A 72-year-old Caucasian male comes to your office. He is complaining of hoarseness for the past six months. He says the hoarseness has been gradually worsening, and now he has developed difficulty in swallowing, pain in both ears, and exertional shortness of breath. He adds that he recently had a couple of episodes of hemoptysis. On examination, significant cervical lymphadenopathy is present. Chest x-ray is normal. Flexible fiberoptic endoscopy shows a laryngeal mass involving both supra glottic and infra glottic regions, as well as the vocal cords. The biopsy report reveals squamous cell carcinoma. The surgery and otolaryngology team, after careful review of all the findings, declare the lesion inoperable. At this time, what is the most appropriate treatment option for your patient?

Question

A 72-year-old Caucasian male comes to your office.  He is complaining of hoarseness for the past six months.  He says the hoarseness has been gradually worsening, and now he has developed difficulty in swallowing, pain in both ears, and exertional shortness of breath.  He adds that he recently had a couple of episodes of hemoptysis.  On examination, significant cervical lymphadenopathy is present.  Chest x-ray is normal.  Flexible fiberoptic endoscopy shows a laryngeal mass involving both supra glottic and infra glottic regions, as well as the vocal cords.  The biopsy report reveals squamous cell carcinoma.  The surgery and otolaryngology team, after careful review of all the findings, declare the lesion inoperable.  At this time, what is the most appropriate treatment option for your patient?

Quizplus · Accepted Answer

Explanation: Over 50,000 new cases of head and neck cancer (HNC) are diagnosed every year in the United States. At the time of diagnosis, about 60% of these cases are regionally advanced (stage lll and lV). Wide surgical excision is not the immediate therapeutic option for most of these locally advanced HNC. A number of studies have shown that a course of combined chemotherapy and radiotherapy, also known as chemoradiotherapy (CRT), promises superior results over chemotherapy or radiotherapy alone. It not only increases the 5-year survival rate, but also renders some inoperable HNC cases operable after treatment. (Choice A) Radiotherapy alone results in a 5-year survival rate of 10-30 percent. However, this rate still remains lower than that of CRT. (Choice B) Chemotherapy alone has produced a good response in a number of patients. This mode of management may render some laryngeal masses operable from their previously inoperable state. However, combined chemotherapy and radiotherapy promises superior results over chemotherapy alone. (Choice C) With CRT, high survival rates have been demonstrated. Unless the patient refuses to consent to chemotherapy or radiotherapy, just doing comfort measures without trying to treat the patient is inappropriate. Educational Objective: About 60% of head and neck cancers are locally advanced at the time of diagnosis and are inoperable. CRT promises superior results than chemotherapy or radiotherapy alone.

A 72-Year-Old Caucasian Male Comes to Your Office