Laryngeal cancer: choosing treatment tactics

Abstract

Relevance of the problem. The five-year survival rate of patients with laryngeal cancer with combined treatment does not exceed 30%. Ways to improve long-term results of treatment, as well as ways to prevent disability, are being sought. Purpose of the study: to evaluate the effectiveness of chemotherapy and radiation therapy. Materials and methods of study. Chemoradiation treatment was performed on 67 patients with laryngeal cancer. As a result, the comprehensive examination revealed destructive T2 N0-3 M0 - 10, T3 N0-3 M0 - 38 and T4 N0-3 M0 - in 19 patients. Most patients (57-85.1%) had widespread tumors of the larynx, 46 patients (68.6%) had cancer metastases in the cervical lymph nodes before the start of treatment. Thus, the analyzed group of patients had a poor prognosis of the disease. All patients underwent 2-3 courses of combined chemotherapy according to three schemes PF, PFB and CPFB: drugs such as cisplatin, 5-fluorouracil, bleomycin). Comparative results of the effectiveness of the presented chemotherapy regimens showed the identity of therapeutic effects. Complete regression of the tumor or progression of the disease was not observed in any of the cases. Tumor reduction of at least 50% was observed in 64.2% of patients, none of the chemotherapy regimens was beneficial. Tumor reduction of more than 35.8% in 50% of patients indicates the high effectiveness of the combination of these drugs. A decrease in the inflammatory component of the tumor and surrounding tissues was observed. The primary tumor was reduced more effectively than regional metastases. After 7-10 days, after 2-3 courses of combined chemotherapy, patients underwent remote gammatherapy according to the allocated program to a total focal dose of 65-70 Gy. Evaluation of the results of chemoradiation treatment was carried out 2 months after the end of the treatment procedures. Results. Of the total number of patients (67), 29 patients (43.3%) were alive after chemoradiation treatment. The three-year survival rate was determined by the extent of the metastatic process. In the group of patients (21) with clinically non-enlarged lymph nodes, 11 patients (52.4%) were cured. Residual tumors were detected in 28 patients (41.8%), which was a sufficiently high rate and required radical treatment of this group of patients.

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