Bozec Alexandre, Culié Dorian, Poissonnet Gilles, Dassonville Olivier
Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, 06103 Nice, France.
Cancers (Basel). 2020 Mar 3;12(3):584. doi: 10.3390/cancers12030584.
In this article, we aimed to discuss the role of total laryngectomy (TL) in the management of patients with larynx cancer (LC) in the era of organ preservation. Before the 1990s, TL followed by radiotherapy (RT) was the standard treatment for patients with locally advanced LC. Over the last 30 years, various types of larynx preservation (LP) programs associating induction or concurrent chemotherapy (CT) with RT have been developed, with the aim of treating locally advanced LC patients while preserving the larynx and its functions. Overall, more than two-thirds of patients included in a LP program will not require total laryngectomy (TL) and will preserve a functional larynx. However, despite these advances, the larynx is the only tumor site in the upper aero-digestive tract for which prognosis has not improved during recent decades. Indeed, none of these LP protocols have shown any survival advantage compared to primary radical surgery, and it appears that certain LC patients do not benefit from an LP program. This is the case for patients with T4a LC (extra-laryngeal tumor extension through the thyroid cartilage) or with poor pretreatment laryngeal function and for whom primary TL is still the preferred therapeutic option. Moreover, TL is the standard salvage therapy for patients with recurrent tumor after an LP protocol.
在本文中，我们旨在探讨全喉切除术（TL）在器官保留时代喉癌（LC）患者管理中的作用。在20世纪90年代之前，全喉切除术联合放疗（RT）是局部晚期喉癌患者的标准治疗方法。在过去30年里，已经开发出了各种将诱导化疗或同步化疗（CT）与放疗相结合的喉保留（LP）方案，目的是在保留喉部及其功能的同时治疗局部晚期喉癌患者。总体而言，纳入LP方案的患者中超过三分之二将不需要全喉切除术（TL），并将保留有功能的喉部。然而，尽管有这些进展，喉部是上呼吸消化道中唯一一个近几十年来预后没有改善的肿瘤部位。事实上，与原发性根治性手术相比，这些LP方案均未显示出任何生存优势，而且似乎某些喉癌患者无法从LP方案中获益。T4a期喉癌（肿瘤通过甲状软骨向喉外扩展）患者或术前喉部功能较差的患者就是这种情况，对于他们来说，原发性全喉切除术仍然是首选的治疗选择。此外，对于接受LP方案后出现肿瘤复发的患者，全喉切除术是标准的挽救治疗方法。
