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Abstract
Laryngeal carcinoma is the eleventh-most common form of cancer among men worldwide and is the second-most common malignancy of the head and neck. Squamous cell carcinomas of the larynx occur most often in the glottic larynx (56%), next most often in the supraglottic larynx (31%) and rarely in the subglottis (1%).
The symptoms of glottic carcinoma start with the early grades of carcinoma as hoarseness of voice which help in early diagnosis and better prognosis. With further progress of the tumor it may gives rise to many symptoms as hemoptysis , referred otalgia , odynophagia , dysphagia ,neck adenopathy and Stridor frequently occur with large bulky tumors that obstruct the airway.
In treating vocal cord carcinoma the goal of treatment is the cure with the best functional result and the least risk of a serious complication, so the management of T3 glottic carcinoma is still a subject of great controversy.
The options for treatment of T3 glottic carcinoma are expanding and include: total laryngectomy, partial laryngectomy ,laryngectomy and postoperative radiotherapy, radiotherapy alone with laryngectomy reserved for local recurrence, induction chemotherapy followed by radiotherapy in responders and transoral microsurgery.
Total laryngectomy is the standard against which all other forms of therapy for laryngeal cancer must be measured because total laryngectomy is highly effective in managing glottic carcinoma.
Conservation partial laryngeal surgery is defined as removal of a portion of the larynx with preservation of the respiratory, sphincteric, and vocal functions of the larynx. Organ preservation surgery for laryngeal cancer is an art. The art is in determining which patients are eligible for an organ preservation surgical procedure. One must delicately balance the need for maximizing local control versus a good functional outcome.
The most important advantage of radiotherapy is the very good quality of voice after treatment in the majority of cases and the fact that the treatment failures still have the chance of surgical salvage. Short-term side effects of radiation lasting up to 6 weeks after the therapy include: mucositis, odynophagia, dysphagia, skin erythema, altered taste, and edema.
Chemotherapy had not traditionally been part of larynx cancer primary treatment protocols. Starting in the 1980s, organ-preserving protocols using chemotherapy in conjunction with radiation for advanced stage laryngeal cancer have been compared with standard surgery and radiation treatment.
In this systematic review study we try to assess the outcome measures (5 years local control, 5 years disease specific survival) of partial laryngectomy in managing of T3 glottic carcinoma in comparison with total laryngectomy and radiotherapy.
Searches for articles published in English language in Pubmed (Medline data base) for management of T3 glottic carcinoma yielded 86 relevant articles, of which only 22 articles were included according to specific inclusion criteria, pooling 1455 patient with clear 5 years disease specific survival and 1104 patient with clear 5 years local control but for total laryngectomy the only available control was locoregional control. Among these included articles 5 articles had partial laryngectomy as an intervention, 7 articles had total laryngectomy as an intervention, and 15 articles had radiotherapy as an intervention. The other 64 articles were excluded as it did not fulfill inclusion criteria.
Our results as regarding 5 years local control rate were after Partial laryngectomy (87.2%), after Radiotherapy (43.6%) and 5 years locoregional control after Total laryngectomy (67.2%).
As regarding 5 years disease specific survival rate the results were after Partial laryngectomy (81.6%), after Total laryngectomy (69.3%) and after Radiotherapy (63.2%).
Using Review Manager (RevMan 5) to analyze this data we concluded that:
• Reported results of Partial laryngectomy are not less than total laryngectomy in managing T3 glottic cancer.
• Radiotherapy reported results in managing T3 glottic cancer are significantly inferior to surgery.
• There is evidence that postoperative radiotherapy after total laryngectomy improve loco-regional control, but there is no evidence that this has an impact on survival rates.