Glottic Tumors Research Articles

Transoral Laser Microsurgery Versus Radiotherapy for T1-T2 Glottic Cancer with Anterior Commissure Involvement: A Systematic Review and Meta-Analysis.

To identify the most effective treatment modality for achieving favorable outcomes in early glottic tumors with anterior commissure involvement (ACI). PubMed, Embase, Web of Science, and ScienceDirect. Random-effects proportional meta-analysis model is used to evaluate the oncological and functional outcomes of transoral laser microsurgery (TLM) versus radiation therapy (RT) in early glottic (T1-T2) cancer with ACI. From a total of 736 studies, 40 studies were included, comprising 2666 early glottic tumor patients with ACI. TLM (52%) and upfront RT (48%) were the primary treatment groups. TLM had better 5-year overall survival (OS) (84.5% [80.3%-88.0%] vs. 79.4% [75.7%-82.7%]). Similarly, TLM-treated patients had better 3-year pooled disease-free survival (DFS) compared with RT-treated patients (82.7% [77.1%-87.1%] vs. 73.3% [23.8%-96.0%]). TLM exhibited a better 5-year local control rate (LCR) than RT (77.2% vs. 71.6%). In our temporal analysis, TLM had a higher 5-year LCR than RT (78.2% vs. 63.5%) in 2001-2012, with similar rates in 2013-2024 (76.8% vs. 78.4%). TLM-treated patients had higher laryngeal preservation rates compared with RT patients (93% [90.6%-94.8%] vs. 87.6% [82.8%-91.2%]). Our meta-analysis is the first in the literature to compare the outcomes between TLM and RT-treated patients with ACI in early glottic tumors. TLM-treated patients appear to have superior 5-year OS and laryngeal preservation compared with upfront RT-treated patients. However, both TLM and RT exhibited comparable oncological outcomes in early glottic tumor patients with ACI during the recent period from 2013 to 2024. Laryngoscope, 2025.

Maximising efficiency with exoscopic surgery: a versatile approach for transoral laryngeal and oropharyngeal procedures.

Several devices have been developed to improve head and neck surgery. 3D exoscopes provide surgeons a viable alternative to microscopes. We propose our setting for transoral exoscopic oropharyngeal (TOEOS) and transoral exoscopic laryngeal surgery (TOELS). A case series of patients treated with the exoscopic setup at the Otolaryngology Unit of IRCCS San Martino Hospital, Genoa, is presented. Our surgical setup and surgical and oncological outcomes are described. Among 40 patients undergoing TOELS for glottic and supraglottic tumours, negative superficial and deep margins were achieved in 79.2% and 75% of patients, respectively. The mean operative time was 73.7 ± 35.9 minutes. Fourteen patients were treated by TOEOS and in only one case was re-resection required due to a positive deep margin. The mean operative time for TOEOS was 140.3 ± 82.1 minutes and the average duration of hospitalisation was 10.3 ± 3.8 days. 3D exoscopes improve visualisation of the surgical site in different environments and allow the use of multiple surgical instruments and lasers, easing transoral surgery. In addition, as the first surgeon's view is shared between the operatory room (OR) staff, the exoscopic setup plays a crucial role in the collaboration between the OR team and for teaching purposes.

Primary Site Influences the Ability of Magnetic Resonance Imaging to Assess Cartilage Invasion in Advanced Laryngeal Cancer.

Accurate staging of advanced laryngeal cancer is important, as treatment can vary significantly between larynx preservation and total laryngectomy. The purpose of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) in assessing features of T4a disease in locally advanced laryngeal cancer and determine if primary site played a role in the accuracy of MRI in this setting. A retrospective cohort study of patients undergoing a total laryngectomy in a tertiary referral center for head and neck cancer over a 10-year time period was carried out. Patients met inclusion criteria if they underwent a primary total laryngectomy for squamous cell carcinoma (SCC) of the larynx during the study period. Data collected included basic demographic data, primary tumor subsite, and clinical and pathological staging. The predictive ability of MRI on outer thyroid cortex invasion, extralaryngeal extension, and overall T4a stage was analyzed with receiver operating characteristics analysis. Analysis was compared to histological data on outer thyroid cortex invasion, extralaryngeal extension, and histological T4a stage. A total of 112 patients met inclusion criteria. The mean age of the cohort was 65.1. Glottic primary subsite was associated with a statistically significant elevated risk for histological outer cortex erosion (p = 0.006), but MRI demonstrated worse sensitivity in detecting this outer cortex invasion in glottic primaries(p = 0.002). Glottic primaries tumors display an increased likelihood of thyroid cartilage invasion, however, MRI demonstrates a poorer sensitivity for detecting these features. Level 3 Laryngoscope, 2024.

A Retrospective Analysis of Treatment of Advanced Laryngeal Squamous Cell Carcinoma at the Clinical Oncology Department Ain Shams University Hospitals

Abstract Background Laryngeal squamous cell carcinoma is one of the most common head and neck malignancies, and up to 40% of patients present with advanced disease. Several studies have proven the prognostic significance of different parameters including age, sex, smoking, grade, staging, and different treatment modalities. Aim of the Work To retrospectively study and analyze the treatment modalities of advanced stage laryngeal cancer, factors affecting response to treatment, and survival including overall survival (OS) and progression free survival (PFS). Patients and Methods We conducted a retrospective study of 60 patients' charts histopathologically diagnosed with advanced stage laryngeal squamous cell carcinoma. The patients were treated at the head and neck clinic at the Clinical Oncology Department, Ain Shams University, between January 2016 and December 2020. We reviewed patient demographics, tumor characteristics, treatment modalities, and survival data. Results Sixty patients were accrued in our study. The mean age of the patients was 62 years, and 93.3% were male. The most common site affected was the glottic area, and smoking was a risk factor in 83.3% of patients. Majority of the tumors had a moderate degree of differentiation (G2). All the patients had squamous cell carcinoma. Treatment modalities showed statistically significance effect on the response to treatment. The patients treated with total laryngectomy plus radiotherapy and/or chemotherapy achieved complete response compared to the patients who were treated with chemo-radiation or radiotherapy alone (p > 0.001). Tumor grading, nodal staging and T staging tended to positively affect response to treatment but did not reach statistical significance. The percentage of the patients with G1 disease who achieved complete response was 100% (p > 0.37), the patients percentage with nodal negative disease who achieved complete response was 62.1% (p > 0.57) and regarding T staging the percentage of the patients in stage III, IV who achieved complete response was 50%, 64.3% respectively (p > 0.27). Of the different tumor factors, only the tumor grade showed a statistically significant impact on survival. The 5-year overall survival rate (OS) was 100% for grade I, 67.6% for grade II, and 53.3% for grade III (p < 0.04). Other factors with negative impact on survival but did not reach statistical significance were site of the tumor and tumor stage. The percentage of the patients with stage III and IV who remain alive was 66.7% and 63.3% respectively (p > 0.41). Regarding tumor site the 5-years OS was 71.9 for glottic tumors, 50% for supraglottic tumor and 70% for transglottic tumor (p > 0.37). Our study aimed to assess the PFS, unfortunately it couldn’t be assessed as the number of patients who developed progression was only 3/60(5%) patients and 57/60 (95%) of the patients did not show progression. The mean OS of our study was 32 months and the median OS was 34 months. Conclusion Our study revealed that total laryngectomy plus radiotherapy and/or chemotherapy is the preferred treatment modality for advanced laryngeal cancer patients. Tumor grade is one of the most significant prognostic factors and is a predictor of survival.

A Rare Case of Pulmonary Tuberculosis Masquerading as Laryngeal Tuberculosis or Malignant Manifestation

Introduction: Laryngeal tuberculosis (LTB) is usually accompanied by pulmonary tuberculosis (TB) involvement. Misdiagnosis often occurs because the symptoms are non-specific and resemble laryngeal malignancy. We reported a rare condition of pulmonary TB masquerading as larynx abnormalities such as malignant manifestations. Case: A 59-year-old man presented with a main complaint of prolonged hoarseness without clinical respiratory complaints. The patient additionally reported coughing as a symptom while receiving medical treatment in the hospital. A computed tomography (CT) scan of the neck without contrast revealed a glottic tumor invading the vocal cord – T3N2cMx. Laryngoscopy examination revealed T1-T1 tonsils. The pharyngeal mucosa was slightly hyperemic. The arytenoids and epiglottis were less hyperemic. There was no edema, the left vocal fold was paralyzed, could not be adducted, and there was a lump. The glottis rima gap was narrow, size 3–4 mm, and the mass could not be evaluated. Chest X-ray examination was normal, but rapid molecular tests of TB detected very low Mycobacterium tuberculosis (MTB) levels. The patient was treated with anti-TB treatment (ATT) according to body weight. An evaluation was performed after 2 weeks, and the patient's clinical and physical condition improved. Conclusion: Pulmonary TB patients in endemic countries can have clinical manifestations such as LTB or laryngeal malignancy in 1% of cases. The prognosis for LTB with pulmonary T involvement is quite good with ATT administration.

Extraosseous osteosarcoma of the larynx: an unusual tumor managed with radical surgery – case report

Introduction and importance: Extraosseous osteosarcoma (EOO) is a malignant tumor that arises in soft tissue without affecting bone or periosteum but produces osteoid, osseous, or chondroid material. It is a very rare malignancy that accounts for approximately less than 1% of all tissue sarcomas and ~2–4% of all osteosarcomas. EOO in the head and neck region is extremely rare; however, in the larynx, it is exceptional, with only one case reported worldwide in the literature to date. Case presentation: A 72-year-old male with no personal history of interest in the current condition presented with dysphonia, hoarseness, and dyspnea for 6 months. A flexible nasofibrolaryngoscopy (FNFL) and computed tomography (CT) scan exhibited a glottic tumor with a lumen obstruction of 90%. An endoscopic resection was performed, reporting an EOO, osteoblastic, and ulcerated type. During follow-up, tumoral persistence was detected, leading to the decision to perform a definitive radical treatment with a total laryngectomy. Clinical discussion: Its presentation in the head and neck region is exceptional, with only a few isolated cases reported in the literature. Available data on treatment recommendations have emphasized the importance of timely surgical intervention with adjuvant radiation therapy if necessary for the head and neck. Conclusion: Extraosseous osteoblastoma of the larynx is an extremely rare and infrequent disease. Correct diagnosis and oncological surgical management of this disease are essential for optimal and even curative treatment of the patient.

Isoprognostic functional CT map for open partial horizontal laryngectomy.

To identify a radiological map of laryngeal subsites whose involvement by the tumor could predict patients' functional outcomes after open partial horizontal laryngectomy (OPHL). The present retrospective analysis concerned 96 patients with glottic squamous cell carcinoma, who were radiologically staged with contrast-enhanced neck CT scans before undergoing supracricoid or supratracheal laryngectomy. A radiological map of patients' functional risk was developed by considering the distribution of functional outcomes in relation to the laryngeal subsites involved. The functional outcomes considered were: (i) decannulation at discharge; (ii) time to removal of the nasogastric feeding tube (NFT); (iii) postoperative complication rate; and (iv) length of hospital stay. Involvement of the anterior supraglottis was related to a longer need for NFT, and a longer hospital stay (p = 0.003, and p = 0.003, respectively). Involvement of the posterior glottis negatively affected the time to decannulation, and the likelihood of postoperative complications (p = 0.000, and p = 0.002, respectively). Anterior glottic small tumors (without significant subglottic and/or supraglottic extension) are related to the best functional outcomes after OPHL, since the suprahyoid epiglottis and both the arytenoids are likely to be spared.

External validation of the GETTEC algorithm for elective neck dissection in patients candidates for salvage total laryngectomy

ObjectiveTo perform an external validation of the algorithm for elective treatment of the lymph node areas proposed by GETTEC for patients candidates to salvage total laryngectomy after radiotherapy. This algorithm is based on the initial lymph node status, local extension of the recurrence and time to recurrence. Material and methodsRetrospective study performed in 151 patients treated with salvage total laryngectomy without clinical or radiological evidence of regional involvement at the time of diagnosis of recurrence (rcN0). The percentage of patients with occult lymph node metastases was calculated according to the algorithm proposed by GETTEC. ResultsA total of 14.6 % (n = 22) of the patients had occult lymph node metastases. Patients with locally advanced recurrences (rcT4) had a higher risk of occult lymph node metastases. There were no significant differences in the risk of occult lymph node metastases according to initial lymph node status or time to recurrence. When applying the algorithm proposed by GETTEC, there were no significant differences in the percentage of occult lymph node metastases between the group of patients who were candidates for follow-up (14.4 %) and those candidates for elective neck dissection (14.9 %) (P = 0.940). According to our results, patients who were candidates for an elective neck dissection were those with tumors located in the supraglottis or rcT4 glottic tumors. ConclusionOur results do not validate the algorithm proposed by GETTEC for the management of the lymph nodes in rcN0 patients who are candidates for salvage total laryngectomy after radiotherapy.

Prognostic value of preoperative inflammatory ratios in early glottic cancer treated with transoral laser surgery.

There is growing evidence regarding the prognostic utility of ratios such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammatory index (SIII) in head and neck squamous cell carcinoma (HNSCC). However, most studies to date include heterogeneous series with different treatments or tumor subsites. We collected data from 201 patients with stage I-II glottic squamous cell carcinoma treated with transoral laser surgery. NLR, PLR, and SIII were calculated from preoperative cell blood count, cut-off points were obtained by ROC curve analysis, and survival rates were calculated. High NLR (p = 0.012) and SIII (p = 0.037), but not PLR (p = 0.48), were associated with worse disease-specific survival (DSS). A similar trend was observed with overall survival (OS), although it did not reach statistical significance. On multivariable analyses, both high NLR (HR = 3.8, 95% CI = 1.5-9.9, p = 0.006) and high SIII (HR = 2.77, 95% CI = 1.1-6.9, p = 0.03) were significantly associated with shortened DSS. Preoperative NLR and SIII emerge as independent prognostic biomarkers for early-stage surgically treated glottic tumors and could guide individualized follow-up.

Influence of tumor topography on clinical-morphological profile of laryngeal malignancies.

Laryngeal cancers are redoubtable because they are still diagnosed in advanced stages which results in poor survival and the decline of life quality. The authors intend to identify if the tumor topography influences clinical behavior, the morphological profile and therapeutic strategy. The study group included 188 patients with laryngeal malignancies diagnosed and treated in an Ear, Nose and Throat (ENT) Department. The patients have been divided into four groups according to the tumor topography and extension. Three categories of parameters were defined (epidemiological, clinical, and morphological) and analyzed comparatively between the four groups using filter scales and the χ² (chi-squared) correlation test. Epidemiological parameters (sex, age, socio-economic status) showed no significant differences between the four groups. Clinical parameters (symptoms, lymphadenopathies, surgical procedures, and hospitalization) instead registered significant differences between the four groups. Morphological parameters (longitudinal diameter, transverse diameter, shape, gross aspect, histopathological aspect, grade, local invasion - pT, lymph node invasion - pN, metastases - pM and tumor stage), excepting shape, registered too significant differences between the four groups. The analysis of the whole set of parameters in each group revealed different, distinct profiles for each of the topographic groups, especially for glottic and large tumors. Our results concerning the entire series of tumors ranged in the limits of variation of each of the parameters observed in the literature. Our study revealed that tumors placed in different regions of the larynx have distinct profiles from epidemiological, clinical, and morphological points of view. However, the profile of our entire group of tumors proved to be comparable with the literature data.

Value and role of surgical margins in transoral laser microsurgery of the larynx, literature review and clinical considerations.

There is no agreement on the most appropriate post-operative pathway for the management of positive margins after laser cordectomy for early stage glottic tumours (T1-2N0M0). This literature review and meta-analysis aim to evaluate the post-operative treatment with the best oncological results among follow-up, radiotherapy (RT) and surgical second look. The parameters utilized were incidence of recurrence, overall (OS), disease-specific (DSS) and disease-free (DFS) survival and larynx preservation (LP). The articles were found through a string typed into PubMed from 2007 to 2022. The studies with detailed oncological results were selected according to inclusion criteria, and then the meta-analysis was carried out. Sixteen studies met the inclusion criteria for 2808 patients. The positive margin was found in 748 patients (26.6%), of which 416 were referred to follow-up, 89 to RT and 242 to a surgical second look. A false positive margin was found in 58/104 patients (56%). The recurrence rate in patients with positive margins was significantly higher (p = 0.003). In OS, DSS, DFS and LP, the odds ratio (OR) value was always greater than 1, assessing the role of the positive margin as a risk factor. Prospective studies will be necessary to establish the role of positive margin as a prognostic factor. A surgical second look in case of positive margin seems to be the best option for the patient in terms of lower risk of recurrence and better oncological results. Better collaboration between surgeon and pathologist would be desirable to limit the real and false positive margins.

Extended partial laryngectomy with functional preservation using the rotational crico-thyrotracheopexy.

Glottic tumors with infiltration of the anterior/posterior commissure, and lesions with subglottic, cricoid, or cricoarytenoid joint infiltration have been highly controversial in the past, from the perspective of oncological safety. Although conservation laryngeal resection options exist, most are limited by the extent of resection proscribed by the technique and the postoperative functional results. Oncologically speaking, extended vertical hemilaryngectomy is often the optimal solution. However, limited reconstruction methods often compel total laryngectomy. Eight patients with vocal fold malignancy, which infiltrated the anterior and sometimes the posterior commissure and with subglottic extension and resultant uni/bilateral vocal fold motion impairment, were treated by single stage extended vertical partial laryngectomy with rotational crico-thyrotracheopexy as a functional reconstruction of the laryngeal framework. Patients were evaluated with objective and subjective function tests. Histologic examination demonstrated tumor-free margins in every case. Definitive decannulation was successful in all cases within 2 weeks. All patients had a stable and adequate airway during follow-up and reported socially acceptable voice. Oral feeding was possible in seven patients. Rotational crico-thyrotracheopexy, as a single stage reconstruction technique, is based on well-vascularized, readily available, appropriately shaped local tissues, without significant donor site morbidity or need for long-term stenting to reconstruct large laryngeal defects after extended vertical hemilaryngectomy for advanced unilateral glottic tumors and is applicable even with supra/subglottic invasion or infiltration of the contralateral vocal fold. An adequate airway can be achieved with socially acceptable voice and safe swallowing without compromising oncologic reliability. 4 (retrospective case series review).

Fabrication of Graphene Optical Devices for Endoscope Calibration

Endoscopic devices used in the clinical examination of pathologies such as glottic tumors can record real-time images of the vocal cords during vibration. Quantitative analysis of the glottic surface requires the metric system to obtain the absolute dimensions of the larynx in a series of acquired images. However, so far, there is no effectively automated and stable calibration method for clinical use. Therefore, most metrics used by professionals are invasive and subjective. Thus, this study reports the microfabrication of a diffractive optical element (DOE) that could potentially quantify cancer cells from the glottic surface of patients. It has been observed that the image of the glottis seen through an endoscope is shaped by its geometric properties and by the shading of color and brightness. Therefore, tumor location and size can be quantified by overlaying the DOE metric with light spots on images that include the glottic region. DOE was developed from processes used in the fabrication of integrated circuits and MEMS, already quite mature. To obtain high-quality images from optical reconstruction of the glottis, the use of graphene monolayers grown by chemical vapor deposition (CVD) on copper (Cu) foil was investigated. This was transferred to a glass substrate by wet method (Fishing method) and the etching steps of the Cu substrate were carried out. In this method, polymethylmethacrylate (PMMA) was used as the supporting polymer through the spinner. Two lithographs were made under the glass substrate with different approaches (using a Karl Suss MJB3 mask aligner system with a maximum resolution of 1 µm). The first, which preceded the thin-film transfer, aimed to delineate the graphene transfer area using an aluminum (Al) deposition technique by sputtering. The second lithography, linked to oxygen Ashing plasma corrosion, made it possible to study the modulation of a microrelief containing parallel and serpentine patterns, of amplitude and phase, spaced from 1 to 10 μm. An optical system containing an EOD and a Fourier lens was attached to the endoscope end to project a laser line parallel to the vocal cords. Image processing methods automatically identify pixels in the image data that belong to the projected laser line. Thus, the detection of the diffractive pattern was based on segmentation of endoscopic images centered on Sobel filtering and on the method with active boundary regions of the watershed. These use successively robust temporal and spatial characteristics of the laser lines projected onto the endoscopic image sequence. In short, the combination of laser projection device and image processing allows calibration of endoscopic images and can provide quantitative metric data for tumors on the surface of the vocal cords. Therefore, the proposed calibration method can be considered a powerful tool to aid in the prognosis of laryngeal pathologies. Figure 1

Impact of Anterior Commissure Involvement and Frozen Guided Resections on Oncological Outcomes after Laser Cordectomy in Early Glottic Cancers – A 10-year Retrospective Analysis from a Tertiary Care Cancer Center in India

Background: Early glottic cancers can be treated using different options such as transoral laser microsurgery (TLM), open partial laryngectomy (OPL), and radiation therapy (RT). TLM provides similar oncological benefits to OPL in a few subsets of patients, and the quality of voice is comparable to RT, while hospitalization time is reduced. Resection by laser microsurgery of early glottic cancer with anterior commissure involvement (ACI) is more challenging mainly due to difficulty in adequate exposure. The frozen section is reliable in TLM for determining the extent of resection and the real depth which may be masked on videoscopy. Materials and Methods: This study is a retrospective analysis of patients with early glottic cancer (Tis, T1) who underwent TLM in a tertiary cancer center in South India from January 1, 2012, to December 31, 2019. All patients were identified from the hospital registry. Results: The study included 89 patients, and the median follow-up was 54 months. Out of 89 patients, 14 patients had local recurrence which was managed with salvage TLM/salvage RT/salvage laryngectomy. There were three patients with nondisease-specific deaths. Among the study population, the laryngeal preservation rate was 96.6%, the cause-specific survival rate was 100%, and the overall survival rate was 97.7%. The 3-year disease-free survival rate was 84.4%. ACI and frozen margin positivity were statistically significant poor prognostic factors. Conclusion: TLM is a safe and effective treatment of early glottic carcinoma. Apart from tumor (T) staging, ACI and frozen positivity were negative predictive factors. The results suggest the need to consider ACI in the T staging of glottic tumors. Frozen positivity helps us in re-excision but signifies that the disease is deeply infiltrative or aggressive and a vigilant follow-up is required for these patients.

Glottic lesion segmentation of computed tomography images using deep learning

The larynx, a common site for head and neck cancers, is often overlooked in automated contouring due to its small size and anatomically complex nature. More than 75% of laryngeal tumors originate in the glottis. This paper proposes a method to automatically delineate the glottic tumors present contrast computed tomography (CT) images of the head and neck. A novel dataset of 340 images with glottic tumors was acquired and pre-processed, and a senior radiologist created a detailed, manual slice-by-slice tumor annotation. An efficient deep-learning architecture, the U-Net, was modified and trained on our novel dataset to segment the glottic tumor automatically. The tumor was then visualized with the corresponding ground truth. Using a combined metric of dice score and binary cross-entropy, we obtained an overlap of 86.68% for the train set and 82.67% for the test set. The results are comparable to the limited work done in this area. This paper’s novelty lies in the compiled dataset and impressive results obtained with the size of the data. Limited research has been done on the automated detection and diagnosis of laryngeal cancers. Automating the segmentation process while ensuring malignancies are not overlooked is essential to saving the clinician’s time.

Oncological and Functional Outcomes for Horizontal Glottectomy: A Systematic Review.

Horizontal glottectomy (HG) is a particular type of partial laryngectomy indicated for exclusive glottic tumor with anterior commissure involvement. The purpose of this study is to systematically review the literature about functional and oncological outcome of HG. This systematic review adhered to the recommendations of the PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analysis) 2009 guidelines. Articles mentioning patients undergoing HG for laryngeal squamous cell carcinoma were included. A total of 14 articles were selected and reviewed from 19 identified. The whole study population consisted of 420 patients who underwent HG. Three hundred and thirty-nine patients out of 359 were staged as T1. The range of post-operative follow-up was 5 months to 10 years. Fifty-five recurrences were experienced, being local, regional and distant in 35, 12 and 8 patients, respectively. Laryngeal preservation rate was 93.6%. Nasogastrict tube was removed on average after 10.1 days. The tracheostomy was maintained for 11.3 days. Mean hospitalization lasted for 11.7 days. According to the results of this systematic review, HG is an oncologically safe surgical option for T1a-T1b glottic tumors with oncological outcomes comparable to other treatment. HG could be a good therapeutical choice whenever poor laryngeal exposure and/or patient's refusal of radiotherapy are encountered, or when patient's medical history represents a contraindication for radiation therapy.

Diagnostic Accuracy of Preoperative CT and Endoscopy Staging in Early Laryngeal Cancer.

This study aims to evaluate the diagnostic accuracy of preoperative computed tomography (CT) and intraoperative endoscopic tumor staging with regard to histopathologic staging in patients with early laryngeal cancer. A retrospective nonrandomized single-institution comparative cohort study including 109 patients. A tertiary surgical center. Patients were treated for T1a, T1b, and T2a laryngeal squamous cell carcinoma by endoscopic laser surgery. The outcome measures were the presence of under- or overstaging in endoscopic and CT findings and positive postoperative margins. Endoscopic overstaging as compared with histopathologic T category correlated with rising tumor category (P = .001; odds ratio [OR], 69.1) and CT findings showing anterior commissure involvement (P = .002; OR, 9.54), while endoscopic understaging correlated with rising tumor histologic grade (P = .039; OR, 4.28) and smaller tumor size (P = .011; OR, 6.39). CT overstaging vs histopathologic T category correlated with CT findings showing anterior commissure involvement (P = .001; OR, 21.76), supraglottic involvement (P = .001; OR, 59.98), subglottic involvement (P = .001; OR, 39.94), rising clinical T category (P = .01; OR, 9.11), and rising tumor histologic grade (P = .004; OR, 10.95). CT understaging as compared with histopathologic T category correlated with smaller clinical T categories (P = .002; OR, 12.72) and smaller tumor histologic grade (P = .030; OR, 7.02). Rising age, rising tumor size, anterior commissure involvement on CT, and tumor extension into the supraglottis were risk factors for positive margins. Our results indicate that CT adds little valuable information in differentiating small superficial lesions in the glottis, while systematically overstaging cases of early laryngeal cancer. In T1a and T1b glottic tumors, endoscopy should be the preferred diagnostic method.

Oncological and Functional Outcomes of Supracricoid Partial Laryngectomy

Objective: The aim of this study is to review the oncological outcomes of T1-T4 glottic or supraglottic tumor patients who underwent supracricoid partial laryngectomy in our clinic. Material and Methods: A total of 43 patients with laryngeal squamous cell carcinoma who underwent supracricoid partial laryngectomy between January 2014 and December 2016 in the Otorhinolaryngology Department of Istinye University Hospital were retrospectively analyzed. Postoperative data of these patients regarding surgical margin, nasogastric feeding tube removal time, decannulation time, postoperative radiotherapy, local regional recurrence, and distant metastases were recorded. Results: Cricohyoidoepiglotopexy was applied to 16 patients by preserving both arytenoids and applied to 7 patients with a single arytenoid; Cricohyoidopexy was applied to 14 patients with both arytenoids preserved, and 6 patients were treated with a single arytenoid. The five-year survival was compared for Cricohyoidopexy/Cricohyoidoepiglotopexy with single arytenoid to double arytenoid preservation and found to be 80%-76% (p=0.56). The mean 5-year survival was 88% in the post-operative radiotherapy group, and 86% in the non- radiotherapy group. The study compared patients with Cricohyoidopexy/Cricohyoidoepiglotopexy with a single arytenoid to those with double arytenoid preservation; the mean decannulation time was 54.23±34.12 to 35.62±27.08 (p=0.05). Postoperative radiotherapy prolonged the decannulation time (51.16±38.5 versus 32.68±20.1; p=0.043). The duration of nasogastric tube placement in the Cricohyoidopexy/Cricohyoidoepiglotopexy with a single arytenoid group was 50.3±14.3 and double arytenoid preservation was 35.17±32.9 (p=0.088). Nasogastric tube removal time was 53.29±50.2 in the post-operative radiotherapy group and was 30.24±16.8 in patients who did not receive post-operative radiotherapy (p=0.040). Conclusion: Supracricoid partial laryngectomy with Cricohyoidoepiglotopexy and Cricohyoidopexy had satisfactory oncological outcomes, and laryngeal function was preserved by rebuilding the neolarynx.

Association of tumor volume and outcomes in T3 larynx cancer with organ preservation approach.

e18044 Background: Organ preservation approaches to treatment of locally advanced larynx cancers are widely used and consist of radiotherapy (RT) with or without concurrent systemic therapy (CRT). Analyses of the National Cancer Database point to decreasing survival as CRT became widely adopted in place of total laryngectomy (TL). Tumor volume in T3 laryngeal tumors has been postulated as one variable to explain this finding, with higher volume associated with lower local control based on small sample size studies largely in pre-intensity modulated radiotherapy (IMRT) era, and low volume T3 tumors being associated with improved local control with CRT. We sought to validate these findings in a contemporary cohort of T3 larynx patients treated with IMRT. Methods: This was a national, multicentre retrospective cohort study of patients diagnosed with American Joint Committee on Cancer (AJCC) T3 N0-3 M0 glottic and supraglottic cancers who underwent curative intent IMRT with or without systemic treatment from 2002-2018. Tumor volumes were calculated using a validated standardized approach by a Neuroradiologist. Primary predictor was tumor volume, primary outcome was local control (LC), and secondary outcomes included overall survival (OS), as well as late grade 3+ toxicities. Kaplan Meier estimates and log-rank tests were used for survival analyses, with Cox proportional hazards used for univariable analyses. Results: 246 patients met inclusion criteria, 147 glottic and 99 supraglottic cancers. At baseline, glottic patients were more likely to be male (p < 0.01), have a fixed vocal cord (p < 0.01), not have pre-epiglottic space invasion ( < 0.01), be cN0 (p < 0.01), and have lower grade tumors (p < 0.01). Mean tumor volumes for glottic and supraglottic tumors were 5.0 (4.2-5.8) cc and 13.0 (10.3–15.6) cc respectively. Univariable analysis showed systemic therapy was associated with improved local failure (HR 0.49, 95%CI 0.24 – 0.99, p = 0.05). Within the glottic cohort, tumor volume was not associated with local failure (HR 1.09, 95%CI 0.71 – 1.67, p = 0.38), however having a local failure event was associated with increased feeding tube dependence (HR 2.52, 95%CI 1.05 – 6.02, p = 0.04). Median local failure free survival in the overall cohort was 28.5 months, with median OS 23.2 months. There was a trend towards improved local control in the supraglottic cohort compared to glottic patients (log-rank p = 0.08), but the supraglottic cohort had significantly worse overall survival (log-rank p = 0.02). Conclusions: In this retrospective cohort study, there were baseline and outcome differences between patients with T3 glottic and supraglottic larynx cancer, with worse overall survival in supraglottic patients. Tumor volume was not associated with local control in the glottic cohort. These findings are pending further validation in a larger cohort and will be analyzed separately for supraglottic tumors.

Diagnostic accuracy of flexible fiberoptic laryngoscopy: experience from a tertiary health institution in Nigeria.

Flexible fibreoptic laryngoscopy (FFL) is a technique of laryngeal visualization. The instrument (flexible laryngoscope) is relatively scarce in resource challenged countries. Where available, it is a useful compliment to the armamentarium of clinical tools at the disposal of the otolaryngologist. We evaluated the diagnostic value of flexible fibreoptic laryngoscope in a tertiary health institution in Nigeria. And we hypothesized that its diagnostic precision is comparable to direct laryngoscopy. This is a retrospective study of records of 360 patients referred for FFL at the ENT clinic. Sensitivity and specificity of FFL for laryngeal lesions were determined using direct laryngoscopy (DL) as the gold standard. Of the 360 FFL reports studied, 336 additionally underwent DL. FFL findings in 311 (92.6%) cases were comparable with that of DL. FFL had a good detection rate for vocal cord palsy (sensitivity 100%, specificity 80.7%). Pick-up rate for vocal nodules, polyps, papillomatosis and palsy were statistically equal for FFL and DL (p value = 0.96). Diagnostic accuracy of FFL was good for supraglottic (sensitivity 100%, specificity 88.0%) and glottic (sensitivity 100%, specificity 92.3%) tumours; relatively lower for subglottic (sensitivity 83.3%; specificity 100%) and transglottic (sensitivity 80.0%, specificity 100%) tumours; and least for tumours involving more than on subsites (sensitivity 50%, specificity 100%). The sensitivity and specificity of FFL were not the same for all endo-laryngeal lesions; yet, the overall diagnostic accuracy of FFL is comparable with DL. Clinicians should be mindful of this variability to optimize its application.