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Cancer of the larynx
Abstract
In Europe, laryngeal cancer accounts for only 2-5% of all cancers, the incidence being much higher among males than among females. Smoke and alcohol represent the major behavioural risk factors. Several carcinogens, occupations and vitamin deficiencies have been associated with laryngeal cancer. A genetic susceptibility to environmental risk factors and carcinogens is recognized. Hoarseness is the main symptom for which patients call for medical consultation. Mucosa is the most common histologic site of the primary lesions considered in the present chapter. Nodal involvement, the site and volume of the primary tumour, and some genes expression represent the major prognostic factors. A high death rate for not cancer-related events is to be pointed out. The loco-regional extent of the disease determines the success of cure. Surgery and radiotherapy represent the main therapeutic options. The choice between these two procedures is often controversial.
... However, age-adjusted incidence rates for laryngeal cancer have been declining in countries with higher sociodemographic indices, reflecting shifts in smoking and alcohol consumption patterns [5]. In Europe, laryngeal cancer accounts for 2-5% of all cancers, with higher incidence rates in males compared to females [7]. Nevertheless, recent years have seen a rise in cases among younger women, particularly in European countries, potentially attributable to gender-specific trends in tobacco and alcohol use [8,9]. ...
... However, age-adjusted incidence rates for laryngeal cancer have been declining in countries with a higher sociodemographic index, reflecting changes in smoking and alcohol consumption behaviors. In Europe, laryngeal cancer accounts for 2-5% of all cancers, with a much higher incidence among males than females [7]. In a U.S. cohort study from 1986 to 2018, the incidence of laryngeal cancer decreased, although mortality rates did not decline at the same rate. ...
The incidence of head and neck cancer (HNC) has significantly increased over the past two decades. Material and methods: This study analyzed trends in HNC incidence and mortality using data from the Polish Cancer Register (1999–2021) across three age cohorts (60–69, 70–79, and 80+) and projected trends through to 2035. Statistical analyses included regression, correlation, and parallelism tests, with significance levels of α = 0.05 and Bonferroni correction applied (αc ≈ 0.017). Results: In the 60–69 cohort, incidence rates increased faster than mortality rates (p < 0.001), especially for oral and oropharyngeal cancers in women (p < 0.001). For the 70–79 cohort, mortality rates rose slower than incidence (p < 0.05), most notably for salivary gland cancers across genders and oral cavity cancers in women. In the 80+ group, both incidence and mortality increased (p < 0.05), but mortality rates rose faster for laryngeal, hypopharyngeal, and oral cancers in men and the general population (p < 0.017). The largest increases were observed in oral cancer among women, with a marked rise across all age groups (p < 0.001). Gender-specific patterns highlighted stable or modestly rising trends in males but a notable increase in females, particularly in the 80+ group. Conclusions: These findings underscore that older patients are not a homogeneous group in terms of HNC incidence and survival. This study emphasizes age- and gender-specific strategies for prevention and management. Expanding HPV vaccination and improving early detection are crucial, particularly for high-risk groups like older women and those with HPV-related cancers. Tailored approaches could mitigate rising trends and improve survival outcomes.
... O câncer de laringe ocorre predominantemente em homens e é um dos mais comuns entre os que atingem a região da cabeça e pescoço 3 . Representa cerca de 25% dos tumores malignos que acometem essa área e 2% de todas as doenças malignas. ...
... A audiometria tonal liminar foi realizada em cabina acústica com uso de fones supra-aurais 22 (3,40) 0,00 15,00 ...
Purpose:
to describe the audiological and otoacoustic emission findings in patients who had head and neck cancer and compare them with individuals without the disease.
Methods:
a comparative, cross-sectional, observational study encompassing two groups: Study: individuals with a history of head and neck cancer, submitted to chemotherapy and/or radiotherapy; Control: individuals without the disease. The sample comprised 23 individuals in each group, matched for age and gender. Procedures in which the groups were compared: meatoscopy; pure-tone threshold and high-frequency audiometry; speech audiometry; transient-evoked otoacoustic emissions. Statistical tests: Pearson’s chi-square; Fisher’s exact; two-proportion Z-test; Wilcoxon; Mann-Whitney; Student’s t-test.
Results:
the comparison between the groups revealed statistically significant differences at the 3, 6, 8, 10, and 12.5 kHz frequencies in the pure-tone threshold audiometry, with better pure-tone auditory thresholds in the control group. No significant differences were observed between the groups in the otoacoustic emissions regarding the general response and frequency band.
Conclusion:
individuals with a history of head and neck cancer had higher pure-tone auditory thresholds than their controls, especially at the higher frequencies. This evidences the deleterious effect of ototoxicity on the peripheral auditory system of adults. The otoacoustic emissions were similar in the two groups.
... The incidence of laryngeal cancer is notably higher in men than in women [1]. The most common pathological type of larynx cancer, making up the majority of cases, is squamous cell cancer [2]. The treatment of laryngeal cancer usually depends on surgical treatment and radiotherapy. ...
... Human subjects: Consent was obtained by all participants in this study. Ethics Committee of Shanghai Sixth People's Hospital issued approval 2018-95- (2). Ethical approval for the use of patient tissues was provided by the Ethics Committee of Shanghai Sixth People's Hospital (Shanghai, China). ...
Objective
Patients with advanced laryngeal cancer have a poor prognosis. The purpose of this work was to analyze the connection between clinical factors and survival and to try to identify survival prognostic factors.
Methods
Sixty-one laryngeal cancer patients received radiotherapy. All of their clinicopathologic material was gathered from a retrospective review of the medical records and subjected to further analysis. We examined the prognostic significance of the C-reactive protein (CRP)/prognostic nutritional index (PNI) ratio.
Results
We assessed the CRP and PNI levels before radiotherapy. An analysis of overall survival (OS) of patients with high CRP/PNI was markedly shorter than for those patients with a low CRP/PNI (P=0.010). Multivariable analysis showed that a high CRP/PNI ratio was a disadvantageous independent prognostic marker.
Conclusions
The data show that CRP/PNI may be used as a prognostic indicator for laryngeal cancer patients treated with radiotherapy.
... 1,2 Early glottic cancer can be improved by radiotherapy (RT), laser surgery and surgery; each of these modalities to be equally successful in terms of local control and cure rates. [3][4][5] RT is typically delivered via parallel-opposed beams to doses between 60 and 70Gy. Recently highly conformal techniques such as intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT) have been described but carry a risk of geographical miss with unclear benefits. ...
... These technological advances have made it possible to reduce the dose to normal tissue structures and consequently minimize the risk of toxicity and morbidity, while allowing for dose escalation to the tumor volumes, potentially leading to improved local regional control. [3][4][5][6] The success of radiotherapy treatment is directly related to the delivery of treatment. Daily setup variations and internal organ motion and deformation are a concern for external beam radiation therapy because they can modify the actual dose distribution in the patient, and consequently alter the clinical outcome and have effects on organs at risk different from the expectations of the planned dose distribution. ...
In early stage laryngeal radiotherapy, movement is an important factor. Thyroid cartilage can move from swallowing, breathing, sound and reflexes. The effects of this motion on the target volume (PTV) during treatment were examined. In our study, the target volume movement during the treatment for this purpose was examined. Thus, setup margins are re-evaluated and patient-based PTV margins are determined. Intrafraction CBCT was scanned in 246 fractions for 14 patients. During the treatment, the amount of deviation which could be lateral, vertical and longitudinal axis was determined. ≤ ± 0.1cm deviation; 237 fractions in the lateral direction, 202 fractions in the longitudinal direction, 185 fractions in the vertical direction. The maximum deviation values were found in the longitudinal direction. Intrafraction guide in laryngeal radiotherapy; we are sure of the correctness of the treatment, the target volume is to adjust the margin and dose more precisely, we control the maximum deviation of the target volume for each fraction. Although the image quality of intrafraction-CBCT scans was lower than the image quality of planning CT, they showed sufficient contrast for this work.
... The majority of larynx cancer was squamous cell cancer (SCC), and they can involve the supraglottis (30%), glottis (65%), and subglottis (5%). [1] These tumors spread regionally by the lymphatic way and distally by the hematogenous way, except for glottic cancers. Tumor volume and biological aggressiveness affect the regional and distant metastases. ...
... The commonly used treatment modalities are both surgery and radiotherapy. [1] Several investigators have reported using conformal radiation therapy or hepatic arterial infusion chemotherapy [9] for patients with isolated SCC metastasis to the liver. The benefit of liver surgery in hepatic-only metastasis from head and neck cancer is not clear. ...
Laryngeal cancer is the second most common type of head and neck malignancy, representing approximately 45% of all head and neck cancers. Hematogenous spread to the liver rarely occurs without evidence of pulmonary and bone disease. We report a patient who had been treated 7 years earlier for laryngeal squamous cell cancer and who had isolated liver metastasis on fluorodeoxy D-glucose positron emission tomography-computed tomography.
... Early epidemiological studies reported an increased risk for laryngeal cancer in workers exposed to straight oil metalworking fluids and less risk for those exposed to soluble oils (Eisen et al., 1994; Friesen et al., 2011; Tolbert et al., 1992; Zeka et al., 2004); there are no data on cancer risks associated with exposure to semisynthetic or synthetic MWFs. Although laryngeal cancer is rare in rodents, squamous cell carcinoma of the larynx is the second most common cancer of the respiratory tract in humans (Heroiu et al., 2013; Licitra et al., 2003). The risk of laryngeal cancer in humans is greatly increased by tobacco smoking and alcohol consumption (Licitra et al., 2003 ). ...
... Although laryngeal cancer is rare in rodents, squamous cell carcinoma of the larynx is the second most common cancer of the respiratory tract in humans (Heroiu et al., 2013; Licitra et al., 2003). The risk of laryngeal cancer in humans is greatly increased by tobacco smoking and alcohol consumption (Licitra et al., 2003 ). As in the lung, it is possible that chronic irritation of the larynx caused by exposure to MWFs in combination with tobacco smoking and alcohol consumption may increase the risk of laryngeal neoplasia in workers. ...
Metalworking fluids (MWFs) are complex formulations designed for effective lubricating, cooling, and cleaning tools and parts during machining operations. Adverse health effects such as respiratory symptoms, dermatitis, and cancer have been reported in workers exposed to MWFs. Several constituents of MWFs have been implicated in toxicity and have been removed from the formulations over the years. However, animal studies with newer MWFs demonstrate that they continue to pose a health risk. This investigation examines the hypothesis that unrecognized health hazards exist in currently marketed MWF formulations that are presumed to be safe based on hazard assessments of individual ingredients. In vivo 13-week inhalation studies were designed to characterize and compare the potential toxicity of four MWFs: Trim VX, Cimstar 3800, Trim SC210, and Syntilo 1023. Male and female Wistar Han rats or Fischer 344N/Tac rats and B6C3F1/N mice were exposed to MWFs via whole-body inhalation at concentrations of 0, 25, 50, 100, 200, or 400 mg/m3 for 13 weeks, after which, survival, body and organ weights, hematology and clinical chemistry, histopathology, and genotoxicity were assessed following exposure. Although high concentrations were used, survival was not affected and toxicity was primarily within the respiratory tract of male and female rats and mice. Minor variances in toxicity were attributed to differences among species as well as in the chemical components of each MWF. Pulmonary fibrosis was present only in rats and mice exposed to Trim VX. These data confirm that newer MWFs have the potential to cause respiratory toxicity in workers who are repeatedly exposed via inhalation.
... This means that the larynx undergoes changes related to sex hormones, such as estrogen and androgens, which affect the development and functioning of this area of the body. However, recent studies suggest that hormones, including estrogen and androgens, could play a significant role in the development and progression of LC [13]. ...
Laryngeal cancer is one of the main causes of morbidity and mortality worldwide, with a significantly higher prevalence among men than women. However, the incidence, clinical characteristics, and specific treatment of laryngeal cancer in women have often been overlooked by research. This review aims to examine gender differences in incidence, risk factors, hormonal mechanisms, survival, and therapeutic approaches for laryngeal cancer in women. Although smoking and alcohol remain the main risk factors, evidence suggests that women may be more vulnerable to the harmful effects of these behaviors, with a relative higher risk than men. In addition, hormonal factors such as estrogen may influence women’s susceptibility to laryngeal cancer, accelerating tumor growth and complicating treatment. Differences in treatment between the sexes, with women tending to receive less intensive treatment than men, is another crucial aspect that needs more attention. This article also analyses the disparities in survival, highlighting that women often have a better prognosis, although this trend varies according to demographic characteristics and the health system. The increasing incidence of laryngeal cancer in women requires increased research to fully understand risk factors and underlying biological mechanisms in order to develop more personalized treatments and optimize clinical outcomes for patients.
... Although it was the commonest symptoms of both supraglottic and glottic carcinoma, there is a significant difference between the frequencies of its occurrence in the lesions of the two sites. Hoarseness was more common among the patients of glottic tumour, but it was also the leading symptom in supraglottic tumour [13]. Their findings are similar to the findings of current study. ...
Background: Head and neck cancer is the eighth most common cancer (1-2%) as estimated from worldwide data. Laryngeal malignancy is the second most common malignancy in head neck region worldwide. There are variety of malignant tumour arising in larynx. Carcinoma of the larynx interferes with most vital functions in the sufferers like voice, respiration and swallowing by virtue of its anatomical location, local infiltration and direct extension. Objectives: The aim of the study was to evaluate the laryngeal carcinoma: topographical distribution. Methods: This cross-sectional observational study was carried out in the Department of Otolaryngology & Head-Neck Surgery, Dhaka Medical College Hospital during January 2019 to July 2020. Purposive consecutive sampling method was used to collect data. After taking detailed history, clinical examination including indirect laryngoscopy, fiber optic layngoscopy CT scan of neck & direct laryngoscopic evaluation under general aneasthesia was done. Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: Total 93 patients of different age, sex, socioeconomic status was taken. Hoarseness of voice (87.1%), dysphagia (58.1%), difficulties in breathing (57%) and neck lump (50.5%) were the common presenting complaints. 87.1% patients were smoker. Most of patients were attended with stage-III disease. Supraglottis (63.4%) was the most common site of laryngeal cancer followed by glottic (34.4%) and subglottic (2.2%). Aryepiglottic fold (23.73%) and epiglottis (20.74%) are commonly involved in supraglottic carcinoma. Single vocal cord commonly involved in glottic carcinoma. Most supraglottic carcinoma involved more than one sub site (52.34%). Supraglottic carcinoma is the most common site of laryngeal carcinoma. Combined sub site is more involved in supraglottic carcinoma. Conclusion: The topographical distribution of laryngeal carcinoma play
... 7 Laryngeal cancer is very common in men and total laryngectomy is a mandatory choice for advanced-stage patients. [8][9][10] In people undergoing total laryngectomy, because the trachea and lower airways are directly open to the outside, the functions of the nose and nasopharynx to warm and humidify the air for respiration and nasal and nasopharyngeal mucociliary activity to prevent incubation of the droplets into the respiratory tract are disabled. [11][12][13] It therefore could be said that those who have had a total laryngectomy for a longer period of time face a greater risk of Covid- 19. ...
Objective
This study aimed to evaluate rate of the COVID-19 disease, its severity, mortality rate and anxiety levels in subjects who underwent total laryngectomy.
Methods
The subjects who underwent total laryngectomy were included in the study. The data were first obtained retrospectively and then a telephone survey was applied. Anxiety levels was evaluated by the Coronavirus Anxiety Scale (CAS).
Results
A total of 54 subjects were included in the study. Nine (16.7%) males were reported to be infected with SARS-CoV-2. Five (55%) of them were hospitalized; 2 of them (22%) were taken to intensive care units, and one subject (11%) died. Although a tendency to increase risk of COVID-19 disease in the tracheoesophageal voice prosthesis users (23.1% vs 14.63%) was observed, statistically difference was not significant. The average total CAS score was significantly higher in those who had COVID-19.
Conclusion
The data documented that people who underwent total laryngectomy developed more frequent and more severe COVID-19 disease and had a higher mortality rate. Although no obvious variable was found, our data suggest that using a tracheoesophageal voice prosthesis may be somewhat effective. Besides, our subjects presented very low anxiety about COVID-19.
... Irradiation using photons with energies from 4 MeV to 25 MeV allows performing treatment of deeper localisations. [41]. For example, breast cancer irradiation is usually performed with 6 MeV (maximum energy of the photons), while the prostate treatment -15 MeV. ...
Spine metastases are common and complex cancer, which induce severe pain and neurological problems, such as sensitivity reduction, paralysis, etc.
The primary lung localisation stereotactic radiotherapy was performed, using two different fractionation schedules (48Gy (6Gy/8 fr.) and 60 Gy (7.5 Gy/ 8 fr.)). Two additional plans for the recurrent disease treatment were planned (planning target volume (PTV)+spinal cord (SC) and PTV-SC), using volumetric modulated arc therapy technique. PTV+SC means, that the spinal cord was involved in PTV volume, while PTV-SC means, that the spinal cord was contoured separately as an organ at risk. These plans were evaluated, using 5 different dose fractionation schedules (30 Gy (3 Gy/10 fr.); 20 Gy (4 Gy/5 fr.); 20 Gy (5 Gy/4 Fr); 8 Gy (8 Gy/1 fr.) and 7 Gy (7 Gy/1 fr.)). These two cases for the recurrent disease (spine metastasis) irradiation were planned, trying to minimize side effects for SC.
Treatment planning results were evaluated dosimetrically (DHI, DCI, DGI) and biologically (BED, EQD). It was found, that 4 different fractionation schedules were in a tolerance level, while the other cases differed from the low risk of myelopathy up to the high risk of myelopathy. It means that the fractionation schedule is an important step for recurrent disease irradiation in the near vicinity of the primary tumour. Also, it is important to pay attention to the interval between two treatment courses.
... The larynx is one of the major organs of the upper respiratory tract and plays important roles in functions such as phonation, swallowing, and respiration. Laryngeal cancer, when it occurs, impairs these functions, and hoarseness is the most frequent symptom for medical consultation [1]. The treatment of laryngeal cancer has evolved within the balance of pursuing a cure and preserving function [2]. ...
Background
The management of laryngeal cancer involves balancing curative treatment with preserving essential functions. This study aimed to evaluate the clinical outcomes of helical tomotherapy, an advanced form of radiation therapy, as a primary treatment modality for laryngeal squamous cell carcinoma (LSCC).
Methods
A retrospective analysis of data obtained from a tertiary referral center was performed to assess treatment response rates, survival outcomes, disease control, and treatment-related adverse events.
Results
The study included 45 patients with LSCC treated with helical tomotherapy between May 2015 and September 2022. The 5-year overall survival (OS) rate and disease-free survival (DFS) rate were 89.2% and 71.1%, respectively. Local control and laryngeal preservation rates at 5 years were 79.7% and 84.7%, respectively. Subgroup analysis revealed higher DFS rates in early-stage patients (84.2%) compared to advanced-stage patients (58.9%).
Conclusions
The results indicate that helical tomotherapy offers effective tumor control and potential for laryngeal preservation in LSCC. Further prospective studies and longer follow-up are needed to validate these findings and optimize treatment strategies for LSCC patients.
... Environmental, exogenous and endogenous factors, as well as individual factors, including genetic predisposition, contribute to the development of cancer (Schulz et al. 2008). Tobacco smoking and alcohol consumption (irrespective of the type of beverage) have been established as the main etiologic risk factors for LC (Licitra et al. 2003). Tobacco dominates the risk for cancers of the vocal cords and glottis, alcohol is more prominent for cancer in the supraglottic region (Glade 1999). ...
Background
To date, there are no studies that have analyzed the possible influence of exposure to prenatal sex hormones on the risk of laryngeal cancer (LC) and premalignant laryngeal lesion—vocal fold leukoplakia (VFL). Digit ratio (2D:4D) is suggested to be a proxy of prenatal sex hormone exposure.
Objective
To examine 2D:4D in patients with LC and clarify if it could add to the verified risk factors in estimating the overall risk of LC.
Methods
511 subjects participated in the study. The study group included 269 patients: with LC ( N = 114, 64 men) and VFL ( N = 155, 116 men). Controls included 242 healthy individuals (66.40 ± 4.50 years (106 men)).
Results
Predictive models estimating the risk of VFL and LC in women, based solely on predictors like smoking and alcohol consumption had a lower area under the ROC curve (AUC) than the model with left 2D:4D. AUC for the model estimating the likelihood of VFL increased from 0.83 to 0.85, and for LC from 0.76 to 0.79.
Conclusions
Low left 2D:4D may be associated with an increased risk of developing leukoplakia and laryngeal cancer in women. In the case of laryngeal cancer, left 2D:4D may serve as additional variable (to other known risk factors, such as smoking and/or alcohol consumption), which can improve cancer risk prediction.
... Model 1 was adjusted for age, sex, and ethnicity (White/non-White); model 2 was additionally adjusted for work (employed/unemployed), education (0-7 years, 8-10 years, 11-15 years, or 16 or more years), income (< 18,000; 18,000-52,000; 52,000-100,000; > 100,000), physical activity (continuous), alcohol-drinking status (never/past/current), and smoking status (never/past/current); model 3 was additionally adjusted for BMI (continuous), SBP (continuous), hypertension at baseline (yes/no), and diabetes at baseline (yes/no). Trends were estimated by regarding quintiles as continuous variables (i.e., 1-5), and restricted cubic splines were used to examine the relationship between each pollutant, air pollution scores, and the risk of laryngeal cancer (Licitra et al. 2003). ...
We assessed the association between long-term joint exposure to ambient air pollutants and the risk of laryngeal cancer and whether this risk was modified by genetic susceptibility. We used a multivariable Cox proportional hazards regression model to analyze data from UK Biobank to determine the relationship between long-term exposure to air pollutants–nitric oxide (NO), nitrogen dioxide (NO2), and 2.5-µm and 10-µm particulate matter (PM2.5 and PM10) and the risk of laryngeal cancer. In multivariable-adjusted models, in model 3 and compared with the participants with lower quintile scores for air pollution, the participants with the highest quintile scores for air pollution had a higher laryngeal cancer risk. The observed association was more pronounced among the participants who were female, were smokers, had a systolic blood pressure equal to or greater than 120 mmHg, and had diabetes. Compared with the participants with a low GRS and the lowest quintile score for air pollution exposure, those with an intermediate GRS and the highest quintile score for air pollution exposure had a higher risk of laryngeal cancer. Long-term exposure to NO2, NO, or PM2.5, individually or jointly, was associated with a risk of incident laryngeal cancer, especially in the participants with an intermediate GRS.
... Laryngeal carcinoma is a common head and neck tumor, and SCC, including traditional keratinized SCC, nonkeratinized SCC, laryngeal basal SCC, verrucous SCC, papillary SCC, and spinous SCC, accounts for about 95% of all laryngeal carcinomas (the histological classification of SCC is based on the World Health Organization's classification of laryngeal carcinoma) (19,20). ...
Background:
Laryngeal carcinoma is one of the most common types of head and neck tumors. The mortality rate in patients with laryngeal cancer has not declined in recent years. Previous studies have shown that laryngeal cancer mortality is related to the extent of laryngeal cancer, the proportion of lymph node metastases, treatment modalities, and postoperative lifestyle habits. Thus, early identifying patients at high risk of laryngeal cancer-specific death is of great clinical importance. However, in the presence of competing risk, the existing survival models based on Cox proportional hazards model may be biased in estimating tumor-specific mortality. In this study, we developed and validated a nomogram based on competitive risk analysis for patients with laryngeal cancer.
Methods:
We used SEER*Stat (Version 4.6.1) software to identify patients in the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with laryngeal cancer between 2000 and 2019 as study subjects. The collected data included demographic data, the primary site of laryngeal cancer, the histological type of tumor, tumor size, and other variables. After excluding cases with missing information, the entire cohort was randomly split into a training cohort and a validation cohort at a 7:3 ratio. The training cohort was used in building the model while the validation cohort was used to validate the model. Univariate and multivariate Fine&Gray regression analyses were used to screen statistically significant variables, and the model performance was measured by establishing a consistency index, receiver operating characteristic curve (ROC), and calibration curves.
Results:
After excluding cases with missing information, 3,805 patients (2,264 in the training cohort and 1,141 in the validation cohort) were included in the study and followed for a median of 16 months. A total of 411 died of laryngeal cancer, and 2,104 patients died from other causes. Among 3,805 patients, the vast majority was male (80.9%), and Caucasian (77.2%), and aged 60-80 years old (58.4%).
Conclusions:
Advanced age and keratinized SCC are risk factors for laryngeal cancer-specific death. These high-risk patients should be given more attention and closer monitoring in clinical practice.
... Clinical staging of cancer larynx using direct laryngoscopy is performed under general anesthesia for accurate determination of tumor extent and proper pathological diagnosis. 1 Direct laryngoscopy with excisional biopsy has a therapeutic role in management of hyperplastic epithelial lesions of the larynx. 2 It is a day case procedure done under general anesthesia. ...
Background: Direct laryngoscopy is a day case procedure used for diagnosis and sometimes in treatment of laryngeal tumors. It is a short procedure that requires complete relaxation and rapid recovery. Rocuronium emerged as a good alternative to succinylcholine with better profile. Adding magnesium sulphate (MgSO4) to rocuronium can accelerate its onset of action with better relaxation. The aim of this study is to investigate the effect of MgSO4 when added to low dose of rocuronium on neuromuscular blockade and anesthetic profile. Methodology: Sixty ASA I-II patients, scheduled for direct laryngoscopy were randomly allocated to group R: received rocuronium dose of 0.6 mg/kg and group RM: low dose rocuronium 0.4 mg/kg and MgSO4 50 mg/kg. Results: RM group showed shorter onset, and less time to achieve deep level of neuromuscular blockade but prolonged duration when compared to R group (P value = 0.035, <0.001 and <0.001 respectively). Heart rate, mean arterial blood pressure and BIS values were lower in RM group compared to R group. Conclusions: Adding MgSO4 to low dose rocuronium hastens its onset of action and shorten the time needed to achieve deep blockade but with prolonged duration. It had a favorable anesthetic profile when compared to conventional anesthesia. Trial registration: The trial was registered at ClinicalTrials.gov with registration number (NCT 04510337) https://clinicaltrials.gov/ct2/show/NCT04510337. Citation: Wadod MA, Elsabeeny WY. The effect of adding magnesium sulfate to low dose rocuronium on neuromuscular blockade and anesthesia for direct laryngoscopy: A randomized controlled trial. Anaesth. pain intensive care 2021;25(5):607-612;
... Baş boyun kanserleri içerisinde en sık karşılaşılan kanser ise larinks kanseridir (4,11 Larinks kanserinin gelişiminde sigara ve alkol başta olmak üzere erkek cinsiyet, ileri yaş ve düşük sosyoekonomik durum gibi birçok etken larinks kanserinin artmış insidansı ile yakın ilişkili bulunmuştur. Risk faktörlerinin ortadan kaldırılması ile hastalık gelişiminde %90'a varan oranlarda azalma olabileceği bildirilmiştir (13)(14)(15). Sigara ve alkol dışında herpes simplex virüs ve human papilloma virüs enfeksiyonları, sıcak buhar inhalasyonu, gastroözefageal reflü hastalığı, termal yanıklar, iyonize radyasyona maruziyet, asbestozis, nikel, tekstil ürünleri, formaldehit, vinil klorid ve benzopiren gibi çeşitli kimyasallar ve kan grubu farklılıklarının da larinks kanser gelişiminde etiyolojik risk faktörü olduğuna yönelik görüşler öne sürülmüştür (3,4,9) (4,17,23,24). Ayrıca tümörogeneziste hücre yüzeyi karbonhidrat yapısı ile ABO kan grubu antijenleri karbonhidrat yapılarındaki sentez ve ekspresyon değiştiği ve bu karbonhidratprotein etkileşiminin hücreler arası adezyonda ve tümör metastazında rol oynayabileceği gibi görüşleri destekleyen çalışmalar yapılmıştır. ...
... Bireyler hastalığın erken evrelerinde karşılaşılan semptomların farkında olursa, hastalar erken evrede yakalanabilir. Bu nedenle larinks kanseri önlenebilir kanser türleri arasındadır 5,6 . Biz bu çalışmamızda KBB hastalıkları polikliniğine başvuran bireylerin larinks kanseri farkındalığını değerlendirmeyi amaçladık. ...
... Hoarseness was the chief complaint in our study. In fact this is the main symptom leading to diagnosis especially in the early stage of the disease [13]. Studying VC mobility using office endoscopy is an important step in physical examination. ...
Objective: To report our experience with Tucker's operation in terms of postoperative and oncologic outcomes. Methods: Medical records of patients operated for squamous cell carcinoma (SCC) of the glottis using the frontal anterior laryngectomy (FAL) between the years 2000 and 2016 were retrospectively collected. Suspension laryngoscopy and cervico-thoracic computed tomography (CT) scans were systematically performed. Statistical analysis was performed with SPSS 21 for windows. Means and Standards deviations were reported for descriptive statistics. Kaplan Meier's method was used for the calculation of survival. Survival prognostic factors were studied by the comparison of survival curves using the Log Rank Test. Results: Forty-eight records were exploitable. The anterior commissure (AC) was involved in 33 cases (69%). The tumor was extended to the Morgani Ventricles in 10 patients. Ventricular folds (VF) were involved in 3 cases (6%). Vocal cord mobility was reduced in 2 cases (4%). Fourteen patients required an ipsilateral neck dissection. Histopathological examination of the specimen concluded to SCC with free margins in all cases. The mean hospital stay was 19 ±4 days. The mean time for decannulation and removal of the nasogastric tube were respectively 13 ±5.1and 18 ±7.3 days. Infection of the tracheostomy site was the most frequent postoperative complication (19%). The 3-year and 5-year overall survival (OS) were 97%. The 3 and 5-year disease-free survival were 94%. Tumor differentiation was the only factor associated to survival (p= 0.04). Conclusion: Tucker's laryngectomy is a reliable technique in early glottic cancers. It offers good local control and a reasonable postoperative morbidity rate. The relatively long hospital stay and wound healing problems remain its main drawbacks. RÉSUMÉ Objectif: Rapporter notre expérience concernant les résultats post opératoires et oncologiques de la laryngectomie partielle de Type Tucker. Méthodes: Il s'agit d'une étude retrospective ayant colligé les patients ayant eu une laryngectomie frontale antérieure pour carcinome épidermoïde glottique entre les années 2000 et 2016. Tous les patients ont bénéficié d'une laryngoscopie en suspension ainsi qu'un scanner cervico thoracique. L'étude statistique était réalisée moyennant SPSS 21 pour Windows. Une étude descriptive était réalisée rapportant les moyennes avec les écarts type. La méthode de Kaplan Meier était utilisée pour le calcul de la survie. La recherche des facteurs pronostiques de survie a été effectuée en comparant les courbes de survie par le test du Log Rank. Résultats: quarante huit dossiers étaient exploitables. Trente trois cas (69%) ont présenté une atteinte de la commissure antérieure. La tumeur était étendue au ventricule de Morgani dans 10 cas (21%) et aux bandes ventriculaires dans 3 cas (6%). La mobilité des cordes vocales était réduite dans 2 cas (4%). Quatorze patients ont eu un curage ganglionnaire homolatéral. L'examen anatomopathologique de la pièce opératoire a conclu à un carcinome épidermoïde dans tous les cas avec des limites d'exérèse saines. La durée moyenne d'hospitalisation était 19 ±4 jours. Les délais moyens de décanulation et d'ablation de la sonde nasogastrique étaient respectivement 13 ±5,1 et 18 ±7,3 jours. L'infection du site de trachéotomie était la complication post opératoire la plus fréquente (19%). Les survies globales à 3 et à 5 ans étaient 97%. Les survies sans récidive à 3 et à 5ans étaient 94%. Le degré de différenciation tumorale était le seul facteur associé à la survie (p=0,04). Conclusion: la laryngectomie partielle de type Tucker est une technique fiable dans le traitement des carcinomes glottiques précoces. Elle offre un bon contrôle local de la maladie tout en gardant un faible taux de morbidité. La durée d'hospitalisation relativement prolongée ainsi que les problèmes de cicatrisation restent les principaux inconvénients de cette chirurgie. Mots clés: Laryngectomie frontale antérieure ; Carcinome épidermoïde ; Résultats oncologiques 57 J. TUN ORL-N o 44 OCTOBRE 2020 58 J. TUN ORL-N o 44 OCTOBRE 2020 INTRODUCTION:
... Smoking is responsible for up to 95% of causes of laryngeal cancer [21]. In the current study, 86.1% of patients with laryngeal cancer were smokers. ...
... This is an early symptom for glottic lesions, but a late one for supraglottic tumours. 8 This probably explains the relatively early presentation in glottic tumors and late presentation in supraglottic tumors. ...
p> Background: Carcinoma of larynx is the third most common cancer in head and neck, sixth most common cancer among men in India. This study aims to identify the patterns of clinical presentation, epidemiological features and management of laryngeal carcinoma in a tertiary care centre of Indian armed forces.
Methods : This is a retrospective analysis of patients admitted in a Command hospital from January 2007 to December 2009.
Results : A total of 28 patients were treated in 3 year duration. All the patients were males. The majority of patients belonged to 7th decade of life with youngest 49 years old and the oldest 80 years. Supraglottic carcinoma (71%) was the most common laryngeal carcinoma followed by glottic carcinoma(29%).Hoarseness of voice (82%) was the most common presenting complaint followed by dysphagia (42%) and dysponea (21%). 32% of patients reported after initial emergency tracheostomy. 12 (42%) patients were treated with curative surgery, 4 (14%) were treated with curative radiotherapy. Rest of patients required palliative therapy.
Conclusions: Laryngeal carcinoma is found predominantly in males at seventh decade of life and advanced stage. Treatment with curative intent may be possible in around 70% of patients . </p
... 9 According to Altieri et al (2002) and Licitra et al (2003) about 90% of cancer larynx incidence could be avoided by preventing tobacco smoking and by changing smoking status. [10][11] As regarding Alcohol intake, it is a major risk factor for incidence of cancer larynx 10, 12 which is not compatible with our results. In this study alcohol consumption among patients with cancer larynx was(9%) while non-drinker were (91%) this result is compatible with multiple studies that stated that the pattern of incidence and rate of mortality of upper aerodigestive tract (UADT) cancers is different among Africans especially Algerian, Tunisian , Moroccan and Egyptians because they do not drink alcohol for religious reasons. ...
... Según el Anuario de Mortalidad del Ministerio del Poder Popular para la Salud, para el año 2012, fallecieron 333 hombres y 51 mujeres, reportándose en el estado Mérida, 10 hombres y 3 mujeres fallecidos por esta causa; en edades comprendidas entre 55 y 70 años. La edad de presentación esta entre los 45 y 70 años, con un pico entre los 60 y 70 años (Licitra et al., 2003). Su incidencia está estrechamente asociada al consumo de cigarrillo y el alcohol y en los últimos años, también se ha vinculado al virus del papiloma humano (VPH). ...
Revista GICOS, Volumen 1, Número 4, octubre-diciembre 2016
... These technological advances have made it possible to reduce the dose for normal tissue structures and consequently to minimize the risk of toxicity and morbidity, while allowing for dose escalation to the tumour volumes, potentially leading to improved local control. [4][5][6] The success of RT treatment is directly related to the delivery of the treatment. Daily set-up variations and internal organ motions may lead to changes in dose distribution and target misalignment. ...
... Laryngeal carcinoma is the second most common malignancy of the head and neck region, 90% to 95% of which is laryngeal squamous cell carcinoma (LSCC). 1 This disease is much more common in male gender, 1 and the most important risk factors are tobacco and alcohol. 2 The incidence of laryngeal cancer is increasing annually worldwide. 3 In Tunisia, it increased, between 2006 and 2009, from 5.6 to 6.1 for men and from 0.34 to 0.4 for women per 100 000 inhabitants. ...
The objective of this study was to evaluate the expression of survivin and p16 in laryngeal squamous cell carcinoma (LSCC) in order to analyze their pathogenesis and prognostic significance in Tunisian patients. A total of 70 patients with LSCC collected at the Salah Azaiez Cancer Institute of Tunis were retrospectively evaluated. Expression of survivin and p16 was examined using immunohistochemistry, and the correlations with clinicopathological parameters, overall survival (OS), and disease-free survival (DFS) were statistically evaluated. The positive expression of survivin and p16 were found in 58.6% and 51.43% of LSCC cases, respectively. The p16 expression was not associated with either clinical parameters or patient survival, whereas there was a strong correlation of survivin expression and lymph node metastases (P = .002), alcohol consumption (P = .024), and therapeutic protocol (with or without chemotherapy; P = .001). Kaplan-Meier survival curves showed that patients with LSCC having positive survivin expression have shorter OS (P = .026) and shorter DFS (P = .01) than those with negative expression. Positive survivin expression was also correlated with high recurrence rate (P = .014). Therefore, survivin is a poor prognostic marker for LSCC but the therapeutic protocol remains, in multivariate study, the most decisive for the OS and DFS of our patients with P < .01. Our data indicated that, in Tunisian laryngeal squamous cell carcinoma, survivin expression is associated with unfavorable outcomes and represents a predictor marker of recurrence and chemoresistance. However, p16 expression has no prognosis value.
... Although, it is well known that tobacco and alcohol abuse are major risk factors for the development of laryngeal SCC (Licitra et al, 2003), however and in this setting, laryngeal malignant tumors, among all head and neck cancers, deserve special attention in relation to Epstein-Barr virus. And as such, and to the best of our knowledge, this research work is the first to study Epstein-Barr virus in relation to a set of laryngeal cancers in Iraq. ...
Epstein-Barr virus has been linked to the development of variety of human malignancies. Laryngeal squamous cell carcinomas are aggressive neoplasms that might have such linkage with Epstein-Barr virus (EBV). To assess the rates of occurrence of latent EBV infection in a group of laryngeal tissues with carcinoma and benign hyperplasia. Seventy (70) formalin-fixed, paraffin-embedded laryngeal tissues were enrolled in this study; (30) biopsies from laryngeal carcinoma and (40) laryngeal tissues as a control group: (25) from laryngeal benign hyperplasia and (15) from apparently normal laryngeal autopsies. Detection of EBV-EBERs was done by ultra-sensitive version of in situ hybridization (ISH). Detection of EBERs-ISH reactions in tissues with laryngeal carcinoma was observed in 12 out of 30 (40%), while in those tissues with benign laryngeal nodules was 15.4% (2 out of 13) and in benign laryngeal polyp tissues was 8.3% (1 out of 12). No positive EBERs-ISH reactions in apparently normal laryngeal tissues of control group were revealed. The statistical differences between the rates of EBERs in laryngeal carcinoma tissues and each of laryngeal benign hyperplasia & control tissues were highly significant (P value = < 0.001). Our results indicate that the EBV might contribute to the development of a subset of laryngeal malignant tumors.
... [6] The rates increase at the ages of 55-65 and larynx cancers are more common in males. [8,9] In our study, the mean ages and gender ratios were similar to other studies in the literature: the mean age was calculated as 60±9.5 years and the rates of larynx cancers were much higher in males. ...
... Additionally, LZTS2 promoter methylation levels were significantly increased in patients with lymph node metastases, advanced clinical stages, and advanced T classifications. It is wellunderstood that T classification and lymph node metastases are crucial to the prognosis of LSCC patients [17]. The present results suggested that LZTS2 promoter methylation also contributed to LSCC progression and ultimate prognosis. ...
Background:
LZTS2 (leucine zipper tumor suppressor 2), a candidate tumor suppressor gene, suppresses cell growth and plays a vital role in the carcinogenesis and development of tumors. No studies to date have described methylation of the LZTS2 promoter in human cancers, including LSCC (laryngeal squamous cell carcinoma). Therefore, the aim of this study was to explore the relationship between LZTS2 promoter methylation and risk of LSCC.
Methods:
In our study, LZTS2 promoter methylation levels in LSCC tumor and adjacent normal tissues from 96 patients were measured using quantitative methylation-specific polymerase chain reaction (qMSP) assays.
Results:
The qMSP analyses revealed that LZTS2 promoter methylation levels in the LSCC tumor samples were significantly higher than those in paired adjacent healthy tissue samples. Furthermore, LZTS2 methylation levels were elevated in smokers, advanced T classified, and clinically staged patients, as well as in patients with lymph node metastases. In addition, Kaplan-Meier survival curves results showed that overall survival of LSCC patients with hypomethylated LZTS2 promoters was significantly higher than that in patients with hyper-methylated LZTS2 promoters (log-rank test P = 0.028). Meanwhile, the area under the receiver operating characteristic curve was 0.920. The diagnostic threshold value for LZTS2 methylation was 11.63% (94.7% sensitivity and 80.4% specificity).
Conclusions:
LZTS2 promoter hypermethylation is associated with risk, progression, and prognosis of LSCC in a cohort of 96 human subjects; LZTS2 promoter hypermethylation is a candidate diagnostic and prognostic biomarker for LSCC.
... Según el Anuario de Mortalidad del Ministerio del Poder Popular para la Salud, para el año 2012, fallecieron 333 hombres y 51 mujeres, reportándose en el estado Mérida, 10 hombres y 3 mujeres fallecidos por esta causa; en edades comprendidas entre 55 y 70 años. La edad de presentación esta entre los 45 y 70 años, con un pico entre los 60 y 70 años (Licitra et al., 2003). Su incidencia está estrechamente asociada al consumo de cigarrillo y el alcohol y en los últimos años, también se ha vinculado al virus del papiloma humano (VPH). ...
Resumen: Introducción: El Cáncer de laringe es la neoplasia maligna más común en cabeza y cuello; Su incidencia está estrechamente asociada al consumo de cigarrillo. Ocupa la tercera causa de muerte por Cáncer en hombres en nuestro país. Objetivo: Determinar la prevalencia y manejo del Carcinoma Epidermoide de laringe en el Instituto Autónomo Hospital Universitario De Los Andes del Estado Mérida en el periodo de 2010-2014. Materiales y métodos: estudio no experimental, descriptivo, de corte retrospectivo. Se incluyeron los 52 pacientes diagnosticados con Cáncer Epidermoide de Laringe en el Instituto Autónomo Hospital Universitario de Los Andes, durante el período: 2010-2014. Resultados: El 98,1% (51) de los sujetos son de sexo masculino y el 1,9% (1) son de sexo femenino, edades entre 39 y 79 años, promedio de 60,23 años. El estado con mayor frecuencia Mérida con un 75,0%. La mayoría de sujetos de la muestra fumaron o fuman con un 71,2% (37). Localización más frecuente: glotis 67,3%. Complicación post tratamiento más frecuente: fistula traqueo esofágico. Conclusiones: El hábito tabáquico se considera un factor predisponente para el Cáncer de laringe. Este estudio es un primer paso en el servicio de otorrinolaringología del IAHULA hacia futuras investigaciones en el área.
... One well-characterised posttranscriptional regulator is the HuR protein, a member of embryonic lethal abnormal vision Drosophila-like family (ELAV) of RBPs, consisting of Hel-N1/HuB, HuC, HuD, and HuR proteins, initially identified as specific tumour antigens in patients with paraneoplastic neurological phenomena [4,5]. HuR protein is normally expressed in a variety of cell types, including adipose tissue and the intestine, spleen, thymus, and testis with low-level expression in the liver and uterus [6,7]. ...
Background
Hu-antigen R (HuR) is a posttranscriptional regulator of several target mRNAs, implicated in carcinogenesis. This review aims to present the current evidence regarding the biological role and potential clinical significance of HuR in head and neck carcinomas.
Methods
The existing literature concerning HuR expression and function in head and neck carcinomas is critically presented and summarised.
Results
HuR is expressed in the majority of the examined samples, showing higher cytoplasmic levels in malignant or premalignant cases. Moreover, HuR modulates several genes implicated in biological processes important for malignant transformation, growth, and invasiveness. HuR seems to be an adverse prognosticator in patients with OSCCs, whereas a correlation with a more aggressive phenotype is reported in several types of carcinomas.
Conclusions
A consistent role of HuR in the carcinogenesis and progression of head and neck carcinomas is suggested; nevertheless, further studies are warranted to expand the present information.
... Early stage glottic LSCC has favorable prognosis (5-year survival rate, > 70%), whereas the prognosis of supraglottic and subglottic LSCC is poor because of late stage at diagnosis (5-year survival rate, < 50%) [2]. The poor prognosis of LSCC is mainly attributed to lymphatic metastasis [3]. Lymphatic metastasis is an important prognostic indicator for patients with LSCC. ...
Background
Lymphatic metastasis contributes to the poor prognosis of laryngeal squamous cell carcinoma (LSCC). This study aimed to investigate the roles of two metastasis suppressor genes, KAI1 and nm23, in lymphangiogenesis and lymph metastasis of LSCC.
Methods
A total of 45 LSCC patients were enrolled in this study. The positive expression rates of KAI1 and nm23 protein were detected via immunohistochemistry in 45 LSCC and 22 normal laryngeal mucosa adjacent to LSCC. Micro-lymphatic vessel density (MLVD) was detected via immunohistochemistry with the specific antibody D2-40. Associations between KAI1 and nm23 expression and clinical characteristics of LSCC were then evaluated.
Results
The positive expression rates of KAI1 and nm23 were significantly lower in LSCC than normal laryngeal mucosa (P < 0.05). Significantly lower positive rates of KAI1 and nm23 were found in LSCC with lymphatic metastasis than those without lymphatic metastasis (P < 0.05), whereas MLVD was negatively correlated with the expression of KAI1 and nm23 (P < 0.05). However, no significant associations were found between KAI1 and nm23 expression and clinical characteristics of LSCC (sex, age, disease position, differentiation, and T-stage).
Conclusions
Both KAI1 and nm23 can inhibit lymphangiogenesis and lymphatic metastasis in LSCC.
... Since the 1970s' when Labayle and Piquet introduced supracricoid partial laryngectomy for glottic cancer treatment [9,10] and Steiner commenced TLM for laryngeal carcinomas in 1979 [11], laryngeal preservation procedures have paved the pathway for the contemporary management of laryngeal cancer. However, whereas chemoradiation therapy protocols have a tough scientific basis [12][13][14], indications for conservative surgery still wait for full validation. ...
Goal:
Controversies exist regarding the treatment of advanced laryngeal carcinomas. The purpose of this systematic review was to evaluate the oncologic outcomes of both transoral laser and open partial laryngectomies for advanced (T3-T4) squamous cell laryngeal cancers management.
Introduction:
A systematic review of literature was led searching for articles mentioning the following terms: advanced (T3-T4) laryngeal cancer AND laser; AND open partial laryngectomy; AND transoral laser microsurgery; AND cordectomy; AND conservative surgery; AND tracheohyoidopexy or tracheohyoidoepiglottopexy; AND supratracheal partial laryngectomy; AND supracricoid partial laryngectomy; AND cricohyoidopexy or cricohyoidoepiglottopexy. Then a quantitative analysis was carried on papers published after 1980.
Discussion:
The search identified 110 publications, and a total of 21 articles satisfied inclusion criteria and were selected for quantitative synthesis. 10 out of 21 studies had a good quality score, 10 were fair and only one rated a poor score. The pooled disease-free survival (DFS) was 79% (95% CI 74-85), and pooled overall survival (OS) was 71% (95% CI 64-78) at 5 years from all 1921 patients included in the study, with significant heterogeneity (I (2) = 89.7% and I (2) = 90.4%), respectively. Significant heterogeneity value (p = 0.118) was seen by comparing transoral laser and open partial laryngectomies in terms of DFS.
Conclusion:
The two surgical techniques are both valid conservative surgical options for advanced laryngeal cancer treatment.
... Potential benefits of radiotherapy are related to a better voice, especially in stage T2 [3]. For T3 and T4 tumors, there are three therapeutic plans that offer superior local control rate: frontolateral hemilaryngectomy or total laryngectomy, with or without neck dissection, radiotherapy followed by salvage surgery [4]. ...
The CO2 laser surgery represents a treatment method of laryngeal bicordal and anterior commissure glottic cancer T1b, T2, N0. In Department of ENT, Timisoara, Romania, during 1.01.2001-31.12.2011 were analyzed 781 files from patients with laryngeal neoplasm. One hundred twenty-seven patients presented the tumor that involved both vocal cords and anterior commissure, stages T1b, T2 and T3. Therapeutic options included CO2 laser microsurgical excision for 55 (43.30%) patients, frontolateral hemilaryngectomy for 16 (12.59%) patients, total laryngectomy for 42 (33.07%) patients, radiotherapy for 10 (7.87%) patients, and four (3.14%) patients, initially, refused any treatment modality. Endoscopic laser CO2 microsurgery was the primary and solitary management for curative resection of the glottic cancer. All operations were performed under general anesthesia with orotracheal intubations. The mean follow-up was 58 months, with the range between 36 to 84 months. Suspended microlaryngoscopy with CO2 laser surgery has been performed in 43 (33.85%) patients staged T1bN0Mx and 12 (9.44%) patients staged T2N0Mx. In five (9.09%) patients, we encountered local recurrences. The endoscopic CO2 laser surgery is in our view the elective and preferable surgical method in laryngeal glottic cancer stage T1b and T2 for cure, with oncological and functional results superior to those of conventional surgical procedures.
... The phonetic function and living quality of patients are severely affected after surgery. Moreover, tumor cells are resistant to chemotherapy drugs and are not sensitive to radiotherapy, which is likely to cause cancer recurrence and metastasize (2)(3)(4). Therefore, looking for an efficient molecular targeted therapy to improve the survival rate and life quality of patients with laryngeal cancer is very important for clinical treatment. ...
Laryngeal carcinoma is one of the most common malignant tumors in otorhinolaryngology. Moreover, experimental investigation showed that cancerous inhibitor of protein phosphatase 2A (CIP2A) expressed highly in various cancers. Therefore, we investigated whether CIP2A can regulate the proliferation, invasion and migration by RNA interference in Hep-2 cells and AMC-NH-8 cells and further affect the activation of phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) pathway. Overexpression of CIP2A was evaluated in tumor tissue and laryngeal cancer cell lines (Hep-2 and AMC-NH-8 cells) by real-time quantitative polymerase chain reaction (RT-qPCR) and western blot assay. In a follow-up experiment, we confirmed that CIP2A siRNA effectively suppressed the cell proliferation at 48 and 72 h, and arrested cell cycle at G0/G1 in Hep-2 cells and AMC-NH-8 cells. The invasion and migration of cell in siRNA CIP2A group were markedly inhibited. Moreover, the experimental results showed that the expression levels of invasion- and migration-related genes, including E-cadherin, metastasis-associated gene 1 (MTA1) and matrix metalloproteinases-2/9 (MMP-2/9), were regulated by CIP2A siRNA. Phosphorylation levels of PI3K and AKT proteins were reduced by CIP2A siRNA. Importantly, it suggested signaling through PI3K/Akt as a critical mechanism by which CIP2A siRNA may suppress cell proliferation, invasion and migration in laryngeal carcinoma cells.
... patients; M = male; F = female; y = years; VEGF = vascular endothelial growth factor; mon = months; FU = follow-up; IHC = immunohistochemistry; ELISA = enzyme-linked immunosorbent assay; DFS = disease-free survival; OS = overall survival; U = univariate multivariate analysis; M = multivariate analysis; T = tumour-node-metastasis tumour grade; N = tumour-node-metastasis node grade; NR = not reported. * Crude hazard ratio used for meta-analysis.VASCULAR ENDOTHELIAL GROWTH FACTOR OVEREXPRESSION PREDICTS WORSE LARYNGEAL CANCER PROGNOSISexpression of genes such as BCL2, p53 and BAX.25 These prognostic factors are confounders in the assessment of the relationship between vascular endothelial growth factor expression and laryngeal cancer prognosis. ...
Objective
This study assessed the relationship between vascular endothelial growth factor expression and the laryngeal cancer prognosis.
Methods
Systematic computerised searches of PubMed were performed up to 31 January 2015. Prognostic endpoints were overall survival and disease-free survival. The pooled hazard ratios for overall survival and disease-free survival were also calculated.
Results
Seven studies containing 975 patients were included. The pooled hazard ratio was 1.703 (95 per cent confidence interval, 1.373 to 2.112; z score = 4.85, p = 0.000) for overall survival and was 1.918 (95 per cent confidence interval, 1.410 to 2.609; z score = 4.15, p = 0.000) for disease-free survival. No significant publication bias was found. A sensitivity analysis showed that the results were robust. Power analyses also showed there was enough power to detect the calculated hazard ratios.
Conclusion
The study found that vascular endothelial growth factor overexpression predicted a worse prognosis for laryngeal cancer patients. This supports a strategy of targeted therapy by blocking the vascular endothelial growth factor receptor.
... In the head and neck region, ER expression was initially evaluated in laryngeal cancer. This type of cancer is 11 times more common in males than females, despite similar rates of alcohol abuse and smoking in both genders (15,23). Previous studies have demonstrated that 23-79% of laryngeal cancer cases express ERs (16-18,24), concluding that positive ER expression is gender independent with a positive prognostic influence on survival. ...
Head and neck squamous cell carcinoma (HNSCC) is the fifth most common cancer in the world. Although multimodal and targeted therapy is now used in therapeutic procedures, the survival of patients with HNSCC has remained unchanged over the last 30 years. A number of studies have demonstrated that the increased expression of intranuclear ERβ in breast, lung and colon cancer is a favorable prognostic marker associated with higher survival rates. However, the clinical significance of sex hormone receptors in HNSCC remains unclear. The current study aimed to assess the expression of ERβ in HNSCC immunohistochemically and investigate any possible association between ERβ expression, and clinical and histopathological factors, disease recurrence and patient survival. The present study included 174 patients (165 males and 9 females) with a median age of 60.8 years (range, 39-79) with HNSCC who were primary surgically treated between January 2000 and December 2006. Immunohistochemical reactions for ERβ demonstrated that 73 patients (42%) exhibited positive ERβ expression. Distribution of ERβ status among different head and neck subsites indicated that > 40% of all negative cases were located in laryngeal primaries, while incidence of other sublocalization within positive cases was similar and comparable (P=0.04). Furthermore, a correlation was observed between ERβ immunopositivity and the survival of patients, with respect to the primary tumor site. Patients with ERβ positive oropharyngeal cancer had a survival rate of 35.3% at 5-years compared with 25% for patients with negative expression. However, ERβ status was not significantly correlated with any other clinical or histopathological parameter. After an average follow-up time of 38.5 months (range, 3-60 months), 54 patients (31.1%) had succumbed to disease recurrence while 50 (28.7%) succumbed to other causes. In conclusion, ERβ positivity indicates improved survival of patients with oropharyngeal cancer. Further research is required in order to implement novel therapeutic strategies.
... For example, glottic cancer has a better prognosis than supraglottic and subglottic cancer. 17 Until now, prevention and early diagnosis with function-preserving treatment have been considered to be the most effective approach. 3 The aim of this study was to evaluate the expression of parafibromin in LSCC and verify its potential In addition to tumor size and volume, which are encompassed by the T stage, advanced stage disease with vocal cord fixation might be a significant parameter of tumor aggressiveness. ...
Background:
Parafibromin is a product of the tumor suppressor gene that has been studied as a potential indicator of tumor aggressiveness in the parathyroid, breast, colorectum, and stomach. However, the clinical significance and potential function of parafibromin expression in head and neck squamous cell carcinomas remain largely unknown. The aim of this study was to evaluate the expression of parafibromin in laryngeal squamous cell carcinoma (LSCC) and to verify its potential as a biomarker of tumor behavior.
Materials and methods:
Parafibromin expression was evaluated in 30 cases of LSCC using immunohistochemistry. The correlations between parafibromin expression and clinicopathologic parameters were investigated.
Results:
Parafibromin expression was positive in 15 cases (50%) and negative in 15 cases (50%). Tumor size and T stage showed a statistically significant inverse relationship with parafibromin expression (p= .00 and p= .028, respectively). Parafibromin expression was not associated with age, sex, lymph node metastasis, tumor differentiation, or tumor location. There was no statistically significant relationship between parafibromin expression and progression-free survival in the patients (p> .05).
Conclusion:
Our results indicate that the downregulation or loss of parafibromin expression can be employed as a novel marker of tumor progression or aggressiveness in LSCC.
... Laryngeal cancer is one of the most common types of head and neck cancer, and the majority of laryngeal cancers are squamous cell carcinomas (1). The incidence rate of laryngeal cancer accounts for 1-5% of all malignancies, and is third most common head and neck cancer tumor (2). ...
The purpose of the present study was to screen the key genes associated with laryngeal carcinoma and to investigate the molecular mechanism of laryngeal carcinoma progression. The gene expression profile of GSE10935 [Gene Expression Omnibus (GEO) accession number], including 12 specimens from laryngeal papillomas and 12 specimens from normal laryngeal epithelia controls, was downloaded from the GEO database. Differentially expressed genes (DEGs) were screened in laryngeal papillomas compared with normal controls using Limma package in R language, followed by Gene Ontology (GO) enrichment analysis and pathway enrichment analysis. Furthermore, the protein-protein interaction (PPI) network of DEGs was constructed using Cytoscape software and modules were analyzed using MCODE plugin from the PPI network. Furthermore, significant biological pathway regions (sub-pathway) were identified by using iSubpathwayMiner analysis. A total of 67 DEGs were identified, including 27 up-regulated genes and 40 down-regulated genes and they were involved in different GO terms and pathways. PPI network analysis revealed that Ras association (RalGDS/AF-6) domain family member 1 (RASSF1) was a hub protein. The sub-pathway analysis identified 9 significantly enriched sub-pathways, including glycolysis/gluconeogenesis and nitrogen metabolism. Genes such as phosphoglycerate kinase 1 (PGK1), carbonic anhydrase II (CA2), and carbonic anhydrase XII (CA12) whose node degrees were >10 were identified in the disease risk sub-pathway. Genes in the sub-pathway, such as RASSF1, PGK1, CA2 and CA12 were presumed to serve critical roles in laryngeal carcinoma. The present study identified DEGs and their sub-pathways in the disease, which may serve as potential targets for treatment of laryngeal carcinoma.
... Classification of precancerous lesions must be based on the progression of the specific histopathological characteristics with high reproducibility, applicability, and predictive value. Several pathologists have assessed the interobserver variability in the classification of laryngeal precancerous lesions using the WHODC, squamous intraepithelial neoplasia, 14 and Ljubljana classification (LC) systems. 15 However, none of them could give precedence to any particular classification system with statistically similar kappa values. ...
Objectives/hypothesis:
This study was designed to assess the feasibility of the submucosal infusion technique combined with microflap dissection as a radical therapeutic and diagnostic option for precancerous laryngeal leukoplakia.
Study design:
Retrospective study.
Methods:
Severe dysplasia or carcinoma in situ was diagnosed after phonomicrosurgical dissections in 25 patients with unilateral laryngeal leukoplakia. Of these, 15 patients preferred no additional surgery (observation group), whereas 10 patients underwent further laser subligamental cordectomy (additional surgery group). The relationship between the initial surgical margin and histopathological characteristics of additionally excised tissues was assessed to evaluate diagnostic reliability. Disease control was assessed to determine the oncologic efficacy of the therapeutic procedure. Comparative multidimensional vocal assessments were performed in both groups to evaluate functional advantages of one-stage excision.
Results:
After the initial phonomicrosurgical resection, three patients had residual dysplastic lesions near the vocal process and anterior commissure, whereas three other patients had lesions suspicious for recurrence. No postoperative malignant transformation was observed in any patient. Although well-preserved vocal function was observed in the observation group, vocal quality deteriorated shortly after laser surgery in the additional surgery group. Regarding acoustics, aerodynamics, and quality-of-life evaluations, statistically equivalent scores were observed between the observation and control groups, whereas scores were inferior in the additional surgery group than in the control group.
Conclusions:
Phonomicrosurgical resection may be a therapeutic option with oncologic efficacy against precancerous laryngeal leukoplakia. This radical management might achieve more satisfactory postoperative vocal function.
Level of evidence:
NA Laryngoscope, 2016.
... A recent review of seven of the 12 population-based registries of the 50 Spanish provinces over a period of 11 years (representing approximately 14% of the country's population) revealed an increase in larynx cancer in women over the 10 years studied [13]. An increased incidence in women has also been reported in Poland, Lithuania, Italy, and Denmark [14,15,16 && ], as well as in Canada, United States, and Australia [17]. In Latin American countries, different incident trend patterns are suggested for Cuba (steady increase), Puerto Rico (stable), and Cali, Colombia (decreasing). ...
Purpose of review:
Laryngeal cancer published literature was reviewed, with emphasis on reporting on young patients (<40 years). With such information, to comment on the evidence or not, that such patients, should they be nondrinkers and nonsmokers, have a differing cause and genetic/molecular profile rather than a spectrum of the classic disease.
Recent findings:
Head and neck cancer in young patients is documented at a rate of 0.4-3.6%, with laryngeal cancer being identified in less than 2% of all diagnosed head and neck cancer patients overall. Head and neck cancer in nondrinking nonsmokers has been reported from tertiary clinical hospitals only, with few patients having a diagnosis of laryngeal cancer, and thus their documented drinking and smoking habits may be considered suspect. Most of the molecular or genetic studies on young patients, who probably have had varying degrees of drinking and smoking habits, have been reported on nonlaryngeal head and neck sites. These finding should be confirmed on a 'pure group' of young patients (<40 years) with laryngeal cancer who confirm that they have been nondrinkers, and nonsmokers.
Summary:
Many authors comment that laryngeal cancer in young (<40 years) nondrinking nonsmoking patients is likely explained by some molecular or genetic level abnormality rather than histological and should be considered a distinct group. However, because of a low incidence of such patients and the rapid development in genetic sequencing, that such a project be completed requires greater collaboration between clinicians and pathologists.
Objective
Diagnostic role of autoantibodies (AAb) as serological biomarkers has not been specifically investigated in laryngeal cancer (LC) previously. The study investigates the presence of anti-LC AAbs and their potential as a biomarker for early diagnosis of LC, to improve patient outcome.
Method
Anti-LC AAb levels were investigated in LC patients (n = 30) and healthy individuals (n = 30) by indirect enzyme-linked immunosorbent assay (ELISA). Patient AAb levels were analyzed with various clinical factors, primarily tumor stage.
Results
AAb levels were significantly higher in LC patients than in the control group (P = .019). The diagnostic performance of AAb-level testing for LC detection presented a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 70% each. The positive likelihood (LR+) and negative likelihood (LR−) ratios were 2.33 and 0.43, respectively. AAb levels were independent of cancer stage (P = .708), duration since first appearance of symptoms (P = .228), duration of medical attention (P = .231), and degree of risk-factor exposure (P = .478).
Conclusion
Significant level of AAbs could be detected among LC patients with good diagnostic performance, irrespective of stage. Thus, anti-LC AAbs reflect potential to be utilized as predictive biomarkers in early diagnostics of LC.
Rupture of a metastatic liver tumor associated with laryngeal cancer is a very rare complication with no previous case in the literature. We present a case of ruptured liver metastases which was treated conservatively. Dynamic contrast-enhanced computed tomography demonstrated active extravasation and discontinuity of liver capsule. When the patient came to our hospital from the external medical center, we did not see active extravasation on control computed tomography. This case highlights the role of radiologic imaging in the diagnosis and follow-up of ruptured hepatic metastases.
The aim was to evaluate the clinical impact of IGF-1/IGF-1R in Tunisian laryngeal carcinoma. A high IGF-1R immunohistochemical expression was found in our series (81.43%). A tendency toward an association between IGF-1R expression and lymph node metastasis was found (p = 0.068). Patients with positive IGF-1R expression showed a short disease free survival (p = 0.053) and a high recurrence rate. Furthermore, circulating IGF-1 levels sera, detected by ELISA, were higher among patients compared to controls (p < 0.001). IGF-1R might have a prognostic significance and could be a factor of tumor recurrence. However, high levels of IGF-1 increase the risk of developing of LSCC disease.
Background: The expression and function of androgen receptors (AR) and estrogen receptor alpha (ER-ɑ) in laryngeal squamous cell carcinoma (LSCC) have remained controversial for decades. Prolactin receptor (PRLR) is a sex-related hormone, that has been rarely documented in terms of expression or function compared with data on other hormone receptors in laryngeal carcinoma.
Methods: This study reports on immunohistochemical and reverse transcription-polymerase chain reaction (RT-PCR) analysis of tumour tissue and adjacent normal tissue in 96 patients with LSCC (82 males and 14 females). The expression levels of the receptors were related to clinicopathologic parameters and survival data.
Results: At both protein and mRNA levels, the expression level of AR, ER-ɑ, and PRLR was much higher in LSCC than in adjacent normal tissues (p < .05). Among them, higher PRLR expression in tumour tissues tended to have a significantly poorer survival rate (p = .03) for patients with LSCC. Furthermore, higher expression of ER-ɑ in tumours was correlated with higher expression level of PRLR (r = .823, p = .03).
Conclusion: The findings of this study indicate that the sex-related hormone receptors play an important role in the development of LSCC. The PRLR represents a novel prognosticator, because of its negative effect on survival and its interaction with ER-ɑ.
Bisphenol A (BPA) can be accumulated into the human body via food intake and inhalation. Numerous studies indicated that BPA can trigger the tumorigenesis and progression of cancer cells. Laryngeal cancer cells can be exposed to BPA directly via food digestion, while there were very limited data concerning the effect of BPA on the development of laryngeal squamous cell carcinoma (LSCC). Our present study revealed that nanomolar BPA can trigger the proliferation of LSCC cells. Bisphenol A also increased the in vitro migration and invasion of LSCC cells and upregulated the expression of matrix metallopeptidase 2. Among various chemokines tested, the expression of IL-6 was significantly increased in LSCC cells treated with BPA for 24 hours. Neutralization antibody of IL-6 or si–IL-6 can attenuate BPA-induced proliferation and migration of LSCC cells. Targeted inhibition of G protein–coupled estrogen receptor, while not estrogen receptor (ERα), abolished BPA-induced IL-6 expression, proliferation, and migration of LSCC cells. The increased IL-6 can further activate its downstream signal molecule STAT3, which was evidenced by the results of increased phosphorylation and nuclear translocation of STAT3, while si–IL-6 and si-GPER can both reverse BPA-induced activation of STAT3. Collectively, our present study revealed that BPA can trigger the progression of LSCC via GPER-mediated upregulation of IL-6. Therefore, more attention should be paid for the BPA exposure on the development of laryngeal cancer.
Proteolytic enzymes mediate the activation or inactivation of many physiologic and pathologic processes. The PHEX gene (Phosphate-regulating gene with homologies to endopeptidase on the X chromosome) encodes a metallopeptidase, which is mutated in patients with a prevalent form (1:20,000) of inherited rickets-X-linked hypophosphatemia (XLH). XLH shows growth retardation, hypophosphatemia, osteomalacia, and defective renal phosphate reabsorption and metabolism of vitamin D. Most PHEX studies have focused on bone, and recently we identified osteopontin (OPN) as the first protein substrate for PHEX, demonstrating in the murine model of XLH (Hyp mice) an increase in OPN that contributes to the osteomalacia. Besides its role in bone mineralization, OPN is expressed in many tissues, and therein has different functions. In tumor biology, OPN is known to be associated with metastasis. Here, we extend our PHEX-OPN studies to investigate PHEX expression in a squamous cell carcinoma (SCC) cell line and its possible involvement in modulating OPN function. Real-time PCR showed PHEX-OPN co-expression in SCC cells, with sequencing of the 22 exons showing no mutation of the PHEX gene. Although recombinant PHEX hydrolyze SCC-OPN fragments, unlike in bone cells, SCC PHEX protein was not predominantly at the plasma membrane. Enzymatic activity assays, FACs and immunoblotting analyses demonstrated that membrane PHEX is degraded by cysteine proteases and the decreased PHEX activity could contribute to the inappropriate OPN regulation. These results highlight for the first time PHEX in tumor biology.
• The emergence of the multitude of modified techniques for neck dissection procedure has resulted in a nomenclature system that is nonuniform. To eliminate potential misinterpretation, overlap, and lack of standardization, the Academy's Committee for Head and Neck Surgery and Oncology, with input from the Education Committee of the American Society of Head and Neck Surgery, has developed a classification system for these procedures. This has now been adopted by the American Academy of Otolaryngology—Head and Neck Surgery. The classification is based on the following concepts: (1) radical neck dissection is the fundamental procedure with which all other neck dissections are compared, (2) modified radical neck dissection denotes preservation of one or more nonlymphatic structure(s), (3) selective neck dissection denotes preservation of one or more group(s) of lymph nodes, and (4) extended radical neck dissection denotes removal of one or more additional lymphatic and/or nonlymphatic structure(s). Adherence to the principles of this classification system to describe neck dissection techniques should provide an improved method of communication. Furthermore, the system provides a rational framework on which subsequent terminology can be added.
(Arch Otolaryngol Head Neck Surg. 1991;117:601-605)
Verrucous carcinoma of the larynx clinically resembles laryngeal papilloma in that both are wart-like masses on the vocal cords and may be characterized by multifocality and recurrence. Human papillomavirus (HPV) infection is an etiological factor in laryngeal papilloma, and recent evidence implicates HPV in squamous neoplasias. To determine whether HPV is also associated with verrucous carcinoma of the larynx, we analyzed tissue specimens from six patients with verrucous carcinoma of the larynx by Southern and DNA dot blot hybridization for HPV DNA. From three patients, specimens of normal laryngeal epithelium were also studied. All tissues showed evidence of HPV sequences related but not identical to HPV-16. They were negative for HPV-11. In contrast, four squamous cell carcinomas of the larynx and three normal laryngeal tissues were negative for HPV DNA. Histological sections of the six verrucous lesions were found to contain koilocytosis. Immunoperoxidase staining for HPV capsid antigens was negative in all these cases. The consistent and specific association of HPV with the verrucous carcinomas in this report suggests the possibility of a pathogenic involvement.
Aim
To present data on cancer prevalence for the areas covered by Italian cancer registries, by using a standardized set of data collection and elaboration criteria, and a single method of data analysis.
Subjects and Methods
Data on over 250,000 patients with cancer, diagnosed between 1978 and 1992, from 11 Italian cancer registries covering about 12% of the Italian population were collected, validated and analyzed according to the unified protocol of the ITAPREVAL project. The method implemented in the PREVAL computer program was used to provide prevalence estimates for the period covered by cancer registration. The total prevalence for each registry and for the pool of all registries was then estimated by correcting for incomplete observations due to the period in which the registration was not yet activated. All prevalence estimates were for 1992.
Results
Prevalence figures are presented by cancer site, age, sex, years from diagnosis and registry area. For all malignancies combined, total prevalence ranged from 1,350 per 100,000 inhabitants in Ragusa to 3,650 per 100,000 inhabitants in Romagna, the ratio between these two extremes being 2.7. For the pool of the areas covered by registration cancer prevalence was 3,100 per 100,000 females and 2,250 per 100,000 males. About a third of the total female cases and about half the male cases were diagnosed in the previous five years. Among those aged over 75 years, total prevalence was higher for males than for females: 11,300 versus 8,900 per 100,000 respectively.
Conclusions
This is the first large-scale estimate of the burden of cancer in Italy. It is also one of the first studies in the world which was aimed to study cancer prevalence in detail. These data are necessary for predicting health service needs and help in the evaluation of differences in health service demand by sex, age and Italian regions.
PURPOSEThe Southwest Oncology Group (SWOG) conducted a randomized comparison of cisplatin plus fluorouracil (5-FU) and carboplatin plus 5-FU versus single-agent methotrexate (MTX) in patients with recurrent and metastatic squamous-cell carcinoma (SCC) of the head and neck. The primary objective was to compare separately the response rates of each combination regimen to standard weekly MTX.PATIENTS AND METHODS
Two hundred seventy-seven patients diagnosed with SCC of the head and neck were randomized to one of three treatments: (1) cisplatin 100 mg/m2 intravenously (IV) on day 1 and 5-FU 1,000 mg/m2 per day for a 96-hour continuous infusion repeated every 21 days; (2) carboplatin 300 mg/m2 IV on day 1 and 5-FU 1,000 mg/m2 per day for a 96-hour continuous infusion repeated every 28 days; and (3) MTX 40 mg/m2 IV given weekly.RESULTSAll three treatment regimens were well tolerated. However, both hematologic and nonhematologic toxicities were significantly greater with cisplatin plus 5-FU compared with MTX (P = ...
This article describes a new method of subtotal laryngectomy which is called cricohyoido epiglotto pexy. The technique is developed from Majer and Labayle's operation. It enables extensive fixed glottal cancers to be treated without the sub glottal region being affected. Convalescence was uncomplicated for the 23 patients operated on and it was possible to decannulate all of them.
Purpose: The optimal fractionation schedule for radiotherapy of head and neck cancer has been controversial. The objective of this randomized trial was to test the efficacy of hyperfractionation and two types of accelerated fractionation individually against standard fractionation.
Methods and Materials: Patients with locally advanced head and neck cancer were randomly assigned to receive radiotherapy delivered with: 1) standard fractionation at 2 Gy/fraction/day, 5 days/week, to 70 Gy/35 fractions/7 weeks; 2) hyperfractionation at 1.2 Gy/fraction, twice daily, 5 days/week to 81.6 Gy/68 fractions/7 weeks; 3) accelerated fractionation with split at 1.6 Gy/fraction, twice daily, 5 days/week, to 67.2 Gy/42 fractions/6 weeks including a 2-week rest after 38.4 Gy; or 4) accelerated fractionation with concomitant boost at 1.8 Gy/fraction/day, 5 days/week and 1.5 Gy/fraction/day to a boost field as a second daily treatment for the last 12 treatment days to 72 Gy/42 fractions/6 weeks. Of the 1113 patients entered, 1073 patients were analyzable for outcome. The median follow-up was 23 months for all analyzable patients and 41.2 months for patients alive.
Results: Patients treated with hyperfractionation and accelerated fractionation with concomitant boost had significantly better local-regional control (p = 0.045 and p = 0.050 respectively) than those treated with standard fractionation. There was also a trend toward improved disease-free survival (p = 0.067 and p = 0.054 respectively) although the difference in overall survival was not significant. Patients treated with accelerated fractionation with split had similar outcome to those treated with standard fractionation. All three altered fractionation groups had significantly greater acute side effects compared to standard fractionation. However, there was no significant increase of late effects.
Conclusions: Hyperfractionation and accelerated fractionation with concomitant boost are more efficacious than standard fractionation for locally advanced head and neck cancer. Acute but not late effects are also increased.
The decreasing incidence rate and improvement in survival of laryngeal cancer patients in Finland are exceptions among western countries. A descriptive study of these trends was conducted including both nationwide population-based cancer registry data with 5 766 patients diagnosed in 1956–1995 and regional hospital-based data from Northern Finland, allowing classification into supraglottic and glottic cancers, with 353 patients diagnosed in 1976–1995. In Finland, the age-adjusted incidence rate among males decreased from 6.5 per 100 000 in 1956–1965 to 3.5 in 1986–1995, while in females the rate remained around 0.3 per 100 000. The rates in Northern Finland were slightly higher and the supraglottic to glottic incidence ratio diminished from 1.4 : 1 in 1976–1985 to 0.5 : 1 in 1986–1995. The 5-year relative survival rate improved in both Northern Finland and the whole country, most noticeably among males and the elderly. In the data from Northern Finland, the survival rate was more favourable in glottic (80...
We compared the management and outcome of glottic cancer in Ontario, Canada to that in the Surveillance, Epidemiology and End Results (SEER) Program areas in the United States to determine whether the greater use of primary radiotherapy with surgery reserved for salvage in Ontario was associated with similar survival and better larynx retention rates than the U.S. approach where primary surgery is used more often. Electronic, clinical and hospital data were linked to cancer registry data and supplemented by chart review where necessary. Initial treatment and survival in patients diagnosed in the SEER areas from 1988 through 1994 were compared to patients from Ontario diagnosed from 1982 through 1995. Actuarial laryngectomy rates were compared for patients over 65 at diagnosis in the two regions. Analyses were conducted over all cases and stratified by disease stage. In localized disease (T1 or T2), conservative treatment was the most common initial treatment in both regions, although total laryngectomy was used more often in SEER than Ontario (6.2% vs. 0.2%, respectively, P < .001). In advanced disease (T3 or T4), total laryngectomy was more commonly used as initial treatment in SEER (62.9% vs. 21.0% in Ontario, P ⩽ .001). Over all cases, the relative survival rate was 80% in Ontario at 5 years compared to 78% in SEER (P = .33). In localized disease, the relative survival rates were 4 to 5% higher in Ontario from the second year on, while in advanced disease 2 to 3% higher rates in SEER did not approach statistical significance. Actuarial laryngectomy rates at 3 years differed between the two regions, with a 4% higher rate in SEER (P = .01). In localized disease, 12.6% of Ontario patients had a laryngectomy by 3 years postdiagnosis compared to 17.9% in SEER (P = .05). In advanced disease, the rates were 63.3% and 79.2%, respectively (P = .07). There are large differences in the management of glottic cancer between the SEER areas of the U.S. and Ontario and no evidence that a policy emphasizing radiotherapy with surgery reserved for salvage is associated with worse survival. Ultimate laryngectomy rates are lower in Ontario for localized disease and may be lower for advanced disease. Conservation treatment should be used for localized disease while the treatment decision in advanced disease may be especially sensitive to patient values for voice retention versus initial cure.
Objective:
To determine the impact of delayed regional metastases, distant metastases, and second primary tumors on the therapeutic outcomes in squamous cell carcinomas of the larynx and hypopharynx.
Study design:
Chart review and statistical analysis.
Methods:
A retrospective tumor registry analysis was made of patients with squamous cell carcinomas of the larynx and hypopharynx who were treated with curative intent in the Department of Otolaryngology-Head and Neck Surgery and the Radiation Oncology Center of the Washington University School of Medicine (St. Louis, MO) between January 1971 and December 1991 and developed delayed regional metastases (2 y after treatment), distant metastases, and second primary malignancies.
Results:
In 2550 patients, the mean age (59.8 y), sex (8.5 male patients and 1 female patient), and tumor differentiation did not affect the incidence of delayed distant, regional, or second primary malignancies. The overall incidence of delayed regional metastases was 12.4% (317/2550 patients); distant metastases, 8.5% (217/2550); and second primary tumors, 8.9% (228/2550), with a 5-year disease-specific survival of 41%, 6.4%, and 35%, respectively. Second primary malignancies were not statistically related to the origin of the primary tumor, tumor staging, or delayed regional and distant metastases (P =.98). Delayed regional metastases and distant metastases were related to advanced primary disease (T4 stage), lymph node metastases (node positive [N+]), tumor location (hypopharynx), and locoregional tumor recurrence (P < or =.028). Advanced regional metastases at initial diagnosis (N2 and N3 disease) increased the incidence of delayed and distant metastases threefold (P =.017). These two metastatic parameters were significantly greater in hypopharyngeal tumors than in laryngeal tumors (P =.037). The incidences of delayed regional metastases by anatomical location of the primary tumor were as follows: glottic, 4.4%; supraglottic, 16%; subglottic, 11.5%; aryepiglottic fold, 21.9%; pyriform sinus, 31.1%; and posterior hypopharyngeal wall, 18.5%. The incidences of distant metastases were as follows: glottic, 4%; supraglottic, 3.7%; subglottic, 14%; aryepiglottic fold, 16%; pyriform fossa, 17.2%; and posterior hypopharyngeal wall, 17.6%. Seventeen hypopharyngeal tumors (2%) presented with M1 disease. Delayed regional metastases to the ipsilateral treated neck had a significantly worse survival prognosis than delayed metastases to the contralateral nontreated neck (P =.001).
Conclusions:
Conclusions are as follows: 1) The incidence of second primary tumors is independent from the primary tumor staging and distant and delayed regional metastases. The highest incidence occurred in patient groups with the highest disease-free survival rates (P =.0378). 2) Highest incidence of delayed and distant metastases occurred in hypopharyngeal tumors and was three times greater than in laryngeal cancers (P =.028). 3) Salvage therapeutic rates were poor for delayed metastases to the ipsilateral treated nodes and distant metastases as compared with contralateral neck metastases and second primary tumors (P =.001). 4) Delayed and distant lymph node metastases were significantly higher in advanced primary disease (T4 stage), locoregional recurrences, and regional disease (N2 and N3) (P =.028) in both the larynx and hypopharynx. 5) The higher incidence of delayed and distant metastatic disease was related to more advanced initial tumor presentation in hypopharyngeal cancer as compared with laryngeal cancer (P =.039). 6) Incidence of distant metastases was greatest between 1.5 and 6 years after initial treatment with a mean incidence being less than or equal to 3.2 years.
Neck recurrence‐free curves corrected for local recurrence were compared for 494 patients who underwent 565 comprehensive neck dissections. In 42 dissections, no radi‐cality could be obtained. Of the 523 histologically radical dissections, examination revealed tumor in 352 cases. Patients in whom three or more positive nodes or extranodal spread in one or more nodes were found received postoperative radiotherapy. In the histologically NO group, the incidence of neck recurrence after 5 years was 3%; in the N+ group as a whole, it was 10%. Analysis of the influence of extranodal spread and the number of positive nodes showed that the group with one or two positive nodes without extranodal spread (that did not receive postoperative radiotherapy) did not statistically differ from the other groups.
This suggests that the results of the group with one or two positive nodes without extranodal spread can be improved by postoperative radiotherapy.
BACKGROUND
The objectives of this study were 1) to describe patterns of use of computed tomography (CT) in laryngeal carcinoma, and 2) to characterize the contribution of CT to the T classification of laryngeal carcinoma.METHODS
The study population comprised 1195 patients with laryngeal carcinoma diagnosed from 1982 through 1995 chosen randomly from the Ontario provincial cancer registry. A chart review was conducted to obtain data on each case. Patient-related, tumor-related, and health-system-related factors were analyzed to identify factors associated with the use of CT. Descriptions of clinical exams and CT reports were reviewed to see how CT information modified T classification. Actuarial local control and cause specific survival curves were plotted by clinical T classification without and with CT to evaluate stage migration. The percentage of the variance in outcome explained by T classification in a Cox analysis was used to evaluate whether the prognostic accuracy of T classification was improved with the use of information from CT.RESULTSPatients with glottic (20.1%) and supraglottic (41.7%) carcinoma underwent CT. The use of CT increased over time in glottic and supraglottic carcinoma combined from 17.2% in 1982–5 to 33.9% in 1991–5. Computed tomography was used less often in older patients with a 16% (95% confidence interval, 5– 27%) decrease in the odds of having CT with each 10-year age increment. Computed tomography use varied considerably across the cancer center regions in Ontario. Computed tomography altered the T classification in 20.2% of those patients who had CT, with most being “upstages.” Stage migration due to CT was demonstrated. Using information from CT in the assignment of T classification for 27.8% of this study population did not make a significant contribution to the ability of T classification to predict outcome over the entire group.CONCLUSIONS
There is large variation in the use of CT among different age groups and regions. The ability to compare outcomes by stage across geographic areas is compromised when the use of CT varies. Cancer 2001;91:394–407. © 2001 American Cancer Society.
A variety of opinions have been expressed in the literature concerning asbestos and laryngeal cancer. This paper presents an analysis of epidemiological studies based on criteria that prioritized the most heavily exposed cohorts. Emphasis was given to the six cohorts or subcohorts with lung cancer relative risk estimates of 2 or more. The two groups of workers with the highest lung cancer relative risk estimates (4.06 and 3.28) both gave strong support for a causal association of asbestos and laryngeal cancer, with relative risk estimates of 1.91 (90% confidence limits 1.00 to 3.34) and 3.75 (90% confidence limits 1.01 to 9.68), respectively. Confounding with cigarette smoking or alcohol consumption does not explain the findings. Case-control studies gave mixed results, but generally supported the hypothesis. It was concluded that asbestos is a probable cause of laryngeal cancer in view of the reasonable consistency of the studies, the strength of the association in key studies, the evidence for dose-response relationships, and the biological plausibility for asbestos being a cause of laryngeal cancer.
(C)1990 The American College of Occupational and Environmental Medicine
Vita. U.M.I. no. 3006248. Thesis (Ph. D.)--Johns Hopkins University, 2001. Includes bibliographical references (leaves 107-112). Microfilm.
Retrospective review of 160 patients with carcinoma of the supraglottic larynx was accomplished for the period 1964 to 1974. The majority were treated by low dose preoperative radiation and conservation surgery and the rest by preoperative radiation and total laryngectomy or radiation alone. Relapse-free and actuarial 5 year survival for all patients was 71% and 45%, respectively. Of primary and neck failures, 85% occurred within 2 years. Primary, nodal, and distant failures occurred in 11%, 21%, and 14% of all patients, respectively. Of 40 T and/or N failures, 33 (83%) occurred in the neck and three T and six N failures (23%) were surgically salvaged. Voice was preserved in 71% of the patients. Major complications were noted in 16% and minor complications in 26% of surgically managed patients; operative mortality was 4%. The presence of microscopic lymph node metastases best predicted those who would later develop T and/or N failure and distant metastases. Second primary tumors occurred in 26% and the leading cause of death was tumor.
Eighty-one patients with preinvasive carcinoma of the vocal cord, seen over a thirteen year period, were reviewed histologically and analyzed for response to treatment. Sixty-seven cases were clinically T1 and fourteen cases T2 (by virtue of extension of disease beyond the vocal cord). All patients had mobile cords. Histological criteria for in situ carcinoma and the spectrum of microscopic patterns are presented. Sixty-nine patients were treated by external beam radiotherapy--the remainder by a variety of surgical procedures. Five and ten year actuarial, recurrence-free rates 83% and 75%, respectively for the group treated by irradiation. No difference in local control was observed when analyzed for: 1) dose response, 2) initial extent of disease, 3) treatment plan, or 4) histologic diagnosis. Analysis of failures reveals that 15/17 patients with local failure were salvaged, eleven of these patients requiring laryngectomy. Time to appearance of recurrence ranged from seven to one hundred and seven months.
In this report on anterior commissure cancer the following points were considered: to define accurately the boundaries of the subglottis and the anterior commissure and to discuss the related anatomy; to discuss special pathologic features involved in these areas; to discuss the special diagnostic problems related to lesions in these areas, and to review the current methods of therapy for lesions in these areas and to attempt to reach a consensus for each.
In a total of 511 patients with T3,N0-3,M0 laryngeal carcinoma, 24 possible prognostic factors were analyzed retrospectively. The factors were age, sex, mode of treatment, duration of several clinical symptoms, the presence of sore throat, otalgia, dyspnea, and dysphagia, previous tracheotomy, tumor extension, lymph node status (five items), histologic grading, smoking habits, and alcohol intake. For 300 patients in whom surgery was part of the primary treatment, pathologic staging of the primary tumor and of lymph nodes in neck dissection specimens, cartilage invasion, radicality of the operation, differentiation grade, and subglottic extension ware also evaluated. In a univariate analysis for the whole group, tumor extension (limited to the glottic region), lymph node status (clinically palpable lymph nodes, cytologically confirmed positive lymph nodes), level of lymph node metastasis (high and midjugular site), histologic grading (poor differentiation grade), and treatment modality (planned combined therapy) were considered to be prognostic factors of corrected actuarial survival. In the group that underwent surgery, all factors derived from specimens of the larynx and neck dissections had prognostic significance. Multivariate analysis revealed that the glottic site of the tumor, the presence of cyto- and histopathologically proven metastatic lymph nodes, pretreatment tracheotomy, positive resection margins, and planned combined treatment had a significant influence on corrected actuarial survival.
In a retrospective study of 556 patients (505 men, 51 women) with laryngeal cancer the incidence and prognosis of lung malignancies was studied in patients who were examined yearly by chest radiography. In 69 patients (12.4%) a lung malignancy was diagnosed, with 28 having a histologically confirmed second primary malignancy. All of these 69 patients were men. The incidence of radiologically detected lung malignancies, both second primary and metastatic cancer, is higher and more prolonged following supraglottic carcinoma than following glottic carcinoma. In 47 patients (68%) without symptoms, the lung malignancy was detected by routine annual chest radiography. The survival rate in patients with lung cancer detected by the yearly radiography was significantly higher than in patients diagnosed after symptoms (median survival 10 and 4 months, respectively). However, taking into account the lead time between early radiologic diagnosis and the time a tumor would have been diagnosed following symptoms, the observed survival benefit of yearly radiography was much lower, or even nil.
Clinical findings, treatment and results have been recorded prospectively in 661 patients with carcinoma of the head and neck. With an average follow-up of 3 years 7813 follow-up consultations revealed 220 recurrences. The overall "recurrence pick-up rate" and subsequent "cure rate" was 1:36 and 1:113 consultations, respectively. Laryngeal carcinomas treated with radiotherapy and oral carcinomas receiving radiotherapy and limited resections showed recurrence "cure-rates" of 1:89 and 1:110, respectively. For other tumour sites the average "cure-rate" was 1:238. Only 39% of the recurrences were detected through physical examination. Follow-up consultations revealed 9.1% of second primaries. More time should be spent on training patients to recognise symptoms and signs of recurrence. Routine follow-up is rarely indicated beyond the third year after completion of treatment, or in patients for whom we have little to offer in terms of curative treatment.
The Southwest Oncology Group (SWOG) conducted a randomized comparison of cisplatin plus fluorouracil (5-FU) and carboplatin plus 5-FU versus single-agent methotrexate (MTX) in patients with recurrent and metastatic squamous-cell carcinoma (SCC) of the head and neck. The primary objective was to compare separately the response rates of each combination regimen to standard weekly MTX.
Two hundred seventy-seven patients diagnosed with SCC of the head and neck were randomized to one of three treatments: (1) cisplatin 100 mg/m2 intravenously (IV) on day 1 and 5-FU 1,000 mg/m2 per day for a 96-hour continuous infusion repeated every 21 days; (2) carboplatin 300 mg/m2 IV on day 1 and 5-FU 1,000 mg/m2 per day for a 96-hour continuous infusion repeated every 28 days; and (3) MTX 40 mg/m2 IV given weekly.
All three treatment regimens were well tolerated. However, both hematologic and nonhematologic toxicities were significantly greater with cisplatin plus 5-FU compared with MTX (P = .001). Toxicity from carboplatin plus 5-FU was intermediate compared with the other regimens. The complete and partial response rates were 32% for cisplatin plus 5-FU, 21% for carboplatin plus 5-FU, and 10% for MTX. The comparison of cisplatin plus 5-FU to MTX was statistically significant (P less than .001), and the comparison of carboplatin plus 5-FU to MTX was of borderline statistical significance (P = .05). Median response durations and median survival times were similar for all three treatment groups. Logistic regression models showed that only treatment assigned was associated significantly with response (P = .001). Cox proportional hazards models indicated that only performance status was associated significantly with survival (P less than .01).
We conclude that combination chemotherapy resulted in improved response rates but was associated with an increased toxicity and no improvement in overall survival. Therefore, new treatments that may alter the course of disease in recurrent head and neck cancer patients still need to be identified.
To determine whether combination chemotherapy is superior to single agents for recurrent/metastatic head and neck cancer, we compared the efficacy and toxicity of cisplatin (CP) and fluorouracil (5-FU), alone and in combination in a phase III trial.
Two hundred forty-nine patients with recurrent head and neck cancer were randomized to one of three treatments: CP (100 mg/m2) and 5-FU (1 g/m2 x 4), CP, or 5-FU every 3 weeks.
The overall response rate to the combination (32%) was superior to that of CP (17%) or 5-FU (13%) (P = .035). Response was associated with good performance status (PS) but not with primary site, site of recurrence, histology, prior irradiation, or relative dose intensity. Median time to progression was less than 2.5 months, and there was no significant difference in median survival (5.7 months) among the groups. By multivariate analysis, patients with better PS and poorly differentiated tumors had superior survival. Hematologic toxicity and alopecia were worse in the combination arm.
Although the response rate to the combination of CP plus 5-FU was superior to that achieved with single agents, survival did not improve.
We first described subtotal laryngectomy with crico-hyoido-epiglotto-pexy in 1974. This procedure is a modification of Majer's operation and results in the complete resection of the intact thyroid cartilage. The epiglottic petiole, the false cords, the true cords, and one arytenoid are also excised, along with the paraglottic space. The pharynx is closed by suturing the cricoid to the epiglottis and the hyoid bone. The neoglottis is occluded during deglutition by the epiglottis and the base of tongue, which come into contact with the remaining arytenoid. Postoperative hospitalization lasts approximately 3 weeks, and patients have a strong but deep voice. Between 1972 and 1985, we treated 104 patients with stage T2 and T3 lesions of the glottis using this method. A retrospective analysis showed that the overall survival rate of patients was 86% at 3 years and 75% at 5 years. Five patients experienced local recurrence. Seven patients had recurrences in the neck, and eight developed second primaries. Thirteen patients were lost to follow-up or developed intercurrent disease. Patients with T3NO lesions were treated with unilateral prophylactic neck dissection, and positive nodes were found in 23% of cases. We believe that the high proportion of positive nodes justifies routine prophylactic neck dissection in these patients. Because our operation is associated with good local control (5% recurrence rate), we propose that, for the treatment of extended glottic cancers, it replace transcartilaginous procedures that are associated with much higher recurrence rates.
A variety of opinions have been expressed in the literature concerning asbestos and laryngeal cancer. This paper presents an analysis of epidemiological studies based on criteria that prioritized the most heavily exposed cohorts. Emphasis was given to the six cohorts or subcohorts with lung cancer relative risk estimates of 2 or more. The two groups of workers with the highest lung cancer relative risk estimates (4.06 and 3.28) both gave strong support for a causal association of asbestos and laryngeal cancer, with relative risk estimates of 1.91 (90% confidence limits 1.00 to 3.34) and 3.75 (90% confidence limits 1.01 to 9.68), respectively. Confounding with cigarette smoking or alcohol consumption does not explain the findings. Case-control studies gave mixed results, but generally supported the hypothesis. It was concluded that asbestos is a probable cause of laryngeal cancer in view of the reasonable consistency of the studies, the strength of the association in key studies, the evidence for dose-response relationships, and the biological plausibility for asbestos being a cause of laryngeal cancer.
A personal series of 1171 patients with a laryngeal tumour seen in a 27-year period from 1962 to 1988 is reported. Of these patients, 763 were previously untreated and had a histologically proved squamous cell carcinoma. The interaction between the host factors (age, sex and general condition) and other tumour factors, and the effect of the host factors on survival were analysed.
The maximum age incidence was the same in the two sexes but performance status (general condition) declined with increasing age. There was no relation between age and site or histological grade of the tumour. However, the incidence of T3-T4tumours increased up to the seventh decade and then declined again. Age was not a significant predictor of survival when allowance was made for patients who were untreated, or who had died of intercurrent disease or a second primary tumour.
Men were more likely to have a glottic tumour: these tumours presented at an earlier stage and were likely to be well differentiated, mainly because glottic T, carcinoma is almost exclusively a male disease. When individual sites are examined the crude survival for supraglottic tumours in women is better than that in men because of a higher death rate from other diseases and other tumours in men. Sex had no other effect on survival.
Good performance status was associated with lower T-stage but not quite significantly so. It was not associated with any other tumour parameters. Performance status significantly affected survival of treated patients, probably indicating that general condition affects the patient's ability to resist his tumour.
The partial horizontal supracricoid laryngectomy with cricohyoidopexy consists of resection of the whole thyroid cartilage and paraglottic space, as well as the epiglottis and the whole pre-epiglottic space. The cricoid cartilage, the hyoid bone, and at least one arytenoid cartilage are spared. Sixty-eight patients with squamous cell carcinoma of the supraglottis who underwent this procedure during the period from 1974 through 1986 are presented. Conventional horizontal supraglottic laryngectomy was contraindicated in all cases. All but three patients (95.4%) recovered physiologic deglutition, and none required a permanent tracheostomy. The 3-year actuarial survival rate was 71.4%. No local recurrences were encountered. The indications for the procedure are carcinomas of the supraglottis that 1. involve the glottis and anterior commissure, 2. invade the ventricle, 3. present with a marked limitation of true vocal cord mobility (transglottic lesions), and 4. invade the thyroid cartilage. The procedure is presented as a useful alternative to radiation therapy, horizontal supraglottic laryngectomy, and total laryngectomy in select cases of supraglottic carcinoma.
A total number of 564 patients with glottic (427) and supraglottic (137) laryngeal carcinoma was prospectively staged clinicoendoscopically (CS) and radiologically (RS). These patients were treated from 1974 to 1985 with quality-controlled high-dose radiation therapy. The validity of CS versus RS was checked in this study with the parameter of recurrence-free adjusted survival (RFADS) at 3 and at 5 years. It appears that RS is more valid and has therapeutic implications in planning the target volume for irradiation. The CS should be regarded as inadequate for radiotherapeutic considerations. The International Union Against Cancer (UICC) 1987 norms for staging laryngeal carcinoma (clinical, endoscopic, and imaging) should be strictly followed.
A phase III 2x2 factorial trial of cisplatinum and bleomycin in 116 patients with recurrent or advanced squamous cell carcinoma of the head and neck is reported.
Thirty percent of patients proved to be unfit for chemotherapy, and of those treated progression of tumour was the commonest “response”. However, 25% of patients achieved a partial or complete response, with no significant difference in response rates between the treated arms.
The median number of courses received was 1 (range 0–6) and the commonest causes for discontinuation of treatment were renal toxicity and death.
Bleomycin reduced survival, but not significantly so, whereas cisplatinum prolonged median survival significantly by 10 weeks.
Significant predictors of survival, in addition to treatment by cisplatinum, were age, performance status, N status, number of courses and response of the tumor.
In a study of 213 patients with oral cancer, we investigated the incidence and prognosis of lung malignancies in patients offered a yearly chest radiography in the follow-up. Three conclusions can be drawn. (1) Metastatic or primary lung cancer was diagnosed in 22 (10.3%) patients. The 2-year actuarial incidence rate of lung cancer following cancer of the oral cavity is 13%. No new lung cancers were detected after 2 years follow-up. This suggests that after this period, yearly chest radiography may be superfluous for the early detection of lung cancer. (2) The survival rate of patients with a lung malignancy following cancer of the oral cavity is poor (1-year = 25%). The survival rate of patients detected by the yearly chest radiography without symptoms is higher than for patients detected after symptoms (p = 0.006). It is not clear to what extent this different survival rate is biased by lead-time and selection of patients with a favourable prognosis. A randomized study would be required to assess whether patients with oral cancer do benefit from the yearly chest radiography compared with no regular chest radiography. (3) Of 22 patients with lung cancer, 13 (59%) were detected by chest radiography without symptoms. In the first year following oral cancer, 11 patients were diagnosed with lung cancer. Only 4 of these 11 patients (36%) were detected by chest radiography in an asymptomatic stage. The detection of patients with lung cancer in an asymptomatic stage may be increased by more frequent chest radiography examinations in the 1st year following oral cancer.
The purpose of this study was to determine the survival results and identify favorable selection factors for a group of patients who were found to have metastatic disease from the upper aerodigestive tract to the lung and subsequently underwent pulmonary resection. The medical records of 44 patients treated at our institution were reviewed. The cumulative 5-year survival rate after pulmonary resection was 43 percent. The optimal interval between diagnosis of the primary tumor and the development of pulmonary metastases was 13 to 24 months (p less than 0.005). The most favorable primary site was the larynx. No significant prognostic effect was noted for single versus multiple metastases or T-stage of the primary tumor. The presence of intervening locoregional recurrence prior to pulmonary diagnosis likewise had no significant effect on the survival rate. The initial presence of nodal metastases and primary tumor in the oral cavity had a poor outcome. The worst prognostic indicator was the presence of mediastinal disease (p less than 0.001). We have concluded that aggressive surgical treatment for isolated pulmonary metastases from the upper aerodigestive tract in the absence of mediastinal involvement is therapeutically beneficial. Selection criteria for resection should include site and stage of primary disease, locoregional control, interval from primary to pulmonary diagnosis, extent of pulmonary disease and mediastinal involvement, and the general medical condition of the patient.
Thirty-three patients with newly diagnosed laryngeal carcinoma underwent endoscopic treatment with the carbon dioxide laser under microscopic control and venturi jet ventilation. Ten of these patients underwent emergency tumor debulking to relieve airway obstruction and to avoid emergency tracheotomy for airway control, and 23 had definitive treatment of superficial or frankly invasive carcinoma. Among the first group, all had an adequate airway after tumor debulking and could be treated with elective laryngectomy with or without radical neck dissection once their metabolic conditions had improved and they had been appropriately evaluated. Among the second group, two died of lung carcinoma but were free of laryngeal disease and two were lost to follow-up at one year. With a minimal three-year follow-up, six of the remaining 19 patients underwent additional laser procedures. None have required external laryngeal surgery or radiation therapy. Endoscopic laser therapy appears preferable to a more radical approach for carcinoma in situ, microinvasive carcinoma, or superficially invasive carcinoma of the larynx.
A case-control study on larynx and hypopharynx cancer was carried out in 6 populations including the city of Turin and the province of Varese (Italy), the provinces of Navarra and Zaragoza (Spain), the canton of Geneva (Switzerland), and the département of Calvados (France). This report presents an analysis of the risk associated with alcohol and tobacco consumption based on 1,147 male cases and 3,057 male population controls. Special attention was given to the study of the risk at various sites of larynx and hypopharynx. The effect of tobacco is similar for all sites and the risk associated with ever smoking is on the order of 10. The risks from alcohol drinking depend on site. They are similar for epilarynx and hypopharynx (RR = 4.3, for more than 80 g/day) and lower for endolarynx (RR = 2.1, for more than 80 g/day). For all sites the risk decreases after quitting (RR = 0.3 after 10 years); exclusive use of filter cigarettes is protective (RR = 0.5 relative to smokers of plain cigarettes only) as is exclusive use of blond tobacco (RR = 0.5 relative to smokers of black tobacco only). Inhalation increases the risk of endolaryngeal cancer but not that of hypopharynx or epilarynx. The relative risks for joint exposure to alcohol and tobacco are consistent with a multiplicative model.
The prognostic significance of 20 clinical and histologic parameters was evaluated in a series of 416 laryngeal carcinomas treated between 1969 and 1981 at the Hospital de Santa Cruz y San Pablo, Barcelona, Spain. Clinical follow-up ranged from 2 to 13 years. The variables considered were: age, smoking habits, previous laryngeal disease, duration of clinical symptoms, motility of vocal cords, interval between diagnosis and treatment, postoperative infection, topographic location of the tumor, previous tracheostomy, ulceration, tumor size, resection margins, histologic grading, patterns of growth, types of invasion, mitotic index, depth of invasion, positive lymph nodes, T categories and N categories. Fourteen parameters were found to be significantly related to survival. After a multifactorial study using Cox's life table regression model, 5 of those 14 parameters were found to influence survival independently. The five variables ordered according to prognostic significance were: (1) positive lymph nodes, (2) T categories, (3) histologic grading, (4) ulceration, and (5) location.
Multiple primary malignancies were found in 32 of 295 consecutive patients (10.8%) treated for carcinoma of the larynx. Synchronously developing second primary lesions were found in four patients while metachronously presenting lesions were diagnosed in 28. Second and third primary tumors were most commonly found in the larynx (11 patients, all with extralaryngeal index lesions) and lung (11 patients). The results of this retrospective study confirm the high incidence of multicentric neoplasia in the upper aero-digestive tract, lungs and esophagus. The rationale for including broncho-esophagoscopy in the evaluation of patients with laryngeal index tumors is discussed.
Seven of 16 patients with secondary lymphoma of Waldeyer's ring (15 with non-Hodgkin's lymphoma and one with Hodgkin's disease) had their primary diagnoses made at another extranodal site, usually the gastrointestinal tract. The median interval until development of Waldeyer's ring disease was 37 months. Presenting features were similar to those in previous reports of primary lymphoma of Waldeyer's ring except for the striking degree of cranial nerve dysfunction (83 per cent) in patients with secondary nasopharyngeal disease. Non-Hodgkin's lymphomas were predominantly diffuse (80 per cent) with large cell morphology (53 per cent). Of nine patients who obtained complete remission after Waldeyer's ring involvement, six relapsed (median, 15 months), whereas three remain in complete remission at eight, 32, and 288 months. Twelve patients died (median length of survival, 20 months), eight of whom had disseminated disease, including one patient who also developed massive thyroid lymphoma. Three patients survived at least six years after involvement of Waldeyer's ring. This study confirms the frequent association of secondary lymphoma of Waldeyer's ring with prior extranodal disease, particularly of the gastrointestinal tract. The long latent period and the prolonged survival seen in several patients suggest that occasionally secondary lymphomas of Waldeyer's ring may represent metachronous primary tumors.
Out of a series of 2040 patients referred to the Institut Curie with squamous cell carcinoma of oropharynx and pharyngolarynx, 1666 cases were evaluated on admission regarding the characteristic metastases patterns to their cervical lymph nodes. Incidence and topographic distribution of lymph nodes are correlated with the anatomic sites of primary lesions. Biological virulence of these tumors is emphasized since the overall incidence of positive neck nodes attains 63% (1048/1666) and advanced disease, stage IV in the UICC classification, 61%. Cervical status is also related to several characteristics of the primary: clinical staging and variety, and histopathological differentiation. Ipsilateral cervical involvement is characterized by the high incidence of metastases in the jugular chain for the whole series, in the submaxillary group for oropharyngeal carcinomas and in the spinal accessory chain for cancer of the pharyngolarynx (pyriform sinus and lateral epilarynx). Preliminary therapeutic implications are derived from this nodal distribution. Comparisons are established between the 1978 UICC and 1976 AJC classifications, showing a good correlation despite multiple differences in staging criteria. It is shown that assessment combining both the multiplicity and the volume of cervical metastases allows to evaluate more accurately the aggressiveness of the primary.
The records of 214 consecutively registered, previously untreated patients with squamous cell carcinoma of the head and neck region were reviewed. Among the 157 patients considered "free of disease" following the primary treatment 54 developed recurrences - all but three within three years. Only in patients with carcinoma of the larynx treated with radiation alone did follow-up disclose recurrences for which further treatment resulted in a significant number of cures. For these patients the cure rate was one in 79 routine appointments compared to only one cure in 325 appointments for patients with carcinoma in other localizations. It seems that our routine follow-up procedure for most types of carcinoma is too extensive and that follow-up beyond three years mainly will be of value for the possible detection of second primary malignancies.
Irradiation is a good primary treatment for glottic carcinomas involving and crossing the anterior commissure. Fifty-seven patients were studied and the five-year crude survival rate was 80%. Our results are certainly better than those achieved by older surgical techniques and are comparable with modern conservation surgery.
Immunoperoxidase techniques, applied to fixed paraffin sections, provide a wide range of highly specific special stains of value to the surgical pathologist in diagnostic practice and in investigative studies. The application of "immunostains" provides an independent method of cell identification against which traditional subjective morphologic criteria may be compared: histopathology may thereby be transformed from something of an art to more of a science.
Epidemiological observations indicate that cancers affecting different organs and systems in humans have different causes. At the descriptive level, cancer incidence and mortality rates exhibit patterns of geographic and temporal variation which are distinct and separate for each cancer site and even, at a given site, for different histological types (for instance, increasing squamous cell carcinoma of the lung and decreasing stomach cancer in most developed countries in recent decades). The existence of these distinct patterns in itself indicates that different causes are at the origin of cancers at different sites. Hence, it is of scientific and practical importance not only to identify agents that are carcinogenic to humans but also to specify as definitely as possible the target organ(s) of their action. This is done in the present review of results in the International Agency for Research on Cancer Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans.
Comparison of reported series of laryngeal lesions is complicated by the inconsistency in the terminology. The classification of these lesions should logically be based on the degrees of dysplasia, as this has a bearing on the prognosis. The material for this study consisted of 193 patients with hyperplasia and/or keratosis, with or without mild dysplasia (Group I), moderate dysplasia (Group II), and severe dysplasia and carcinoma in situ (Group III). They were treated over a 14-year period (1966-1979) at Linköping University Hospital. Of the 98 patients in Group I available for follow-up, 23 had repeat excisions. Moderate dysplasia developed in 3 patients, severe dysplasia in 2, and invasive carcinoma in another 2 within 3 and 3.5 years; they both underwent laryngectomy. Among the 24 patients in Group II available for follow-up, severe dysplasia developed in 3 and invasive carcinoma in 3 up to 13 years after the initial diagnosis, all but one (with severe dysplasia) received a full course of radiotherapy, on one case total laryngectomy was subsequently performed for recurrent carcinoma. Of the 39 patients with severe dysplasia and carcinoma in situ 16 were given primary radiotherapy; 4 of these developed invasive carcinoma; 3 of them underwent total laryngectomy and one partial laryngectomy. Excision or stripping of the vocal cords was the primary treatment in 23 cases; 5 of these developed invasive carcinoma; 2 of them underwent total laryngectomy. Diffuse lesions and well differentiated forms of severe dysplasia caused most problems and had the highest incidence of invasive carcinoma irrespective of the form of treatment. Patients with hyperplasia, keratosis, dysplasia and carcinoma in situ should be carefully followed up, as invasive carcinoma may develop many years after the initial diagnosis.
The natural history of squamous cell head and neck cancer is well understood. Locoregional approaches to salvage therapy for this disease have curative potential, primarily because distant metastases are uncommon. Before proceeding with salvage treatment, however, clinicians should identify the extent of disease and determine whether the treatment intent is curative or palliative. Because of the associated morbidity, surgery should be considered only in patients for whom cure of recurrent disease is feasible. Radiation therapy may be indicated in patients whose disease recurs after surgery and in selected patients in whom initial radiation has failed. Single-agent and combination chemotherapy, in particular the combination of cisplatin and 5-fluorouracil, has achieved overall response rates of 30% to 40% in patients with recurrent disease. However, cure after salvage chemotherapy has not been achieved. Until salvage treatment regimens capable of achieving significant long-term survival are identified, symptomatic palliation will remain the main treatment goal in this patient population.