Page 60 - Portuguese Journal - SPORL - Vol 61. Nº2

spaces, not only for assessing the prognosis disease control. 4,12 In these patients, the choice
but also for therapeutic purposes. MRI has
3,8
higher sensitivity than CT in the evaluation
of the paraglottic space, although it can
overestimate , especially in the presence of
previous submucosal biopsies. 10,11 Unlike the
findings of the present study, the accuracy of
evaluation of paraglottic space invasion in the
studies by Jaipuria and Locatello was 82% and
3
9
93.3%, respectively. With regard to invasion of
the thyroid cartilage, differentiating between
invasion and tumor penetration through its
entire thickness remains difficult and the
positive predictive value does not exceed 75%,
unless there is clear extralaryngeal invasion,
which occurred in 55% of our study sample.
2,3
Although only a small percentage of patients
underwent MRI, the latter increased the
diagnostic accuracy of evaluation of invasion
of the thyroid cartilage in 50% cases, validating
its usefulness for evaluating tumor invasion
of the thyroid cartilage. In the present study,
the diagnostic accuracy for invasion of the
preepiglottic space, contralateral extension,
and extralaryngeal extension was higher than
78%, similar to the result reported by Locatello
et al.
3
In the present study, clinical overstaging of
T-category in patients who could have been
candidates for organ-preserving treatment
occurred in seven patients. Retrospectively,
it is difficult to predict what the patient’s
status could have been and whether total
laryngectomy could have been avoided, but
these patients would probably have achieved
good disease control and laryngeal function
with a regimen of organ-preserving treatment.
The decision regarding the treatment of locally
advanced laryngeal cancer should be made by
a multidisciplinary team and individualized; in
addition, the risks and benefits of the different
treatment approaches should be considered,
both surgical and non-surgical. 4,12 In the T4N0
or T4N+ stages, the rate of disease-free survival
was reportedly higher after total laryngectomy
than after organ-preserving treatment
strategies. 4,12 However, in some T3N0 tumors,
the two strategies resulted in similar rates of
202 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
of organ-preserving treatment strategies
should be based on patient factors, such as
age, occupation, comorbidities (including lung
function), compliance, smoking and drinking
abstinence, and tumor factors, including its
size, location, and laryngeal function. 4,12 In fact,
patients with lung disease, vocal cord fixation,
gastrostomy and/or tracheostomy, and large
tumors (supraglottic > 5.0 cm or glottic > 2.5
3
cm ) appear to have better outcomes when
3
treated surgically. 4 Furthermore, factors
associated with the healthcare system
should be considered because regular
follow-up is required to identify and treat
complications associated with chemotherapy
and radiotherapy (such as chronic aspiration,
dysphagia, and dyspnea), as well as relapse or
tumor persistence, which may require salvage
surgery. 4,12 In the study by Sherman et al., the
13
TALK score (T stage, serum albumin, drinking
habits, Karnofsky index) was shown to be a
good predictor for organ-preserving regimens
as it correlates positively with disease control in
the absence of tracheostomy and gastrostomy
tube feeding.
The limitations of this study are that it was a
retrospective study and the patients’ clinical
assessment was performed by different
professionals (surgeons, radiologists, and
pathologists). The decision regarding the
patients’ treatment was always made in a
group consultation setting that included
otorhinolaryngologists, radiologists, and
oncologists.
Conclusion
If the clinical staging of laryngeal and
hypopharyngeal cancer is inaccurate, it
may lead to inadequate treatment and poor
vital and functional outcomes. The correct
characterization of this type of tumor, including
its extension, requires an accurate diagnostic
evaluation of the paraglottic space and
thyroid cartilage. However, these conclusions
are based on the results of an observational
study with a small sample size and should be
validated in a larger multicenter study.