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Myers Lecture: Treatment of Larynx Cancer Evolves

Frans J.M. Hilgers, MD, PhD

Frans J.M. Hilgers, MD, PhD

The treatment landscape for advanced cancer of the larynx has changed considerably over the last two decades. Beyond advances in organ-sacrificing surgery, organ-preserving therapies have evolved, requiring surgeons to go beyond the surgical suite to have a role in the patient’s rehabilitation.

Frans J.M. Hilgers, MD, PhD, Chairman Emeritus of head and neck oncology and surgery at the Netherlands Cancer Institute, Amsterdam, will discuss some of the consequences of this changing landscape during the Eugene N. Myers, MD, International Lecture on Head and Neck Cancer. He will present “Care and Rehabilitation of Patients Treated for Advanced Laryngeal Cancer” from 2:15 pm-3:15 pm today in Ballroom C4.

Total laryngectomy remains indispensable as a primary treatment modality for advanced (T4) larynx cancer, and for the management of recurrent disease and/or debilitating laryngeal dysfunction after prior nonsurgical treatment. Thus, post-laryngectomy rehabilitation remains an essential theme for today’s laryngeal cancer care and rehabilitation.

“The involvement of the head and neck surgeon should not stop at the surgical voice restoration procedure itself, but it should be continued long after, not leaving the allied health professional struggling too long alone with an occasional unavoidable problem, as now sometimes is the case,” Dr. Hilgers said. “Just like the regular multidisciplinary tumor board, there should be a multidisciplinary rehabilitation board dealing with short- and long-term rehabilitation issues, and the head and neck surgeon should be a key member of this board.”

In addition to looking at the pathophysiology of the post-laryngectomy voice, breathing, and olfaction, and current rehabilitation options, he will pay special attention to developments in clinical and voice research, and medical device technology assessment.

“These developments in most cases still enable reliable restoration of pulmonary-driven speech and compensation for lost upper-respiratory tract functions, despite increasing surgical challenges,” he said. “Head and neck surgeons should lead clinicians in head and neck cancer functional research, obviously in close collaboration with their allied health professionals, because together they have the surgical and clinical armamentarium and insights needed to restore lost and impaired functions.

“However, rehabilitation nowadays not only concerns the functional repercussions of the disconnected upper and lower airways, but also functional issues caused by the compromised larynx and pharynx after organ-preserving therapy, which is especially seen by the presence of acute and chronic dysphagia.”

For Dr. Hilgers, past non-surgical protocols should have focused more on function preservation then on mere organ preservation.

“We more or less were caught by surprise that organ preservation is not necessarily synonymous with function preservation,” he said. “Function preservation thus should be a key element in any new non-surgical protocol, also in view of the fact that in many instances, overall quality of life after surgical and non-surgical treatment is more or less similar. This means that one can not assume that quality of life after organ preservation is ‘automatically’ better than after organ-sacrificing treatment.

“When we invest similar time and energy into dysphagia research and rehabilitation, as we have done in post-laryngectomy rehabilitation, my expectation is that we will be able to also solve, or at least improve, this debilitating aspect of organ-preservation treatment better than so far deemed possible.”