Abstract
CASTLE seem to have a better prognosis. However, CASTLE has a potentially invasive behavior, and invasion of neighboring cervical structures is possible. In particular, tracheal or laryngotracheal resections have been necessary to excise the lesion. The extent of this invasion may sometimes prevent a complete resection or require surgically challenging procedures, as in our experience. The parietal invasion can involve the muscles, connective tissue, and skin. Nodal involvement is probably a negative prognostic factor, because it has been associated with the occurrence of locoregional or systemic spread. Adjuvant radiotherapy is generally advocated in case of nodal metastasis. On the other hand, local recurrence is possible in the absence of nodal disease, thus suggesting a role for systematic adjuvant radiotherapy because of the radiosensitivity of this tumor.
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