الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Laryngeal cancer is one of the most common head and neck cancers. Squamous cell carcinoma of the larynx is currently the second most common malignancy of the airway after lung cancer. It is the predominant cancer of men aged 60 years or over. In Egypt, it is the second most common head and neck cancer. Smoking is the predominant risk factor in laryngeal carcinogenesis. Nearly all malignant tumors of the larynx arise from the surface epithelium and therefore are squamous cell carcinoma or one of its variants.
Multiple treatment options are available for management of laryngeal cancer. For early (stage I and II) larynx cancer, both larynx-sparing surgery (transoral endoscopic or open surgical resection) and definitive radiation therapy (RT) generally offer equivalent local tumor control and survival, Organ-sparing approaches permit larynx preservation in patients with locoregionally advanced cancer of the larynx, but do not provide a survival advantage over total laryngectomy. However, because of the importance of the larynx to speech and swallowing function, most patients with advanced cancer of the larynx (stage III and IV) should be offered the option of organ preservation, unless contraindicated.
Although locoregional control of the tumor is one of the most important aims in tumor management nowadays, there is great interest in organ preservation modality of treatment as well as functional preservation.
In this study 40 cases of advanced stage laryngeal SCC (T3 and T4) were divided into two groups, 20 cases for each group, group (A) managed by organ preservation protocol, and group (B) managed by total laryngectomy. Both groups were followed up for 18 months. Assessment of swallowing and respiration were assessed in both groups. Mean age was 61+/-7.5 SD years old in both groups and 90% of case were males. More than 80% of cases were smokers.
group (A) received induction chemotherapy (Cisplatin + 5 flourouracil) for 4 days and the cycle repeated every 28 days for three cycles.4-8 weeks after the third cycle Reassessment was done using indirect laryngoscopy and contrast enhanced computed tomography of the neck.
Cases showed regression of the tumor size started course of radiotherapy
(35 sessions of radiotherapy) with weekly concomitant chemotherapy dose. On the other hand, cases who showed no regression of the tumor size underwent laryngectomy.
group (B) Cases managed by total laryngectomy and neck dissection. Both groups were followed up for 18 months after management either by surgery or organ preservation protocol for detection of recurrence by imaging and clinical examination. Cases showed recurrence underwent salvage laryngectomy. Assessment of swallowing and respiratory functions was done for both groups about 6 months after management.
Swallowing function assessment was done using FEES, video fluoroscopy and DHI questionnaire. Respiratory function assessment was done using SGRQ.
Results showed that better locoregional control in cases managed surgically than cases managed by organ preservation protocol (incidence of recurrence was lower in cases managed surgically). Assessment of laryngeal functions showed that swallowing difficulties were less evident in cases managed by total laryngectomy than cases managed by organ preservation protocol. There were also some changes in phases of swallowing in both groups like prolongation of oral phase and pharyngeal phase in group (A). while there was prolongation of the pharyngeal and esophageal phases in group (B). Also, there were anatomical abnormalities like anterior pouch, pseudo epiglottis and delayed peristalsis after laryngectomy. Respiratory function assessment showed non-significant differences between both groups regarding daily activities.
Assessment of swallowing and respiratory functions was done for cases after salvage laryngectomy also. Cases that underwent salvage laryngectomy suffered from swallowing difficulties more than cases managed by laryngectomy from the start.
Tumor stage, lymph node metastasis, smoking and age of the patients had a great effect on the result. Advanced tumor stage (T4), lymph node invasion and smoking were associated with higher incidence of tumor recurrence. Also advanced tumor stage and old age were associated with more swallowing difficulties after management in both groups.