Head and neck cancer is a heterogenous group of cancers involving the upper aerodigestive tract. In this review article, the most common sites will be discussed, including the oral cavity, oropharynx, hypopharynx, and larynx. Etiology and epidemiology will be discussed followed by staging, treatment, and survival.

Current treatment of head and neck squamous cell cancer

Background. Several functional advantages have been described for the transoral laser supraglottic laryngectomy as compared with open techniques. However, comparative studies have been rarely performed. Methods. Functional results in 26 patients treated with a transoral approach were retrospectively compared with those of a comparable series of 26 patients who underwent a trans- cervical approach. Results. The only significant differences found between the two groups were a lesser number of temporary tracheot- omies and a shorter time of removal of the nasogastric tube in the laser group. No significant differences were found in the incidence of postoperative complications, hospital stay, and swallowing capacity. Conclusions. The rate of functional problems after transoral laser surgery did not greatly decrease compared with the rate after the conventional procedure. The mayor advantage of the transoral approach was the lower incidence of temporary tracheotomies. A 2004 Wiley Periodicals, Inc. Head Neck 26: 653-659, 2004

Oncologic outcomes of transoral laser surgery of supraglottic carcinoma compared with a transcervical approach.

Background.

The objective of this study was to evaluate the outcomes of transoral laser microsurgery (TLM) in T3 laryngeal carcinomas and to identify prognostic factors for survival and laryngeal preservation.



Methods.

This study aimed to provide a retrospective analysis of 147 consecutive patients, evaluating their overall survival, disease-specific survival, laryngectomy-free survival, and function preservation rate.



Results.

Five-year overall, disease-specific, and laryngectomy-free survivals were 53.1%, 70.2%, and 62.3%, respectively. Disease-specific survival differed between glottic and supraglottic tumors (86.3% vs 61.8%; p = .015). Function preservation was 65.5% in supraglottic and 49.1% in glottic tumors (p = .002). Disease-specific survival was not related to pre-epiglottic involvement, cord fixation, or focal cartilage infiltration (p > .05). Vocal cord fixation and cartilage infiltration were independent negative prognostic factors for organ preservation (odds ratio [OR] = 0.184; 95% confidence interval [CI] = 0.082–0.411; p = .000 and OR = 0.331; 95% CI = 0.139–0.789; p = .013, respectively).



Conclusion.

Our conclusion is that TLM is a good alternative in a large number of T3 laryngeal tumors, with adequate survival and organ preservation rates above 60%. © 2009 Wiley Periodicals, Inc. Head Neck, 2010

Transoral laser microsurgery for T3 laryngeal tumors: Prognostic factors.

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.

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Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery

The objective of the study was to evaluate the oncological and functional results of transoral laser microsurgery (TLM) in patients with supraglottic laryngeal squamous cell carcinoma. Between June 1980 and December 2006, 277 patients with squamous cell supraglottic carcinoma of all stages were treated by primary carbon dioxide laser microsurgery. All treatments were performed with curative intention. The goal was the complete tumor removal with preservation of functionally important structures of the larynx. The administered treatment was exclusively TLM with or without selective or modified radical neck dissection in 215 cases (78 %); TLM with postoperative radiotherapy was performed in 62 cases (22 %). Data were analyzed using the Kaplan–Meier method. The median follow-up was 65 months. We achieved a 5-year local control rate of 85 % for pT1/pT2, 82 % for pT3, and 76 % for pT4. The 5-year overall, recurrence-free and disease-specific survival rates for stages I and II were 76, 81, and 92 %, for stages III and IVa 59, 65, and 81 %, respectively. With respect to local control and survival, these results are comparable with the results achieved by conventional partial and total resection of the larynx, while being superior to primary (chemo)radiotherapy. Transoral laser microsurgery results in a low morbidity, rapid recovery, and superior function compared with standard therapy.

/pdf/results-of-transoral-laser-microsurgery-for-supraglottic-4bynghppz7.pdf

Results of transoral laser microsurgery for supraglottic carcinoma in 277 patients.

We present the results of a retrospective study of 903 patients treated with conservation surgery for carcinoma of the supraglottic larynx so we can evaluate our management of supraglottic cancer with different types of surgery. In 301 patients, an extended supraglottic laryngectomy was performed. The recent selective use of transoral laser resection appears to be a rational approach. The 5-year uncorrected survival was 84%, 81%, 76%, and 55% for stages I, II, III, and IV, respectively. The most common site for local-regional failure was the cervical lymphatics. The percentage of occult disease in the NO neck was 21% and epilaryngeal supraglottic location, locally advanced and GIII tumors have a higher frequency of lymph node involvement. There were no differences between comprehensive and anterolateral elective neck dissections. A bilateral elective neck dissection is recommended. In histologically positive neck disease, the survival rates were better with postoperative radiotherapy only in cases of extracapsular spread.

Manuel FernÁNdez-Vega

Papers

Management of cancer of the supraglottis