The probability and method of curing laryngeal cancer with radiotherapy

The larynx is the main respiratory channel of the human body and also the organ of pronunciation. It is connected to the pharynx above and the trachea below. In addition to the respiratory function, the larynx also has the functions of voice and swallowing. For a long time, total laryngectomy has dominated the clinical treatment of laryngeal cancer. Its advantage is that the cancerous tissue is removed relatively thoroughly and the chance of local recurrence is relatively small. The disadvantage is that the patient will lose the larynx for life, lose the normal language function, and cannot guarantee the normal physiological respiratory pathway. This is indeed a pity for some early patients, especially those whose tumors are still localized.

Because of this, the medical community has paid more and more attention in recent years to preserving the function of the throat as much as possible while removing the tumor. That is to say, under the premise of completely removing the tumor, it is best not to remove what can be removed, and if only a small part can be removed, do not remove more. After a lot of practice, many doctors believe that the 5-year survival rate after hemi-laryngectomy or partial laryngectomy is not inferior to that of total laryngectomy.

Surgery is not necessary for early-stage laryngeal cancer

With the improvement of radiotherapy technology and equipment, radiotherapy has become one of the main treatment methods for clinical laryngeal cancer. For some early-stage patients, it is indeed possible to achieve the goal of cure through radiotherapy alone without surgery. In addition, radiotherapy can also be used as an auxiliary treatment before and after surgery to increase and consolidate the treatment effect and make up for the shortcomings of surgical treatment.

For some early-stage laryngeal cancer patients, it is more appropriate to preserve the throat and treat them with simple radiotherapy. This is because laryngeal cancer is mainly squamous cell carcinoma, which is generally more sensitive to radiation. In addition, studies have shown that for early-stage laryngeal cancer, especially laryngeal cancer without cervical lymph node metastasis, the long-term survival rate of patients treated with simple radiotherapy is equivalent to that of surgery. Even if radiotherapy fails, the success rate of salvage surgery is still around 80%.

Chemotherapy alone can better protect the patient's speech and swallowing functions, and guarantee the patient's quality of life to the greatest extent. However, for patients with advanced laryngeal cancer, if surgical resection is possible, it is better to use radiotherapy as an auxiliary treatment measure.

Radiation therapy for laryngeal cancer

Laryngeal cancer is mainly squamous cell carcinoma, which is generally more sensitive to radiation. The better the degree of differentiation, the less sensitive it is to radiotherapy. In addition, patients with proliferative tumors have richer blood circulation and are more sensitive to radiation. Patients with shallow ulcers or ulcers on the surface of the tumor are moderately sensitive, while patients with invasive tumors without ulcers are less sensitive to radiotherapy. In terms of the location of the tumor, tumors located on the upper part or edge of the vocal cords are most sensitive to radiation and have the best effect of radiotherapy. Patients located in the subglottic area generally do not choose radiotherapy.

1. Radiotherapy alone

Radiotherapy alone is mainly used for patients with early vocal cord cancer and those who are not suitable for surgical treatment due to systemic conditions. Some people believe that radiotherapy can be used as the first choice for the treatment of early glottic cancer, including patients who are suitable for both surgery and radiotherapy, and should also consider radiotherapy first, because radiotherapy can preserve the pronunciation and respiratory function of the larynx and can achieve the purpose of treatment. However, for patients with advanced laryngeal cancer, if surgical resection can be achieved, it is better to use radiotherapy as an auxiliary treatment measure.

2. Preoperative Radiotherapy

Preoperative radiotherapy is the most common method in clinical practice. It is mainly suitable for patients with advanced stage and relatively large tumors. The purpose of radiotherapy is to shrink the tumor, suppress the activity of cancer cells, make the tumor more limited and have clear boundaries, which is conducive to complete surgical resection, and can effectively reduce or prevent the spread and metastasis of the tumor caused by surgery. Radiotherapy for subglottic cancer followed by laryngectomy can also effectively reduce the recurrence of cancer at the tracheostomy site.

3. Postoperative Radiotherapy

Postoperative radiotherapy can only be used for postoperative recurrence or metastasis of cervical lymph nodes, small lymph nodes found during surgery, and pathologically confirmed metastasis. Because the local tumor and its surrounding vascular bed are destroyed due to surgery, the sensitivity to radiation is relatively low, and the effect of postoperative radiotherapy is not ideal.