života »Larynx preservation strategy« (LPS) je razvijena u ranim devedestetim godinama 20. st. Novi modaliteti također uključuju ciljanu terapiju, kao anti-EGFR monoklonalno protutijelo, cetuximab. Konkomitantni cetuximab i RT postiže veće preživljenje i bolju lokoregionalnu kontrolu u usporedbi samo sa RT.

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