Recurrent Laryngeal Carcinoma Research Articles

Neuroendocrine carcinoma of the larynx with metastasis to the eyelid.

Neuroendocrine tumors are a rare type of neoplasms that comprise only 0.5% of all malignancies.¹ They usually arise from the gastrointestinal tract and the lung.¹,² Neuroendocrine carcinoma of the head and neck is a relatively rare malignancy described in the literature. The larynx is the most commonly affected region of the head and neck.³,⁴ Nevertheless, small-cell carcinoma comprises only 0.5% of all laryngeal cancers.⁵ Neuroendocrine carcinoma of the larynx carries variable prognosis depending on the histological subtype.⁶ Typical carcinoid rarely metastasizes, but atypical carcinoid and small-cell carcinoma have high rates of metastasis, usually in the lung and liver.² Cutaneous metastasis from neuroendocrine carcinoma is an extremely rare entity, with only few cases reported in the English literature.⁷,⁸ We report the case of an elderly man with recurrent laryngeal neuroendocrine carcinoma with metastasis to the eyelid.

Intraoperative opioids use for laryngeal squamous cell carcinoma surgery and recurrence: a retrospective study

Study ObjectiveTo assess whether the use of intraoperative opioids is associated with poor recurrence-free survival (RFS) and overall survival (OS) after lung cancer surgery. DesignRetrospective study. SettingAcademic hospital. SubjectsPatients with laryngeal primary or recurrent laryngeal squamous cell carcinoma who had surgery. InterventionsIntravenous opioids (remifentanil, fentanyl, sufentanil, and hydromorphone). MeasurementsUnivariate and multicovariate Cox proportional hazards models were applied to assess the effects of covariates of interest on OS and RFS. Main ResultsA total of 195 patients were included. All received opioids intraoperatively. The multivariate analysis demonstrated that age (hazard ratio [HR], 1.03; P = .005), negative margin status (HR, 0.163; P = .001], postoperative chemotherapy (HR, 7.38; P < .001), and concurrent chemotherapy and radiation (HR, 3.11; P < .001) treatment and fentanyl equivalent use (HR, 1.001; P = .02) were all predictor factors for 3- and 5-year RFS. The same variables were predictor factors for OS (age: HR, 1.03 [P = .003]; negative margin status: HR, 0.14 [P = .001]; postoperative chemotherapy: HR, 4 [P < .0001]; and fentanyl equivalent use: HR, 1.001 [P = .02]). ConclusionsOur study demonstrates a very weak association between the use of intraoperative opioids and cancer recurrence after laryngeal squamous cell carcinoma surgery.

Treatment and predictive factors in patients with recurrent laryngeal carcinoma: A retrospective study.

The aim of the present retrospective analysis was to evaluate the treatment results for recurrent laryngeal cancer and to analyze the factors that may affect survival. A retrospective review was performed in 309 patients with recurrent laryngeal carcinoma, 224 of whom were treated between 1996 and 2009 at Sun Yat-Sen University Cancer Center (Guangzhou, Guangdong, China) and 85 of whom were treated between 2006 and 2013 at Zhejiang Cancer Hospital (Hangzhou, Zhejiang, China). The Kaplan-Meier method with the log-rank computation was used for the analysis of survival. The Cox proportional hazards model was applied to identify covariates that were significantly associated with overall survival. The actuarial 3-, 5- and 10-year survival rates were 68.9, 53.6 and 35.7%, respectively. Univariate analysis indicated that the following factors were associated with survival: Age, smoking index, tumor grade, primary tumor site, nodal status of the primary tumor, initial T stage, initial Union for International Cancer Control stage, initial treatment (radiotherapy or chemotherapy), disease-free interval, eligibility for surgery and extent of recurrence. Multivariate analysis of these factors indicated that the initial T stage, tumor grade, nodal status, disease-free interval and eligibility for surgery were significantly associated with survival. Overall, these results indicate that initial tumor stage T1 or T2, a high differentiation rate, no initial cervical lymph node metastasis, a long disease-free interval and a strong indication for salvage surgery are good prognostic factors for the survival of patients with recurrent laryngeal carcinoma.

Open partial horizontal laryngectomy for salvage after failure of CO₂ laser-assisted surgery for glottic carcinoma.

Total laryngectomy (TL) is often still recommended as a salvage approach for recurrent laryngeal squamous cell carcinoma (LSCC). Considering LSCC recurrences after the failure of primary transoral laser microsurgery (TLM), open partial horizontal laryngectomy (OPHL) could be a valid alternative to TL in selected patients. The aim of the present study was to analyze retrospectively the oncological outcome of a consecutive series of 17 patients treated at the Otolaryngology Unit of Vittorio Veneto Hospital (Italy) with OPHL after primary TLM had failed. Nine patients (53 %) had no further recurrences after salvage OPHL. Eight patients had a second recurrence of LSCC after OPHL, and five of them were cured by further salvage treatment, while the other three died of their disease. We found an overall and disease-specific survival both of 82 % and a loco-regional control rate and an ultimate organ preservation rate of 82 and 70 %, respectively. Patients who underwent two-stage bilateral cordectomy for primary glottic carcinoma showed a trend towards a higher rate of second recurrences, a lower ultimate organ preservation rate and a shorter disease-free survival after salvage OPHL. Further studies on larger cohorts of patients are needed to identify potential clinical and/or pathological prognostic parameters capable of pinpointing patients at higher risk of second recurrences after salvage OPHL in cases where TLM has failed. A salvage TL might be reasonably proposed as a first salvage choice in such cases.

Assessment of hypoxic subvolumes in laryngeal cancer with 18F-fluoroazomycinarabinoside (18F-FAZA)-PET/CT scanning and immunohistochemistry

Background and purpose18F-fluoroazomycinarabinoside (18F-FAZA) is a promising hypoxia radiopharmaceutical agent with outstanding biokinetic parameters. We aimed to determine the accuracy of 18F-FAZA-PET/CT scan in detecting hypoxic regions within the tumor using immunohistochemical markers in a pilot study. Patients and methodsEleven patients with primary or recurrent laryngeal squamous cell carcinoma were indicated for total laryngectomy (TLE). Patients underwent 18F-FAZA-PET/CT scan before TLE. Hypoxic regions inside the laryngeal tumor were determined. After TLE, regions with high uptake on 18F-FAZA-PET scan were selected for immunohistochemical examination for exogenous (pimonidazole) and endogenous (HIF1α, CA-IX and GLUT-1) hypoxia markers. To assess the accuracy of 18F-FAZA-PET scanning, radiopharmacon accumulation was related with immunohistochemical expression of hypoxia markers. ResultsInter- and intratumoral heterogeneity of tumor hypoxia was observed on 18F-FAZA-PET scan. Nine of the eleven tumors were hypoxic with 18F-FAZA-PET. Hypoxia could also be detected with pimonidazole, HIF1α, CA-IX and GLUT-1 expression in some tumors. No clear association was observed between 18F-FAZA uptake and hypoxia markers. ConclusionsThis pilot study could not prove the accuracy of 18F-FAZA-PET in determining hypoxic subvolumes in laryngeal cancer. Further study is required to investigate the benefit of 18F-FAZA-PET imaging in radiotherapy planning.

Transoral laser microsurgery for recurrent laryngeal carcinoma after primary treatment: A systematic review and meta-analysis.

To evaluate the efficacy and oncologic outcomes of transoral laser microsurgery (TLM) for recurrent laryngeal carcinoma after previous treatment. A systematic search in PubMed was performed using mesh word for "laryngeal cancer," crossed with "recurrent," and "TLM." The primary endpoints, including overall survival (OS) rate, local control rate, and disease-specific survival (DSS) were summarized using RevMan software. Adverse events and complications were recorded if reported. The pooled odds ratios (ORs) for main outcomes, including local control, 5-year OS, and DSS were 3.08 (95% confidential indexed [95% CI], 1.88-5.05), 2.29 (95% CI, 1.42-3.67), and 5.05 (95% CI, 2.75-9.27), respectively. The pooled OR for functional outcome, larynx preservation, was 3.82 (95% CI, 2.46-5.94), whereas the pooled risk difference of local recurrence was 45% (95% CI, 26-64%). It seems that TLM is an effective option for recurrent laryngeal cancer with regard to the high incidence of OS, local control, and especially organ preservation. However, more prospective studies are needed to confirm its efficiency.

Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

To assess the clinical utility of elective neck dissection in node-negative recurrent laryngeal carcinoma after curative radiotherapy for initial early glottic cancer. A retrospective review was undertaken of 110 consecutive early glottic cancer patients who developed laryngeal recurrence after radiotherapy (34 recurrent T1, 36 recurrent T2, 29 recurrent T3 and 11 recurrent T4a) and received salvage laryngeal surgery between 1995 and 2005. Six patients presented with laryngeal and neck recurrence and underwent salvage laryngectomy with therapeutic neck dissection, 97 patients with recurrent node-negative tumours underwent salvage laryngeal surgery without neck dissection and only 7 underwent elective neck dissection. No occult positive lymph nodes were documented in neck dissection specimens. During follow up, only three patients with neck failure were recorded, all in the group without neck dissection. There was no significant association between the irradiation field (larynx plus neck vs larynx) and the development of regional failure. A higher rate of post-operative pharyngocutaneous fistula development occurred in the neck dissection group than in the group without neck dissection (57.2 per cent vs. 13.4 per cent, p = 0.01). Multivariate logistic regression analysis showed that early (recurrent tumour-positive, node-positive) or delayed (recurrent tumour-positive, node-negative) neck relapse was not significantly related to the stage of the initial tumour or the recurrent tumour. An age of less than 60 years was significantly associated with early neck failure (recurrent tumour-positive, node-positive). Owing to the low occult neck disease rate and high post-operative fistula rate, elective neck dissection is not recommended for recurrent node-negative laryngeal tumours after radiation therapy if the initial tumour was an early glottic cancer.

LOH detected by microsatellite markers reveals the clonal origin of recurrent laryngeal squamous cell carcinoma.

BackgroundThe question of whether “recurrent” laryngeal carcinoma is truly a new tumour with a clonal origin that differs from that of the primary tumour has remained unanswered. The objective of this study was to determine whether recurrent tumours have the same genetic basis as primary tumours, as the answer to this question is important for the development of treatment strategies.Materials and MethodsMatched samples consisting of primary tumour, recurrent tumour and normal tissue were obtained from the same patient. A total of 37 patients with laryngeal cancer were examined for loss of heterozygosity (LOH) on the 3p, 5p, 7q, 8p, 9p, 13p, 17p and 18q chromosomal arms using PCR to amplify microsatellite markers. All patients were routinely followed up and 5-year survival rates were calculated using directly calculating method and Kaplan-Meier's method.ResultsA total of 28 out of 37 (75.6%) patients showed LOH at a minimum of one locus, and 19 out of 37 (51.3%) patients showed LOH at two loci. Primary and recurrent tumours in each patient showed identical allelic loss patterns and incidence rates. Patients without LOH had a longer average time to recurrence than patients with LOH (P<0.05). Additionally, patients with LOH had a longer average smoking duration prior to surgery than patients without LOH (P<0.05). The 5-year survival rates were 32.14%in patients with LOH versus 44.4% in patients without LOH.ConclusionsThe data indicate that primary and recurrent tumours have the same clonal origin. This result implies that we failed to radically resect the primary tumours and/or micrometastases in these patients. Consequently, some form of adjunctive therapy may be necessary. Additionally, the data indicate that the recurrence of laryngeal squamous cell carcinoma is closely related to chromosomal aberrations (specifically LOH).

The primary use of pectoralis myofascial flap in salvage laryngectomy

The salvage laryngectomy (SLE) is very often the only curative option in recurrent laryngeal or hypopharyngeal carcinomas. But the SLE is associated with an increased risk of complications such as the formation of salivary fistulas. To reduce the rate of fistulas a simultaneous elevation of the myofascial pectoralis major flap (PMML) is described. The aim of this study was to compare the SLE with and without the use of the PMML for prophylaxis of salivary fistulas. 9 patients were included, suffering from a T4a larynx or hypopharynx carcinoma recurrence after RCT in the years 2012 and 2013 and subsequently treated by a SLE. An additional elevation of PMML was indicated due to the following criteria: end of RCT less than one year ago, tumor localization outside the glottis, infiltration of thyroid cartilage and prelaryngeal muscles. After PMML elevation the flap was sewed onto a primary closed pharynx. 6 out of 9 patients (2/3) received an additional covering of the pharynx by the PMML during SLE. In no case a postoperative salivary fistula was seen. In the remaining 3 patients (1/3) the pharynx was primarily closed without an additional covering by the PMML. In this group of patients one postoperative salivary fistula was seen. Due to the simultaneous application of the PMML in the context of SLE the rate of postoperative salivary fistula could be effectively reduced in our own patients. The PMML is suitable due to its safe elevation technique, the missing secondary thoracal cutaneous defect, and a good modelling possibility in the recipient area.

Surgical management of post-therapeutic recurrence in laryngeal carcinoma

喉癌是常见的头颈部恶性肿瘤之一,在我国北方地区尤为高发.同人体其他部位的恶性肿瘤一样,喉癌具有向邻近组织浸润和侵袭、容易发生转移、对放化疗等综合与辅助治疗方法具有一定抵抗作用等特点,在经过不同的治疗方案治疗后,仍然有相当一部分（特别是局部晚期肿瘤）患者发生复发.这类患者预后差,在临床治疗时相对比较棘手,处理起来也比较困难.选择合适的患者实施积极有效的手术治疗是目前认为最有效的方法.因此,如何正确对喉癌治疗后的复发实施恰当合理的手术治疗是一个值得研究和探讨的临床问题.

Frequent hypermethylation of WNT pathway genes in laryngeal squamous cell carcinomas.

Aberrations in the function of the WNT signaling pathway have been recently implicated in the pathogenesis of head and neck cancer, and the hypermethylation of several WNT cascade inhibitors were shown to be useful in disease prognosis. However, the extent of deregulation of WNT pathway by DNA hypermethylation has not been studied in detail in laryngeal cancer so far. The aim of this study was to establish the frequency of methylation of WNT pathway negative regulators in laryngeal squamous cell carcinomas and evaluate its prognostic significance. Twenty-six laryngeal squamous cell carcinoma cell lines and samples obtained from twenty-eight primary laryngeal carcinoma patients were analyzed. The methylation status of DKK1, LKB1, PPP2R2B, RUNX3, SFRP1, SFRP2, and WIF-1 was assessed using the methylation-specific polymerase chain reaction. Frequent hypermethylation of DKK1, PPP2R2B, SFRP1, SFRP2, and WIF-1 was detected, and a high methylation index was usually observed. Half of the cell lines analyzed and seventy percent of primary laryngeal carcinoma cases were characterized by the methylation of at least four genes. The hypermethylation of PPP2R2B or WIF-1 was associated with longer survival in laryngeal carcinoma cell lines. Moreover, the concurrent methylation of PPP2R2B and SFRP1 differentiated primary from recurrent laryngeal carcinoma cell lines. Frequent hypermethylation of WNT pathway negative regulators is observed in laryngeal squamous cell carcinomas. The possible prognostic significance of the methylation of DKK1, PPP2R2B, and SFRP1 needs to be evaluated in further prospective studies.

Oncologic results of the surgical salvage of recurrent laryngeal squamous cell carcinoma in a multicentric retrospective series: Emerging role of supracricoid partial laryngectomy

Several studies in the last decade evaluated conservative surgical procedures and, in particular, supracricoid operations as an alternative to total laryngectomy for the salvage of recurrences of laryngeal squamous cell carcinoma (SCC) after a first attempt of organ preservation. The clinical records of 68 consecutive patients primarily treated by irradiation or endoscopic surgery and surgically salvaged by total laryngectomy or supracricoid partial laryngectomy in 2 large university hospitals in Italy from 2004 to 2010 were reviewed. The survival was not affected by the primary treatment or by salvage modality. The only parameter always keeping a prognostic value is the involvement of resection margins of salvage surgery. Patients with early relapse seem to have a worse prognosis than patients with a delayed relapse (p = .05 at Cox multivariate analysis and p = .048 at Wilcoxon test for overall survival [OS] from the primary treatment). Supracricoid operations, if the indications are careful, can prove reliable salvage procedures.

Development of TRAIL Resistance by Radiation-Induced Hypermethylation of DR4 CpG Island in Recurrent Laryngeal Squamous Cell Carcinoma

There are limited therapeutic options for patients with recurrent head and neck cancer after radiation therapy failure. To assess the use of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) as a salvage chemotherapeutic agent for recurrent cancer after radiation failure, we investigated the effect of clinically relevant cumulative irradiation on TRAIL-induced apoptosis. Using a previously established HN3 cell line from a laryngeal carcinoma patient, we generated a chronically irradiated HN3R isogenic cell line. Viability and apoptosis in HN3 and HN3R cells treated with TRAIL were analyzed with MTS and PI/annexin V-FITC assays. Western blotting and flow cytometry were used to determine the underlying mechanism of TRAIL resistance. DR4 expression was semiquantitatively scored in a tissue microarray with 107 laryngeal cancer specimens. Methylation-specific polymerase chain reaction and bisulfite sequencing for DR4 were performed for genomic DNA isolated from each cell line. HN3R cells were more resistant than HN3 cells to TRAIL-induced apoptosis because of significantly reduced levels of the DR4 receptor. The DR4 staining score in 37 salvage surgical specimens after radiation failure was lower in 70 surgical specimens without radiation treatment (3.03 ± 2.75 vs 5.46 ± 3.30, respectively; P<.001). HN3R cells had a methylated DR4 CpG island that was partially demethylated by the DNA demethylating agent 5-aza-2'-deoxycytidine. Epigenetic silencing of the TRAIL receptor by hypermethylation of a DR4 CpG island might be an underlying mechanism for TRAIL resistance in recurrent laryngeal carcinoma treated with radiation.

Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage

The primary objective was to determine the incidence of pathologically positive lymph nodes in clinically N0 larynx cancer patients undergoing salvage surgery following nonsurgical primary therapy. Secondary aims included assessment of the impact of laryngeal subsite and neck dissection on disease status and survival. Retrospective chart review. Sixty-eight patients with recurrent laryngeal cancer and no evidence of neck disease who underwent salvage laryngectomy and neck dissection after undergoing failed primary radiotherapy or chemoradiation were examined. Main outcome measures included: standard demographics, primary, clinical, radiologic, and pathologic recurrent TNM stage, laryngeal subsite, nodal neck level, surgical intervention, margin status, disease status, survival, and imaging results. Fifty-three men and 15 women, aged 33 to 88 years (mean=62.7 years) with recurrent laryngeal cancer were included. Overall, 28.3% of patients had pathologic nodal disease, with supraglottic cancer showing the highest rate (60%, P=.02). Survival was not associated with laryngectomy type (P=.35). However, on multivariate analysis, laryngeal subsite was significantly predictive of survival with transglottic recurrences demonstrating decreased mean survival (20.7 months, P=.02), and supraglottic recurrences demonstrating prolonged mean survival (37.1 months, P=.03). Metabolic imaging (negative predictive value=0.86) proved more reliable than anatomic imaging (negative predictive value=0.71). The incidence of pathologically positive lymph nodes in clinically negative patients with recurrent laryngeal carcinoma following nonsurgical therapy warrants standard selective neck dissection. Subsite of recurrence, specifically supraglottis and transglottis, correlates with pathologic neck node positivity and survival. Metabolic imaging proved more reliable than anatomic imaging in negative predictability for nodal disease. 4.

Which is the most reliable diagnostic modality for detecting locally residual or recurrent laryngeal squamous cell carcinoma after (chemo)radiotherapy?

Radiotherapy and, more recently, chemoradiotherapy have become important treatment modalities in the treatment of laryngeal squamous cell carcinoma (LSCC). In early stage LSCC, it is an alternative to minimally invasive (microscopic laser) surgery or partial laryngectomy and in advanced stage disease chemoradiotherapy is an organpreserving alternative for laryngectomy [1–4]. Therefore, the head and neck surgeon must frequently deal with recurrent or residual LSCC. The recurrence rate in T2–T4 LSCC after (chemo)radiotherapy is reported between 25 and 50 % [5]. The identification of recurrent or residual disease may be difficult. Clinical symptoms and signs secondary to radiation toxicity such as hoarseness, dysphagia, respiratory distress and pain are quite similar to those of recurrent carcinoma. Moreover, the growth pattern of recurrent LSCCs is different from that of primary carcinomas [6]. Many recurrences, even after initial T1 or T2 carcinomas, present with multicentric tumor foci, localized below an intact mucosa. The distinction between recurrent or residual carcinoma and radiotherapeutic sequelae such as fibrosis, edema, soft tissue necrosis, perichondritis and cartilage necrosis can be challenging either by endoscopy with biopsies or by imaging studies. The focus of this Editorial is on (1) which is the appropriate diagnostic modality to distinguish recurrent or residual disease from post-(chemo)radiotherapy changes and (2) recurrent tumor assessment and cr-T-classification, which is a prerequisite for voice-preserving salvage surgery.

Abstract 4431: TRAIL resistance by radiation induced hypermethylation of DR4 CpG island in recurrent laryngeal squamous cell carcinoma .

Abstract The radiotherapy has been known as one of standard treatment methods in larynx cancer, and the many targeted therapies have been developed for improving radiotherapy. In this regard, the tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) can be one promising candidate, because TRAIL has a high selectivity for tumor cells and radiation efficiently sensitizes tumor cells towards apoptosis induction by TRAIL. It has been showing that irradiation strongly sensitizes malignant cells to TRAIL-induced apoptosis without any synergistic effects in normal tissues. Up to now, however, most studies have focused on immediate TRAIL-effect after small amount of irradiation. In this study, we aim to investigate the effect of chronic irradiation on TRAIL response to see if TRAIL could be an effective targeted therapy in recurrent laryngeal squamous cell carcinoma. Using previously established AMC-HN3 cell line from laryngeal SCCa patient, we have generated isogenic model of chronic irradiated HN3R cell line after every 2 or 3 day irradiation of 2 Gy/day of X-rays (70 Gy cumulative doses). Interestingly, through MTS assay, HN3R cells show much more resistance to TRAIL induced apoptosis than HN3 cells. Among suggested mechanisms, we found that a significantly reduced DR4 receptor is the cause of this resistance. Reverse transcription-PCR, western blotting and FACS analysis for DR4 receptors show that the expression of mRNA and the total amount, and surface expression of DR4 protein was much less in HN3R cells. Inhibition of DR4 by antagonistic antibody or si-DR4 significantly decreased TRAIL sensitivity in HN3 cells, and overexpression of DR4 enhanced the TRAIL sensitivity in HN3R cells. To evaluate this result in laryngeal cancer specimens, tissue microarray with 81 advanced laryngeal cancer specimens was constructed. Immunohistochemical assessment score of DR4 staining in 23 salvage surgical specimens after radiation failure shows statistically significant lower score than 58 surgical specimens without radiation treatment (3.09±2.23 vs. 4.43±3.36, p=0.040). Postulating that DR4 gene might be silenced by hypermethylation after long-term irradiation, methylation-specific PCR for DR4 was undertaken. Compared to HN3 cells, HN3R cells had a methylated 5’ regulatory CpG island that was partially demethylated by the DNA demethylating agent 5-aza-2’-deoxycytidine (5-AZAdC). In conclusion, chronic irradiation induces the TRAIL resistance by hypermethylation of CpG island of DR4 receptor in recurrent laryngeal squamous cell carcinoma. Thus, the status of receptor methylation might be one of biomarker to predict TRAIL response especially after radiation failure. Citation Format: Jong Cheol Lee, Won Hyeok Lee, Young Joo Min, Yoon-Se Lee, Jung Je Park, Seong Who Kim, Sang Yoon Kim. TRAIL resistance by radiation induced hypermethylation of DR4 CpG island in recurrent laryngeal squamous cell carcinoma . [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4431. doi:10.1158/1538-7445.AM2013-4431

Anterior mediastinal tracheostomy for malignancy: analysis of 12 cases

Anterior mediastinal tracheostomy is indicated in extensive cervicothoracic malignancy with cervical mediastinal involvement of the trachea. This study was designed to assess the therapeutic outcome of anterior mediastinal tracheostomy. From 2001 to 2010, 10 men and 2 women, with a median age of 64.5 years, underwent anterior mediastinal tracheostomy and were followed up for at least for 1 year. Seven patients had stomal recurrence following laryngectomy, 3 had carcinoma of the cervical esophagus, 1 had squamous cell carcinoma of the trachea invading the subglottic larynx, and 1 had adenoid cystic carcinoma of the trachea invading the subglottic larynx. They were evaluated in terms of etiology of the primary lesion, previous treatment, complications, hospital death, and Kaplan-Meier survival estimate. The tumor was completely resected in all cases. Postoperative complications included atelectasis (3 patients), stomal necrosis (1 patient), and anastomotic leak (1 patient). There were 2 (16.6%) postoperative hospital deaths. The mean duration of follow-up was 23 months, and the mean overall survival time was 25.59 months. Survival was calculated for 3 groups based on primary etiology: stomal recurrence of laryngeal carcinoma (12.85 months), cervical esophageal cancer (28 months), and primary malignancy of the trachea (29 months). Because of the small number of patients, a definitive conclusion was difficult, but acceptable morbidity, mortality, and relative survival in selected patients, in whom an extensive cervicothoracic operation was performed by an experienced and skilled team of surgeons, demonstrated that anterior mediastinal tracheostomy can be a helpful procedure for patient survival.

Diagnostic accuracy of computed tomography findings for patients undergoing salvage total laryngectomy

Conclusions: Computed tomography (CT) imaging has clear limitations for the diagnosis of cartilage invasion or tumor spread in recurrent laryngeal cancer. Alternative methods of pretreatment assessment are needed for recurrent laryngeal cancer. Objectives: The diagnosis and staging of recurrent laryngeal cancer, previously treated by radiation therapy (RT), remains challenging. Practically, surgeons need to depend on imaging to predict which patients will have a chance for conservation salvage laryngectomy. The purpose of the present study was to determine the accuracy of preoperative CT performed for recurrent laryngeal carcinoma evaluation following RT. Methods: This retrospective review identified 32 patients who underwent salvage total laryngectomy after RT from 1998 to 2010. For our radiologic classification of the thyroid cartilage, we analyzed the conditions as normal, sclerosis, invasion, penetration, and extralaryngeal spread and categorized the state of the arytenoids and cricoid into three possible conditions: normal, sclerosis, and destruction. Radiographic findings were correlated with pathology findings. Results: Sensitivity and specificity for the detection of the thyroid cartilage infiltration were 57% and 94%, 50% and 89% for the cricoid cartilage, and 33% and 76% for arytenoid cartilage, respectively. The accuracy of recurrent tumor classification was 59.4%. Three carcinomas were over-staged and 10 were under-staged.

Management of a case of misadventure with lasers

Transoral laser microsurgery in the management of primary as well as recurrent laryngeal carcinoma has been well-established throughout the world as an organ-preserving surgical procedure. We present a patient with early glottic carcinoma who inadvertently underwent several laser excisions and finally ended up with a total laryngectomy.

Prognostic value of hypoxia-inducible factors (angiogenin and endoglin) in open partial laryngectomies: uni- and multivariate analyses

PurposeAdvances in transoral laser microsurgery, radiotherapy, and chemotherapy (and their combinations) have reduced the indications for open partial laryngectomies, although they have replaced total laryngectomies in selected advanced or recurrent laryngeal squamous cell carcinomas (LSCCs). Tissue hypoxia in malignancies appears to be strongly associated with tumor cell invasiveness and metastases. Whether hypoxia-inducible factors can contribute to a rational recommendation of open partial laryngectomy should be investigated. Materials and methodsFifty consecutive patients who had undergone primary open partial laryngectomy (supraglottic and supracricoid laryngectomies) were investigated, measuring the immunohistochemical expression of the hypoxia-inducible proteins angiogenin and endoglin in their primary LSCCs also with image analysis. ResultsUnivariate analysis showed a significantly higher recurrence rate (P = .007) and shorter disease-free survival (P = .0047) in patients with LSCC with endoglin expression more than 9.0%. Multivariate analysis found endoglin expression independently prognostic in terms of disease-free survival (P = .012). Angiogenin expression (in carcinoma or endothelial cells) was not associated with prognosis. ConclusionsEndoglin should be further studied as a biomarker of patients with LSCC at higher risk for recurrence after open partial laryngectomy who may benefit from more aggressive treatments. Endoglin expression in positive laryngeal biopsies may prove useful as a parameter for choosing between different surgical and multimodality approaches to controversial LSCC cases.