management of locoregionallyadvanced laryngeal cancer...esmo preceptorship programme management of...

ESMO Preceptorship Programme

Management ofLocoregionally Advanced Laryngeal

Cancer

Erald Ruci

University Hospital ”Mother Teresa”

Head and Neck Cancers – Zurich, Switzerland – 22-23 May 2018

ESMO PRECEPTORSHIP PROGRAMME

Patient Background

� 61-year-old male presented with a 10-month history

of hoarseness and sore throat.

� He also reported of a lump in his left neck.

� He smoked 1 pack of cigarettes per day for 40

years and quit approximately 3 months ago.

� Other comorbidities: Hypertension under treatment.

ESMO PRECEPTORSHIP PROGRAMME

Work-up

� A 3-cm node is identified on physical examination, and computed tomography (CT) scan of the neck reveals the presence of a mass in the preepiglottic space and an enlarged jugulodigastric lymph node.

� Rigid direct laryngoscopy: Exophytic mass in laryngeal surface of epiglottis which invades the larynx entrance.

� Biopsy: Squamous cell carcinoma, G2; 3 from 13 lymph nodes metastatic; thyroid cartilage invasion.

� Imaging of the chest shows no evidence of metastasis. The tumor is classified as stage IV A (T3N2M0).

ESMO PRECEPTORSHIP PROGRAMME

Treatment

� Initially total laryngectomy with bilateral neck

dissection is performed.

� Followed by concurrent chemoradyotherapy.

� Cisplatin 50 mg weekly+RT 5days/week for 6 weeks up 60 Gy for laryngeal region

and bilateral cervical LN stations.

ESMO PRECEPTORSHIP PROGRAMME

Follow-Up

� During Radiotherapy patient develops erythema G1,

mucositis G2 ,dysphagia .

� 1 month after completion of Chemo-Radiation, the

patient was T0N0M0.

� The patients remains disease free since February

2017.

� Regular follow-ups every 3 months.

ESMO PRECEPTORSHIP PROGRAMME

Discussion

� Which would be your initially treatment, surgery as

in this case or induction chemotherapy followed by

chemoradiation or just concurrent

chemoradyotherapy?

� Do you suggest to include in follow-up the PET-CT

even if it continues to be T0N0M0?

ESMO PRECEPTORSHIP PROGRAMME