High Technology Letters ISSN NO : 1006-6748

Laryngeal Cancer Treatment : An Update Review

AMALIA TRI UTAMI1, PUTU ADITYA B2, NUR AKBAR AROEMAN2, YUSSY AFRIANI DEWI2
1
Department of Pathology, Faculty of Medicine and Health Science, Maulana Malik Ibrahim
State Islamic University, Indonesia
2
Department of Otolaryngology Head and Neck Surgery, Dr. Hasan Sadikin Hospital, Faculty
of Medicine, Padjadjaran University, Indonesia
Corresponding author: Amalia Tri Utami, Email: amalia1991@uin-malang.ac.id

ABSTRACT
Treatment of larynx cancer has changed drastically over the past a few a long time. Novel
modalities of treatment have been presented as organ conservation has been created. In
expansion, unused focused on treatments have showed up, and changes in radiotherapeutic
and surgical strategies have been presented. Hence, a huge assortment of treatment choices
is expanding neighborhood control rates and in general survival; in any case, selecting the
foremost suitable treatment remains a challenging choice. This article centers on the
multidisciplinary care of early-stage and locally progressed larynx cancer and endeavors
to entirety up diverse approaches. Additionally, it audits state-of-the-art treatment in
larynx conservation, which has been solidified in later a long time.

Keywords: Laryngeal Carcinoma, Treatment, Update

1. Introduction
The rate of head and neck cancer is expanding quickly, bookkeeping for > 550,000
cases yearly worldwide,1 of which 130,000 are unused laryngeal cancer cases.2 There are
geographic contrasts within the frequency since of the diverse predominance of hazard
variables, basically tobacco and liquor, among populaces, which moreover makes
the illness more common in men since of their more prominent presentation to those
components. Tumors can create in any portion of the larynx; the glottis is the foremost
common location, taken after by the supraglottis and the subglottis.3 The signs and side
effects, which incorporate roughness, stridor, sore throat, tireless hack, or a neck mass,
depend on the measure and area of the tumor.4 Regularly, glottic tumors are analyzed at
early stages, since a change in voice quality is famous moderately early within the course of
the illness. In any case, supraglottic and subglottic tumors frequently show with progressed
infection since their side effects are less self-evident.

2. Epidemiology

Approximately 60% of individuals analyzed with larynx cancer have arrange I or II

cancer (no prove of lymph hub association or thyroid cartilage invasion).5 With radiotherapy
(RT) or surgery, 10-year disease-specific survival rates are > 90% and 70%, individually, for
patients with arrange I and II cancer.6,7 Larynx conservation ought to be considered in
patients with early-stage cancer. Both medicines, RT and surgery, work well
in nullifying early-stage cancer, with no contrasts in oncologic outcomes.8-10 Be that as it may,

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High Technology Letters ISSN NO : 1006-6748

RT is as a rule favored since of its useful results.11 Components such as tumor characteristics,
coordinations, and quiet inclinations ought to be considered in selecting the treatment.

3. Treatment of Early-Stage (Arrange I and II)

Disease Larynx-preserving medications with RT, halfway laryngectomy, or transoral

laser surgery ought to be the introductory approach for patients with early-stage larynx
cancer. In any case, there are no randomized thinks about of RT and preservation surgery
that compare neighborhood control or survival for patients with early-stage laryngeal cancer.

A. Supraglottis

Supraglottic cancers speak to around one third of laryngeal cancers.

Most ponders propose that RT moves forward utilitarian results and is way
better at protecting voice quality. RT is compelling for organize I larynx cancer within
the supraglottic locale. Sykes et al12 appeared a nearby control of 92% with RT (with
surgery after repeat) for patients with organize I supraglottic tumors, and territorial
lymph hub control of 91% with a 5-year survival rate of 83%. Then again, a review
consider comparing radical RT (60 to 66 Gy) versus halfway laryngectomy in patients
with T1 to T2 N0 found that surgery is successful, with comes about comparable to
those of RT.6

B. Subglottic

Subglottic cancers speak to < 2% of laryngeal cancers. Most cases are

analyzed in patients with progressed infection, so information on treatment are based
on few patients in each think about. Early stages in this area are as a rule treated with
RT. On the off chance that RT isn't fruitful, a hemilaryngectomy ought to be
performed.13

C. Glottis

Cancer of the glottis speaks to around two thirds of all cases of laryngeal
cancer. Patients with early-stage cancer ought to be treated employing a larynx-
preserving approach, with either RT or transoral laser surgery. A few ponders have
famous that transoral laser surgery offers an compelling approach to early-stage glottic
cancer. Stoeckli et al8 compared treatment between laser surgery and RT (68 to 70.2
Gy) including 140 patients with T1 to T2 glottic cancer. Neighborhood control,
progression-free survival, and generally survival were comparable between bunches in
patients with T1. In any case, surgery had way better nearby control for patients with
T2 than did RT. Larynx preservation was predominant within the surgery bunch (T1,

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High Technology Letters ISSN NO : 1006-6748

82% for RT v 96% for surgery; T2, 77% v 89%). In an Italian ponder with T1a and T1b
glottic cancer, laser surgery brought about in a 90% nearby control.14

A comparative survey of RT, transoral laser surgery, and fractional open

laryngectomy in T1 to T2 larynx cancer appeared that patients treated with RT had 5-
year nearby control rates of 85% to 94% and 70% to 80% for T1 and T2, separately
(Table 1). The by and large survival was comparable for all treatments.9
These creators concluded that nearby control after RT is unfavorably affected by
expanding T organize, male sex, drawn out in general treatment time, destitute
histologic separation, and moo pretreatment hemoglobin level.9,15,16 Other considers
recommend the same comes about, appearing no contrasts in nearby control,
progression-free survival, and by and large survival between laser surgery and RT in
patients with T1b glottic cancer.16

Table 1. Rate of Local Control

Therapy Control Rate

T1 T2
Radiotherapy 94 75
Open Partial Laryngectomy 92 78
Transoral Laser Resection 88 84

In a meta-analysis including 7,600 patients with early-stage glottic cancer that

compared RT with laser surgery, no contrasts were found in neighborhood control. In
any case, laser surgery appeared to be prevalent to RT in moving forward generally
survival (chances proportion, 1.48; 95% CI, 1.19 to 1.85).17

In a imminent consider, Yamazaki et al18 assessed diverse plans of RT

(little tumors [less than two thirds glottis], classic RT [60 Gy; 2 Gy/fr] v exploratory RT
[56 Gy; 2.25 Gy/fr]; huge tumors [two thirds glottis or more], classic RT [66 Gy; 2
Gy/fr] v exploratory RT [63 Gy; 2.25 Gy/fr]). In spite of nearby control being
predominant within the exploratory arm (92% v 77%, P = .004), there were no
contrasts in generally survival. This strategy can diminish the dosage to solid tissues
and increment the measurements to tumor with less harmfulness; be that as it
may, understanding choice criteria are basic. As of late, in an investigation of the
National Center Institute’s Soothsayer, a advantage in terms of cancer-specific
survival for intensity-modulated RT (84.1%) versus other methods (66%) was
observed.19

Besides, extra review information bolster the utilize of carotid-sparing

intensity-modulated RT over ordinary RT in T1 to T2 N0 larynx cancer, illustrating no
distinction in adequacy with altogether lower measurements to the carotid arteries.20

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Whether this interprets into made strides long-term vascular results is still unknown.
Therefore, patients with early-stage malady may well be treated with either RT or
transoral laser surgery. Those with the next hazard (since of association of
the front or back commissures or reciprocal malady) are ordinarily treated with RT
since of the hazard of positive margins.21,22

4. Treatment of Locoregionally

A. Progressed Organize (Arrange III and IV M0) Disease

Until 1990, laryngectomy was the standard treatment of locoregionally

progressed malady. As of now, all patients with arrange III and IV ought to be
assessed some time recently treatment by a multidisciplinary tumor board, which
can alter the administration and in this way make strides the survival of patients.23
Larynx conservation is considered basic. Useful organ conservation is suggested
and as a rule includes a combination of chemotherapy and RT. In any case, laryngeal
conservation surgery can be an alternative treatment in carefully chosen patients.10,24
It may be utilized in combination with chemoradiotherapy or postoperative RT as
an elective choice for patients with a little T-stage essential tumor but with progressed
infection owing to neck hub malady. These sorts of approaches have not been
compared with chemoradiotherapy; hence they ought to be utilized for carefully
chosen patients as it were.

The locoregionally progressed bunch has two sorts of patients: those who are
candidates for organ conservation and those who are not. As of now, the line
between them isn't clear and the choice depends on the specialist and the institution.
Most considers don't clarify resectability criteria. Be that as it may, a few anatomic
criteria are unequivocal, as the taking after: inclusion of the hyoid bone or cricoids
cartilage, extralaryngeal spread, inclusion of prevertebral belt, vascular structure
intrusion, or total resection isn't possible.5 In expansion to these criteria, other
viewpoints of a resectable tumor must be considered, and these increment the
significance of a multidisciplinary tumor board.

B. Progressed (Arrange III and IV) Disease

In locally progressed laryngeal cancer, the conventional approach has been

laryngectomy taken after by adjuvant RT, coming about in a misfortune of normal voice
generation. Be that as it may, this approach has critical impediments: a problematic rate
of malady control (35% to 75%), a 60% chance of locoregional backslide, and a 20%
chance of metastasis after 5 years.25,26 Since of this, we started trying to find options to
surgery.

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Medicines for the head and neck have changed drastically with the appearance
of novel modalities such as combined treatment. The advancement of modern
chemotherapy specialists (taxanes and cetuximab) and the presentation of unused
forecast variables (edges and extracapsular nodal expansion) have changed the way we
treat these patients; these advancements have gotten to be an imperative portion of the
entire handle.

5. Other Invasive Treatment

A. Surgery

The most common treatment of locoregionally progressed illness is

chemoradiotherapy. All things considered, surgery is vital for chosen patients who are
not candidates for or who select not to experience chemoradiotherapy.

B. Larynx conservation surgery

Larynx conservation surgery is utilized in combination with adjuvant RT or

chemoradiotherapy. It is an alternative for patients with a little essential tumor but
who have progressed malady owing to neck hub burden.27

C. Preservation surgery

Conservation surgery is utilized as an forceful treatment of locally repetitive

infection after RT.28,29 In expansion, endoscopic strategies are utilized for early stages.
In chosen T3 or T4 tumors, transoral laser surgery, in combination with postoperative
treatment, may be considered, driving to an fabulous oncologic survival outcome.30

D. Total laryngectomy

Usually, add up to laryngectomy is utilized to treat locally repetitive illness

after chemoradiotherapy. Additionally, it ought to be utilized in more seasoned or
slight patients.31,32 Be that as it may, bulky T4 tumors can be treated with forthright
chemoradiotherapy.33

E. Adjuvant Treatment

After larynx conservation surgery, adjuvant RT is required for patients with

locoregionally progressed malady, with or without chemotherapy.34 Adjuvant
chemotherapy (cisplatin 100 mg/m2 each 21 days) concurrent with RT has superior
neighborhood control, progression-free survival, and by and large survival than does
RT alone in patients with high-risk locoregionally progressed malady (the European
Association for Inquire about and Treatment of Cancer and Radiation Treatment
Oncology Bunch thinks about included around 22% of patients with larynx cancer and

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both trials illustrated a critical advantage in disease-free survival and locoregional

control).35 Positive edges and extracapsular nodal expansion are the hazard variables
that have advantage in generally survival and nearby control of concurrent
chemoradiotherapy. There are no particular information for larynx cancer.

F. Acceptance Chemotherapy

Induction chemotherapy is an alternative for useful larynx conservation in

locoregionally progressed illness. As a rule, the conspire is acceptance
chemotherapy taken after by conclusive RT; in any case, this treatment is less
successful than concomitant chemoradiotherapy treatment in terms of locoregional
control.43 Acceptance chemotherapy has appeared a survival advantage impact. That
has been tried in a few trials (Paccagnella et al44; Domenge et al45; Pignon et al34,46,47),
which have appeared a reliable survival advantage and expanded remedy rates in a
subset of nonoperable patients. Within the Pignon et al34 meta-analysis,
the analysts famous a 5% increment in survival, coming to measurable centrality (P
= .05), in trials employing a cisplatin-plus-fluorouracil regimen as it were.

G. Concurrent Chemoradiotherapy

Concurrent chemoradiotherapy was created initially as a authoritative

treatment alternative for inoperable patients; it had great detailed nearby control and
survival rates. Concomitant chemoradiotherapy endeavors to require advantage of
the radiosensitizing properties of chemotherapy. The most issue with this treatment is
an increment in review 3 and 4 intense toxicities. A few trials utilizing seriously
chemoradiotherapy regimens have taken note a survival advantage without surgery.40

6. Conclusion

In conclusion, the treatment of larynx cancer has changed significantly over the past
3 decades. The foremost imperative adjustment is the utilize of the multidisciplinary
approach. Some time recently treatment, all patients with larynx cancer, particularly those
with locally progressed infection, ought to be assessed by a multidisciplinary tumor board. For
the lion's share of patients with locally progressed (arrange III or IV) laryngeal cancer,
a useful organ conservation approach with chemoradiotherapy is prescribed. Be that as it
may, surgery may be an alternative for chosen patients and for those who are not candidates
for larynx conservation. Focused on treatments play a part in chemoradiotherapy,
but encourage comparative trials must be performed. Awesome progresses have been made
in larynx cancer treatment, but we must proceed making strides our information and quality
measures to advantage as numerous patients as conceivable.

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Therefore, the Prophet Muhammad SAW exclaimed, "So seek treatment, and do not
treat yourself with what is forbidden." (Narrated by Abu Dawud). Among the haram for
example khamr. The Prophet SAW informed, "Khamr is not a medicine, but it is a disease."
(HR. Muslim). Treatment can be with honey that tastes sweet, delicious, and halal. Allah SWT
says, "Then when you have made up your mind, then put your trust in Allah. Verily, Allah
loves those who put their trust in Him." (Surah Ali Imran 3:159). God willing, people who seek
treatment are people who put their trust in Allah SWT so that they get a reward that is liked by
Him. However, it seems that people who are sick do not get enough treatment as a form of
endeavor and trust in Allah SWT, but also have to be patient. Patience when sick is a moral
attitude that leads a person to heaven. To be patient in this context is to be patient in feeling
the pain that is being tested by Allah. If the above therapy still fails, try using the blink blink
solution in the style of the Prophet Muhammad SAW. "Indeed the charity of a Muslim can
increase his age, can prevent a bad death (su'ul khotimah), Allah will remove from him pride,
poverty and pride in oneself".

Conflict of Interest
The authors declare that there is no conflict of interest.

Acknowledgement
The authors want to say Alhamdulillah and Sholawat to beloved Prophet Muhammad SAW.
This research was supported by Maryam & Isa Clinic. The researchers also want to give
thanks to all the people that help to arrange this research. Jaazakumullohu khoiron katsiro.

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