| February 1,
2001
STUDY DEMONSTRATES IMPROVED QUALITY
OF LIFE FROM ORGAN PRESERVATION SURGERY APPROACH IN
TREATMENT OF SOME LARYNX CANCERS.
Evidence now demonstrates that a novel partial
voice box resection, in which up to 75% of the voice
box is removed and the rest reconstructed, can be just
as effective as total laryngectomy, with significant
improvement of quality of life.
(Philadelphia, PA)- Researchers
at the University of Pennsylvania Cancer Center have
completed a study assessing both the oncologic outcome
and quality life implications following a novel surgical
technique to partially remove the larynx ("voice box")
of patients with cancer of the larynx, as opposed to
a total removal of the larynx (TL). This organ preservation
surgical procedure is known as the supracricoid partial
laryngectomy (SCPL). The study which will be published
in the February issue of Laryngoscope, demonstrates
that the SPCL procedure provides excellent local control
of the cancer, significantly improves a patient's quality
of life vis-a-vis the TL procedure, and suggests that
many patients who underwent total voice box removal
in the past could have been reasonable candidates for
this partial removal procedure to save their voice box.
The treatment of larynx cancer, the most common form
of head and neck cancer, can have a major impact on
many aspects of the quality of life of patients, including
their ability to swallow and speak, as well as their
ability to breathe normally. Depending on the size and
extent of the cancer, several surgical and non-surgical
procedures are available as treatment options. Historically,
a total removal of the larynx has been the most common
treatment method in cases where the cancer was very
extensive and when non-surgical interventions such as
chemotherapy and/or radiation have failed, resulting
in a recurrence of the cancer. The main problem encountered
after total removal of the voice box is that the patient
no longer breathes through their nose and mouth, and
must breathe through a "stoma", or breathing hole in
the neck.
Total laryngectomy impacts on quality of life in numerous
ways including: one's self-image because of the cosmetic
impact of a breathing hole in the neck, by causing swallowing
dysfunction, and other problems such as a marked decrease
in smell and taste because of lack of breathing through
the nose. This still remains the case today in most
such situations. However, the SCPL, now provides a new
option for both intermediate as well as advanced size
cancers, resulting in improved breathing and swallowing
without the need for a permanent breathing hole in the
neck, which significantly improves quality of life in
these patients.
While the SPCL procedure first originated in Europe
in 1959 and has been performed extensively there for
years, it was not initially available to patients in
the United States and was not first performed here until
1989, 30 years after it's European introduction. Gregory
S. Weinstein, MD, Associate Director of the Center for
Head and Neck at Penn's Cancer Center, the first surgeon
to perform this procedure in the United States, serves
as the primary instructor of this procedure in the nation
" Informing the public of this option is crucial" said
Weinstein.
In many situations, this procedure, can provide much
less hardship to the patient, lessen the negative impact
on the patient's quality of life, with just as much
oncologic success and excellent local control. A patient
with larynx cancer should no longer be unaware of the
availability and clinical effectiveness of this procedure
which has been shown to be less drastic and less debilitating"
notes Weinstein. The primary indications for the SCPL
are selected cancers with intermediate to advanced stage
larynx cancers in which the only other surgical option
is total removal of the voice box. A second important
indication of the SCPL is as an alternative to non-surgical
approaches such as radiation or chemotherapy and radiation
when the risk for treatment failure may be high. The
final indication is for patients who already underwent
radiation therapy for very early cancers of the voice
box and then had the cancer recur. Unfortunately, if
a patient undergoes radiation or chemotherapy and radiation
for an intermediate or advanced cancer and then has
a recurrence in the voice box, they are almost never
a candidate for a SCPL at that point. The cure rate
in the voice box following SCPL, however, is consistently
in the 90% range.
Quality of post-operative life is a key concern for
surgeons and patients alike. All medical treatments
have some degree of acute and chronic side effects.
The expected outcome after SCPL is temporary difficulty
swallowing, a temporary breathing tube in the windpipe
("tracheostomy") and some degree of permanent hoarseness.
In addition, post-surgical voice box swelling occurs.
Although this swelling is temporary, a temporary tracheostomy
tube is put into the windpipe, but typically removed
after two weeks.
Speech after total removal of the voice box is frequently
facilitated by either an implanted or hand-held prosthetic
device. The SPCL patient, who will have some degree
of permanent hoarseness, is able to speak without the
need for a permanent breathing hole in the neck and
without the need for using prosthetic tone/voice generators.
Evidence suggests that the absence of such prosthetic
devices has a significant positive effect on the patient's
physical functioning, general health, vitality and emotional
state.
Generally, three months after the SPCL procedure, treatment
and rehabilitation have ended, the patients' quality
of life issues such as eating, breathing, speaking and
other activities of life far exceed his or her initial
expectations. What the SPCL procedure now allows for
is the local control of cancer, while preserving enough
of the larynx to allow for speech and swallowing without
the need for a permanent tracheostomy, concludes Weinstein.
Also contributing to this study performed at the University
of Pennsylvania and to this article were Mohamed Mahmoud
El-Sawy, MD and Mostafa Mohamed El-Sayed, MD of the
Al-Ashar University, Cairo, Egypt, Cesar Ruiz, MA, Patricia
Dooley, MA, and Ara Chalian, MD, University of Pennsylvania
and Andrew Goldberg, MD, University of San Francisco.
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