Therapeutic strategies for locally advanced laryngeal cancer. Part 1: Radical treatment.
Source: ORL. The main therapeutic goals are local control and survival, but also the functional organ preservation speech, swallowing and airway patencyif possible. To achieve these objectives, the management should be established by a multidisciplinary tumor board, based on the analysis of patient-specific factors age, performance status, comorbidities, and psychosocial supportcancer topography and staging, but also the physician expertise and the availability of rehabilitation services.
Regarding the larynx preservation, there are two major therapeutic strategies: total laryngectomy associated with adjuvant radio- and chemotherapy and larynx preservation strategy, which includes neoadjuvant chemotherapy followed by exclusive radiotherapy or concurrent radio-chemotherapy or radio-biotherapy.
Total laryngectomy can be performed by open surgery or, in order to avoid a wide surgical field and reduce the local morbidity, by transoral techniques. After laryngectomy, the recurrence can be local, at the resection site, nodal, at cervical lymph nodes, or distal, the lung being the most common site of recurrence as a distant metastasis.
To improve locoregional control and survival, adjuvant treatments are proposed, including radiotherapy, chemoand biotherapy.
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