Post Cricoid Research Articles

Retrospective Study of Laryngeal Preservation Treatment for Hypopharyngeal Carcinoma with Transoral Resection or Induction Chemotherapy

We have performed transoral surgical resection for patients with T1/T2 hypopharyngeal cancer and induction chemotherapy with docetaxel for patients with T2/T3 disease. The patients were analyzed in order to determine the current situation of larynx preservation in patients with hypopharyngeal cancer. The data of a total of 83 patients with hypopharyngeal cancer were analyzed retrospectively. The primary subsites were : pyriform sinus (PS) in 61 patients, posterior wall (PW) in 13 patients, and postcricoid (PC) in 9 patients. The number of patients classified as having T1, T2, T3 and T4 disease were 14, 29, 23 and 17, respectively. The main therapies employed in the patients were as follows: transoral surgical resection plus radiation therapy for T1 disease, radiation therapy, induction chemotherapy, and partial resection for T2 disease, induction chemotherapy, radiation therapy, and pharyngo-laryngoesophagectomy for T3 disease, and pharyngo-laryngoesophagectomy plus induction chemotherapy for T4 disease. The 5-year larynx preservation rates in the patients with T1, T2, T3 and T4 disease were 100%, 73%, 39% and 35%, respectively. Our method was able to improve the larynx preservation rate without having any adverse effect on the survival rate. However, the strength of treatment for T 3 disease needs to be improved, because a large number of recurrences and deaths due to the primary disease were encountered in this patient group.

Pattern of clinical presentation of hypopharyngeal carcinoma

Objectives: To determine the pattern of clinical presentation of hypopharyngeal carcinoma and pattern of metastases. Methods: This was a cross sectional study with 60 patients. Study was carried out in the Department of Otolaryngology and Head Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and Mitford Hospital during the period of July 2005 to June 2007. This diagnosis was made by detailed history clinical examination and relevant investigation. Analyzed data and presented by various tables, graphs and figures. Result: In this study majority of the patients were within 51-60 years, male female ratio was 7.5:1, majority was smoker (91.66%), 58% patients had habit of tea, 88.32% of the patients chewed betel, Majority of the patients (81.16%) had presented with progressive dysphagia 76.66% and hoarseness of voice (60%), There was neck swelling in 53.3% and haemoptysis in 25% of patients. 63.33% patients had ulcerative lesion, 40% normal laryngeal movements, 63.33% were adequate airway, 65% patient had cervical lympadenopathy. Primary lesion was 75% in pyriform fossa, 20% in post cricoid region and 5% in posterior pharyngeal wall. 46.66% were T3 stage, 53.33% N1 and 48.71% were level IV nodal involvement. Conclusion: Hypophayngeal carcinoma usually presents in advanced state. DOI: http://dx.doi.org/10.3329/bjo.v19i2.17630 Bangladesh J Otorhinolaryngol 2013; 19(2): 87-93

English

Plummer-Vinson syndrome is known as the association of postcricoid dysphagia, upper oesophageal web, and iron deficiency anaemia. Although correction of iron deficiency may result in resolution of dysphagia and sometimes disappearance of the webs, dilation therapy is usually necessary to remove webs and relieve dysphagia. We report a rare case of Plummer-Vinson syndrome with recurrent post cricoid web. Patient had undergone balloon dilatation for the web three year back and was symptom free for three years. The patient presented this time with significant dysphagia, sideropenia, angular stomatitis and generalised weakness. Our patient had occasional choking and aspiration episodes at eating and endoscope did not pass through at the level of the upper oesophagus. Patient’s barium swallow revealed the presence of webs in part of the post-cricoid region. Patient was treated with oesophageal balloon dilation, blood transfusion and iron supplementation. The patient is put on regular follow-up.

Histologic versus pH probe results in pediatric laryngopharyngeal reflux

ObjectiveA comparison of histologic findings from the post-cricoid region versus nasopharyngeal pH probe results in the diagnosis of laryngopharyngeal reflux (LPR) in the pediatric patient. Study designRetrospective review. SettingOutpatient pediatric otolaryngology private practice. Subject and methods63 consecutive patients, age 6-months to 17-years between June 1, 2009 and October 6, 2010, tested by simultaneous post cricoid biopsy and nasopharyngeal pH probe monitoring using the Restech Dx-pH Measurement System (Respiratory Technology Corporation, San Diego, CA). ResultsOf the 63 total patients (age 6-months to 17-years), 11 (17%) were excluded due to a pulled probe, one additional patient did not have a biopsy taken and one probe failed after insertion making a total of 50 patients with complete data sets. Thirty-six of those 50 patients had a positive probe with a negative biopsy (72%). Four (8%) had both a positive probe and biopsy and 10 (16%) had a negative probe and negative biopsy. No patients had a negative probe and positive biopsy. Symptoms used to identify patients suspected of reflux included: throat clearing, nasal congestion, cough, history of recurrent sinusitis with negative radiographic findings, halitosis, culture negative sore throat, post nasal drip, otalgia, poor appetite and stomach ache. ConclusionEighty percent of our patients (40) were either positive for reflux by pH probe or by pH probe and biopsy. The Restech Dx-pH Measurement System appeared to be well tolerated in all age groups. There were no complications. We found this a useful tool in confirming clinical suspicion of LPR.

化学放射線同時併用療法に伴う経鼻胃管留置が喉頭壊死の一因と考えられた下咽頭癌の1例

A 62-year-old male with cT4bN2cM0 hypopharyngeal carcinoma with ipsilateral vocal cord fixation was initially treated with concurrent chemoradiotherapy. Since the patient complained of dysphagia caused by mucositis, a nasogastric tube was placed on the day of irradiation with a dose of 20 Gy. Bilateral vocal cord fixation and laryngeal necrosis became evident 3 weeks after the concurrent chemoradiotherapy. He underwent a total pharyngolaryngectomy (neck dissection, and reconstruction with a free jejunal graft) followed by adjuvant chemotherapy. It is highly suspected that the nasogastric tube compressed the mucosa of the post cricoid region, resulting in laryngeal necrosis.

A case study of Plummer-Vinson syndrome

The case series presents the pattern of association of different co-morbid conditions of Plummer Vinson's Syndrome. The commonest morbidity is web at post cricoid level. The symptoms of dysphagia are more common and there appears to be a female preponderance. The presenting age us usually 5th decade. Although association with post cricoid carcinoma has been reported but only 10% of cases in the present series had carcinoma at the time of presentation. The effect of iron and B-complex supplementation has been clinically appraised and good symptomatic relief has been seen. Maybe this measure can prevent the progression to malignancy. Bouginage was effective in relieving symptoms in all the cases it was tried.

Foreign bodies in upper digestive tract

Foreign body ingestion is a common problem frequently encountered in both children and adults. A total number of 152 patients (104 children and 48 adults) with ingested foreign body admitted in our hospital are reviewed. Location of foreign body was made out by radiological examination. History of having swallowed foreign body was the most common symptom in both blunt and sharp foreign bodies. Endoscopic removal of foreign body was done under general anaesthesia for all cases, except one in which foreign body was removed by open surgical method. Blunt, foreign bodies were common among children, where as meat with bone was common in adults (19/48). Most of blunt foreign bodies in children (83.5%) were impacted in post cricoid region. Where as in adutls, the foreign bodies (37.5%) were seen in upper oesophagus. Retropharyngeal abscess was seen in 2 cases, which was associated with sharp foreign bodies. In all but one, endoscopic removal was successful. In one case denture impacted in post cricoid region was removed by open surgical method. There was no mortality in our series.

Medial vs lateral wall pyriform sinus carcinoma: implications for management of regional lymphatics.

Our purpose in performing this review is to analyze the relationship between the anatomic site of hypopharyngeal lesions and the pattern of recurrent disease, particularly cervical recurrence. This clinical information can subsequently be used to influence treatment options. The records of 169 patients with carcinoma of the hypopharynx treated between 1975 and 1986 were reviewed retrospectively. Patients were classified as having medial wall pyriform sinus disease (MP) lesions, lateral wall pyriform sinus (LP) lesions, posterior wall (PW), or postcricoid (PC) lesions. All patients were followed a minimum of 36 months. Patients with evidence of recurrent carcinoma were characterized according to the site of recurrence. Recurrent carcinoma in the hypopharynx was noted in seven (4%) of 169 patients. Cervical metastases was the sole site of failure in 27 (16%) of 69 patients, whereas distant metastases developed in 25 (15%) of 169 patients. Failure in the contralateral unoperated neck occurred in 14% (10/71) of patients with MP lesions and, in contrast, 5% (4/76) LP patients. This difference was statistically significant (p = 0.04). Radiotherapy was not effective in preventing cervical recurrence in 20 (74%) of 27 overall neck failures and 11 (79%) of 14 contralateral NO neck failures. These data suggest that patients with carcinoma involving the MP are at greater risk for contralateral cervical metastases. We recommend bilateral neck dissection be offered to patients with MP lesions.

Histopathologic study of carcinoma of the hypopharynx: implications for conservation surgery.

A total of 38 specimens obtained by laryngopharyngectomy were subjected to a whole organ section study. Of the 38, 31 were pyriform sinus (PS), three were postcricoid (PC), and four were posterior wall (PW) carcinomas. The results were as follows. 1) The thyroid cartilage was involved much more frequently than the other laryngeal cartilages. 2) Joint involvements were infrequent. 3) The interarytenoid, thyroarytenoid, and lateral cricoarytenoid muscles frequently were invaded by PS carcinomas, whereas PC carcinomas frequently involved the interarytenoid and posterior cricoarytenoid muscles. 4) The recurrent laryngeal nerve (RLN) was involved in all PC T3 cases, but RLN involvement was rare in PS cases. 5) Involvements of the paraglottic space and periarytenoid region were closely related to fixation of the larynx on the affected side (hemilarynx) in PS carcinomas. 6) Neither hemilarynx fixation nor PS apex involvement was a reliable landmark for determining the exact extent of laryngeal involvement. 7) Conservation surgery could have been employed in 18 of the 38 cases.

Immunopathological correlation with lymph node metastasis in squamous cell carcinoma of larynx and pharynx

In this study, the commonest malignancy was supraglottic carcinoma (12 of 17 cass). Mostly (94%) our patients were males. Histologically moderate or poorly differentiated squamous cell carcinoma was the commonest tumour. Thirteen of 17 (76%) cases had secondaries in neck and bilateral secondaries were seen only in supraglottic carcinomas. Cases with post cricoid involvement (absent laryngeal crepitus) had metastasis in neck in 90% of cases. DIMCB and PHA skin reactivity did not reveal any difference between the cases with secondary tumours and those without secondaries in neck (P>0.05). Absolute lymphocyte count (A.L.C.) was found to be significantly increased in the former group (P<0.05).

教室における下咽頭癌の治療成績

A retrospective analysis was made of 34 cases of hypopharyngeal and/or esophageal carcinoma t-eated from 1972 to 1984. The lesions were found in the priform sinus (17 cases); post cricoid (9), pharyngoesophageal junction (3), posterior wall (2)and unknown (3). According to the UICC classification, there were 3 cases in stage I; 7 in stage II; 11 in stage III and 13 in stage IV. The initial treatment o f the local carcinomas consisted of irradiation in 13, surgery in 21 and no treatment in 3. Three-year and five-year survival rates were 54.4% and 45.6%, respectively.

The results of surgery in advanced carcinoma of the larynx

The present prospective study evaluates the results of surgery along, versus the salvage surgery (in radiationfailed cases in advanced carcinoma of the larynx. The results were distinctly superior in the former group than in the latter group (61% versus 44%). In stage II disease results of therapy were equally good in both groups. However, the number of disease-free survivors during 12–36 months of follow up dropped considerably as the stage of the disease increased in both groups, more so in radiation failed salvage surgery group (Stage III 77% and 44%; stage IV 30% and 0%). The overall results of therapy were worse in supraglottic cancers than in either glottic or transglottic lesions (30%, 62% and 60% respectively). The pyriform fossa and post cricoid cancers treated during the same period have not been included in the present paper.

Megavoltage technique for treatment of carcinoma of the Post Cricoid region

A technique is described for the treatment of carcinoma of the post cricoid region using 2 4Mev x-ray beams. Homogeneity of dosage is achieved and the method is capable of controlling the disease. Many advantages are claimed for the technique.

Factors influencing cure in the radiotherapy of post cricoid carcinoma

One hundred and three cases of post-cricoid carcinoma were treated at Sheffield, England between 1950 and 1961. Eight patients survived over 5 years. The prognosis was better after radical treatment for lesions under 5 cm. long. Most survivors received a tumour dose between 5000 and 5500 r in five weeks. Two patients developed a complicating radiation myelitis.

Post-cricoid carcinoma in plummer-vinson syndrome in males

Two cases of Plummer-Vinson syndrome in males, in whom latter developed post cricoid carcinoma, in a very young age, have been presented with discussion.

The radiotherapy of carcinoma of the oesophagus and post cricoid region in south east Scotland

The author reviews 1640 patients with oesophageal or post cricoid carcinoma occurring in and around Edinburgh from 1931 to 1964. Special reference is made to 144 patients treated since 1956 by megavoltage irradiation with a five year survival rate of 22 per cent. Perhaps equally important for the many aged patients but more difficult to quantitate, radical irradiation is no longer a severe trial for the patient so that in addition to permitting survival for 5 or more years in 20 per cent of those treated it provides useful palliation for most of the others. As compared with the current surgical methods megavoltage irradiation has some advantages resulting in the present trend towards irradiating more and operating on fewer patients with oesophageal and post cricoid carcinoma.

X-ray set triggering for barium swallow radiographs.

In the course of barium swallow examinations there is often difficulty in obtaining films which satisfactorily demonstrate the lower pharynx and the whole of the post-cricoid oesophagus by the passing bolus of barium at these sites. This difficulty arises especially when large tumours of the pharynx and upper oesophagus are present and frequently in these cases the barium is still retained in the mouth or has passed into the stomach at the instant of exposure. In advanced cases of laryngo-pharyngeal lesions, spill of barium into the larynx causes bouts of distressing coughing and repeat films are undesirable and sometimes not possible. To overcome these difficulties and to ensure that each film is exposed only whilst the barium is at the correct level in the post cricoid region, a trip exposure technique has been developed in which the presence of the barium itself activates the exposure impulse to the X-ray set. The method is based on the interruption by the barium sulphate suspension of a subsidiary bea...

The Classification of Laryngeal Cancer from a Radiotherapeutic Viewpoint

For over sixty years it has been customary to classify laryngeal cancer into two main groups: (1) Intrinsic—where cancer arises within the cavity of the larynx (true cords, false cords and ventricle, subglottic space). (2) Extrinsic—where cancer arises from the aperture and pharyngeal surface of the larynx (epiglottis, aryoepiglottic folds, arytenoids, pyriform fossæ, post cricoid region). Considering the difficulties of classification in medicine where cases rarely lend themselves to stereotyped grouping, the persistence and wide adoption of this particular one provide clear evidence of its value. Nevertheless, although this classification is of great use to the surgeon, it does not follow that it is of equal value to the radiotherapist. This is well shown by the confusion in the use of the terms “intrinsic” and “extrinsic” existing in radiotherapeutic literature, where some authors tend to consider all forms together and fail to distinguish between “intrinsic” and “extrinsic” disease, whilst others who make this distinction fail to attach to each group the significance and special consideration that it merits. From the radiotherapist's view-point this surgical classification is unsatisfactory, because included under the heading “laryngeal cancer” are various separate and distinct types of neoplasms between which the only common bond is anatomical proximity to the boundaries of the larynx.