Surgical Treatment Strategies for Laryngeal Chondrosarcomas: A Single Institution Investigation

Aggressive Subtypes of Laryngeal Chondrosarcoma and their Clinical Behavior: A Systematic Review

INTRODUCTION

Laryngeal chondrosarcoma (CS) is a rare indolent malignant tumor. High-grade (G3), dedifferentiated (DD), and myxoid (MY) CSs are considered more aggressive subtypes due to their metastatic potential and relatively poor outcomes. The aim of this systematic review is to evaluate treatment modalities and survival outcomes in patients affected by these rarer CS subtypes.

METHODS

Papers published from January 1, 2000, to August 25, 2024, describing cases of laryngeal G3, DD, and MY CS were included.

RESULTS

A total of 38 patients (15 G3, 13 DD, and 10 MY) were selected. Cricoid cartilage was the most common site of origin. Total laryngectomy (TL) was often performed. Primary conservative approaches in 42.8% of patients were followed by loco-regional recurrence.

CONCLUSIONS

Aggressive subtypes of CS require a radical approach because of the higher rate of loco-regional and distant recurrences compared to low-grade CS. TL with radical intent is the most common treatment, and adjuvant therapy should be considered after careful multidisciplinary discussion.

Contemporary Surgical Approaches in Managing Laryngeal Chondrosarcoma: A Scoping Review

OBJECTIVE

The aim of this scoping review is to describe and evaluate current surgical management options for chondrosarcoma of the larynx, and to summarize these techniques with respect to the laryngeal subsite affected.

DATA SOURCES

PubMed/MEDLINE and EMBASE databases.

REVIEW METHODS

The review was conducted according to the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews.

RESULTS

Forty-one articles met eligibility criteria for inclusion in the final analysis, which included a total of 149 unique surgical cases that were analyzed based on affected laryngeal subsites of cricoid, thyroid, arytenoid, and epiglottis. Management of cricoid chondrosarcoma favored transoral endoscopic resection (TER) or transcervical laryngeal preservation surgery (TPLS), which ranged from limited tumor debulking via laryngofissure to larger operations like subtotal to total cricoidectomy with laryngeal reconstruction. Nearly all cases of arytenoid and epiglottic chondrosarcoma were successfully managed with TER techniques. Thyroid chondrosarcoma primarily affected the outer cortex of the cartilage and very rarely involved the endolaryngeal mucosa, making it very amenable to transcervical approaches to remove part of or the entire affected thyroid lamina.

CONCLUSION

Overall trends in the articles reviewed for this study suggest that more aggressive surgery and R0 resection did not lead to better overall survival, which aligns with the broader philosophical shift in treatment goals to prioritize preservation of the larynx and laryngeal function over complete oncologic resection.

LEVEL OF EVIDENCE

N/A.

Functional or radical surgical treatment of laryngeal chondrosarcoma, analysis of survival and prognostic factors: A REFCOR and NetSarc-ResOs multicenter study of 74 cases

INTRODUCTION

Laryngeal chondrosarcoma (LCS) is a rare tumor of slow evolution whose treatment is poorly codified. For a long time, a radical treatment by total laryngectomy (TL) was proposed. More recent studies tend to propose a conservative surgical approach of the larynx. The objective of this study was to compare the overall survival (OS) of total laryngectomized patients (TL+) versus non-laryngectomized patients (TL-). The secondary objectives were to analyse the reoperation free survival (RFS), the total laryngectomy free survival (TLFS) and to identify the preoperative factors leading surgeons to propose TL.

MATERIALS AND METHODS

A retrospective analysis of prospectively collected incident cases from the REFCOR and NetSarc-ResOs multicenter databases between March 1997 and June 2021 was conducted. A propensity score matching analysis was performed to compare the OS of TL+ and TL-patients.

RESULTS

74 patients were included. After propensity score, the 5-year OS of TL+ and TL-patients was comparable (100 %, p = 1). The 5-year RFS rate was 69.2 % (95 % CI [57.5-83.4]) and the 5-year TLFS was 61.7 % (95 % CI [50.4-75.5]). Cricoid involvement greater than 50 % (HR 3.58; IC 95 % [1.61-7.92] p < 0.001), an ASA score of 3 or 4 (HR 5.07; IC 95 % [1.64-15.67] p = 0.009) and involvement of several cartilages (HR 5.26; IC 95 % [1.17-23.6] p = 0.04) are prognostic factors for TL. Dyspnea caused by the tumour is a prognostic factor for reoperation (HR 2.59; IC 95 % [1.04-6.45] p = 0.03).

CONCLUSION

These results demonstrate that conservative treatment should be considered as first-line treatment for laryngeal chondrosarcoma.

Treatment strategy in laryngeal chondrosarcoma: a multicenter study of 43 cases

PURPOSE

Laryngeal chondrosarcoma is a rare tumor that mostly affects the cricoid cartilage. The aim of this study was to compare outcomes between the various treatments of this pathology as there are no official guidelines for this pathology.

METHODS

A retrospective analysis of the pathology database of nine French tertiary care centers was conducted. Outcomes of patients treated by total laryngectomy were compared with those treated by more conservative approaches (endoscopic debulking, median thyrotomy, partial laryngectomy). Two Kaplan-Meier survival analyses were performed: one to assess the overall survival rate and the other to assess laryngeal preservation over time.

RESULTS

A total of 43 patients were enrolled: 12 with total laryngectomy as the initial treatment, and 31 who initially underwent laryngeal-preserving treatment. With conservative treatment, laryngeal function was preserved in 96% and 75% of patients at 1 and 5 years, respectively. Conservative treatment did not reduce the overall survival rate.

CONCLUSION

These results suggest that laryngeal preservation should be considered as the initial treatment in cases of laryngeal chondrosarcoma.