Supraglottic Carcinoma Research Articles

Functional Results after Larynx-Preserving Treatment of Laryngeal Cancer. Suggestions for follow-up.

ntroduction: Laryngeal cancer and its treatment are associated with both short- and long-term side effects, affecting laryngeal functions and having an impact on the quality of life. Material and methods: Retrospective analysis of the medical records of patients receiving surgical or non-surgical, larynx- -preserving treatment for laryngeal cancer. R esults: After termination of the treatment, the highest proportion of patients with bad voice quality was in the glottic carcinoma group (both in early and late phase), with swallowing dysfunction in the transglottic carcinoma group. Compared to the situation before the treatment, the proportion of patients with impaired voice quality (bad voice quality and loss of voice) initially decreased among all groups (except for supraglottic carcinomas), and during the first post-treatment year either increased or did not change. The proportion of patients with no swallowing dysfunction increased in the supraglottic, subglottic and transglottic carcinoma groups. D iscussion: We consider necessary the implementation of a standard pre- and post-treatment monitoring of the voice and swallowing function in the management of patients with laryngeal cancer.

PTEN Is Associated With Worse Local Control in Early Stage Supraglottic Laryngeal Cancer Treated With Radiotherapy.

ObjectivesThe aim of this study was to establish the prognostic value of the epidermal growth factor receptor (EGFR) and phosphatase and tensin homolog deleted on chromosome 10 (PTEN) expression on local control in patients with early stage supraglottic laryngeal squamous cell carcinoma (LSCC) treated with radiotherapy only.Study designRetrospective cohort study.MethodsImmunohistochemical staining for EGFR and PTEN was performed on pretreatment biopsies of a selected well‐defined homogeneous group of 52 patients with T1–T2 supraglottic LSCC treated with radiotherapy between 1990 and 2008. Kaplan–Meier analysis and univariate and multivariate Cox Regression analyses were performed to correlate clinical data and expression levels of EGFR and PTEN with local control.ResultsKaplan–Meier survival analysis and Cox Regression analysis showed a significant association between PTEN expression and local control (hazard ratio [HR] = 3.26, 95% confidence interval [CI] = 1.14–9.33, P = .027) and between lymph node status and local control (HR = 3.60, 95% CI = 1.26–10.31, P = .017). Both were independent prognostic factors in a multivariate analysis (HR = 3.28, 95% CI = 1.14–9.39, P = .027 and HR = 3.62, 95% CI = 1.26–10.37, P = .017, respectively). There was no significant association between EGFR expression and local control (HR = 1.32, 95% CI = 1.17–10.14, P = .79).ConclusionThis study showed an association between both high PTEN expression and the presence of lymph node metastasis and deteriorated local control in early stage supraglottic LSCC treated with radiotherapy.Level of EvidenceNA

Characteristics of cervical lymph node metastasis of cN0 laryngeal carcinoma

Objective: To investigate the incidence of occult cervical lymph node metastasis and the common neck level of metastases in cN0 laryngocarcinoma, and the relationship between the clinicopathologic features of laryngocarcinoma and cervical lymph node metastasis. Methods: A total of 506 cases with cN0 laryngocarcinoma treated at the First Affiliated Hospital of Chongqing Medical University between March 2011 and March 2018 were enrolled, and their medical records and follow-up data were retrospectively analyzed. Of them, 211 cases of were glottic carcinoma in stage T1 without neck dissection and they were observed by clinical follow-up; other 295 cases, including glottic carcinoma, supraglottic carcinoma and hypopharyngeal carcinoma in stage T2-T4 were treated with surgical resection of the primary lesions and selective neck dissection. SPSS 22.0 software was used to analyze the data. Results: The total incidence of cervical lymph node metastasis was 10.87%(55/506), with a lower incidence in T1 stage glottic carcinoma(6/211,2.84%) than that in other cases(49/295,16.61%). The incidence of cervical lymph node metastasis in glottic carcinoma (29/426, 6.81%) was lower than those in supraglottic carcinoma (22/71,30.99%) and subglottic carcinoma (4/9) (χ(2)=35.810,P<0.01).The pN+ rates of glottic carcinoma at T1, T2, T3 were 2.84%(6/211), 5.31%(6/113), 16.05%(13/81), and 19.05%(4/21), respectively (χ(2)=18.572, P<0.01). The pN+ rates of supraglottic carcinoma at T2, T3 and T4 were 3/13, 32.50%(13/40) and 6/13, respectively (χ(2)=3.649,P>0.05). The incidence of cervical lymph node metastasis in poorly differentiated carcinoma (17/42, 40.48%) was higher than those in moderately differentiated carcinoma (26/205, 12.68%) and high differentiated carcinoma(12/246, 4.88%)(χ(2)=36.356, P<0.01). Moreover, 85 pN+ lymph nodes were obtained by selective neck dissection, respectively 43(50.59%) in level Ⅱa, 30(35.29%) in level Ⅲ, 1(1.18%) in level Ⅳ and 11(12.94%) in level Ⅵ. Conclusions: The occult cervical lymph node metastasis was frequently found in cN0 laryngocarcinoma. Selective neck dissection should be performed with surgery for the primary lesions in T3-T4 glottic laryngeal cancer, T2-T4 supraglottic laryngeal cancer and subglottic carcinoma, and the neck dissection for level Ⅱa and Ⅲ is appropriate. It is required to detect pre-laryngeal and pre-tracheal lymph nodes in patients with subglottic laryngeal carcinoma.

Surgical treatment in 184 patients with supraglottic carcinoma at a single institute

Objective: To summarize clinical experience in surgical treatment of supraglottic carcinoma and reconstructive techniques. Methods: Medical files of 184 patients (173 men, 11 women) were collected and retrospectively analyzed, who underwent surgeries between January 2008 and December 2012 at Qilu Hospital of Shandong University. Among them, T1, T2, T3 and T4 staging tumors accounted respectively for 14.1% (26/184), 41.9%(77/184), 31.5%(58/184) and 12.5%(23/184). Cervical metastasis was histologically identified in 86 cases (98 for N0, 31 for N1 and 55 for N2). Advanced cases (56 cases at stage Ⅲ and 67 at stage Ⅳ), early cases (22 at stage Ⅰ and 39 at stage Ⅱ) accounted respectively for 66.8% and 33.2%. Supraglottic horizontal laryngectomy or total laryngectomy was performed to allow for tumor excision without compromising margins and the tongue flap or sternohyoidmyofascial flap was subsequently used for repairing the defect after removal of tumor. Survival rates were analyzed by the Kaplan-Meier method. Results: Patients receiving conservation laryngeal surgery accounted for 75.5% (139/184). The 3-year and 5-year survival rates for all cases were 84.2% and 70.7%, respectively. Log-rank test demonstrated that cervical lymph node metastasis, primary tumor staging and clinical TNM staging were significantly associated with prognoses of patients (P=0.003, 0.010, 0.035). Dysphagia was not observed in any case and speech function was maintained in petients with partial laryngectomy. Conclusion: Adequate pre-operative evaluation, individualized treatment, and comprehensive application of flaps for repair are critical to precise tumor excision and reconstruction of laryngeal functions.

Cambios en la vascularización de la mucosa faringolaríngea tras radioterapia y quimioterapia concomitante observados con imagen de banda estrecha. Descripción de dos casos

Introduction and objective: Narrow Band Imaging (NBI) is an image enhancement system used to detect vascular anomalies in the mucosa and submucosa of neoplasms. In 2011 Ni established the five types of imaging patterns in the laryngeal mucosa relating them to the histopathological findings of the lesions. However, these patterns are modified by previous treatments of laser surgery, radiotherapy and chemotherapy. Our objective is to describe the NBI type images obtained in patients treated with the therapeutic regimen of radiotherapy and concomitant chemotherapy. Description: NBI images in a 68-year-old patient with stage III supraglottic non-keratinizing squamous cell carcinoma treated with radiotherapy and concomitant chemotherapy at three months and the year after treatment. NBI images in a 50-year-old patient with stage II nasopharynx non-keratinizing squamous cell carcinoma treated with radiotherapy and concomitant chemotherapy at three months and the year after treatment. Results: The obtained patterns are not identified with any of those previously established by Ni. The images differ depending on the time elapsed since the treatment. Conclusions: It is important to know the alterations observed in the mucosa and submucosa of patients treated with radiotherapy and concomitant chemotherapy since they differ from the characteristic patterns described by Ni associated with the presence of neoplasia.

The prognostic value of tumor depth for cervical lymph node metastasis in hypopharyngeal and supraglottic carcinomas.

BackgroundTo analyze the prognostic value of the clinicopathological parameters of primary lesions for predicting cervical lymph node metastasis in patients with hypopharyngeal and/or supraglottic carcinoma.MethodsWe enrolled 127 patients with squamous cell carcinomas originating in the hypopharyngeal and/or supraglottic regions.ResultsMultivariate analysis identified the tumor depth as an independent predictive factor for lymph node metastasis (odds ratio, 4.959; 95% confidence interval, 2.290‐10.739; P < 0.0001) with a predictive value of 0.966. A cutoff value of 4.5 mm was determined.ConclusionThe tumor depth of the primary lesion is a potent predictor of cervical lymph node metastasis in hypopharyngeal and supraglottic carcinomas. In cases with clinically negative nodal status, elective neck dissection should be adopted for patients with a tumor depth reaching 4.5 mm. Regular outpatient follow‐up is recommended for patients with a tumor depth less than 1.0 mm. Close follow‐up or preventative therapy should be considered between 1.0 and 4.5 mm.

Oncological outcome following TORS in HPV negative supraglottic carcinoma.

The aim of this study was to determine the oncological and functional outcomes following transoral robotic surgery (TORS) in human papilloma virus negative supraglottic cancers. A prospective observational study at a tertiary cancer care center, New Delhi, India. From February, 2013 to December, 2015, 45 patients with supraglottic lesions underwent TORS using the da Vinci® surgical system. Forty-five patients underwent TORS for supraglottic laryngectomy (SGL), with all patients undergoing bilateral neck dissection. The most common site was Ary-epiglottic fold. 47.9% were cT1 and 52.1% were cT2. Average robotic set-up time was 8.8 min and average robotic operative time was 42.9 min. A positive or close margin was seen in 12 patients (26.7%) on frozen, which were revised intraoperatively. On final histology, 3 (6.7%) patients had a margin of <5 mm. The average closest margin was 5.7 mm. Patients tolerated oral feeds within 2 weeks of procedure. All patients were HPV negative. Postoperatively, all patients had adequate swallowing and speech. Follow-up ranged from 24 to 58 months. Thirty-eight (84.4%) patients were alive and disease free. TORS is a safe, feasible, minimally invasive, and oncologically safe procedure in patients with early HPV supraglottic cancers. It has less morbidity and offers benefits in terms of early airway and feeding rehabilitation and avoids complications resulting from radiation therapy for these patients.

Supraglottic Squamous Cell Carcinoma: A Population-Based Study of 22,675 Cases.

The authors used the Surveillance, Epidemiology, and End Results (SEER) database to analyze epidemiological features of patients presenting with supraglottic squamous cell carcinoma (SCCa) and to evaluate treatment trends and outcomes. The SEER database was queried for patients with supraglottic SCCa from 1973 to 2013. Information on demographics; tumor size; histologic grade; American Joint Committee on Cancer (AJCC) stage; SEER local, regional, distant stage; and treatment modality were analyzed. There were 22,675 cases of primary supraglottic SCCa identified. The mean age at diagnosis was 62.3 years, with males accounting for 70.3% of all cases. A high percentage of patients presented with stage IV disease (44.9%). The most common treatment modality was radiotherapy (46.6%), followed by combination of surgery and radiotherapy (29.2%) and surgery alone (15.0%). Overall 5-year disease-specific survival (DSS) for all cases was 54.0%. When stratified by treatment modality, 5-year DSS was best for patients receiving surgery alone (64.2%). However, for patients with AJCC stage IV disease, survival was significantly better with combined surgery and radiotherapy (52.5%). In general, supraglottic SCCa is treated most commonly with radiotherapy, followed by surgery and radiotherapy. Patients managed surgically had better 5-year DSS when compared to patients treated by other modalities. However, when stratified by stage, patients with AJCC stage IV disease had significantly better survival with combined surgery and radiotherapy. Of patients receiving surgery, supraglottic laryngectomy was found to have a significantly better 5-year DSS when compared to both total laryngectomy and laryngectomy, not otherwise specified. NA Laryngoscope, 129:1822-1827, 2019.

The Precise Local Tumor Characteristics of Supraglottic Carcinoma: A Comparison between Clinical, Radiological and Pathological Findings

AbstractBackground: In most cases of supraglottic cancer the tumor has already involved more than one sub site including a broad surface of mucosa with asymmetric extension in both surface and depth. In order to achieve proper loco-regional control of supraglottic cancer while at the same time providing the best possible results regarding organ preservation, knowl-edge of accurate tumor extension is necessary. This is achieved by thorough clinical, radiological and post-operative patho-logical assessment.Aim of the Study: Determine the accurate extension of supraglottic squamous cell carcinoma by whole organ section-ing and comparing it with radiological and endoscopic findings.Material and Methods: This study included 36 patients suffering from Laryngeal carcinoma originating from the supraglottic larynx. Direct laryngoscopy was done for all patients under general anesthesia for detailed primary tumor assessment. Detailed radiological assessmentusing C.T with contrast was done. Detailed histopathological examination by whole organ sectioning was done for the laryngectomy specimen.Results: Radiological assessment was superior to clinical assessment in detection of tumor extension. On comparing radiological and pathological assessment the percentage increase of invasion of the paraglottic space and strap muscles were the only variables that were statistically significant (p-value=0.025, 0.001 respectively). On comparing clinical and pathological assessment base of tongue, vallecula and pyriform sinus were found to increase significantly statistically by pathological assessment (p-values=0.025, 0.046, 0.046 respec-tively).

Oncological outcomes of surgical treatment for T3 supraglottic laryngeal squamous cell carcinoma patients

Background: T3 supraglottic laryngeal carcinoma (LC) is a common advanced laryngeal cancer. Objective: This study was conducted to assess the clinical results of pathological T3 (pT3) supraglottic LC patients who were amenable to laryngectomy treated with primary surgery and postoperative therapy. Methods: Retrospective review of 202 pT3 cases of supraglottic laryngeal squamous cell carcinoma. Results: The five-year cancer specific survival (CSS) rate was 63.7% and the overall survival rate (OS) was 62.8%. For T3 supraglottic patients who underwent total laryngectomy, the five-year disease-free survival (DFS) was 51.8%, and the CSS was 62.5%. For patients who underwent partial laryngectomy, the five-year DFS was 72.2%, and the CSS was 79.0%. High lymph node and stage status are predictors of mortality for these patients. No difference was found in the DFS and CSS rates between patients with negative margins and those with positive margins following postoperative radiotherapy and chemotherapy. Conclusion: Surgical treatment of T3 supraglottic LC patients achieved satisfactory results. Postoperative radiotherapy and chemotherapy are an effective method of treatment for T3 supraglottic LC patients, especially for those with a positive margin.

Preradiotherapy Tumor Volume in Local Control of Squamous Cell Carcinoma of the Supraglottic Larynx

Examine the utility of pretreatment computed tomography in predicting local control (LC) in squamous cell carcinoma of the supraglottic larynx treated with primary radiotherapy (RT). In total, 167 patients treated between 1983 and 2013 were reviewed. Patients had received pretreatment diagnostic computed tomographic imaging of the larynx and neck from which primary tumor volume (PrTV) was delineated. LC, larynx function at last follow-up, and RT complications were recorded. PrTV was evaluated with respect to outcome. In this study, median age was 61 years, and mean follow-up was 96 months. In total, 43% had T1-T2, 46% had T3, and 11% had T4 disease; 49% had N0 disease. Median tumor volume, 5.1 cm (0.4 to 188 cm). Mean dose, 74 Gy; 20% received concurrent chemotherapy. Overall, 10-year LC was 78.9%. Ten-year LC stratified by tumor volume was: 0 to 4.9 cm, 90.8%; 5 to 8.9 cm, 67.3%; and >9 cm, 69.4%. Ten-year LC with preserved larynx function was: 0 to 4.9 cm, 76.7%; 5 to 8.9 cm, 61.5%; and >9 cm, 53.4%. LC and LC with preserved larynx function was significantly different between PrTV groups (P<0.001). On multivariate analysis, PrTV was a significant predictor of LC and LC with preserved larynx function (P<0.005). Six patients developed soft tissue necrosis; 2 suffered fatal carotid blowouts. Patients with grade 5 complications received concomitant chemotherapy. Four patients required total laryngectomy; 14 required permanent tracheostomy or gastrostomy tube. Pretreatment PrTV helps identify patients most likely to experience LC with primary RT alone or combined chemoradiation. LC for supraglottic larynx squamous cell carcinoma is optimal if the PrTV is <5.0 cm.

A Rare Case of Chilaiditiʼs Sign Associated with Cervical Neuropathy

Chilaiditi's sign, the colonic interposition between the liver and diaphragm, is an uncommon radiographic finding.1 While it has been previously observed in the setting of cirrhosis, chronic obstructive pulmonary disease, obesity, near-term pregnancy, mental disorder, and primary lung cancers, its etiology is unknown.2 We describe a case of a man with cervical neuropathy and esophageal strictures as a consequence of radiation therapy and a total laryngectomy for head and neck carcinomas, who was found to have Chilaiditi's sign following an endoscopic esophageal dilation. A 70-year-old man was referred to our clinic for endoscopic dilation of known esophageal strictures in the setting of progressive dysarthria, dysphagia, and weight loss. He was initially treated with radiation therapy for nasopharyngeal carcinoma at age 47, and at age 55, he underwent a total laryngectomy and additional radiation for supraglottic laryngeal carcinoma. During the next fifteen years, he developed progressive dysarthria and weakness of the neck, shoulder, and rotator-cuff muscles secondary to nerve impingement from extensive fibrosis, lymphedema, and neck scarring. He developed dysphagia due to recurrent esophageal strictures, responsive to periodic endoscopic dilations. A repeat, uneventful endoscopic esophageal dilation was performed, after which he returned to clinic three days later with complaints of subjective fevers and heartburn. He denied abdominal pain, nausea, vomiting, or melena. His examination was notable for vitals within normal range and decreased breath sounds in the right lung base. A CT with oral contrast revealed an increase in the elevation of the right hemi-diaphragm with interposition of the colon between the liver and right hemi-diaphragm, consistent with Chilaiditi's sign (Figures 1-3). He was managed conservatively given lack of dyspnea and resolution of his fevers and heartburn. The etiology of Chilaiditi's sign is unknown and rarely discussed in the literature. Our case highlights a potential association between Chilaiditi's sign and cervical nerve damage as a result of post-laryngectomy and radiation-induced fibrosis. Fibers from the C3, C4, and C5 nerve roots innervate the muscles of the upper extremity and neck and also compose the phrenic nerve. Our patient's cervical neuropathy and its potential effects on diaphragmatic function may serve as a causative link between the two findings.1498_A Figure 1. Coronal CT slice of the colonic interposition between liver and diaphragm1498_B Figure 2. Second coronal CT slice of Chilaiditi's sign1498_C Figure 3. Axial CT slice demonstrating Chilaiditi's sign

A rare case of laryngeal carcinoma in pregnancy

Cancer in pregnancy is uncommon. The ethical problem of managing head and neck cancer in pregnancy has always been a common issue to ensure the mother and fetal well-being. Choices for the diagnostic and treatment modalities are crucial to ensure optimal outcome for the mother as well as to preserve fetal vitality. Best clinical decision for the pregnant patient should be made through a multidisciplinary approach. We are reporting a case of a 24-year-old female patient who presented with stridor owing to supraglottic squamous cell carcinoma at 13 weeks of gestation. She underwent tracheostomy as an emergency procedure and later had tumor excision using carbon dioxide laser at 15 weeks of gestation. She was subsequently decannulated off tracheostomy and later underwent normal vaginal delivery at term and had no recurrence within 2-year follow-up.

Carotid Blowout Syndrome: A Rare Case of Bleeding Which Can Be Initially Missed in Patients

Introduction: There are two types of Carotid blowout syndrome (CBS): Threatened or type I carotid blowout refers to an exposed carotid artery as a result from a previous neck dissection or flap reconstruction. Impending or type II carotid blowout is seen in a patient with a short duration of acute hemorrhage that resolves spontaneously or controlled with applied pressure. Case Report: 69-year-old F presents to the Emergency Room with complaints of difficulty swallowing solids and liquids for the past 2-3 weeks. PET/CT and biopsy revealed T3N0M0 supraglottic squamous cell carcinoma and several rounds of chemo-radiation therapy were completed with a complete clinical response. With concern for airway obstruction, the patient underwent a tracheostomy and subsequent total laryngectomy for recurrence of the malignancy. Several weeks later, the patient was seen in the Emergency Room for difficulty in swallowing and food impaction. The obstruction was subsequently removed. On physical exam, the patient was a thin, cachectic, fully oriented and in no acute distress. The patient was admitted to the ENT service for esophageal stenosis with possible esophageal dilation. A nasogastric tube was subsequently placed, and the patient was observed to be sipping fluids without difficulty. After a few hours, she started vomiting large amounts (>500 cc) of bright red blood, passing clots and bleeding from the nose. ENT performed a flexible fiberscopic laryngoscopy, but no lacerations were seen and there was no active bleeding in the upper aerodigestive tract down. CT Angio of the neck revealed the injury to the distal branches of the external carotid artery as the location of the hemorrhage. The patient was taken for emergent embolization and 4 coils were successfully deployed in the right external carotid artery just distal to the occipital artery with a resolution of the bleed. Discussion: CBS continues to be a life-threatening complication in head and neck squamous cell carcinoma. CBS is typically seen in patients with head and neck cancers usually treated with radiation therapy which weakens the arterial wall and eventually leads to rupture. The gold standard for diagnosis is with angiography. Impending CBS in the locally advanced head and neck cancer can be treated successfully with sequential approaches such as induction chemotherapy followed by vascular interventions to sustain relevant clinical responses or to further decrease the volumetric burden of a given tumor mass.

CO2 Transoral Microsurgery for Supraglottic Squamous Cell Carcinoma

The present study analyzed the results of the endoscopic approach to T1, T2 and selected T3 supraglottic carcinoma with the aim of reviewing functional and oncologic outcomes after different types of endoscopic supraglottic laryngectomies. This is a retrospective clinical study of 42 consecutive patients (mean age of 61.8 years, 33 males, 9 females) treated by the senior author for supraglottic squamous cell carcinoma with a transoral CO2 laser approach and reviewed from November 2010 to September 2017. Surgical procedures were classified according to the European Laryngological Society. In addition to the standardized transoral supraglottic laryngectomies, we introduced a modified type IVb by sparing the inferior third of the arytenoid if not directly involved in the tumor. Swallowing was evaluated with the Swallowing Performance Status Scale reported by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology. Survival probabilities were estimated using Kaplan-Meier curves. Two type I, 2 type IIa, 2 type IIb, 3 type IIIa, 12 type IIIb, 13 type IVa, 3 type modified IVb, and 5 type IVb supraglottic laryngectomies were performed. Twenty-one patients (50%) underwent primary neck dissection. The pathologic TNM classification according to the 8th edition of the American Joint Committee on Cancer system was as follows: 9 pT1cN0, 2 pT1N0, 1 pT1N1, 7 pT2cN0, 1 rypT2cN0, 9 pT2N0, 4 pT2N1, 2 ypT2N1, 2 pT3cN0, 2 rypT3cN0, 1 pT3N1, and 2 pT3N2b. Mean follow-up was 3.4 years (range of 9 months to 6 years). According to the Kaplan–Meier analysis, 5-year disease-specific survival, local-relapse-free survival, nodal-relapse-free survival, overall laryngeal preservation and overall survival of patients without previous head and neck radiotherapy/open surgery were 100%, 95.2%, 87.8%, 100%, and 64.6%, respectively. Patients who underwent type I, IIa, and IIb resections (n = 6) started oral feeding the day after surgery, patients who underwent type III-IVb modified resections (n = 31) started oral feeding 3–4 days after surgery, and patients who underwent standard type 4b resections (n = 5) started oral feeding 7 days after surgery. Three months after surgery, patients without a clinical history of previous head and neck radiotherapy/open surgery who underwent type III, IVa, and modified IVb resections showed significantly better swallowing compared to patients who underwent standard type IVb resection: grade 4–6 impairment of swallowing in 8 and 66.7% of cases, respectively (p = 0.006072); patients with a clinical history of previous head and neck radiotherapy/open surgery who underwent type III, IVa, and modified IVb resections showed not statistically significant better swallowing compared to patients who underwent standard type IVb resection: grade 4–6 impairment of swallowing at 3 months in 16.7% and 50% of cases, respectively (p = 0.23568). Transoral CO2 laser supraglottic laryngectomy is an oncologic sound alternative to traditional open neck surgery and chemo-radiotherapy. Recovery of swallowing is significantly worsened after total resection of the arytenoid. Modified type IVb procedure leaving intact, when possible, the inferior third of the arytenoid and consequently the glottic competence, improves functional outcome.

Oncologic outcomes with transoral robotic surgery for supraglottic squamous cell carcinoma: Results of the French Robotic Surgery Group of GETTEC.

Transoral robotic surgery (TORS) is an option to treat supraglottic squamous cell carcinomas (SCCs). We studied the oncologic outcomes after TORS for supraglottic laryngectomy (SGL). We conducted a multicenter observational study of SGL using TORS for patients with supraglottic SCC with at least 2 years of follow-up. One hundred twenty-two patients were included in our study. Mean follow-up was 42.8 months. Local control was 94.3% at 2 years and 90.2% at 5 years. Overall survival and disease-free survival were 86.9% and 95.1% at 2 years, and 78.7% and 94.3% at 5 years, respectively. Sixty-three patients (51.6%) received adjuvant radiotherapy. For 16 of them, this was due to close or positive margins. Local control rate after TORS SGL was at least equivalent to what has been described in the literature for open or transoral laser surgery, or with radiotherapy. Using TORS seems to be an effective therapeutic treatment of early-stage and intermediate-stage supraglottic SCCs.

The role of E-cadherin and β-catenin in laryngeal cancer.

Epithelial cadherins with catenins form the E-cadherin-catenin complex that acts on cell-to-cell adhesion. The loss of these complex lead to the reduction or absence of epithelial cadherin expression in the cell membrane, cytoplasmic accumulation of β-catenin and its translocation to the nucleus, contributing to carcinogenic events. The objective of this study was to evaluate the expression of epithelial cadherin and β-catenin in patients with laryngeal tumor. A retrospective study of 52 patients with glottic or supraglottic squamous cell carcinoma was conducted and evaluated according to the tumor site, histological differentiation, TNM stage, survival analysis and compared with the immunohistochemical expression of epithelial cadherin and β-catenin. We observed statistically significant association between the epithelial cadherin expression reduction and supraglottic localization of the lesion, the presence of cervical metastasis, poorly differentiated tumors and locally advanced tumors when in glottic topography. Related to the expression of β-catenin, statistical significance was also found to the presence of cervical metastasis and tumor of low differentiation with the decreased expression of this marker. Regarding survival analysis, the low expression of β-catenin is related to worse overall survival and the reduction of expression of both markers to worse disease-free survival. We concluded that the reduction in expression of the markers studied leads to a prognostic impact as they are related to tumors with greater local aggressiveness and presence of cervical metastasis.

Transoral Laser Microsurgery for Supraglottic Cancer.

Transoral laser microsurgery (TLM) is an accepted and effective treatment strategy for supraglottic carcinomas. Early supraglottic carcinoma has excellent outcomes independently of the treatment approach. The role of TLM for the treatment of locally advanced tumors is debated. Particularly, the functional outcomes after TLM have to be proven by functional assessment of large cohorts of patients. This study analyzes the oncologic and functional outcomes after TLM for supraglottic carcinomas. Ninety-one patients with pT1-pT4a supraglottic carcinomas treated between January 2002 and December 2012 were analyzed. Distribution of tumors (UICC 2010) was 11 patients with pT1, 31 patients with pT2, 36 patients with pT3, and 13 patients with pT4a tumors. Node status was positive in 40 (43.6%) patients; 61 (67.1%) patients had stage III or IVa disease. Local control and survival were estimated using the Kaplan-Meier method. For the assessment of functional outcomes, the MD Anderson Dysphagia Inventory (MDADI), the Voice Handicap Index-10 (VHI-10), and the performance status scale for head and neck cancer [Performance Status Scale for Head and Neck (PSS-HN)] were used. The median age was 62 years (range, 33-88 years). Fourteen (15.4%) patients developed a local or locoregional recurrence. The 5-year local control rate and 5-year ultimate local control rate were 72 and 92%, respectively. The 5-year overall survival rate was 63%. Twelve (13.2%) patients needed temporary tracheostomy. Sixty-eight (74.0%) patients had a nasogastric feeding tube post-operatively. At 1-year post-operative follow-up, only three patients were PEG dependent. The median VHI-10 score was 35, the median MDADI composite score was 80, and the median score of the domain "normalcy of diet" in the PSS-HN was 91. The oncologic outcomes are comparable to the results of open surgery for early and advanced supraglottic carcinomas. Functional swallowing outcome is superior to open surgery and to concomitant chemoradiation. Patients treated with TLM perceive low levels of voice- and swallowing-related quality of life impairment.

A 9-year analysis of transoral laser microsurgery (TLM) of head and neck cancer on their potential suitability for transoral robotic surgery (TORS) for estimation of future TORS-specific caseload.

After that the establishment of transoral robotic surgery (TORS) for head and neck cancer has been adopted in North America, it has also recently been adopted in Europe. In these parts, transoral laser microsurgery (TLM) is widely applied. The aim of the study was to identify the absolute number of operations amenable to TORS at a TORS initiating institution on the basis of all former TLM cases. All laser surgery procedures from May 2004 to April 2013 (108 months) were initially retrospectively registered; after that, all stage pT1 and pT2 squamous cell carcinomas of the oropharynx, hypopharynx, and larynx were selected. Over a period of nine years out of all TLM cases, there were 45 cases of pT1 and pT2 orohypopharyngeal and supraglottic squamous cell carcinomas, which could have been considered for TORS surgery. With the inclusion of a nowadays-typical TORS indication such as tonsil cancer, 142 cases would have been amendable to TORS. The indication for TORS would have been made in five of the TLM cases per year. Institutions initiating TORS, which own an intensive TLM experience, are encouraged to TORS indications in more than solely typical TLM indications. By indicating TORS instead of handheld surgery, a higher caseload of more than 15 cases per year can be achieved for TORS indications.

Feasibility of Salvage Selective Neck Dissection after Primary Irradiation of Pharyngeal and Laryngeal Carcinoma

Introduction: The concept of neck dissection (ND) in the management armamentarium of head and neck squamous cell carcinoma has evolved throughout the years. Nowadays, ND becomes more functional. Methodology: A retrospective study of 865 patients was performed at Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital to investigate the feasibility of selective ND (SND). All patients with squamous cell carcinoma of the pharynx and larynx who received primary radiation and underwent salvage ND were included in the study. Result: A total of 29 NDs were analyzed. In 17 neck sides, viable metastases were found (58%), whereas in the other 12 specimens there were no viable metastases. In 16 of the 17 necks (94%), the metastases were located either in level II, III, or IV or in a combination of these 3 levels. Level V was involved in only 1 case (6%). Conclusion: It is well justified to perform a salvage SND (levels II, III, and IV) for pharyngeal and laryngeal carcinoma after primary radiation. In carefully selected cases of supraglottic and oropharyngeal carcinoma, a superselective ND also appears as an efficient option.