Considering specifically laryngeal squamous cell carcinoma, indications for post-operative RT to reduce the risk of local recurrence currently include: irradical resection; perineural/lymphatic/vascular spread, extra-laryngeal carcinoma extension, carcinoma growth through the laryngeal cartilage and subglottic extension. Moreover, post-operative RT to reduce the regional recurrence risk is given in case of extracapsular spread, multiple metastatic nodes, or metastatic node(s) larger than 3 cm.

The problem is that locoregional recurrences occur in patients that in the light of these guidelines DO NOT necessitate of postoperative RT. How do we identify them before or after the primary surgery directing them to a postoperative adjuvant treatment?

I have to say you asked a very powerful question. I totally agree with you that sometimes we underestimate some laryngeal SCC and their agressiveness. There are some multidisciplinary teams in the UK that would also take in consideration the histopathology results as indicators for aggressivess whether its to do with the cellular dysplasia or to do with HPV -ve results.

Also in some units they have recognised that if you aim to do simple resection surgery esp with laser, you sometimes miss on the depth of invasion, that might look clinically safe, but pathologically isnt. Hence why in patients having only local resection the follow up every 6-8 weeks for the first 1-2 years with repeated flexiscoing them in every attendance and having a low threshold to take them for further biopsy if there is anything suspicious, has become a trend.

That leaves us with the patients having laryngectomy and definitely considering the aggressivess with the criteria written above and close monitoring, but there is nothing else to my knowledge.

In a retrospective setting, we are constructing a prognostic model to see whether adding a selected group of tumor tissue markers to the conventional criteria for decisions regarding postoperative RT would significantly improve our ability to pinpoint laryngeal SCC patients at higher risk of locoregional recurrence.

Regardig this very specific subject have a look to:

Marioni G, et al. Indications for postoperative RT in laryngeal carcinoma: A panel of tumor tissue markers for predicting locoregional recurrence in surgically-treated carcinoma. A pilot study.

Head Neck. 2013 Aug 30. doi: 10.1002/hed.23493. [Epub ahead of print]

Source

Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy.