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PubMed1975

Reasons for irradiation failure in squamous cell carcinoma of the larynx.

The reasons for irradiation failure in squamous cell carcinoma of the larynx can be: 1. Geographical miss because of undiagnosed extensions is the exception. Almost all of the recurrences were well within the treatment portals. 2. Specific extensions with an unfavorable tumor bed. Extension of disease into poorly vascularized structures and/or deep infiltration with fixation are causes of failure. 3. Low dose for the volume cancer. Higher doses delivered in longer treatment time are necessary for 90 percent control of bulky exophytic supraglottic lesions. 4. Techniques which do not assure daily coverage of the tumor. With carefully drawn and checked anatomical portals, geographical misses should be nonexistent. 5. Sigmoid response curve. There is an 85 percent control of the T1 glottic tumors. The control rate is 90 percent of the T1 and T2 supraglottic tumors, and the 10 percent failures have no obvious explanation except that the plateau of the sigmoid response curve has been reached. A negligible yield would be obtained by increasing doses which would not be justified because of concomitant increase in frequency and severity of complications and lessening of the quality of voice. 6. New cancer. Probably 25 percent of the so-called recurrences on the vocal cords are actually new primary lesions. The ultimate failure rates respectively are 2 percent for T1 lesions and 10 percent for T2 lesions after a rescue surgical procedure. All patients with T1 vocal cord lesions who did not experience a failure or a complication, have a normal voice. In the patients with T2 lesions in whom the cancer had completely replaced the cord(s), some hoarseness is present; but most of these lesions would have been suitable only for a total laryngectomy. In the 15 failures in T1 and T2 supraglottic lesions, surgery was not attempted in only three patients, one of whom was salvaged by re-irradiation. Following 12 laryngectomies there is only one definite failure and two patients died within two years NED locally. Except in the patients who had severe edema and/or necrosis, the voice has been normal or near normal. In patients with lesions of the suprahyoid epiglottis which had amputated the suprahyoid epiglottis swallowing difficulty has not developed.

Carcinoma, Squamous Cell↗

PubMed1997

Can radiologists accurately predict preepiglottic space invasion with MR imaging?

OBJECTIVE: The purpose of this study was to evaluate whether observers of MR imaging can accurately predict invasion of the preepiglottic fat (PEF) in patients with oropharyngeal and supraglottic laryngeal squamous cell carcinoma. MATERIALS AND METHODS: For 41 patients with pathologically proven squamous cell carcinoma of the oropharynx and supraglottic larynx, we retrospectively analyzed their MR images for the presence or absence of PEF neoplastic invasion. Unenhanced T1-weighted, fat-suppressed T2-weighted, and contrast-enhanced fat-suppressed T1-weighted scans were analyzed independently by two neuroradiologists who were unaware of the surgical findings. Proof of diagnosis was determined by pathologic analysis, intraoperative assessment, or both. RESULTS: Sixteen patients had neoplastic infiltration of the PEF. All infiltration was correctly predicted by the two observers of MR imaging, resulting in a sensitivity of 100%. Twenty-five patients had no invasion of the PEF by pathologic or surgical evaluation or both. Of these patients, negative findings were correctly predicted on MR imaging in 21 patients, whereas positive findings were incorrectly predicted on MR imaging in the remaining four patients, resulting in a specificity of 84% and an accuracy of 90%. In two of the four false-positive cases, effacement of the fat in the preepiglottic space by large tumors was mistaken for invasion. In a third patient, spread to the paraglottic space was mistaken for PEF extension. In the fourth false-positive case, glandular tissue along the ventral epiglottis may have been mistaken for tumor. The observers believed that unenhanced sagittal and axial T1-weighted scans were particularly useful because fat saturation artifacts may degrade T2-weighted and contrast-enhanced T1-weighted scans. CONCLUSION: Unenhanced T1-weighted MR images are highly sensitive for neoplastic infiltration of the preepiglottic space in patients with oropharyngeal and supraglottic laryngeal carcinoma who are at risk for such spread. Identification of PEF invasion is important because it affects prognosis and may affect surgical management.

Adipose Tissue↗

PubMedDate not supplied

Closure of the laryngeal vestibule during deglutition.

With the aid of high-speed cineradiography (up to 100 frames per second) the closure of the laryngeal vestibule during deglutition was studied in 150 volunteers free from swallowing complaints. The closure was observed to be effected by a peristaltic-like wave from below. This was accomplished in two steps. First the caudal segment of the vestibule, the supraglottic space, was closed by an apposition of the side walls. Then the cranial segment of the vestibule, the supraglottic space, was closed by an apposition of the fixed part of the epiglottis to the arytenoid region. The subdivision of the vestibule was made by an imaginary plane between the interarytenoid incisure and incisure of the thyroid cartilage. This subdivision corresponds to the location of the thyroarytenoid muscles lateral to the supraglottic space and the thyroepiglottic muscles lateral to the subepiglottic space. In this way the two muscle pairs contribute indifferent and distinct ways to the closure of the vestibule during deglutition.

Adult↗

PubMed2002

[A clinical study of 213 patients with laryngeal cancer].

We retrospectively analyzed 213 patients--197 men and 14 women aged 40 to 87 years--with laryngeal cancer treated at our department from September 1986 to December 1997. The male to female ratio was about 12:1. Cases included 120 glottic (56.3%), 90 supraglottic (42.3%), and 3 subglottic (1.4%). Radiotherapy for early cases and surgery, mainly total laryngectomy for T3 and T4 were conducted first. The 5-year cause-specific survival by site was 97.6% glottic and 77.5% supraglottic. The five-year survival was 88.6% overall. Local control was 83.8% in glottic T1a and 84.6% in glottic T1b. The 3-year preservation of the larynx was 89.1% in glottic T1a and 92.3% in glottic T1b. Distant metastases were observed in 14 cases, mostly to the lung, bones, and liver. At high risk for distant metastasis were those with supraglottic T3-T4, N1, N2b, or pN2c.

Adult↗

PubMed1999

Conservation surgery for laryngeal and hypopharyngeal cancer.

The charts of 173 patients treated by conservation laryngectomy and pharyngolaryngectomy were retrospectively reviewed. The patients treated by endoscopic laser resection were excluded of this study. Glottic carcinoma was diagnosed in 101 patients, supraglottic carcinoma in 44 patients, hypopharyngeal carcinoma in 24 patients and oropharyngeal carcinoma in 4 patients. The median follow-up period was 44 months, 84/101 glottic cancer, 34/44 supraglottic cancer, 23/24 hypopharyngeal cancer and 2/4 oropharyngeal cancer were staged as T1 and T2. A voice-sparing external approach was carried on in 20 patients with locally advanced tumor (T3-T4). At time of the last follow-up, 132 patients (77%) were alive when 41 patients (23%) died. Overall survival rates for patients treated for T1-T2 glottic cancer at 3, 5 and 10 years were 90, 90 and 78% respectively. Overall survival rates for patients treated for T1-T2 supralottic cancer at 3, 5 and 10 years were 73, 68 and 48% respectively. Overall survival rates for patients treated for T1-T2 hypopharyngeal cancer at 3 and 5 years were 74 and 37% respectively. The site of the primary tumor (glottic versus supraglottic or hypopharynx) showed significant impact on survival (P = 0.0025)). Regarding survival, T stage and N stage were not found statistically significant.

Carcinoma, Squamous Cell↗

PubMed1975

Limitations of horizontal partial laryngectomy.

The author considers successively: 1--The theoretical justifications for horizontal partial laryngectomy (anatomical considerations, indications as to the modalities of extension of supraglottic tumors, results concerning the cancer itself, functional results). 2--The indications of and contraindications for this type of surgery, with special reference to two types of cancers: median supraglottic carcinomas and antero-lateral epilarynx carcinomas. 3--Some specific problems, namely that of large supraglottic laryngectomy, of combined nodal surgery, and of preoperative radiotherapy. The limits of horizontal partial laryngectomy are specified on the basis of two criteria: its value as far as cancer is concerned (five-year survival rate), the quality of functional results.

Glottis↗

PubMed1998

[Preoperative radiation plus surgery vs. operation alone for laryngeal carcinoma].

OBJECTIVE: To study the validity of preoperative radiation in improving the survival rate of laryngocarcinoma. METHODS: A prospective randomized clinical trial was conducted with preoperative radiation plus surgery (RS) as one group and surgery alone (SA) as the other group. The ages of the patients were less than 75 years, and the operative types were decided after clinical examination. The patients were divided into SA or RS group by random. Doses of preoperative irradiation was 40 Gy. Three hundred and seventy patients with laryngocarcinoma were treated, 215 in the SA group; 155 in the RS group. All patients were followed up over three years. RESULTS: In SA group, 3 years survival rate was 83.3%, 5-year survival rate 82.6%, 10-year survival rate 80.3%. In RS group, 3-year survival rate was 78.9%, 5-year survival rate 76.4%, 10-year survival rate 68.6%. There is no statistically significant difference in survival rates between the groups (P = 0.1); but, the 10-year survival rate in SA group was better than that in RS group for the stage III and IV supraglottic carcinomas, the former was 73.6% and the latter 63.5% (P = 0.003). The 10-year survival rate for the patients with T3 and T4 supraglottic carcinomas who underwent total laryngectomy in SA group was better than that in RS group. The former was 68% and the latter 50% (P = 0.0001). CONCLUSION: Preoperative radiotherapy with 40 Gy didn't increase the survival rate of laryngeal carcinoma. The 10-year survival of stages III and IV supraglottic carcinoma in combined treatment group was lower than that in the surgery alone group.

Adult↗

PubMed2002

Carcinoma larynx--topographical distribution.

One hundred and sixty subjects were included in our study, collected from four hospitals in Dhaka City. The mean age (+/- SD) of study subjects were 54.67 +/- 11.27 years. Out of 160 subjects 155 was males and 5 were females, and male to female ratio was 31:1. The highest number of study subjects was related to cultivation (40.62%). The majority of study subjects were from the low socio-economic status (68.72%). Carcinoma larynx is a multifactorial disease. Smoking and chewing habit are the most important factors associated with carcinoma larynx. Most of the male (93.12%) subjects were smoker. One hundred and fifteen (71.87%) subjects were found chewing habit of betel leaves with other ingredients. Hoarseness of voice was the commonest symptom 65.62%. Regional distribution of tumour showed supraglottic carcinoma topping the list (69.38%) followed by glottic carcinoma (30.62%) and there was no subglottic carcinoma. Site involvement in supraglottic carcinoma was found in combined location topping the list (89.20%). In glottic carcinoma majority was found glottic with supraglottic extension (65.31%). In majority cases growth were exophytic 52.50%. Palpable lymph mode was found in 48.75% of cases. All the carcinoma of larynx was found histologically of squamous cell type.

Adult↗

PubMed2002

[Study on voice quality after different layers injured in vocal fold with CO2 laser microsurgery].

OBJECTIVE: To investigate the nature of pathological voice after injured in different layers of vocal fold with CO2 laser microsurgery. METHOD: 50 cases of precancerous lesion (keratosis and leukoplakia) were treated with laser mucosa ablation. Glottal carcinoma (Tis-T2) were treated with laser microsurgery in mucosal stripping(30 cases) or with laser cordectomy(60 cases). Vocal function was examined by acoustic analysis (F0, Jitter, Shimmer, NNE, HNR), aerodynamic analysis (MPT, S/Z) and videostroboscopic examination. RESULT: For lesion mucosa ablation, hoarseness improved quickly after operation and acoustic analysis became normal. There were 18.2% decreased mucosa wave, 16.7% mild-moderate supraglottal hyperfunction. For mucosa stripping (cover layers excised), 63.3% decreased and 10.0% absented with mucosa wave, 46.7% mild-moderate supraglottal hyperfunction, glottal closure was incomplete. Acoustic analysis showed that Jitter, Shimmer, F0 different from normal(P < 0.05), HNR significantly different from normal(P < 0.01). For cordectomy: Acoustic analysis showed significantly worse than normal(P < 0.01), 61.7% mild-moderate supraglottal hyperfunction. The ipsilateral mucosa wave was absent, but 30.0% showed mucosa wave of vocal process and 13.3% with ventricular fold wave. There was little difference with or without vocalis muscle excision in acoustic analysis. To compared with mucosa stripping, the NNE, HNR, Jitter, Shimmer of cordectomy group was worse and amplitude was higher in cordectomy(P < 0.01). CONCLUSION: Although the acoustic characteristic and vibration mode of mucosa ablation and mucosa stripping was distinct to each other, within the cover layer injured, vocal function will be good. Once the body layer is injured, vocal quality will decrease significantly.

Adult↗

PubMed2003

[Study on post-laryngectomy partial laryngeal defect repaired with omohyoid myofascial flap].

OBJECTIVE: To explore the clinical effect on defect of post-laryngectomy partial laryngeal repaired with omohyoid myofascial flap. METHOD: Twenty-four cases of supraglottic and glottic cancer were treated surgically. The tumors and involved cartilages were removed entirely. The omohyoid myofascial flap was utilized to repair the defects of larynx and reconstruct the glottis. For the cases of unilateral fixation of arytenoid, the arytenoids were removed and replaced by a piece of omohyoideus linked to hyoid bone, then were covered with mucous. The cases above T2 supraglottic and T3 glottic received radiotherapy. RESULT: The following-up time is 1-5 years. One case of supraglottic cancer(T3) dies from local recurrence after operation for 2 years and 9 months. One case of glottic cancer(T3) dies from neck and bone metastasis after operation for 4 years and 3 months. Swallow function was preserved in all cases. The rate of deconnalation was 95.8%. 91.7% patients had laryngeal functions restored. CONCLUSION: For selected cases, using omohyoid myofascial flap to repair the partial laryngeal defect and reconstruct glottis is available and practicable.

Aged↗

PubMed2003

[The clinical analysis of cervical lymph node metastases from squamous cell carcinoma of the larynx and hypopharynx treated with total laryngectomy].

OBJECTIVE: To detect the distribution and characteristics of lymph nodes metastasis in patients of laryngeal and hypopharyngeal cancer. METHOD: A retrospective review of 129 patients who had radical neck dissection, including first recurrence in cervical lymph nodes after laryngectomy, was performed to analyze the cervical lymph node metastases of different types of laryngeal and hypopharyngeal cancer treated by total laryngectomy. RESULT: The patients of the hypopharyngeal and supraglottic cancer had a tendency of cervical lymph nodes metastasis in their early stage. The rate of the fusional lymph nodes was high in hypopharyngeal cancer, and so as to the rate of the positive lymph nodes in their level IV. In our study the percentage of the poor-differentiated squamous cell carcinoma was relatively high in hypopharyngeal and supraglottic cancer than in glottic cancer. And there was no statistical difference in stages of the primary tumour between groups of neck dissection with laryngectomy simultaneously and of first recurrence in lymph nodes after laryngectomy. CONCLUSION: The latent lymph nodes metastasis and preventive neck dissection should be considered in patients of hypopharyngeal and supraglottic cancer in or above stages of T2, especially in patients with poor-differentiated squamous cell carcinoma, though the sign of positive lymph nodes was not evident.

Adult↗

PubMed2004

Videofluorographic observations on swallowing in patients with dysphagia due to neurodegenerative diseases.

We examined three intervention methods for their efficacy in preventing aspiration in 25 patients with Parkinson's disease (PD) and 23 patients with degenerative cerebellar ataxia (CA). On videofluoroscopic examination. 13 patients with PD (52%) and 7 patients with CA (30.4%) showed aspiration. In all PD patients and 5 patients with CA, no aspiration was observed after changing the food form. With the chin down posture and supraglottic swallow techniques, no aspiration was observed in only 1 PD patient. Among 7 patients with CA, the chin down posture and supraglottic swallow techniques resulted in the disappearance of aspiration in 4 patients. This indicates that changing the food form (ex. jelly) was effective in preventing aspiration in both PD and CA patients with a history of aspiration. In addition, the chin down posture and supraglottic swallow techniques were effective in preventing aspiration in CA patients with good sitting-position balance and cervical control.

Aged↗

PubMed1992

Carcinoma of the larynx. Surgery: general aspects.

A necessary and adequate selection of operations capable of meeting all the indications involved by partial surgery, is required. We suggest such a selection inspired on that of 1983. Partial laryngectomies for glottic carcinoma: CO2-laser endoscopic cordectomy, fronto-lateral partial laryngectomy (LEROUX-ROBERT), hemiglottectomy (GUERRIER), anterior partial laryngectomy with epiglottoplasty (TUCKER), subtotal laryngectomy with cricohyoidoepiglottopexy (MAJER-PIQUET). Partial laryngectomies for supraglottic carcinoma: horizontal supraglottic laryngectomy (anterior approach), CO2-laser endoscopic epiglottectomy, lateral supraglottic pharyngo-laryngectomy (ALONSO), subtotal laryngectomy with cricohyoidopexy (LABAYLE). Total laryngectomy As from the early eighties onwards, the great progress in vocal rehabilitation following laryngectomy has certainly been the development of phonatory prosthesis.

Humans↗

PubMed1992

[The potentials and limits of the radiotherapy of laryngeal carcinoma].

Early stage glottic carcinoma can be treated with primary radiotherapy reaching equally good results compared to primary surgery; for supraglottic carcinoma surgery offers only slight advantages over primary radiotherapy. Tumor control for recurrences is considerably improved by salvage surgery. The use of primary radiotherapy allows improved or at least preserved voice and reduced rates of acute complications and late treatment sequelae. However, treatment duration is longer and probably more expensive compared to function preservation microlaryngoscopic surgery. Which treatment approach is chosen, depends on individual patient factors and specific conditions in the clinical setting. In any case, primary radiotherapy deserves a stronger say in the early stage tumor situation. In our institution early stage supraglottic carcinomas undergo primary surgery. Advanced carcinomas (T2b and more) are rarely suited for primary radiotherapy with the exception of some very confined T3 tumors. Surgical approaches should be favoured, since they provide a detailed pathohistological tumor staging including R-classification, which would be lacking using primary radiotherapy. There are clear reasons to treat the lymph nodes for glottic carcinomas stage T2b and more and for all supraglottic carcinomas with radiotherapy. Specific risk factors are: tumor at the margins of the incision (R1), infiltration of the cartilage and pre-epiglottic space, paratracheal and subglottic extension of more than 1 cm, perineural invasion, grade III and IV as well as emergency tracheostomy. Postoperative radiotherapy should be given to the lymph nodes for all positive neck-dissections. New therapeutic approaches are on the horizon, which may improve the results of radiotherapy even for advanced larynx carcinomas, like hyperfractionation radiotherapy and simultaneous radio-chemotherapy combined enoral resection and postoperative radiotherapy may yield larynx preservation even for advanced stages. New imaging techniques allow an improved staging and predictive radiobiological assays may play a major role in tumor prognosis.

Carcinoma↗

PubMed1991

[Invasion of the thyro-hyoid-epiglottic space by carcinoma of the vestibulum laryngis: prognostic and therapeutic implications].

Invasion of the thyro-hyoid-epiglottic (TIE) space in supraglottic carcinoma is a frequent occurrence which, in most cases, only reveals itself upon post-surgical histology. In order to verify the current feeling that subclinical invasion does not in any way worsen prognosis the authors performed a retrospective study on the oncological results of 98 patients with T1-T2 supraglottic carcinoma. Of these 67 were treated by supraglottic laryngectomy while 31, taken as controls, had undergone total laryngectomy because of contraindications of a general nature. Histological examination of the surgical samples showed signs of space invasion in 60% of the cases. In these cases, there was a higher percentage of poor results (greater than 20%; mainly T recurrence) no matter what type of surgery had been performed. Therefore, subclinical invasion of the space must be considered as having an effect on prognosis and the authors feel that, whenever the pre-operative semiological criteria are insufficient to optimize surgical results, the patients presenting subclinical invasion of the space should be subjected to complementary radiotherapy.

Adult↗

PubMed1987

Alterations in nasal physiology after laryngectomy: the nasal cycle.

Several changes in nasal physiology have been reported following laryngectomy. This paper reviews these changes and investigates the cycle of alternating distribution of nasal airflow in 20 adults. Information about the cyclic activity was obtained from the areas of condensation formed by nasal expiration on the surface of a Gertner-Podoshin plate. Consecutive measurements of these areas were made at 15-minute intervals during a 6-8 hour period. Five control subjects demonstrated a nasal cyclic activity which was absent in five patients 1-3 years post-laryngectomy. Two patients with preoperative cycles showed none three weeks after laryngectomy. Three patients with a temporary surgical diversion of supraglottic airflow showed cessation of the cycle, which resumed after restoration of the natural airway; one of these patients had undergone hemilaryngectomy with section of both superior laryngeal nerves. Five patients showed no alteration after operation involving no diversion of supraglottic airflow (tonsillectomy). These results demonstrate cessation of the cycle following chronic absence of supraglottic airflow, temporary, cessation during acute absence, and independence of the cycle from superior laryngeal innervation.

Adolescent↗

PubMed1979

The management of laryngeal cancer.

Carcinoma of the larynx is best managed in an interdisciplinary centre with wide therapeutic and rehabilitative services. Current management is confused, but may be simplified by consideration of three groups: 1) no fixation of laryngeal structures, 2) fixation of laryngeal structures and extension beyond the larynx, 3) all others including carcinoma in situ, verrucous carcinoma, transglottic tumor, and squamous carcinoma with marked airway obstruction. The rational treatment of Group 1 glottic tumors is primary radiation, which produces 75% crude and 92% corrected five year tumor free survival. If surgery is undertaken as primary treatment or for salvage, a vertical hemilaryngectomy may preserve the voice. Group 1 supraglottic carcinomas may be divided into supraglottic and marginal. Thirty per cent have palpable nodes at diagnosis and a further 20% occult disease in the cervical chain. Irradiation of neck nodes or block dissection is an integral part of treatment. The indications for a supraglottic horizontal partial laryngectomy are outlined. Where indicated this has five year survival figures of 70%. Recurrence is usually in the neck. Marginal tumors have a 50% five year survival rate when treated by conservation surgery combined with pre-operative radiation. Recent radiotherapeutic advances have improved treatment of these lesions. Thirty to 40% of patients with Group 2 tumors have regional metastases at presentation. There are no fixed protocols for treatment of these patients, less than 50% of whom will survive five years tumor free. The difficulty in carrying out a protocol based on pre-operative radiation with planned surgery is outlined. Under optimum conditions treatment should be primary radiation with salvage surgery for failures or recurrence, for the results are almost as good as primary surgery but 30% of larynges are saved. The difficulties of diagnosing recurrent tumor in irradiated tissue are discussed. Care must be taken to recognize that group of patients in whom tissue edema is the result of perichondritis rather than tumor recurrence, because in these patients surgery is extremely hazardous. Problems of diagnosis and methods of treatment of carcinoma in situ, and verrucous carcinoma are described. Transglottic carcinomas are defined and treatment is primary total laryngectomy with appropriate neck dissection. Similarly if tumors are causing major airway obstruction, treatment is by primary laryngectomy.

Airway Obstruction↗

PubMed1981

[Squamous cell carcinoma of the anterior commissure and penetration of the laryngeal framework].

61 glottic and 57 supraglottic advanced carcinomas of the larynx were investigated histologically by serial coronal sections. 29 glottic cancers spreading out more horizontally also rose from the anterior commissure. 7 supraglottic and 24 glottic carcinomas with a vertical extension to the sub- or supraglottic space involved the anterior commissure or the anterior subglottic wall secondarily. After a short introduction in the actually known principles of the anatomy of laryngeal cancer the behaviour of squamous cell carcinomas at the anterior commissure is reported. Carcinomas of the anterior commissure have a high tendency to involve the anterior subglottic wall. Tumour growth in this area is the most important condition for penetration of the laryngeal framework. Nearly all these cancers broke through the lower frontal ossified part of the thyroid cartilage without or including the cricothyroid membrane. Therefore glottic cancers with subglottic spread also preferred this direction to the prelaryngeal space. The importance of further histological findings for the technique of partial laryngectomy is discussed. More than half of the investigated carcinomas were treated by a planned preoperative irradiation of 3000 rad. By comparison with the posterior regions the frontal areas of these tumours showed microscopically a lower visible response to the radiotherapy. In our opinion this indicates that radiation failure in carcinomas of the anterior commissure is caused by the usually applied cross field radiation technique.

Carcinoma, Squamous Cell↗