Efficacy of non-surgical larynx-preservation comprehensive treatment in advanced laryngeal carcinoma

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Efficacy of non-surgical larynx-preservation comprehensive treatment in advanced laryngeal carcinoma

For patients with advanced laryngeal cancer, the choice between radical surgery (which often removes the larynx) and non-surgical treatments to preserve speech, breathing, and quality of life is a life-altering decision. While research has confirmed that larynx preservation is possible, doctors continue to debate the best strategies. A 2020 study from the Chinese People’s Liberation Army (PLA) General Hospital aimed to evaluate whether a personalized, non-surgical “comprehensive treatment” could effectively save the larynx while improving survival and reducing side effects.

Study Background

The study included 67 patients with advanced laryngeal squamous cell carcinoma (30 stage III, 37 stage IV) who strongly desired to preserve their larynx and refused radical surgery. All patients were pathologically diagnosed, and those with distant metastasis or second primary cancers were excluded. The group had a mean age of 59.1 years (range: 26–80), with 61 men and 6 women.

The study was approved by the PLA General Hospital Ethics Committee, and all patients provided informed consent. A multidisciplinary team (ENT surgeons, radiation oncologists, and other specialists) assessed each patient to create a personalized treatment plan.

Treatment Approach

The team used a flexible, patient-centered strategy with three key components:

  1. Midterm Assessment: After 20 sessions of radiotherapy (42.2 Gy), doctors checked if the tumor had shrunk. If no partial response (PR) was seen, treatment was stopped, and surgery was recommended.
  2. Personalized Therapies:
    • Older/High-Risk Patients: Those over 75 or with other health issues received concurrent radiotherapy (CRT) plus epidermal growth factor receptor inhibitors (EGFRi)—drugs that block a protein that helps cancer cells grow.
    • Large Tumors (T4): Most received induction chemotherapy (chemo before radiation) followed by CRT (with or without EGFRi).
    • Moderate Tumors (T2–T3): Concurrent chemoradiotherapy (chemo + radiation at the same time) with or without EGFRi.
  3. Precision Radiotherapy: Three advanced techniques were used to target tumors while sparing healthy tissue:
    • Helical Tomotherapy (HT): 11 patients
    • Volumetric-Modulated Arc Therapy (VMAT): 44 patients
    • Intensity-Modulated Radiotherapy (IMRT): 12 patients

All patients received the same radiation doses: 70 Gy to the main tumor/metastatic lymph nodes, 60 Gy to nearby at-risk areas, and 54 Gy to broader regions—delivered in 33 daily sessions over 6.5 weeks.

Results

The treatment was highly effective:

  • Tumor Response: 52 patients had complete response (CR, total tumor shrinkage) and 15 had partial response (PR) initially. By one month post-treatment, all PR patients achieved CR—100% efficacy.
  • Survival & Larynx Preservation:
    • 3-year overall survival (OS): 81.3%
    • 5-year OS: 65.7%
    • 3-year larynx-preservation survival (LPS): 89.9%
    • 5-year LPS: 87.2%
  • Recurrence: Eight patients had local laryngeal recurrence, and four had lymph node recurrence. All refused salvage surgery.
  • Quality of Life: Thirteen patients needed a temporary tracheostomy (breathing tube) before treatment; 10 had it removed 6 months later. No one required permanent feeding tubes, had severe dysphagia (trouble swallowing), or lost the ability to speak. The most common side effects were mild dry mouth (44 patients) and laryngeal edema (43 patients).

What It Means

Previous studies reported 5-year larynx preservation rates of 66–84%, but this study’s 87.2% rate is higher—likely due to:

  1. Managing Side Effects: The team effectively treated severe mouth sores (oropharyngeal mucositis), which often force radiation to stop early.
  2. Precision Radiotherapy: IMRT, VMAT, and HT minimized harm to healthy tissue, reducing long-term complications.
  3. Personalized Plans: Tailoring treatment to each patient’s age, tumor stage, and health helped balance cancer control and quality of life.

Conclusion

This study shows that non-surgical comprehensive treatment—when paired with careful management of side effects—can preserve the larynx in advanced laryngeal cancer, significantly improving quality of life. While progress has been made, more research is needed to refine strategies and find the best balance between saving the larynx, controlling cancer, and minimizing side effects.

Nan-Xiang Chen¹, Wen-Jun Fan², Lin Ma², Jia-Ling Wang¹, Wen-Ming Wu¹, Xin-Xin Zhang¹
¹Department of Otolaryngology, Head and Neck Surgery, Institute of Otolaryngology, Chinese People’s Liberation Army General Hospital; National Clinical Research Center for Otolaryngologic Diseases; Key Lab of Hearing Impairment Science of Ministry of Education; Key Lab of Hearing Impairment Prevention and Treatment of Beijing, Beijing 100853, China
²Department of Radiation Oncology, Chinese People’s Liberation Army General Hospital, Beijing 100853, China

Funding: This work was supported by the National Natural Science Foundation of China (No. 81072195).

Conflicts of interest: None.

References

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doi.org/10.1097/CM9.0000000000000639

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