A clinical trial of continuous cisplatin-fluorouracil induction chemotherapy and supracricoid partial laryngectomy for glottic carcinoma classified as T2
✍ Scribed by Mark I. Singer; Ollivier Laccourreye; Gregory S. Weinstein; Daniel Brasnu; Henri Laccourreye
- Publisher
- John Wiley and Sons
- Year
- 1995
- Tongue
- English
- Weight
- 331 KB
- Volume
- 76
- Category
- Article
- ISSN
- 0008-543X
No coin nor oath required. For personal study only.
✦ Synopsis
A Clinical Trial of Continuous Cisplatin-Fluorouracil Induction Chemotherapy and Supracricoid Partial Laryngectomy for Glottic Carcinoma Classified as T2
I am concerned that the article "A Clinical Trial of Continuous Cisplatin-Fluorouracil Induction Chemotherapy and Supracricoid Partial Laryngectomy for Glottic Carcinoma Classified as T2"' is misleading. The surgical concept cricohyoepiglottopexy, "CHEP," has not gained acceptance in North American treatment centers because it represents a subtotal laryngectomy rather than a conservation laryngectomy. Treatment strategies differ here because the preferred conservation laryngectomy preserves the glottic voicing mechanism to some extent, and therapeutic radiotherapy preserves the entire larynx. The CHEP approach is an extended glottic resection with restoration of a tracheohypopharyngeal shunt that serves the needs of respiration and allows for pseudolaryngeal voice to develop from the walls of the hypopharynx. The authors' claim, that this is laryngeal preservation, could be misunderstood.
The paper is limited by a number of issues. The authors not only attempt to promote the utility of CHEP, but also to support the use of induction chemotherapy. There is no evidence that chemotherapy improved the cure rate of this unnecessarily extensive laryngeal procedure. It implies that induction may be a useful prognosticator. It is incorrect to call this "laryngeal preservation." To us this requires preservation of all or part of the glottic larynx. The CHEP ablates the glottic larynx, and as the illustration points out, is merely an open channel into the hypopharynx shielded by a portion of the epiglottis during deglutition. The authors state on a subjective scale that 37.3% of patients did aspirate 2-6 months postoperatively. This is higher than most standard conservation techniques and is not preservation of normal respiratory physiology. The decision to perform a neck dissection was left to the apparent whim of the surgeon and no protocol seems to have existed. The high rate of neck control is compatible more with the rare incidence of cervical metastasis for T2 glottic carcinoma than the treatment employed.
For readers who treat laryngeal cancer by nonsurgical means, the authors should clarify what they mean by physiologic respiration when aspiration occurs in nearly 2/5 of the patients and "phonation" when there is no glottis. At this time of increasing interest in organ preservation, to state that subtotal laryngectomy is organ preservation confuses the important evolution of improved treatment modalities.