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Master Thesis

Intérêt du curage ganglionnaire cervical lors d’une laryngectomie de rattrapage chez les patients N0 lors de la récurrence

Abstract : Introduction: total salvage laryngectomy (TSL) is the gold standard treatment for patients with recurrent laryngeal cancer after initial radiotherapy. The interest of neck dissection (ND) associated with the STL for N0 patients during recurrence remains to be defined and no scientific consensus has been established to date. Objectives: the main objectives were to establish the proportion of N0 patients before STL as well as the rate of occult metastases in the latter and then to evaluate the risk factors, the incidence of complications and finally to describe the overall survival and the disease-free survival. Methods: This was a multicenter retrospective study including five French centers over a recruitment period between 2008 and 2018. The inclusion criteria were: i) patient treated for laryngeal squamous cell carcinoma in first intention by radiotherapy (alone or potentiated) or induction chemotherapy followed by radiotherapy, ii) operated an STL with ou without ND, iii) with a neck considered N0 at the time of STL. Results: the mean inclusion rate in the study was 14.5%, allowing the selection of 120 patients with inclusion criteria. The group « with ND » included 78 patients (65%) while the group « without ND » included 42 patients (35%). The overall rate of occult metastases was 9.1%. This rate was significantly higher for lesions initially T3-T4 than T1-T2 (73% versus 27% p=0.02) and for patients with positive initial lymph node status (p=0.01). During the recurrence, the rate of occult metastases was significantly higher for lesions: T3-T4 (90.9% compared to 9.1% p = 0.023), with supra-glottic lesions (82% versus 18% p = 0.04), occurring within six months or less of the end of initial treatment (73% vs. 27% p <0.01). For the entire cohort, the 1-year disease-free survival was 60% and at 2 years of 38% without significant difference between the two groups (p = 0.54). In the dissection group, overall survival at 2 years was 85% and at 5 years 71% compared to 72% at 2 years and 62 % at 5 years in the group without ND without significant difference (p = 0.16). Conclusion: the realization of a ND when performing an STL in N0 patients during recurrence does not seem to be indicated systematically due to a rate of occult metastases less than 10%. In the case of advanced diseases, and/or supra-glottic localization and/or in short time after the end of the initial treatment, a ND seems to be necessary. On the other hand, for recurrent beginner stages, in a period greater than 2 years and / or pure glottic localization during recidivism, ND does not seem to impose itself.
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Submitted on : Thursday, February 27, 2020 - 6:41:26 PM
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Romain Dassé. Intérêt du curage ganglionnaire cervical lors d’une laryngectomie de rattrapage chez les patients N0 lors de la récurrence. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02493495⟩

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