NEOADJUVANT CHEMOTHERAPY AND SUPRACRICOID PARTIAL LARYNGECTOMY WITH CRICOHYOIDOPEXY FOR ADVANCED ENDOLARYNGEAL CARCINOMA CLASSIFIED AS T3-T4 - 5-YEAR ONCOLOGIC RESULTS

Background. Historically. total laryngectomy with voice-prosthesis ins ertion and near-total laryngectomy were the surgical options advocated for advanced supraglottic and transglottic tumors classified as T3-T4 . Methods. The present retrospective study reviewed our experience wit h neo-adjuvant chemotherapy and supracricoid partial laryngectomy with cricohyoidopexy (SCPL-CHP) in a series of 60 patients with an isolate d, untreated, advanced supraglottic/transglottic invasive squamous cel l carcinoma classified as T3-T4. Results. The Kaplan-Meier 5-year actu arial survival, local failure, nodal failure, and distant metastasis e stimates were 72.7%, 8.3%, 9.2%, and 9.8%, respectively. Survival was significantly reduced in patients with nodal failure (p = .001) and di stant metastasis (p = .007). Overall, a 91.7% laryngeal preservation r ate and a 98.3% local control rate were achieved. Conclusion. Our repo rt was a retrospective analysis and did not present a control group ex clusively managed with SCPL-CHP. Therefore, we were unable to demonstr ate that the use of neo-adjuvant chemotherapy prior to SCPL-CHP allowe d for an increase in local control, laryngeal preservation, and surviv al. However, the use of neo-adjuvant chemotherapy allowed for remobili zation of a fixed arytenoid cartilage in 10 patients who thus became a menable to SCPL-CHP. The key role of neo-adjuvant chemotherapy in this series was as a prognostic indicator for suitability for SCPL-CHP in the case of supraglottic-transglottic tumor with arytenoid cartilage f ixation. Our data also supported the notion that SCPL-CHP is a valid a lternative to total laryngectomy with voice prosthesis insertion and n ear-total laryngectomy in selected patients with a previously untreate d supraglottic/transglottic invasive squamous cell carcinoma classifie d as T3-T4. Furthermore, the successful use (in terms of surgical outc ome, laryngeal preservation, and survival) of SCPL-CHP after neo-adjuv ant chemotherapy suggested that laryngeal organ-preservation strategie s, in advanced endolaryngeal transglottic and/or supraglottic invasive squamous cell carcinoma, should not be limited to the use of laryngea l radiotherapy after neo-adjuvant chemotherapy. (C) 1998 John Wiley & Sons, Inc.