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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