Update on laryngeal cancer

To Cinzia Maria,

and to Angelo and Paola,

witnesses of a wonderful union

My Official Report, entitled “Update on laryngeal cancer,” aims to provide an up-to-date, critical, and multidisciplinary overview of current knowledge and therapeutic strategies available for treatment of malignant tumours of the larynx. In an era characterised by rapid technological evolution and increasing integration among different areas of expertise, the approach to laryngeal carcinoma can no longer be confined within the limits of a single discipline, but instead requires an harmonious synthesis among various specialties.

Surgery continues to represent a fundamental pillar, not only for its oncological effectiveness but also for its constant evolution toward increasingly conservative and functional techniques. However, this central role is now accompanied – and sometimes challenged – by advances in chemoradiotherapy protocols and non-surgical organ preservation strategies, which have profoundly modified the decision-making algorithm, especially in locally advanced tumours. In this context, the comparison among different therapeutic options should not be seen as a competition, but rather as an opportunity to personalise treatment according to the tumour’s biological characteristics and patient’s needs.

Alongside clinical aspects, ample space is devoted to understanding the molecular mechanisms underlying laryngeal carcinogenesis, a field in which basic research is providing increasingly refined tools for precision medicine. Clinicians are not always able to engage with this dimension of knowledge, yet it is precisely from the integration of laboratory research and daily practice that the most significant innovations will emerge.

While in early-stage tumours different therapeutic modalities show comparable oncological outcomes, in more advanced cases the choice of treatment remains complex and often controversial. Total laryngectomy still retains an indispensable role in a selected group of patients; however, the development of partial surgery and minimally invasive techniques has significantly expanded the possibility of preserving essential functions such as phonation, swallowing, and breathing. This evolution represents one of the most important achievements of modern laryngology.

The history of laryngeal surgery teaches us that every advancement arises from the intuition and courage of pioneers who challenged the limits of their time. During my training in laryngeal oncologic surgery, over 25 years, I had the opportunity to attend the Vittorio Veneto school, founded by Prof. Italo Serafini and later led by my friend Giuseppe Rizzotto, who welcomed me into his group and allowed me to gradually acquire specific expertise in laryngeal oncologic surgery. He deserves credit for performing the first open partial horizontal laryngectomy (OPHL) type III, a true innovation, worthy of the cover of the prestigious journal The Laryngoscope in 2006. Imagine the emotions of a young ENT specialist from Southern Italy actively participating in the development of such a revolutionary surgical treatment. I later had the privilege of participating for many years as a surgeon in the live surgery courses in Vittorio Veneto, and in 2009 I had the honor of performing my first OPHL type III during an international course – a privilege granted only to me. During those courses, I admired great masters with outstanding surgical skills such as Professors Enrico de Campora, Pasquale Laudadio, and Antonino Antonelli – the latter promoter of the current classification of OPHLs – as well as, in subsequent years, my dear colleagues and friends Giuseppe Spriano, Piero Nicolai, Livio Presutti, Marco Radici, and Giovanni Succo. The latter deserves great credit for giving global visibility to reconstructive laryngeal oncologic surgery. I cannot mention all the distinguished colleagues, including international ones, who contributed to the professional and cultural growth of many generations of ENT specialists.

Today, we inherit that legacy in a profoundly changed context, where the patient’s quality of life holds equal, if not greater, importance than disease control. It is no longer just about curing, but about how one is cured – and above all, how one lives after treatment.

In this regard, we must not forget those for whom the disease is not curable. Oncologic medicine, while oriented toward therapeutic success, must also maintain a careful and respectful perspective on end-of-life care, ensuring dignity, relief, and support. The patient is never merely a bearer of disease, but a person with needs, values, and expectations that must remain central to our work.

Within this framework, the contribution dedicated to systemic therapy in the curative treatment of laryngeal carcinoma analyses the increasingly important role of antineoplastic drugs in multimodal protocols, highlighting how the integration of chemotherapy with loco-regional treatments now represents a cornerstone of care. This is complemented by a chapter on radiomics in laryngeal squamous cell carcinoma, which illustrates the state of the art of an emerging discipline capable of extracting quantitative information from radiological images, opening new perspectives in prognostic stratification and personalised medicine.

Attention then shifts to surgical and reconstructive aspects in locally advanced tumours, with a systematic review of surgical outcomes and postoperative complications in relation to the choice of free flaps in the reconstruction of laryngo-hypopharyngeal tumours. Conservative surgery is further explored in a multicentre study involving over 1,000 patients, focusing on the impact of surgical margins and postoperative management after transoral laser microsurgery in glottic carcinomas – an essential issue for optimising oncological outcomes.

Within functional surgery, a comprehensive systematic review is devoted to OPHL, with particular attention to oncological and functional outcomes. A single-centre series analyses cricotracheal resection with anastomosis in primary and secondary tumours of the laryngotracheal junction, offering a significant contribution to a complex and highly specialised surgical field.

The rehabilitative dimension is equally important: the chapter on post-laryngectomy videofluoroscopic evaluation in relation to olfactory recovery using a physiological technique highlights how quality of life is an essential treatment goal. In the same perspective, the study on 5-year oncological outcomes of neoadjuvant chemotherapy followed by transoral robotic surgery represents a significant example of a multimodal strategy aimed at organ preservation.

New technologies are further explored in the contribution dedicated to videomics and artificial intelligence in the endoscopic diagnosis of laryngeal lesions, outlining future prospects for increasingly precise diagnostics supported by advanced analytical systems. At the same time, the chapter “The neck matters” emphasises the importance of neck management in laryngeal carcinoma, an area where therapeutic decisions significantly influence prognosis.

The report is completed with an in-depth analysis of the histological spectrum of laryngeal epithelial neoplasms, essential for understanding the biological complexity of the disease, and with a discussion of the role of adjuvant radiotherapy in patients undergoing partial laryngectomy – one of the most debated topics in contemporary clinical practice.

Taken together, these 12 contributions outline a complex and constantly evolving landscape in which tradition and innovation coexist and integrate. It clearly emerges that progress in the treatment of laryngeal carcinoma is the result of continuous dialogue among different disciplines, each bringing specific expertise but united by a common goal.

As in all areas of oncology, success in laryngeal carcinoma cannot be evaluated solely in terms of disease control, but must necessarily include preservation of function, quality of life, and respect for the patient’s dignity throughout the entire care pathway.

This report does not aim to be exhaustive, nor to replace the vast body of available scientific literature, but rather to offer a tool for reflection, updating, and discussion for all those involved in laryngeal pathology. If it succeeds in raising new questions rather than providing definitive answers, it will have achieved its purpose.

In thanking the SIOeChCf, led by Professor Marco de Vincentiis, and the Executive Board of the AOOI for entrusting me with this demanding task, I would like to express my gratitude to all the distinguished colleagues who contributed with expertise and passion to the realisation of this Official Report, apologizing to those whom I was unable to involve despite their merit. My sincere thanks also go to my dear friend, President Marco Radici, who masterfully organised the 112th SIO Congress at the prestigious Auditorium Parco della Musica in Rome. Last but not least, I thank my closest collaborators, without whom I would not have been able to complete this work, and whose daily commitment makes it possible to translate ideas into clinical practice.

Finally, allow me a special thanks to my wife, Cinzia Maria, who has supported and always encouraged me in my professional and associative activities.

I dedicate this work to her, to my children Antonio, Emilia, and Giovanna, to my granddaughters Cinzia Maria and Bianca, and to my dear mother Aurora – an ever-present figure who, despite her venerable age, continues to inspire me daily to give my best to patients most in need of care. This work represents not only a scientific update, but also a stimulus for reflection and continuous improvement in clinical practice, so that the patient always remains at the centre of our commitment.