Sinus Squamous Cell Carcinoma Research Articles

Acute presentation of locally advanced squamous cell carcinoma of frontal sinus—imaging findings of a rare entity: case report

BackgroundThe squamous cell carcinoma is the most common subtype of malignant sinonasal tumours, predominantly involving the maxillary sinuses and nasal cavities in 70 to 80% of cases, and the frontal sinus is extremely rarely involved, in less than 1% of cases. Early clinical and radiological diagnosis is difficult due to overlap of findings with inflammatory sinonasal disease.Case presentationA 55-year-old Caucasian male patient had presented to the emergency department with three-month history of progressive right frontal swelling, acute frontal pain, recent exacerbation of right eye vision impairment and new lid swelling. There was no recent history of trauma and no neurological deficit on examination. Contrast-enhanced CT head was performed which demonstrated large bony destruction of frontal sinus with partly enhancing necrotic-looking tumour within the sinus. There was further intraorbital and intracranial extension of disease. Subsequent MRI confirmed these findings with better demonstration of intracranial and intraorbital component of the disease. The PET imaging did not reveal any avid disease elsewhere. Histopathology confirmed squamous cell carcinoma.ConclusionsFrontal sinus squamous cell carcinoma is a rare and the least common site within the paranasal sinuses. Early clinical and imaging diagnosis could be challenging; however, the index of suspicion should be high with indeterminate imaging findings. CT and MRI are the complimentary imaging techniques.

Occurrence and Prognosis of Secondary Lung Cancer inPatients with Primary Nasal Cavity and Sinus Squamous Cell Carcinoma.

There is an increasing focus on the burden of long-term survivors of secondary malignant neoplasms (SMNs) after the appearance of the primary tumor. Our goal was to describe the occurrence and prognosis of secondary lung cancer (SLC) in patients suffering from primary nasal cavity and sinus squamous cell carcinoma (NSSCC). Patients with NSSCC who reported to the Surveillance, Epidemiology and End Results (SEER) program between 1973 and 2017 were selected for our analysis. The Kaplan-Meier analysis was employed to predict the overall prevalence of SMNs and survival rates after the development of SMN. Standardized incidence ratios (SIRs) of SMNs have also been assessed after the development of the primary NSSCC. A total of 5354 patients were diagnosed with NSSCC. The type and date of diagnosis of the first malignancy were included in the records. In total 419 patients were reported to have developed SMNs within a median duration of 36months from the time of the primary to the secondary tumor diagnosis. The reported cumulative incidence of SMNs was 14% after 10years from the primary tumor diagnosis and 32% after 20years. Among the solid SMNs, secondary lung cancer was the most common malignancy, with cumulative incidences of 12.4% after 20years. The SIR of SMNs after the primary NSSCC compared with that of the general population was 1.65 and the 5-year overall survival (OS) rate following SMNs was 30%. The SMN lung cancer exhibited a SIR of 3.21 and was associated with a short-term median survival of only 11months. NSSCC survivors are at a high risk of developing SMNs, relative to baseline individuals. Lung cancer is one of the most common SMNs, and it has a poor outcome.

Frontal sinus squamous cell carcinoma with intracranial, extraaxial extension in a dog with chronic sinonasal aspergillosis

AbstractA 10‐year‐old neutered male Golden Retriever with a history of chronic sinonasal aspergillosis was presented for unilateral nasal discharge, severe pain when opening the mouth, mildly reduced mentation and disorientation. CT revealed a mixed osteoproductive and osteolytic soft tissue mass that extended intracranially from the frontal sinus. Additionally, left‐sided nasal turbinate destruction was evident, consistent with chronic destructive rhinitis. The dog was euthanised, and the mass was diagnosed as frontal sinus squamous cell carcinoma (SCC) with intracranial‐extradural extension. This case report correlates diagnostic imaging and necroscopic findings of an osteoproductive and osteolytic frontal sinus SCC in a dog.

Maxillary Sinus Squamous Cell Carcinoma in a Tertiary Hospital in the Philippines

Objective: To establish preliminary demographic and clinicopathologic data on Maxillary Sinus Squamous Cell Carcinoma (SCC) in the Philippine General Hospital
 Methods: 
 Design: Retrospective Case Series
 Setting: Tertiary National University Hospital
 Participants: Socio-demographic and clinical data from records of 22 patients admitted at the Department of Otorhinolaryngology of the Philippine General Hospital from 2013-2016 and histopathologically confirmed to have Maxillary Sinus SCC, were collected and described using means and proportions.
 Results: There were 15 males and 7 females with a mean age of 50-years-old (range 24 to 77-years-old). Maxillary mass/swelling was the most common chief complaint. The mean gap between initial symptoms and consult was 6.77 months. Initial biopsies were obtained from the maxillary sinus in 16 patients, with 1 patient noted to have undergone malignant transformation from a prior intranasal squamous papilloma. Staging was advanced (Stage IVA in 16, IVB in 4, and III in 2), with no patients with Stage I or II disease. Sixteen (16) patients underwent surgery and radiotherapy, while 6 patients received radiotherapy (RT) with or without chemotherapy. Regional and distant metastases were uncommon.
 Conclusion: In this series, maxillary sinus SCC occurs more in males, with a maxillary mass as the most common chief complaint. Delay in treatment is common, with a mean gap of 6 months between initial symptoms and consult. Neck node metastasis is uncommon, and most patients undergo surgery with radiotherapy as treatment.
 
 Keywords: maxillary sinus cancer; paranasal sinus cancer; squamous cell carcinoma

Prognostic Factors in Paranasal Sinus Squamous Cell Carcinoma and Adenocarcinoma: A SEER Database Analysis.

Background Outcome studies on sinonasal malignancy are limited to retrospective case series, often with inclusion of diverse histology and short follow-up. The objective of this study was to identify key predictive variables that independently impact survival for paranasal sinus squamous cell carcinoma (SCC) and adenocarcinoma (AC) and to compare these variables in the context of these two distinct clinicopathologic entities. Methods: Analysis was conducted using the Surveillance, Epidemiology, and End Results database from 1973 to 2012 to identify key variables that impact survival for SCC and AC. Results A total of 3,714 cases were included. There were 2,895 SCC cases and 819 AC cases. The mean age at diagnosis was 64.1 years. The male to female ratio for SCC and AC was 1.85 and 1.04, respectively. Patients with SCC and AC were most often diagnosed with stage IV disease in 61.8 and 63.4% of cases, respectively. The majority of patients received combined surgery and radiation (52% for SCC and 43.1% for AC). For SCC, increased age ( p < 0.001) and stage ( p < 0.001) were negative predictors, and surgery improved survival ( p < 0.001) on multivariate analysis. For AC, prognostic factors associated with worse survival include increased age ( p < 0.001) and grade ( p < 0.001) on multivariate analysis. Overall survival was significantly higher in AC compared with SCC at 5 years ( p = 0.001). Conclusion SCC and AC of the paranasal sinuses are both aggressive malignancies with poor survival. For both histological subtypes, increased age predicts worse survival and grade also closely links to survival in AC. These data have important potential implications for treatment planning and pretreatment counseling.

Clinical outcomes of weekly cisplatin chemoradiotherapy for patients with pyriform sinus cancer.

Pyriform sinus squamous cell carcinoma (SCC) has one of the worst prognoses of all upper aerodigestive tract cancers. Improving clinical outcomes for patients with hypopharyngeal SCC has been particularly challenging for head and neck surgeons and oncologists. We investigated 30 patients with pyriform sinus SCC to verify the effectiveness of weekly cisplatin chemotherapy with concurrent radiotherapy. Cisplatin was administered at a dose of 40 mg/m(2) on weeks 1, 2, 3, 5, 6, and 7 during definitive radiotherapy with the aim of preserving the larynx. All 30 patients achieved definitive radiotherapy at a median dose of 70 Gy (range 64-70 Gy). Cisplatin was administrated concomitantly a median of five times (range 2-6 times). Persistent or recurrent primary disease was observed in four patients (13 %). Persistent or recurrent nodal metastasis was observed in five patients (17 %). Nine salvage surgeries were performed for eight patients, of whom seven survived without any evidence of disease. Post-operative complications were observed in two patients (22 %). The 5-year overall survival and locoregional control rates were 87 and 96 %, respectively. The 5-year laryngeal preservation rate was 74 %. The regimen of weekly cisplatin CRT may be effective for pyriform sinus SCC; however, there were problems with strong selection bias in the current study due to the large number of T2 patients. Salvage surgery was safe and was able to improve the survival rate. This chemoradiation regimen was considered successful in preserving laryngeal function.

Features of morphological variants of squamous cell carcinoma of the maxillary sinus: immunohistochemical characteristic.

Background. The feature of malignant tumours in maxillary sinus is a late appeal of patients (T3-T4), as a result of the absence of pain and minor clinical manifestations, it requires large amounts of surgical interventions and leads to disability. Objective. The article analyzes the morphological variants of maxillary sinus squamous cell carcinoma (SCC) with their immunohistochemical characteristic. Methods. In the study we analyzed the original biopsy material from 37 patients with maxillary sinus cancer T3-4N0-1M0 (31 men and 6 women) aged from 37 to 71 years with histologically confirmed diagnosis of SCC for 2010-2014. The primary monoclonal antibodies CK HMW (clone AE3), p63 (clone 4A4), р16INK4 (clone DCS 240) were used. Results. Analyzing the distribution of various forms of maxillary sinus SCC, it was found that the typical forms of SCC are found in most of cases, 29 of 37 (78.4%), compared with specific morphological forms that accounted for just 21.6%. Conclusions. Due to the expression of the marker CK HMW it was found that in typical forms of SCC and in some special morphological forms (spindle cell carcinoma and verrucous carcinoma) with decreasing degree of squamous cell differentiation, the level of the expression of CK HMW also decreases (p&lt;0,001, r = 0.861; p &lt;0,001, r = 0,638). It is an indicator of poor prognosis, but aggressive behavior of basaloid SCC and adenosquamous carcinoma do not depend on the presence or absence of CK HMW. High expression of marker p63 (average level 92,5±3,67%) is a key-point of verification of basaloid SCC. Lack of positive reaction with the marker of viral lesions p16INK4 in forms with keratinization confirms the idea of different etiologic factors and ways of carcinogenesis of typical forms of SCC.

Larynx Preservation Protocols: Long-Term Functional Outcomes in Good Responders to Induction Chemotherapy for Pyriform Sinus Carcinoma

Background/Aims: Larynx preservation for laryngopharyngeal carcinomas aims to avoid the mutilation of a total laryngectomy without compromising survival or functionality. The aim of the present study on pyriform sinus squamous cell carcinoma (SCC) is to evaluate the long-term functional outcomes of larynx preservation in good responders to induction chemotherapy (ICT). Methods: The study was carried out in a tertiary referral cancer center in France. The subjects were good responders to ICT for pyriform sinus SCC, subsequently treated with adjuvant radiation therapy (RT) - with or without concomitant chemotherapy - between 1999 and 2008. Only patients without recurrence at 3 years were included. The evaluated pharyngolaryngeal functions were airway patency, oral communication and oral feeding, based on a self-administered questionnaire and the patients' medical records. Results: Twenty-eight patients were retained. Two (7%) patients needed a tracheotomy during or after the treatment and 2 (7%) had total laryngectomy for a late local recurrence. At least 3 years after the end of treatment, all patients were exclusively fed by mouth. All the evaluated patients judged their voice performance as ‘adequate for everyday oral communication'. Conclusions: In the long run, patients with pyriform sinus SCC who are candidates for larynx preservation and respond favorably to ICT present a satisfactory functional outcome when treated with adjuvant RT.

Pyriform sinus squamous cell carcinoma: oncological outcomes in good responders of induction chemotherapy-based larynx preservation protocols.

Induction chemotherapy-based larynx preservation protocols use chemotherapy to select exclusively patients with 'chemosensitive' tumors for a nonsurgical treatment with radiation therapy. This study on pyriform sinus squamous cell carcinoma (SCC) is interested in the oncological outcome of treatment based on radiation therapy when offered to patients with tumors responding to induction chemotherapy. This was a retrospective cohort study. The cohort included good responders to induction chemotherapy, subsequently treated with definite radiation therapy (with or without concomitant chemotherapy) for pyriform sinus SCC, in a tertiary referral cancer center. The primary endpoints were overall, laryngectomy-free and disease-free survival and the secondary endpoints were analysis of treatment failures and possibilities of salvage treatment. Forty-two patients fulfilled the inclusion criteria and were retained for analysis; 7% were stage II (3/42), 48% stage III (20/42) and 45% stage IV (19/42). At 1, 3 and 5 years, the overall survival was 95% (40/42), 74% (31/42), and 60% (SE ≈ 0.08), respectively. For the same intervals, the laryngectomy-free survival was 90% (38/42), 69% (29/42) and 50% (SE ≈ 0.08), respectively. The estimated 5-year disease-free survival was also 50%. Disease-free survival was significantly better for N0 patients. There was a 28% recurrence rate, mainly in the primary tumor site (9/11), with or without simultaneous nodal recurrence. Interestingly, more than one-third of all oncologic failures occurred beyond the first 3 years of follow-up. Salvage treatment was not possible or definitely inefficient in at least 2/3 of all recurrences. In candidates for larynx preservation for a pyriform sinus SCC, good response to induction chemotherapy followed by definite radiation therapy seems to be associated with a more favorable prognosis. Nevertheless, in case of locoregional recurrence the possibilities for efficient salvage treatment are limited.

Pattern of cervical lymph node metastasis in medial wall pyriform sinus carcinoma

The aim of this study was to analyze the prevalence and distribution of histologic cervical lymph node metastases in medial wall pyriform sinus squamous cell carcinoma (SCC). Retrospective study of medical records. We reviewed the medical records of 68 medial wall pyriform sinus SCC patients who underwent bilateral neck dissection for primary treatment with curative intent. Thirty-nine patients underwent central compartment neck dissection. Primary tumor was removed using conservative laryngeal surgery with partial pharyngectomy in 39 cases, near total/total laryngectomy with partial pharyngectomy in 24 cases, and total laryngopharyngectomy in five cases. The overall N(+) contralateral lymph nodes rate on pathology was 14.7%. The rate of contralateral occult cases was 5.2%. Advanced primary (T3-4) and nodal (N2b-3) disease, and primary lesion across the midline were correlated with contralateral nodal metastasis. Multivariate analysis revealed that a primary lesion across the midline was an independent factor for contralateral neck nodal metastasis. The rate of level VI node metastasis was 16.2%. The disease-specific survival rate was significantly different according to level VI node metastasis (71% vs. 40%). Pyriform sinus apex invasion and extralaryngeal spread were correlated with level VI nodal metastasis. Multivariate analysis revealed that pyriform sinus apex invasion was an independent factor for level VI nodal metastasis. Contralateral nodal metastasis was less frequent than expected. Bilateral neck dissection is mandatory for primary lesion across the midline. Ipsilateral level VI lymph node should be removed in pyriform sinus apex invasion cases. 4.

OP134: Pattern of cervical lymph node metastasis in medial wall pyriform sinus carcinoma: When do contralateral and paratracheal node dissection necessary?

The aim of this study was to analyze the prevalence and distribution of histologic cervical lymph node metastases in medial wall pyriform sinus squamous cell carcinoma (SCC). Sixty-eight medial wall pyriform sinus SCC patients were retrospectively analyzed in this study. All patients underwent bilateral therapeutic/elective neck dissection. Thirty-nine patients underwent central compartment neck dissection. Eleven patients underwent retropharyngeal lymph node (RPLN) dissection. Primary tumor was removed using conservative laryngeal surgery with partial pharyngectomy in 39 cases, near total/total laryngectomy with partial pharyngectomy in 24 cases, and total laryngopharyngectomy in five patients. The overall N-positive contralateral lymph nodes rate on pathology was 14.7%. The rate of contralateral occult cases was 5.2%. Contralateral nodal metastasis was not significantly associated with disease-specific survival. Multivariate analysis revealed that primary lesion across the midline was an independent factor for contralateral neck nodal metastasis. The rate of level VI node metastasis was 16.2%. The disease-specific survival rate was significantly different according to level VI node metastasis (71% vs 40%). In multivariate analysis, pyriform sinus apex invasion was an independent factor for level VI nodal metastasis. RPLN metastasis was confirmed by pathological analysis in two of the 11 (18.2%) subjects. Contralateral nodal metastasis was less frequent than expected. Bilateral neck dissection is mandatory for primary lesion across the midline. Ipsilateral level VI lymph node should be removed in pyriform sinus apex invasion case. We recommend elective RPLN dissection in case with posterior pharyngeal wall invasion.

Definitive radiotherapy for squamous cell carcinoma of the pyriform sinus

Background and purposeTo report the long-term results after definitive radiotherapy (RT) for pyriform sinus squamous cell carcinoma (SCC). Material and methodsThe data concerning all patients treated for pyriform sinus SCC with RT with a curative intent between 1990 and 2006 were reviewed. ResultsA total of 249 patients were included. The median follow-up is 6.5years. Overall 123 patients had relapsed. For the entire population, the 5-year local control, regional control, freedom-from-distant metastasis, and overall survival rate were 68%, 69%, 78% and 38%, respectively. The 5-year local control rate for the 107 T1–T2 tumors was 85% (95% confidence interval (CI): 75–91). N stage was the main risk factor for the development of distant metastases, with a hazard ratio of 8.9 (95% CI: 2.1–39) and 15.6 (95% CI: 3.6–67.8) for N2 and N3 patients respectively. For patients with N2–N3 disease, pre-RT neck dissection improved regional control but not overall survival. Moderate to severe late complications occurred in 50 patients (28% of the patients without local relapse). ConclusionA high local control rate can be achieved when treating T1–T2 hypopharynx cancers with definitive radiotherapy. The high rate of nodal and distant relapses among patients with N2–N3 disease warrants intensification of therapy.

Loss of p21 expression is associated with p53 mutations and increased cell proliferation and p27 expression is associated with apoptosis in maxillary sinus squamous cell carcinoma

Conclusions. Loss of p21 expression dependent on the p53 mutation may be associated with higher tumor cell proliferation, and low p27 expression may be associated with decreased spontaneous apoptosis, resulting in poorer prognosis in patients with maxillary sinus squamous cell carcinoma (SCC). Objective. We have previously reported that p53 mutations and decreased spontaneous apoptosis were associated with poor prognosis in maxillary sinus SCC. However, whether p21 and p27 expression and cell proliferation correlate with either p53 status, spontaneous apoptosis or prognosis in maxillary sinus SCC has not been evaluated. Material and methods. Seventy patients with maxillary sinus SCC were analyzed. Tumor biopsy specimens were examined for p21 and p27 expression using an immunohistological method. The percentage of proliferating cells labeled by anti-Ki-67 mAb was expressed as the Ki-67 index (KI). Results. Loss of p21 expression correlated with p53 mutations (p=0.0072). The KIs in patients without p21 expression and with p53 mutations were significantly higher than those in patients with p21 expression (p=0.0119) and those without p53 mutations (p=0.0048). Patients with p27 expression showed a significantly higher apoptotic index than those without (p=0.0012). Kaplan–Meier analysis showed that p21 expression was closely associated with prolonged disease-free survival in the group with a normal p53 status (p=0.0472). Multivariate analysis identified high KI as an independent prognostic marker (p=0.047).

VEGF and bFGF expression and microvessel density of maxillary sinus squamous cell carcinoma in relation to p53 status, spontaneous apoptosis and prognosis

We have previously reported that p53 mutations, loss of bax expression or decreased spontaneous tumor apoptosis were associated with poorer prognoses in maxillary sinus squamous cell carcinoma (SCC)(Cancer 94: 1968–1980, 2002). In the present study, we analyzed tumor angiogenesis monitored by expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and tumor microvessel density, in correlation with p53 status, spontaneous apoptosis or disease prognosis in the same group of 70 maxillary sinus SCC patients. Tumor biopsy specimens obtained prior to initiation of treatment were examined for expression of VEGF and bFGF and tumor microvessel density using immunohistological methods. Average vessel density (AVD) (range: 3–75; median: 25) and maximum vessel density (MVD) (range: 4–125; median: 53) were assessed by the number of microvessels stained with anti-CD31 mAb in tumor lesions. VEGF was expressed in 35 (50%) of 70 patients and bFGF was in 43 (61%). Patients with VEGF expression showed significantly higher levels of MVD than those without VEGF expression (57 vs. 38; P=0.019). The VEGF expression was observed more frequently in patients with p53 overexpression and/or mutation than in those with normal p53 status ( P=0.048). The MVD inversely correlated with the apoptotic index (AI) defined as the number of single stranded (ss)-DNA-positive cells per 1000 tumor cells ( r=−0.23; P=0.022). Patients with neck lymph node and/or distant metastases after surgery showed significantly higher levels of MVD than patients without any metastasis (64 vs. 42; P=0.048). Low histological effectiveness of radiochemotherapy correlated with bFGF expression ( P=0.0059). To clarify actual prognostic factors for maxillary sinus SCC, we selected 57 patients treated uniformly with preoperative radiochemotherapy followed by maxillectomy. Kaplan–Meier analysis showed that survival was significantly worse in patients with high MVD (≥80) than in those with low MVD (<80) ( P=0.042). These data suggest that the VEGF expression in association with the p53 overexpression and/or mutations may cause increased microvascularity, decreased spontaneous apoptosis or metastases, while the bFGF expression may be associated with resistance to radiochemotherapy, thereby resulting in poorer prognoses in maxillary sinus SCC. VEGF and bFGF expression and tumor microvessel density in tumor lesions were analyzed in 70 patients with maxillary sinus squamous cell carcinoma. The VEGF expression dependent of p53 overexpression and/or mutations was associated with angiogenesis, decreased spontaneous tumor apoptosis and metastases, while the bFGF expression was associated with resistance to radiochemotherapy, resulting in poor prognosis.

Prognostic value of p53 mutations, bax, and spontaneous apoptosis in maxillary sinus squamous cell carcinoma.

Many researchers have attempted to correlate p53 mutation and spontaneous apoptosis with the effectiveness of radiochemotherapy and with prognosis in several malignancies. The current study group consisted of 70 Japanese patients with maxillary sinus squamous cell carcinoma (SCC). Fifty seven patients were treated with radiochemotherapy followed by total or partial maxillectomy, and the remaining 13 patients were treated with radiotherapy alone. Tumor biopsy specimens at pretreatment status were examined for apoptosis-related proteins such as p53 protein, Fas, bax, bcl-x, and apoptosis using immunohistologic methods. The proportion of apoptotic cells labeled by single stranded DNA antibody was expressed as an apoptotic index (AI). p53 mutations at exons 5 through 8 were analyzed by direct sequence on polymerase chain reaction amplified products obtained from laser microdissected tissues. The effectiveness of radiochemotherapy was investigated histologically on surgically dissected specimens. p53 mutations were identified in 20 (29%) of 70 patients. p53 protein was overexpressed in 39 patients (56%), Fas in 20 patients (29%), bax in 40 patients (57%), and bcl-x in 33 patients (47%). Overexpression of bax was associated with negativity of bcl-x (P = 0.015) and with high AI (P = 0.024). Low AI and/or p53 mutation in the pretreatment tissues correlated with low histologic effectiveness of radiochemotherapy (P = 0.048, P = 0.019, respectively). Kaplan-Meier analysis as well as univariate analysis using the Cox proportional hazards model showed that low histologic effectiveness of radiochemotherapy (P = 0.0281, P = 0.0284, respectively), p53 mutations (P = 0.0095, P = 0.0187, respectively), negativity of bax (P = 0.0069, P = 0.0191, respectively), and low AI (P = 0.0134, P = 0.0407, respectively) were significantly related to worse disease-free survival. Multivariate analysis showed AI as an independent factor predicting for disease-free survival (P = 0.0455). The p53 mutations, expression of bax, and levels of spontaneous apoptosis have prognostic value in maxillary sinus SCC; AI especially is an independent factor for disease-free survival. A high level of spontaneous apoptosis induced by overexpression of bax may increase sensitivity of radiochemotherapy resulting in good prognosis, while p53 mutation may lead to resistance against radiochemotherapy, resulting in poor prognosis.

Conservative surgery in T3-T4 pharyngolaryngeal squamous cell carcinoma: an alternative to radiation therapy and to total laryngectomy for good responders to induction chemotherapy.

To evaluate the possibility of preservation of the larynx after neoadjuvant chemotherapy by performing a conservative surgery instead of total laryngectomy initially planned, in patients with previously untreated laryngeal and piriform sinus squamous cell carcinoma (SCC). Retrospective study. A total of 115 patients treated at Tenon Hospital with induction chemotherapy from 1985 to 1995, all with initial indication of radical surgery, were available for the study. The clinical tumor response was evaluated after three cycles of chemotherapy. According to this response, to preserve laryngeal functions, some patients had a modification of the treatment initially planned: radiation therapy essentially for complete responders, and conservative surgery for some partial responders. Of 69 patients with laryngeal cancer, 14 were treated by partial laryngectomy and 19 by radiation therapy; of 46 patients with piriform sinus cancer, 8 were treated by partial surgery and 12 by radiation therapy; the other patients were treated as was initially planned (total laryngectomy with partial pharyngectomy). Overall survival rates, estimated by the Kaplan-Meier method, were not statistically different between the three treatment groups. The laryngeal functions were preserved in 54% of the patients who were alive at 3 years. This report is a retrospective study, but these results suggest the possibility of using conservative surgery, instead of initially planned total laryngectomy, for good responders to induction chemotherapy with a small residual tumor.