National Cancer Institute®
Last Modified: November 21, 2001
UI - 21202880
AU - Stoeckli SJ; Guidicelli M; Schneider A; Huber A; Schmid S
TI - Quality of life after treatment for early laryngeal carcinoma.
SO - Eur Arch Otorhinolaryngol 2001 Feb;258(2):96-9
AD - Clinic of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland. firstname.lastname@example.org
Radiotherapy and surgery for early laryngeal cancer achieve comparably good results in patient survival, and the choice of treatment between them is being influenced increasingly by the expected voice quality and quality of life (QoL). The superiority of vocal function after radiotherapy has been shown in previous objective voice assessment studies. This study compared the QoL of long-term survivors after endoscopic laser surgery or radiotherapy for early laryngeal carcinoma. QoL was evaluated with two validated questionnaires: the global EORTC QLQ-C30 and the head- and neck-specific EORTC QLQ-H&N35. A total of 62 patients were included. Among 56 patients completing the questionnaires (90% completion rate) 40 were treated by endoscopic CO2 laser surgery and 16 with radiation therapy. All 56 patients showed a good global QoL with no significant difference between the two treatment modalities. The head- and neck-specific evaluation revealed significantly better scores for surgically treated patients in questions about swallowing of solid food, xerostomia, and tooth problems, but no difference in questions about voice quality. Both treatment modalities achieve good QoL after treatment of early laryngeal tumors. Irradiated patients mainly complain about xerostomia related problems. In contrast to objective measurements long-term survivors after surgery do not rate their voice poorer than irradiated patients. The EORTC questionnaires are validated and useful tools in assessing QoL and should further be used in prospective trials.
UI - 21328264
AU - Motta G; Esposito E; Motta S; Testa D
TI - [Microlaryngoscopy treatment of laryngeal dysplasia with CO2 laser]
SO - Acta Otorhinolaryngol Ital 2001 Feb;21(1):32-43
AD - Istituto di Patologia e Clinica Otorinolaringoiatrica, Universita di Napoli Federico II.
Classification of laryngeal dysplasia, the most appropriate treatments and criteria for evaluation of the results is still a highly controversial issue. The objectives of the present study on the treatment of laryngeal dysplasia lesions are to: 1) evaluate the relative incidence of the various forms of dysplasia in relation to grading of the histopathological findings; 2) establish the prognosis for the various forms of dysplasia considered; 3) determine the results achieved by the author's treatment protocol according to the characteristics of the dysplasia; 4) critically evaluate the classifications of laryngeal dysplasia found in the literature in view of the results of the present study. The study involved 141 patients with vocal cord dysplasia (134 men, 7 women; mean age: 56.2 years) who had come under observation at the E.N.T. Dept. of the University of the dysplasia was removed by CO2 laser microlaryngoscopy. Of the 141 patients 89 (63.2%) showed mild dysplasia, 14 (9.9%) moderate dysplasia, 20 (14.2%) severe dysplasia and 18 (12.7%) in situ carcinoma. The five-year survival rate showed an overall actuarial survival of 89.1% for all patients while the corrected actuarial survival was 98.5% and local disease control was 86.1%. In 17 cases (12%) the dysplasia lesion recurred, in 11 (7.8%) an infiltrating carcinoma arose. Recurrences in the dysplasia were encountered in 9% of the patients with mild lesions, 7.1% of those with moderate dysplasia, 15% of the subjects with the severe form and in 27.7% of those with in situ carcinoma. An infiltrating carcinoma arose in 5.6% of the cases of mild lesion, in 7.1% of the medium dysplasias, 5% of the severe forms and in 22.2% of those with in situ carcinoma. The recurrences and infiltrating carcinomas were successfully treated with endoscopic CO2 laser surgery. Only three cases (2.1%) required radical surgery (total laryngectomy): these were patients who had not quit smoking and who had not adhered to the planned follow-up. One of the latter patients died with widespread metastases of the laryngeal cancer. The significantly higher incidence of dysplasia recurrences (P = 0.028) and infiltrating carcinomas (P = 0.015) in those patients with in situ carcinoma shows that, when preparing classification and determining prognosis, these pathologies should be considered separately. Moreover, they require a particularly precise follow-up. In conclusion, the following observations can be drawn from the study: mild and moderate dysplasias are more frequent as compared to severe dysplasia and carcinoma in situ; carcinoma in situ should be distinguished for classification and prognosis from dysplasias, considering their different clinical course and evolution; CO2 laser surgery in these forms is a valid therapeutic approach for its precision, the achievable results, the reduced discomfort to patients and for its evident cost-effectiveness.
UI - 21338554
AU - Sasiadek M; Stembalska-Kozlowska A; Smigiel R; Krecicki T; Blin N;
TI - Mirghomizadeh F Microsatellite and chromosome instability in squamous cell laryngeal carcinoma.
SO - Int J Oncol 2001 Aug;19(2):401-5
AD - Department of Genetics, Medical University of Wroclaw, Marcinkowskiego 1, 50-368 Wroclaw, Poland. email@example.com
Head-and neck squamous cell carcinoma (HNSCC) represents almost 5% of all malignancies in Europe. The aetiology of HNSCC is complex, with both genetic and mutagenic factors involved. The aim of the present study was to investigate the loss of heterozygosity (LOH), mainly at tumour suppressor loci (using markers D1S2883, D2S123, D3S1611, D5S346, D7S501, D8S254, TP53, NM23), microsatellite instability (BAT25, 26, 40) and
UI - 21396151
AU - Leon X; Quer M; Orus C; Lopez M; Gras JR; Vega M
TI - Results of salvage surgery for local or regional recurrence after larynx preservation with induction chemotherapy and radiotherapy.
SO - Head Neck 2001 Sep;23(9):733-8
AD - Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau, Avda. San Antoni M(a) Claret, 167, Universitat Autonoma de Barcelona, 08025 Barcelona, Spain. firstname.lastname@example.org
BACKGROUND: After treatment of locally advanced laryngeal carcinomas with induction chemotherapy and radiotherapy, some patients suffer a local or regional failure of the tumor, and salvage surgery is required. The aim of this study was to review the results of such salvage surgery in this group of patients. METHODS: A retrospective study of a cohort of 110 patients diagnosed between 1989 and 1996 with a locally advanced laryngeal carcinoma (T3-T4) treated with induction chemotherapy and radiotherapy was performed. The results of salvage surgery in patients with a local and/or regional failure of the treatment were analyzed. RESULTS: Forty-two patients presented a local and/or a regional recurrence of the tumor: 26 patients in the larynx, eight in the neck, and a further eight in both in the larynx and the neck. Salvage surgery was carried out in 28 patients (67%), consisting of total laryngectomies with neck dissections (24 cases), endoscopic resection of the tumor (one case), and radical neck dissections (three cases). Five-year adjusted survival for the 42 patients was 38%. Five-year survival for the 28 patients treated with salvage surgery was 57%. Five patients had postoperative complications: four had pharyngo-cutaneous fistulas and one had wound infection. CONCLUSIONS: After a local and/or regional recurrence, 67% of patients with advanced laryngeal carcinoma treated with induction chemotherapy and radiotherapy were candidates to salvage surgery. Five-year adjusted survival for this group of patients was 57%. Copyright 2001 John Wiley & Sons, Inc.
UI - 21439134
AU - Kamijo T; Yokose T; Hasebe T; Yonou H; Hayashi R; Ebihara S; Ochiai A
TI - Image analysis of microvessel surface area predicts radiosensitivity in early-stage laryngeal carcinoma treated with radiotherapy.
SO - Clin Cancer Res 2001 Sep;7(9):2809-14
AD - Pathology Division, National Cancer Center Research Institute East, Kashiwa, Chiba 277-8577, Japan.
PURPOSE: The tissue oxygenation level, which is theoretically governed by distance from blood vessels, is one of the most important modulators of the radiosensitivity of carcinoma. A computed image analysis system for the detection of tissue oxygenation was developed to establish a method of predicting radiosensitivity in early-stage laryngeal carcinoma treated by curative radiotherapy. EXPERIMENTAL DESIGN: Microvessel structures labeled with CD31 antigen were investigated in 55 patients undergoing curative radiotherapy for T1 and T2 laryngeal carcinoma. We calculated (a) microvessel density [(MVD) vessels/field] under a microscope; (b) the ratio of the total microvessel number (TN):tumor area (TA) [TN:TA; vessels/mm2]; (c) the ratio of the total microvessel perimeter (TP):TA (TP:TA; mm/mm2); and (d) the ratio of tumor tissue area >150 microm from microvessels (hypoxic ratio; %) as parameters of tissue oxygenation in each whole biopsy specimen by using an image analyzer. We compared each of these factors with radiosensitivity. RESULTS: Mann-Whitney's U test revealed that tumors with a high MVD (median, 42 vessels/field), high TN:TA ratio (median=40.9 vessels/mm2), high TP:TA ratio (median, 2.92 mm/mm2), and low hypoxic ratio (median, 30.3%) had significantly greater radiosensitivity than tumors with a low MVD, low TN:TA ratio, low TP:TA ratio or high hypoxic ratio (P = 0.002, P = 0.0004, P < 0.0001, and P = 0.004, respectively). CONCLUSIONS: Prediction of radiosensitivity on the basis of the TP:TA ratio can be used as an efficient means of avoiding ineffective radiation, complications after salvage surgery, and prolonged hospital stays.
UI - 21401855
AU - Stranadko EF; Garbuzov MI; Zenger VG; Nasedkin AN; Markichev NA; Riabov
TI - MV; Leskov IV [Photodynamic therapy of recurrent and residual oropharyngeal and laryngeal tumors]
SO - Vestn Otorinolaringol 2001;(3):36-9
Photodynamic therapy (PDT) was given to 61 patients with recurrent cancer of the tongue, oral mucosa, lower lip, oro- and nasopharynx, larynx. Photosensitizers photogem and photosens of Russian produce were employed. The radiation was given twice with the interval 24 and 48 hours, the exposure to light 3 to 30 min. The impact was external, through the instrumental canal of the fibroscope, by intracavitary and interstitial techniques. The response was assessed within 4-6 weeks after the PDT course. The effect was observed in 95.1% patients. Its duration ranged from 4 months to 5 years. Complete resorption of the tumor was achieved in 57.4%. The treatment failed in 4.9% patients.
UI - 21453546
AU - Teknos TN; Myers LL; Bradford CR; Chepeha DB
TI - Free tissue reconstruction of the hypopharynx after organ preservation therapy: analysis of wound complications.
SO - Laryngoscope 2001 Jul;111(7):1192-6
AD - Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan 48109-0312, USA. email@example.com
PURPOSE: Previous series have demonstrated a 77% rate of major wound complications in salvage surgery of the larynx following organ preservation protocols. The purpose of this study is to determine the incidence of wound complications in these patients when microvascular free tissue transfers are used for reconstruction of the hypopharynx. DESIGN: Retrospective case series. SETTING: Academic tertiary care center. PATIENTS AND METHOD: We reviewed the medical records of 42 patients with stage III and IV laryngeal squamous cell carcinoma treated with an organ-sparing protocol consisting of induction chemotherapy followed by definitive radiation therapy. Ten of these patients who required surgical salvage were reconstructed using radial forearm free tissue or lateral arm transfer and constitute the study group. MAIN OUTCOME MEASURES: Wound complications. RESULTS: Wound complications occurred in 2 patients (20%) undergoing free flap reconstruction of the hypopharynx after organ preservation protocols, which was significantly lower (P =.003) than previous reports using other forms of closure and/or reconstruction. One patient in this study group had a small pharyngocutaneous fistula that resolved with conservative therapy after 1 week. The other patient had a larger pharyngocutaneous fistula that resolved over 3 weeks. The mean interval from completion of the chemoradiation regimen to surgery was 21.3 months (range, 2-60 mo). The average free tissue flap size was 94.3 cm(2) (range, 45-165 cm(2)). Average harvest and ischemia times were 59 minutes (range, 41-87 min) and 187.7 minutes (range, 120-240 min), respectively. All flaps survived, and one patient had a minor donor site wound dehiscence. The average hospital stay was 7.8 days. There were no mortalities in this series. CONCLUSIONS: Our results suggest that free tissue transfer reconstruction of the hypopharynx is the preferred method of reconstruction following combined chemotherapy and radiation therapy protocols. Surgical complications are significantly reduced and hospital stays are minimized.
UI - 21453547
AU - Loos BM; Wieneke JA; Thompson LD
TI - Laryngeal angiosarcoma: a clinicopathologic study of five cases with a review of the literature.
SO - Laryngoscope 2001 Jul;111(7):1197-202
AD - Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, DC, USA.
OBJECTIVE: Primary laryngeal angiosarcoma (LA) is rare without a reported series evaluating these tumors. STUDY DESIGN/METHODS: Five patients with LA were retrospectively retrieved from the Otorhinolaryngic Registry of the Armed Forces Institute of Pathology. RESULTS: Three men and 2 women, aged 29 to 71 years, presented with hoarseness (n = 4) and hemoptysis (n = 1). Two patients had previous neck radiation. The tumors involved the supraglottis (n = 4) with a mean size of 3.1 cm. Histologically, all tumors had anastomosing vascular channels lined by remarkably atypical endothelial cells protruding into the lumen, frequent atypical mitotic figures, and hemorrhage. All cases tested (n = 4) demonstrated immunoreactivity with antibodies to Factor VIII-RA and CD34. All patients had surgery followed by postoperative radiation (n = 3 patients). Three patients died with disease (mean, 17 mo), whereas one patient is alive with no evidence of disease at 18 years. CONCLUSIONS: LA is a rare tumor, frequently associated with previous radiation, usually involving the supraglottis with characteristic histomorphologic and immunophenotypic features. LA has a poor prognosis, making appropriate separation from other conditions important.
UI - 21390913
AU - Jing H; Huang W; Qiu J
TI - [Inhibitive effect of bcl-2 antisense oligodeoxynucleotide on Bcl-2 protein synthesis and cell proliferation in human laryngocarcinoma Hep-2 cells]
SO - Zhonghua Er Bi Yan Hou Ke Za Zhi 1998 Feb;33(1):17-20
AD - Department of Otorhinolaryngology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032.
OBJECTIVES: To evaluate the role of bcl-2 antisense oligodeoxynucleotide in the gene treatment of human laryngocarcinoma. METHODS: An antisense oligodeoxynucleotide complementary to the initiation coden and the next four codens of bcl-2 mRNA was synthesized with an automatic DNA synthesizer. It was used to treat cultured Hep-2 cells to observe its effect on cell proliferation. In situ hybridization method and immunohistochemical technology were adopted to detect bcl-2 mRNA and protein and explore the effect of bcl-2 antisense oligodeoxynucleotide fragment on bcl-2 gene expression and protein synthesis and inhibition of cell proliferation. RESULTS: Bcl-2 antisense oligodeoxynucleotide had an obvious effect on bcl-2 mRNA, but inhibited Bcl-2 protein synthesis significantly, the inhibitive rate had positive correlation with concentration of antisense oligodeoxynucleotide and time of action. Twenty mumol/L of antisense oligodeoxynucleotide could inhibit cell proliferation effectively. CONCLUSIONS: It is suggested that bcl-2 antisense oligodeoxynucleotide might specifically inhibit bcl-2 protein synthesis and cell proliferation in Hep-2 cells at translation level.
UI - 21390915
AU - Zhou L; Wang J; Huangfu M
TI - [Long term results of Majer-Piquet's operation in the treatment of laryngeal carcinoma]
SO - Zhonghua Er Bi Yan Hou Ke Za Zhi 1998 Feb;33(1):24-6
AD - Department of Otolaryngology, Ren Ji Hospital, Shanghai Second Medical University, Shanghai 200001.
OBJECTIVE: To investigate the long term results of Majer-Piquet's operation in the treatment of glottic type of laryngeal carcinoma. were T2N0M0 and 1 each for T2N1M0, T3N0M0, T3N1M0. RESULTS: In T1 cases, 2, 3 and 5 years survival rate were 95.8, 93.7 and 90.9% respectively, while in T2 cases, 2, 3 and 5 years survival rate were 100%, 83.3% and 60% respectively. Decannulation rate was 96.9%. All patients could finally take food by mouth without inspiration, and could speak as soon as decannulated. By modifing the operative technique, the cases operated on after 1994 got relatively better results in phonation. CONCLUSION: Majer-Piquet's operation not only is effective in the treatment of T1, T2 and some T3 glottic type of laryngeal carcinomas, but also can satisfactorily reserve laryngeal function and improve the quality of patient's life.
UI - 21453611
AU - Zacharek MA; Pasha R; Meleca RJ; Dworkin JP; Stachler RJ; Jacobs JR;
TI - Marks SC; Garfield I Functional outcomes after supracricoid laryngectomy.
SO - Laryngoscope 2001 Sep;111(9):1558-64
AD - Department of Otolaryngology Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
OBJECTIVES: Local control and 5-year survival rates are similar for patients undergoing total laryngectomy and supracricoid laryngectomy for the treatment of advanced-stage laryngeal carcinoma. However, comprehensive studies of functional outcomes after supracricoid laryngectomy are lacking. STUDY DESIGN: Cohort study. METHODS: This investigation provides objective voice laboratory data, skilled listener impressions of voice samples, swallowing evaluations, and patient self-perceptions of speech ability obtained from 10 supracricoid laryngectomees. RESULTS: Results demonstrated variable acoustic and speech aerodynamic disturbances, hoarse-breathy vocal quality, and speech dysfluency. Patients' self-perceptions of voice revealed severe dysphonia that induced certain emotional, physical, and functional setbacks. However, blinded judges rated these individuals as possessing intelligible speech and communication skills. All patients demonstrated premature spillage of the bolus and varying degrees of laryngeal penetration, aspiration, and retention during swallowing studies. However, each patient used a compensatory strategy to protect the airway. Voice and swallowing abilities appeared to depend on the mobility of the arytenoid cartilages, base of tongue action, and residual supraglottic tissue for the creation of a competent neoglottal sphincter complex that vibrated during phonation efforts and protected the airway during deglutition. CONCLUSIONS: Supracricoid laryngectomy avoids the potential complications, limitations, and emotional problems associated with a permanent tracheostoma. All patients demonstrated intelligible voice and effective swallowing function postoperatively, supporting supracricoid laryngectomy as a suitable alternative surgical approach to the total laryngectomy in select patients.
UI - 21453603
AU - Lai JP; Tao ZD; Xiao JY; Chen XH; Zhao SP; Tian YQ; Betz CS
TI - Microinvasive Nd:YAG laser therapy of early glottic carcinoma and its effect on soluble interleukin-2 receptor, interleukin-2, and natural killer cells.
SO - Laryngoscope 2001 Sep;111(9):1585-8
AD - Department of Otolaryngology, XiangYa Hospital, Hunan Medical University, Changsha, Hunan, Peoples Republic of China. firstname.lastname@example.org
OBJECTIVE: To investigate the effectiveness of microinvasive Nd:YAG laser therapy in human glottic Tis and T1 carcinomas, as well as its effect on the cellular immune function of the tumor-bearing hosts. STUDY DESIGN: We treated 34 patients with microinvasive Nd:YAG laser therapy and evaluated its effect on the cellular immune function of the host. METHODS: Thirty-four patients with glottic Tis or T1 squamous cell carcinoma were treated with fiberoptic laryngoscopic Nd:YAG laser surgery. Both before and after therapy, serum levels of soluble interleukin-2 receptor (SIL-2R) and interleukin-2 (IL-2), as well as natural killer (NK) cell activity, were determined by means of double-antibody sandwich technique, tritiated thymidine-deoxyribonucleoside incorporation, and iodine 125-uridine-deoxyribonucleoside release technique, respectively. RESULTS: All 34 patients tolerated the procedure well. A 3- to 7-year follow-up in a subgroup of 27 patients resulted in an estimated cure rate of 85.2% (23 of 27 patients). In all 27 patients with a regular follow-up, a subjective improvement of phonation was noted after therapy to various degrees. In 74% (20 of 27 patients), voice and speech subjectively recovered to almost normal levels. The post-therapy serum levels of SIL-2R were significantly declined (P <.001), whereas those of IL-2 and the NK activity were significantly elevated (P <.001) as compared with those detected before therapy. CONCLUSIONS: Therapy with fiberoptic laryngoscopic Nd:YAG laser surgery is simple, safe, effective and only minimally invasive for patients with glottic Tis or T1 carcinoma. At the same time, it has an immunoenhancing effect on its host.
UI - 21453626
AU - Dedo HH; Yu KC
TI - CO(2) laser treatment in 244 patients with respiratory papillomas.
SO - Laryngoscope 2001 Sep;111(9):1639-44
AD - Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California 94117, USA.
OBJECTIVE: Respiratory papillomas (RP) tend to recur and the difficulty in eradicating the disease makes their treatment frustrating. Meticulous CO(2) laser excisions every 2 months has been the most effective treatment to date. This article analyzes the results of this plan in 244 patients with RP in the nose, nasopharynx, pharynx, hypopharynx, larynx, trachea, lung parenchyma, and skin. METHODS: Two hundred forty-four patients with recurrent RP were treated by the senior author with CO(2) laser excisions and, in some cases, podophyllum and alpha interferon. Demographics, initial distribution of papillomas, number of operations performed on each patient, and current results were evaluated. RESULTS: Careful laser excisions of RPs every 2 months achieved "remission" of disease (no visible RP on indirect or often direct laryngoscopy 2 mo after last removal) in 37% of patients, "clearance" of the disease process (no RP clinically apparent for 3 y after last removal) in 6%, and "cure" (no clinical recurrence for 5 y after last removal) in 17%. Juvenile-onset RP tends to follow a more aggressive course than adult-onset RP. Four patients (1.6%) developed malignant transformation of their papillomas. Except for ones in lung parenchyma, RP in areas other than the true vocal cords tend to be cleared faster because aggressive removal does not cause hoarseness. Lung parenchyma RPs are eventually fatal because of pulmonary failure from abscesses and cysts resulting from a lack of effective treatment. CONCLUSION: Frequent and meticulously performed CO(2) laser excisions can achieve significant voice and airway improvement, and some clinical "cures." However, effective antiviral medicines and/or immunologic agents are needed to achieve true cures with elimination of all human papilloma virus 6 and 11 viruses.
UI - 21445103
AU - Wolf GT
TI - Commentary: phase III trial to preserve the larynx: induction chemotherapy and radiotherapy versus concurrent chemotherapy and radiotherapy versus radiotherapy--intergroup trial R91-11.
SO - J Clin Oncol 2001 Sep 15;19(18 Suppl):28S-31S
AD - Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI 48109-0312, USA.
UI - 21295693
AU - Aaltonen LM; Chen RW; Roth S; Makitie AA; Rihkanen H; Vaheri A; Aaltonen
TI - LA Role of TP53 P72R polymorphism in human papillomavirus associated premalignant laryngeal neoplasm.
SO - J Med Genet 2001 May;38(5):327
UI - 21449114
AU - Sourvinos G; Rizos E; Spandidos DA
TI - p53 Codon 72 polymorphism is linked to the development and not the progression of benign and malignant laryngeal tumours.
SO - Oral Oncol 2001 Oct;37(7):572-8
AD - Laboratory of Virology, Medical School, University of Crete, Heraklion, Crete, Greece.
The p53 codon 72 polymorphism, resulting in either an arginine or a proline residue has been proposed to affect the susceptibility of p53 protein to human papilloma virus (HPV) E6-mediated degradation in vitro. However, there are controversial results from several clinical studies in various human tumours. The purpose of our study was to investigate the significance of this p53 genotype with respect to the risk of neoplasia development in Greek patients with benign and malignant laryngeal tumours. Furthermore, we searched for an association between p53 alleles and the presence of HPV in the same series of samples. We found a significant statistical association in the distribution of p53 genotypes between laryngeal lesions and normal samples (P<0.001). Allelic analysis of the patients with both benign and malignant tumours revealed a striking over-representation of the homozygous p53Arg allele compared to normal population (P<0.0003). HPV was detected in only 3 laryngeal samples (1 benign and 2 malignant tumours). This is the first study correlating the p53 codon 72 polymorphism in laryngeal tumours. Our results provide evidence that this p53 polymorphism may be implicated at the early stages of the disease and concerns predisposition to premalignant laryngeal lesions rather than to progression from benign tumour toward malignancy. Moreover, we demonstrate that the p53Arg homozygous genotype affects the predisposition for laryngeal tumours while the heterozygous status does not. The low incidence of HPV infection suggests that it is not a major oncogenic factor in the development of laryngeal tumours but may have synergistic action with specific genotypes of p53 gene.
UI - 20059574
AU - Bentzen JK; Hansen HS; Nielsen HW
TI - The prognostic importance of volume-weighted mean nuclear volume, mitotic index, and other stereologically measured quantitative parameters in supraglottic laryngeal carcinoma.
SO - Cancer 1999 Dec 1;86(11):2222-8
AD - Department of Radiotherapy and Oncology, University Hospital in Herlev, Herlev, Denmark.
BACKGROUND: Stereologically measured mean nuclear volume has been proven to have prognostic importance in several types of cancer, such as malignant melanoma and carcinomas of the breast, oral region, bladder, and uterine cervix. The main purpose of the current study was to investigate the possible prognostic importance of mean nuclear volume and mitotic index in carcinoma of the supraglottic larynx. METHODS: The study was performed with a stratified, random sample of 113 patients from a well-defined group of 386 patients with supraglottic laryngeal carcinoma treated with radiotherapy at the Finsen Institute in Copenhagen. Histologic sections from pretreatment biopsies were used to estimate the following parameters: mean nuclear volume (Vv(3)(0)), mitotic index (MI), number of nuclei per mm(2) (QA), mean nuclear profile area (Anuc), and the area fraction of nuclei in cancer tissue (AA). The geometric means of the parameters were used as cutoff points in a single factor and in a multivariate survival analysis with relapse free survival as the primary endpoint. RESULTS: The geometric means of the measured parameters were (Vv(3)(0)) = 480 micro(3), QA = 3630 nuclei/micro(2) cancer tissue, MI = 0.48 mitosis/100 nuclei, AA = 0.21, and Anuc = 57.9 micro(2). CONCLUSIONS: None of the stereologically estimated parameters proved to have prognostic importance, whereas tumor size, and lymph node status did. The method of adaptive, stratified, random sampling used in this study can save a great deal of work and is highly recommended by the authors. Copyright 1999 American Cancer Society.
UI - 21301908
AU - Spector GJ
TI - Distant metastases from laryngeal and hypopharyngeal cancer.
SO - ORL J Otorhinolaryngol Relat Spec 2001 Jul-Aug;63(4):224-8
AD - Department of Otolaryngology--Head and Neck Surgery, Washington University, St. Louis, MO 63110, USA. email@example.com
A retrospective tumor registry analysis of patients with squamous cell carcinoma (SCC) of the larynx and hypopharynx who were treated with curative intent in the Department of Otolaryngology--Head and Neck Surgery at Washington University School of Medicine and Barnes Hospital sex and tumor differentiation did not affect the incidence of distant metastases. The overall incidence of distant metastases was 8.5% (217/2,550 patients) with the following distribution: glottis 4.4%, supraglottis 3.6%, subglottis 14%, aryepiglottic fold 16%, pyriform sinus 17% and posterior hypopharynx 17.6%. The overall 5-year disease-specific survival for distant metastases was 6.4%. Distant metastases were related to advanced local disease (T3 + T4), lymph node metastases at presentation (N+), tumor location (hypopharynx) and locoregional tumor recurrence (p < or = 0.028). A meta-analysis of variables which predispose to a higher incidence of distant metastases indicate that tumor location (hypopharynx > larynx), advanced primary disease (T3 + T4), regional disease (N+), locoregional recurrences, and advanced regional metastases (N2 + N3) are statistically significant. Copyright 2001 S. Karger AG, Basel
UI - 21418645
AU - Amilibia E; Juan A; Nogues J; Manos M; Monfort JL; Dicenta M
TI - [Neoplastic invasion of laryngeal cartilage: diagnosis by computed tomography]
SO - Acta Otorrinolaringol Esp 2001 Apr;52(3):207-10
AD - Servicio de Otorrinolaringologia, Ciudad Sanitaria y Universitaria de Bellvitge, Hospitalet del Llobregat, Barcelona.
The diagnostic of the laryngeal cartilage neoplastic invasion plays an important role in the accurate staging of the laryngeal carcinoma and its treatment. To evaluate the accuracy of the CT diagnosing cartilage involvement, the present study is reported. 127 patients with carcinoma of the larynx and hipopharynx T3-T4, surgical treated between 1993 and 1997 at Ciudad Sanitaria y Universitaria de Bellvitge, are retrospectively studied. TC presents an a accuracy of 78%, a specificity of 91% and a sensitivity of 54% in the diagnostic of laryngeal cartilage invasion of the laryngeal and hipopharyngeal carcinoma.
UI - 21418646
AU - Pinilla M; Gonzalez FM; Lopez-Cortijo C; Vicente J; Gorriz C; Laguna D;
TI - De la Fuente R; Vergara J [Cervical lymph node involvement in laryngeal carcinoma: a retrospective study of 430 cases]
SO - Acta Otorrinolaringol Esp 2001 Apr;52(3):213-8
AD - Servicio de O.R.L. Clinica Puerta de Hierro, Universidad Autonoma de Madrid.
Cervical lymph node involvement in laryngeal tumors could be a market impact on the disease prognosis. We performed a retrospective study of 430 patients who underwent surgery to treat laryngeal carcinoma in our center over a 10-year period. The objective was to correlate clinical and pathological lymph node involvement with the site of origin and size of the tumor, the treatment and its impact on patient survival. We observed a significantly greater incidence of lymph node involvement in tumors originating from supraglottis, with a rate of occult lymph node metastases of 31%. Patients with lymphadenopathy that remained undetected in the absence of surgical treatment and those with nonmetastatic lymphadenopathy presented similar 5-year survival rates, 83% y 98% respectively. However, the 5-year survival decreased to 24% in the presence of metastatic lymph node involvement. These results support the proposal that treatment of laryngeal carcinoma should include the region of the cervical nodes as well.
UI - 21418406
AU - Lahoz Zamarro MT; Galve Royo F; Martinez Subias J; Laguia Perez M
TI - [Distant metastases in patients with advance laryngeal carcinoma]
SO - Acta Otorrinolaringol Esp 2001 May;52(4):307-11
AD - Servicio de O.R.L., Hospital Obispo Polanco de Teruel.
Patients with advanced stage cancer larynx have a higher risk of development of distant metastases which means a bad prognosis. In our study we try to identify risk factors with the idea of involve to all of these patients in more aggressive systemic therapy protocols. Data of 57 patients surgically treated, with squamous pharyngolaryngeal carcinoma, stage III and IV, are evaluated. Advanced T stage or more extensive neck disease more often caused distant metastases (p < 0.05), and also the histological evidence of tumor invasion in three or more cervical nodes (p = 0.02), and poorly differentiated tumors (p < 0.05). Tumor site, surface area in cm, presence of ulceration, and loco-regional uncontrol were not associated with distant metastases.
UI - 21453579
AU - Major MS; Bumpous JM; Flynn MB; Schill K
TI - Quality of life after treatment for advanced laryngeal and hypopharyngeal cancer.
SO - Laryngoscope 2001 Aug;111(8):1379-82
AD - Division of Otolaryngology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, U.S.A.
OBJECTIVES: To compare health-related quality of life measures after treatment for advanced (stages III and IV) laryngeal and hypopharyngeal cancers. STUDY DESIGN: Retrospective chart review and patient response to Health Status Questionnaire-12 (HSQ-12). METHODS: Our study included 54 patients identified from the Tumor Registry of the University of Louisville Brown Cancer Center who were diagnosed and treated between 1995 and 2000. Demographics, tumor data, and treatment information were obtained from the Tumor Registry database. Questionnaires were mailed to all patients and included telephone follow-up. Comparative data and responses were analyzed for the 24 patients who responded to the survey. RESULTS: Fifteen patients were treated with chemotherapy and radiation therapy (CRT). Six patients underwent surgery with postoperative radiation therapy (SRT). The remaining three patients were treated with radiation therapy but were not used in this analysis. The average follow-up was 35 months after treatment. The CRT and SRT groups were statistically similar regarding age, sex, duration of follow-up, tumor grade, and tumor stage. Laryngeal primary tumors were more common in the SRT group than in the CRT group (P =.005). Eight domains were assessed by the HSQ-12: physical functioning, role-physical, bodily pain, health perception, energy/fatigue, social functioning, role-mental, and mental health. No statistical differences were found between the CRT and SRT groups, except for role limitations attributable to physical health (P =.007). CONCLUSIONS: These results indicate that only one of eight domains differs significantly between treatment groups when using the HSQ-12. Two-year survival end-point analysis of global health assessment may represent a simplified and meaningful way to compare treatment modalities in patients with advanced-stage head and neck cancer.
UI - 21453597
AU - Parsons DS; Bothwell MR
TI - Powered instrument papilloma excision: an alternative to laser therapy for recurrent respiratory papilloma.
SO - Laryngoscope 2001 Aug;111(8):1494-6
AD - Department of Otolaryngology-Head and Neck Surgery, University of Missouri Hospital and Clinics, MA 314 One Hospital Drive, Columbia, MO 65212, U.S.A.
UI - 21439831
AU - Behrman A; Abramson AL; Myssiorek D
TI - A comparison of radiation-induced and presbylaryngeal dysphonia.
SO - Otolaryngol Head Neck Surg 2001 Sep;125(3):193-200
AD - Schein Voice and Laryngeal Center, Department of Otolaryngology and Communicative Disorders, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA. firstname.lastname@example.org
OBJECTIVE: The goal of this study was to assess voice after radiotherapy compared with patients with presbylaryngeal dysphonia. STUDY DESIGN AND SETTING: Prospective assessment of 20 patients aged 60+ years who remained free of disease longer than 1 year after radiotherapy for T1 squamous cell carcinoma and retrospective review of 46 patients aged 60+ with presbylaryngeal dysphonia, conducted at a tertiary care, academic hospital. Assessment data included videostroboscopy, spectrography, voice range profile, and Voice Handicap Index. RESULTS: Eighty percent of the radiotherapy patients reported a voice disorder. Acoustic data and functional measures reflected similar limitations and abnormalities for both groups. A high incidence of glottal gap in all patients may have been associated with increased mucosal stiffness in the radiotherapy group and vocal fold atrophy in the presbylaryngeal group. CONCLUSION: Patient perception and functional outcome of voice were similar for both groups, despite differences in etiology of abnormal vocal fold vibratory behavior. SIGNIFICANCE: Radiotherapy in older individuals may yield dysphonia that is no greater than that caused by normal aging.
UI - 21475684
AU - Bron LP; Soldati D; Zouhair A; Ozsahin M; Brossard E; Monnier P; Pasche
TI - P Treatment of early stage squamous-cell carcinoma of the glottic larynx: endoscopic surgery or cricohyoidoepiglottopexy versus radiotherapy.
SO - Head Neck 2001 Oct;23(10):823-9
AD - Department of ENT and Head and Neck Surgery, the Centre Hospitalier Universitaire Vaudois, av Bugnon 46, CH-1011, Lausanne, Switzerland.
BACKGROUND: Both surgery and radiotherapy are recognized treatments of T1-T2 squamous cell carcinoma of the larynx. We retrospectively analyze and compare the oncological outcome of patients treated in a single institution, either by endoscopic surgery or partial supracricoid laryngectomy versus radiation therapy. METHODS: The medical records of 156 patients treated between 1983 and 1996 with either surgery (n = 75) or radiotherapy (n = 81) were reviewed. Male to female ratio, median age, and T-stage distribution were comparable. RESULTS: With a median follow-up time of 59 months, the 5-year cause-specific survival rate of 93% was identical for both groups. The actuarial incidence of metachronous second primaries was 7% at 5 years. Local control at 5 years remained 84% after surgery and 77% after radiotherapy. Anterior commissure infiltration was shown to represent a negative predictive factor of local control for radiotherapy (p =.01). Salvage treatment brought ultimate local control to 96% of patients after surgery and 94% after radiation therapy with long-term laryngeal preservation rate altered significantly (p =.05) in the group of patients who received radiotherapy (90.1% vs 97.4%). CONCLUSION: The treatment of laryngeal cancer is always a compromise between oncological efficiency and preservation of function. Our data suggest that, assuming proper selection of patients, radiation therapy and surgery yield similar local control and survival rates. The functional disadvantages after surgery are moderate and clearly counterbalanced by a significant decrease in long-term laryngeal preservation rate after radiotherapeutic treatment. Copyright 2001 John Wiley & Sons, Inc. Head Neck 23: 823-829, 2001.
UI - 21475690
AU - Lawson G; Jamart J; Remacle M
TI - Improving the functional outcome of Tucker's reconstructive laryngectomy.
SO - Head Neck 2001 Oct;23(10):871-8
AD - Department of ENT - Head and Neck Surgery, Louvain University Hospital at Mont-Godinne, B-5530 Yvoir, Belgium.
BACKGROUND: The goal of reconstructive laryngectomy addressing glottic carcinoma, as described by Tucker, is twofold: achieve local control and preserve as much as possible the physiological laryngeal function. METHODS: The study consisted of long-term assessment of oncological, deglutitory, and vocal outcome in 34 patients following Tucker's reconstructive laryngectomy. Postoperative follow-up included fiberscopic examination, videoradiography, and voice assessment after speech rehabilitation. RESULTS: The 5-year overall survival rate was 92% +/- 5%. Fiberscopic examination and videoradiography contributed to observing and understanding the rehabilitation process and impairment to its progress. Two main compensatory movements were identified: the anticipatory backward movement of the tongue base (50%) and the anticipatory upward laryngeal motion (15%). Both movements occurred simultaneously at the beginning of the pharyngeal stage of the swallow (35%). The median duration prior to tracheostomy tube removal was 14 days. Swallowing of solids resumed on day 9 (median), and liquid intake (water and soup) resumed on day 12 (median). The median duration of hospitalization was 16 days. Following speech rehabilitation, the latest follow-up visit measured as follows: the mean conversational voice intensity at 64 dB (range, 57-79 dB); the mean maximum intensity at 87 dB (range, 78-96 dB); the minimum intensity at 54 dB (range, 45-65 dB); the mean maximum phonation time at 16 seconds (range, 10-29 seconds); and the mean phonation quotient at 284 mL/second (range, 205-341 mL/second). According to our classification, voice spectral analysis revealed 19 class-III patients, 12 class-II patients, and three class-I patients. CONCLUSION: Tucker's reconstructive laryngectomy is reliable in terms of both the oncological and functional outcome. Fiberscopic examination and videoradiography are two complementary methods for assessing postoperative deglutition. Copyright 2001 John Wiley & Sons, Inc. Head Neck 23: 871-878, 2001.
UI - 92352041
AU - Strome S; Strome M
TI - Laryngeal transplantation: ethical considerations.
SO - Am J Otolaryngol 1992 Mar-Apr;13(2):75-7
AD - Joint Center for Otolaryngology, Brigham & Women's Hospital, Boston, MA.
UI - 21321242
AU - de Gier HH; Knegt PP; de Boer MF; Meeuwis CA; van der Velden LA;
TI - Kerrebijn JD CO2-laser treatment of recurrent glottic carcinoma.
SO - Head Neck 2001 Mar;23(3):177-80
AD - Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Rotterdam, The Netherlands.
BACKGROUND: Evaluation of the results of CO2 laser treatment of recurrent glottic carcinoma after radiotherapy. METHODS: Records of all patients treated in the University Hospital Rotterdam and the Dr. Daniel den Hoed Cancer Center between 1980 and 1996 by CO2 laser for recurrent glottic carcinoma were studied. RESULTS: Forty patients were treated by laser surgery. Average follow-up was 77 months. Twenty-three patients (58%) had another recurrence develop after laser surgery. Three were cured by a second laser procedure. Therefore, 20 patients (50%) were successfully treated with laser surgery. In 23 patients the recurrence did not extend into the anterior commissure; in 57% a total laryngectomy could be avoided. In 17 patients the recurrence did extend into the anterior commissure; in 41% a total laryngectomy was avoided. CONCLUSION: Most patients with recurrent carcinoma of the larynx after radiotherapy can be cured by laser surgery if the tumor does not extend into the anterior commissure.
UI - 21321247
AU - Hosal SA; Myers EN
TI - How I do it: closure of tracheoesophageal puncture site.
SO - Head Neck 2001 Mar;23(3):214-6
AD - Department of Otolaryngology, Hacettepe University School of Medicine, Ankara, Turkey.
BACKGROUND: Tracheoesophageal voice prosthesis is highly effective in providing speech after total laryngectomy. Although it is a safe method, tracheoesophageal fistulas occasionally need to be closed, usually at the request of the patient, because of leakage through an enlarging fistula. We present our technique for closure of tracheoesophageal fistula. METHODS: An incision is made at the mucocutaneous junction of the stoma from the 9 to the 3-o'clock position. Tracheoesophageal space is dissected down to and beyond the fistula. The tracheoesophageal tract is divided. The esophageal mucosa is closed with inverted sutures. After multiple layer closure of the esophageal fistula, the tracheal mucosa is closed with everted sutures. RESULTS: This technique has been used in nine patients. Eight were successful. The remaining patient had radiation therapy failure. CONCLUSION: This method of closure is simple and effective for those patients who require permanent closure of the tracheoesophageal fistula.
UI - 21292231
AU - Russolo M
TI - [Correlation between resection margin status and local recurrence in surgery of laryngeal carcinoma]
SO - Acta Otorhinolaryngol Ital 2000 Dec;20(6):395-9
AD - Clinica Otorinolaringoiatrica, Universita di Trieste.
UI - 21292232
AU - Galli V; Testa D; Polce M
TI - [Significance of surgical radicality as presupposition of therapeutic success]
SO - Acta Otorhinolaryngol Ital 2000 Dec;20(6):400-6
AD - Clinica Otorinolaringoiatria, Universita di Napoli Federico II.
UI - 21292233
AU - Almadori G; Galli J; Cadoni G; Bussu F; Scarano E; Maurizi M
TI - [Prospects and therapeutic decisions in the light of biological findings in laryngeal cancer]
SO - Acta Otorhinolaryngo