Preepiglottic Space Involvement Research Articles

Can Hounsfield unit density value accurately predict prelaryngeal invasion in laryngeal carcinoma cases

ObjectiveThe Hounsfield unit density value (HUDV) is a relative quantitative measurement of radio density used by radiologists in the interpretation of computed tomography (CT) images. Our aim is to investigate the role of HUDV in evaluating pre-epiglottic space (PES) involvement of laryngeal carcinoma. MethodsSeventy-four patients treated for laryngeal carcinoma in our clinic between 2014 and 2019 were included in the study. The invasion status of PES was determined radiologically and pathologically. HUDV was measured with a circular selected region of interest, with a constant size of 10 mm2 for PES. The relationship between patological PES invasion, radiological PES invasion, and HUDV was evaluated. ResultsMeasuring HUDV to determine PES invasion (74.3 %) was significantly higher than​​ conventional CT evaluation (59.5 %) (p = 0.001). The agreement coefficient (kappa value) of the conventional CT evaluation and the HUDV regarding PES involvement was 0.673, which was interpreted as ‘good’. ConclusionHUDV could be used as an additional tool in diagnosing pre-epiglottic space invasion in laryngeal cancer.

Transoral laser microsurgery in locally advanced laryngeal cancer: Prognostic impact of anterior versus posterior compartments.

To evaluate the importance of larynx compartments in the prognosis of T3-T4a laryngeal cancer treated with transoral laser microsurgery. Two hundred and two consecutive pT3-T4a larynx carcinomas. Pre-epiglottic space involvement, anterior and posterior paraglottic space (PGS) involvement, vocal cord, and arytenoid mobility were determined. Local control with laser (LC), overall survival (OS), disease-specific survival (DSS), and laryngectomy-free survival (LFS) were evaluated. The lowest LC was found in tumors with fixed arytenoid. In the multivariate analysis, positive margins (hazard ratio [HR]=0.289 [0.085-0.979]) and anterior (HR=0.278 [0.128-0.605]) and posterior (HR=0.269 [0.115-0.630]) PGS invasion were independent factors of a reduced LC. Anterior (HR=3.613 [1.537-8.495]) and posterior (HR=5.195 [2.167-12.455]) PGS involvement were independent factors of total laryngectomy. Five-year OS, DSS, and LFS rates were 63.9%, 77.5%, and 77.5%, respectively. Patients with posterior PGS presented a reduced 5-year LFS. Tumor classification according to laryngeal compartmentalization depicts strong correlation with LC and LFS.

Occult lymph node metastasis in patients with laryngeal cancer and relevant predicting factors: a single-center experience.

To reveal the incidence and predictive parameters of occult cervical lymph node metastasis (LNM) in patients with cN0 laryngeal squamous cell cancer (LSCC) who underwent surgery as definitive treatment. Patients with cN0 laryngeal cancer who had undergone elective neck dissection together with partial or total laryngectomy between January 2006 and November 2020 were retrospectively analyzed. Clinical and histopathologic predictors of occult metastasis were also analyzed. Follow-up data were used to obtain recurrence and survival analysis. A total of 86 patients with a mean age of 62.5 years were included in the study. Occult LNM was detected in 15 (17.4%) patients. Tumor grade, pT stage, thyroid cartilage invasion, and extralaryngeal extension were found to predict occult neck metastasis in univariate analysis. The mean follow-up time was 60.7 months and in the survival/recurrence analysis, pT stage, tumor location, tumor grade, presence of occult metastasis, pre-epiglottic space involvement. and extralaryngeal extension were found to predict poorer outcome. Overall occult LNM is low (17.4%) in N0 laryngeal cancer, but the presence of LNM is a poor prognostic factor. Correct determination of the neck status and proper treatment is crucial. The incidence of LNM is very low in T1-T2 stages and well-differentiated tumors. The "wait and see" strategy may be applied in T1-T2 cases as well as selected T3 cases with well-differentiated tumors.

Does CT help in predicting preepiglottic space invasion in laryngeal carcinoma?

ObjectiveEvaluating preepiglottic space involvement in laryngeal cancer by CT may lead misinterpretation. We sought to understand the causes of misinterpretation in evaluating the preepiglottic space by CT and assessed the effects of misinterpretation in treatment plans of patients with laryngeal squamous cell carcinomas. MethodsSpecimen histopathology reports of 102 (99 male, 3 female) patients who underwent total or partial laryngectomy due to supraglottic and/or transglottic laryngeal carcinoma were reviewed. Neck CTs were also re‐assessed for preepiglottic space involvement by three radiologists. The initial surgical treatment choices were re-examined according to the current radiological evaluation in combination with pathological results of the specimens and physical examination findings in the patients. Interobserver agreement regarding image interpretation was based on a kappa analysis. ResultsThe interclass correlation coefficient in predicting preepiglottic space invasion was 0.74; this was considered ‘good.’ Among the three radiologists, sensitivity, specificity, accuracy of CT in detecting preepiglottic space involvement were 86–93%, 75–93%, and 77–93%, respectively, while the negative and positive predictive values were 97–98% and 38–50%, respectively. Given the previous treatments applied, false-positive diagnoses for PES involvement resulted in overtreatment in 2.9% of cases. False-negative diagnoses of PES involvement (1.9% of cases) did not result in any undertreatment. ConclusionsAlthough CT is a practical and inexpensive imaging tool for evaluating laryngeal carcinomas, the PPV of CT in assessing preepiglottic space invasion, especially in advanced tumors, is low and may lead to overtreatment.

Salvage Transoral Laser Supraglottic Laryngectomy after Radiation Failure: A Report of Seven Cases

We evaluated the oncological and functional outcomes of salvage transoral laser supraglottic laryngectomy after radiation failure. In addition, we demonstrated the usefulness of laser surgery in patients with recurrent supraglottic cancer. Between December 1999 and May 2011,7 patients (6 men and 1 woman) underwent transoral laser supraglottic laryngectomy after radiation failure. We conducted 4 different types of endoscopic supraglottic laryngectomy. In the cases with lymph node metastasis, we performed neck dissection at the time of laser surgery. All patients had recurrent squamous cell carcinoma confirmed on the surgical specimen. Two patients were classified as having T1 disease, 2 as having T2 disease, and 3 as having T3 disease with preepiglottic space involvement. The 2- and 5-year overall survival rates were 85.7% and 68.6%, respectively. There was a recurrence at 8 months of followup after laser surgery in 1 patient; he underwent successful salvage total laryngectomy. The ultimate local control rate was 100%, and the laryngeal preservation rate was 85.7%. The hospitalization times ranged from 2 to 32 days (mean, 15.6 days). The mean decannulation time was 10.7 days (range, 5 to 30 days). All patients started oral feeding within 1 to 3 days after surgery. Salvage transoral laser supraglottic laryngectomy following radiation failure seems a feasible and oncologically safe procedure in recurrent supraglottic cancers ranging from T1 to selected T3 with minimal preepiglottic space involvement. It can be an option for minimally invasive organ preservation surgery with lesser morbidity for recurrent supraglottic cancer.

Transoral CO2 laser microsurgery for Tis-T3 supraglottic squamous cell carcinomas

Eighty patients affected by supraglottic cancer were treated by transoral carbon dioxide laser surgery between 1989 and 2006 in two Italian institutions. Patient staging was as follows: 2 pTis, 20 pT1, 38 pT2, and 20 pT3. Simultaneous or 1-month delayed neck dissection (ND) was performed on 27 (34%) patients, unilaterally in 10 and bilaterally in 17. The pN category was as follows: 9 pN0, 6 pN1, 8 pN2b, and 4 pN2c. A total of 16 (20%) patients received complementary radiotherapy (RT) and 5 (6%) were subjected to chemo-RT for persistent tumor after re-excision due to positive margins, multiple lymph nodes, and/or extracapsular spread after ND. The last follow-up was in December 2008. The 5-year overall, disease-specific and disease-free survivals, local control with laser alone, and organ preservation rates calculated by Kaplan-Meier analysis were 84.4, 97.4, 88.3, 96, and 97.2%, respectively. Univariate analysis showed a statistically significant impact on disease-free survival, local control with laser alone, and organ preservation of pT category (p = 0.009, p = 0.01, and p = 0.03, respectively), while pN category and tumor stage negatively influenced disease-free survival (p = 0.007 and p = 0.01, respectively). This series confirms the good overall oncologic outcomes obtained by transoral laser surgery for Tis, T1, T2, and selected T3 supraglottic cancer with minimal pre-epiglottic space involvement.

Impact of preepiglottic space tumor involvement on concurrent chemoradiation therapy

Purpose The aim of the study was to determine the prognostic impact of preepiglottic space (PES) involvement on local failure after concurrent chemoradiation therapy for squamous cell carcinoma. Materials and methods Retrospective chart review of patients who underwent concurrent chemoradiation therapy for T3 or T4 laryngeal, T4 hypopharyngeal, and T3 or T4 oropharyngeal squamous cell carcinoma were eligible for inclusion. Patients were then stratified by the presence or absence of PES tumor involvement. A multivariate analysis was performed on the presence of recurrence using the following pretreatment variables: PES involvement, tumor extent, pathologic cell differentiation, lymph node involvement, age, and sex. Results A total of 102 patients were included in the study. Twenty-seven (28%) patients had documented PES involvement. Mean follow-up for all patients was 46 months. Involvement of the PES was not significantly associated with local tumor persistence or recurrence ( P = .69). No other variables significantly impacted tumor recurrence. Conclusion Preepiglottic space involvement does not negatively impact local tumor control after concurrent chemoradiation therapy.

P128 Impact of Preepiglottic Space Tumor Involvement on Concurrent Chemoradiation Therapy for Squamous Cell Carcinoma

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Supraglottic Carcinoma Treated with Curative Radiation Therapy: Identification of Prognostic Groups with MR Imaging

To retrospectively assess the prognostic meaning of tumor characteristics depicted on pretreatment magnetic resonance (MR) images for local outcome in supraglottic squamous cell carcinoma treated with definitive radiation therapy. Pretreatment MR images acquired in 84 patients with supraglottic carcinoma treated with curative radiation therapy were reviewed for tumor involvement of laryngeal sites including glottis, subglottis, pre-epiglottic space, laryngeal cartilages, and hypopharynx, and for extralaryngeal extension. The volume of each tumor was estimated, and mean tumor volume was calculated for the group of tumors in each T staging category. Results of univariate analysis showed MR imaging-determined primary tumor volume (P =.03), involvement of pre-epiglottic space (P =.008), abnormal signal intensity in thyroid cartilage (P =.04), and extralaryngeal extension beyond thyroid and/or cricoid cartilage (P =.02) to be significant predictors of local control rate. Results of multivariate analysis with the Cox regression model confirmed statistical significance for invasion of pre-epiglottic space (P =.004) and for abnormal signal intensities in thyroid cartilage adjacent to the anterior commissure (P =.04) and in cricoid cartilage (P =.01). Five-year local control rates were calculated from the regression coefficients of three independent MR imaging prognostic factors, and three prognostic groups were identified on the basis of these control rates. The 5-year local control rate in the high-risk group was 35%, significantly lower than the rates in the intermediate- and low-risk groups (60% and 89%, respectively; P =.002). MR imaging-determined pre-epiglottic space involvement and abnormal signal intensities in the thyroid cartilage adjacent to the anterior commissure and/or the cricoid cartilage are strong predictors of local outcome in supraglottic carcinoma treated with definitive radiation therapy.

Subtotal laryngectomy with cricohyoidopexy as first treatment procedure for supraglottic carcinoma: Institut Gustave-Roussy experience (146 cases, 1974-1997).

Between 1974 and 1997, 297 patients underwent a subtotal laryngectomy at the Institut Gustave-Roussy; 146 of these patients underwent cricohyoidopexy (CHP) for a supraglottic primary as their first treatment. The majority of patients were men (137) aged from 33 to 78 years (median 54 years). The tumour stage at presentation was T1 in 2, T2 in 87, T3 in 53 (preepiglottic space involvement), and T4 (minimal thyroid cartilage invasion) in 4 patients. One hundred and twenty-five patients were N0 (86%) and 21 patients were Np (palpable); 98% had homolateral and 55% had bilateral neck dissections. One patient died postoperatively of a myocardial infarction and 68% patients had an uneventful course. Aspiration was the commonest complication (23 patients, 19%). The median time to removal of the tracheotomy cannula was 10 days and for the nasogastric tube 21 days during the past 10 years. Completion of subtotal laryngectomy into total laryngectomy was done in 21 cases (15%): eight times because of oncological events [five local failures, two second primary (hypopharynx), one positive margin] and 13 times because of aspiration (9%). There were six local failures (4%) and eight nodal failures (5%). The rates of distant metastases and second primaries were 6% and 16% respectively. Half of the local and nodal failures were subsequently sterilized. Findings at death were two local recurrences, four nodal recurrences, eight distant metastases, and 11 second primaries. The 3- and 5-year overall survival rates were 92% and 88% respectively, with an overall laryngeal preservation rate of 86%. When supraglottic laryngectomy is not feasible for supraglottic cancer, subtotal laryngectomy with CHP is a safe and effective oncological procedure, with preservation of satisfactory laryngeal function.

Irradiation alone for supraglottic larynx carcinoma: Can CT findings predict treatment results?

Between January 11982 and December 1986, 54 patients with squamous cell carcinoma of the supraglottic larynx were treated for cure with radiation therapy alone; all had a minimum 2-year follow-up. For 31 patients, highquality pretreatment CT scans were available for review. Scans were retrospectively evaluated by a single radiologist for the percentage of preepiglottic space involvement by tumor, the percentage of paralaryngeal space involvement, and the total tumor volume in cubic centimeters (cc). Volume was measured using a computer digitizer for each CT slice showing tumor. Results showed a significant difference in local control for tumors < 6 cc versus tumors ⪰ 6 cc 15 18 or 6 13 or 46%; p = .038). This difference of both T stage and primary site. For T3 lesions, there was a trend toward decreased local control with increasing percentage of preepiglottic space involvement (0–25% = 85% local control; >25% = 60% local control; p = .384); in most cases, however, the amount of preepiglottic space involvement reflected tumor volume (0–25%, 8 12 or 67% of tumors were <6 cc; >25%, 7 10 or 70% of tumors were ≥6 cc). There was no clear association between degree of paraglottic space involvement and local control. Tumor volume did not correlate with complications of treatment. Because of the limited number of patients in the current study, conclusions should be considered preliminary. However, the data do suggest that pretreatment CT findings, particularly tumor volume, can predict the likelihood of local control with radiation therapy alone for squamous cell carcinoma of the supraglottic larynx.

Clinicopathological Studies of Transglottic Cancer

Clinicopathological studies were performed in twenty transglottic cancers. Each specimen obtained by total laryngectomy was processed for study by whole-organ serial section. Paraglottic space involvement was found in all 20 patients, while preepiglottic space involvement, submucosal infiltration, and thyroid cartilage invasion in about half of the patients. So there was a strong tendency to infiltrate deeply in transglottic cancer. In half of the T2 and T3 patients, the invasion of thyroid cartilage was found. Therefore the laryngologist should look for the cartilage invasion described above if the patients with transglottic cancer are treated by radiotherapy or partial laryngectomy. This tumor tends to infiltrate more deeply than supraglottic cancer and the pattern of cartilage invasion in transglottic cancer differs from supraglottic cancer. The invasion of arytenoid cartilage occurred in all the patients with vocal cord fixation, and the invasion of cricoarytenoid joint in 75%. The in cidence of cervical lymph node metastasis was 30%. There was a tendency to infiltrate deeply in the patients with lymph node metastasis. All 20 patients in this study were smokers. Carcinogenesis in transglottic cancer seems to have a close relationship with tobacco consumption.

Deep spread patterns in CT staging of T2-4 squamous cell laryngeal carcinoma.

In addition to clinical examination and less sophisticated radiographic techniques, high-resolution computerized tomography (CT) can help to stage squamous cell carcinoma of the larynx. This study was undertaken to identify findings on CT scans that might predict the likelihood of radiation therapy (RT) alone, controlling the primary site disease without significant irradiation-related complications. Of 30 patients with T2-4 cancers of the larynx, 13 were classified as favorable and 17 were classified as unfavorable candidates for RT based on the CT criteria of transglottic spread, more than 25% pre-epiglottic space involvement, extensive paralaryngeal space spread, or cartilage involvement. Seven of 17 (41%) unfavorable patients had local recurrences, two are alive with cancer, three patients are dead of disease (DOD), and five had significant complication, but there was no evidence of recurrent cancer. In the favorable group, there were two local recurrences (15%), one distant metastasis, one patient is DOD, and one had a significant complication, but no recurrent cancer. These data may be used to more adequately select and inform patients with T2-4 squamous cell carcinoma of the larynx before RT.