Supraglottic Carcinoma Research Articles

Prognostic value of pathological tumor size in patients with supraglottic carcinoma.

The association between pathological tumor size and predictive value in patients with supraglottic carcinoma who receive surgery is poorly understood. To gain further insight into this association, the influence of postoperative tumor size assessed via pathological evaluation on survival outcomes in patients with supraglottic carcinoma was fully analyzed. This study collected data from 375 consecutive supraglottic carcinoma patients who underwent primary surgical treatment between 2005 and 2010. The parameters of tumor size, including tumor diameter, tumor area, and tumor volume, were used to analyze the prognostic abilities of overall survival (OS) and disease-free survival (DFS) in supraglottic carcinoma. Twelve women and 363 men were included, with a mean age of 61.2years. The 5-year OS and DFS rates were 65.4% and 56.2%, respectively. The mean tumor diameter, tumor area, and tumor volume of all patients was 3.1cm, 8.6cm2, and 9.1cm3, respectively. Tumors with higher pT stages had a larger tumor diameter, tumor area, and tumor volume. These three factors were significantly correlated with pT stage, and tumor volume was the strongest factor contributing to pT stage. Patients with a larger tumor diameter, tumor area, and tumor volume had worse OS and DFS. Tumor area and tumor volume were independent prognostic factors of OS and DFS in supraglottic carcinoma patients. Patients with a larger tumor size have inferior survival outcomes, and tumor area and tumor volume are independent predictive parameters of survival in supraglottic carcinoma patients who are treated with primary surgery.

Supraglottic Carcinoma in Intravenous Opioid Drug Abusers: A Distinct Disease with Improved Survival.

Recent evidence indicates an increased prevalence of intravenous opioid drug abusers (IVDAs) among supraglottic squamous cell carcinoma (SG-SCC) patients. This study investigates whether the clinical course of SG-SCC in IVDA differs from SG-SCC in non-IVDA. A retrospective case-control study conducted in a in two tertiary referral centers. This case-control study compares IVDA with non-IVDA patients diagnosed and treated for SG-SCC in between 2005 and 2018. Disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier estimator. Adjusted odds ratios (ORs) for mortality were calculated using multivariant analyses. A total of 124 patients were included; 21% (26) were IVDA, and 79% (98) were non-IVDA. Age at diagnosis in the IVDA group versus the non-IVDA group was 53 and 66 years, respectively (P = .001). Nevertheless, the age hazard ratio for OS was calculated and found to have minimal to no effect, 1.05 (95% Cl: 1.025-1.076). Otherwise, the two groups were comparable regarding demographics, other risk factors (i.e., gender, smoking, and alcohol), and comorbidities status, as well as the comparable stage at diagnosis, histologic grading, and treatment modalities. Although the DFS was comparable in both groups, the 5-year OS was 55% in the IVDA group compared with 34% among the non-IVDA patients (P = .04). In multivariant analyses for mortality, positive IVDA history was found to be protective, adjusted OR: 0.263 (95% CI: 0.081-0.854). Similarly, within the subgroup of 100 patients with advanced-stage disease (III and IV), the adjusted OR was 0.118 (95% CI: 0.028-0.495). SG-SCC in IVDA patients has a distinct clinical course, presenting at a younger age, and may have improved prognosis. NA Laryngoscope, 131:E1190-E1197, 2021.

声門上癌に合併した線状 IgA 水疱性皮膚症の 1 例

声門上癌に合併した線状 IgA 水疱性皮膚症の 1 例

Patterns of Cervical Lymph Node Metastasis in Locally Advanced Supraglottic Squamous Cell Carcinoma: Implications for Neck CTV Delineation.

ObjectiveTo investigate the prevalence and distribution of cervical lymph node metastasis (LNM) in locally advanced supraglottic squamous cell carcinoma (LASCC) and guide the delineation of clinical lymph node target volumes.Materials and MethodsWe reviewed patients defined as LASCC from January 2000 to December 2017 in our hospital. The primary tumor was operated on using partial or total laryngectomy, and all patients underwent bilateral neck dissection (levels II–IV at least). Univariate and multivariate logistic regressions were used to find risk factors associated with LNM.ResultsA total of 206 patients were enrolled. In the whole group, the rate of ipsilateral metastasis (IM) was 60.9% (67 patients), whereas contralateral metastasis was 25.5% (28 patients). Only positive ipsilateral lymph nodes contributed to contralateral metastasis (p = 0.001). Seventy-six cases were diagnosed with clinical positive lymph nodes (cN+). IM of primary lesions mainly located within the unilateral sites (n = 49 patients) was detected in levels II, III, and IV with lymph node metastasis ratios of 73.5% (36 patients), 63.3% (31 patients), and 20.4% (10 patients), respectively, and contralateral metastasis of 36.7% (18 patients), 16.3% (8 patients), and 6.1% (3 patients), respectively. Involvement of level II or III was associated with metastasis of level IV. No one developed contralateral level IV involvement without metastasis of contralateral levels II and III. A total of 130 cases had clinically negative neck lymph nodes (cN0). The prevalence of occult metastasis (OM) was 35.4%. Among 62 patients with unilateral lesions, the rates of OM to ipsilateral neck levels II, III, and IV were 21, 11.1, and 1.6%, respectively, whereas contralateral neck levels were 6.3, 4.8, and 0%, respectively. In terms of the risk factors, histopathological differentiation was related to OM (p = 0.003). Two of 25 people were with level VIb metastasis, and both of them were with subglottic involvement.ConclusionNeck levels II to IV are most frequently involved and should be included in clinical target volume (CTV) in cN+ patients. Contralateral IV may be omitted when contralateral levels II and III are negative. In cN0 patients, ipsilateral levels II and III are suggested to be included in the CTV, whereas whether contralateral levels II and III should be included needs further research.

Surgical, Oncological, and Functional Outcomes of Transoral Robotic Supraglottic Laryngectomy.

To investigate the surgical, oncological, and functional outcomes of transoral robotic surgery (TORS) for the treatment of supraglottic squamous cell carcinoma. Retrospective chart review. The charts of patients treated by TORS supraglottic laryngectomy (SGL) in an academic medical center were reviewed. The following outcomes were studied according to the tumor location: average robotic setup and operative times, mean estimated blood loss, postoperative complications, need of tracheotomy, refeeding characteristics, mean hospital stay, need of neck dissection and adjuvant therapy, 5-year local and regional controls, overall survival (OS), and disease-free survival (DFS). Seventy-five patients underwent TORS SGL. Tumors were classified as cT1 (32%), cT2 (52%), and cT3 (16%). Average robotic setup and operative times and the mean estimated blood loss were 15 minutes, 55 minutes, and 20 mL, respectively. The mean follow-up period ranged from 2 to 5 years. The 5-year OS and DFS were 80.2% and 94.3%, respectively. Overall, 34.6% of patients received adjuvant radiotherapy. The majority of patients (92%) restarted an oral diet within 24 to 48 hours postsurgery. Transient tracheotomy was performed in 8% of patients. Postoperative hemorrhages occurred in 12 patients (16.0%), lengthening the hospital stay (mean = 6.8 days). There were no outcome differences regarding the tumor location. TORS is an effective and safe therapeutic approach for early- and intermediate-stages cancers. Oncological outcomes may be quite similar to other surgical approaches, including transoral laser and open surgeries. Future randomized controlled studies are needed for comparing TORS SGL with other surgical procedures. 4 Laryngoscope, 131:1060-1065, 2021.

Analysis and management of occult cervical lymph node metastasis of cN0 supraglottic laryngeal carcinoma

Objective:To explore the rule of occult cervical lymph nodes metastasis in clinically node negative（cN0） supraglottic laryngeal carcinoma. Method:The clinical data of 185 patients with cN0 supraglottic laryngeal carcinoma were analyzed retrospectively. All patients received surgical resection of the primary lesions and lateral neck dissection. The survival curve was analyzed by Kaplan-Meier method, and the survival rate was compared by chi-square test and log rank test. Result:The total incidence of occult cervical lymph nodes metastasis in cN0 supraglottic laryngeal carcinoma was 38.9％（72／185）, the unilateral and bilateral neck occult metastases were determined in 51 cases（27.6%） and 21 cases（11.4%） respectively. A total of 266 positive nodes were collected, and the distributions of the 266 positive nodes were as follows: 220（82.7%） in level Ⅱ, 42（15.8%） in level Ⅲ, and 4（1.5%） in level Ⅳ. The occult metastasis rates of bilateral cervical lymph nodes with different degrees of differentiation were 37.5%（12/32） for poorly differentiated squamous cell carcinoma, 7.4%（6/81） for moderately differentiated squamous cell carcinoma, and 4.2%（3/72） for high differentiated squamous cell carcinoma; the occult metastasis rates of bilateral cervical lymph nodes at T1, T2, T3, T4 were 0, 2.7%（2/73）, 8.1%（6/74）, 46.4%（13/28）, respectively，and the difference was statistically significant（P<0.01）. Conclusion:cN0 supraglottic laryngeal carcinoma has a high rate of occult cervical lymph nodes metastasis, and its metastatic area is mainly located in level Ⅱ-Ⅲ, so the primary tumor of the laryngeal carcinoma and the neck lymph node of level Ⅱ-Ⅲ should be managed at the same time. For the cN0 patients with poorly differentiated squamous cell carcinoma or T4 staging should be treated with bilateral neck dissection.

Clinicopathological Study of Carcinoma Larynx

Setting: Department of otolaryngology and Head-Neck surgery, Rajshahi Medical College Hospital, Rajshahi.&#x0D; Methods: 80 patients were included in this study during a period of July 2006 to June 2007. Study based on history, clinical, radiological, laboratory and histopathological examination. The larynx is divided for purpose of tumour classification into three regions- Supraglottic, Glottic and Subglottic.&#x0D; Results: The age ranges from 25 to 85 years. The overall male to female ratio 93.75:6.25. Laryngeal carcinoma shows significant association with low socioeconomic and education group. The commonest symptoms of laryngeal carcinoma was change of voice 100%(20) in case of glottic carcinoma and 90%(54)in cases of supraglottic carcinoma.Other common symptoms were difficulty of swallowing, respiratory distress, cough, neck swelling, haemoptysis, neck pain. Palpable cervical lymph node was present in 50% (40) cases&#x0D; Conclusion: Predominant histological type was squamous cell carcinoma 97.5%(78), undifferentiated carcinoma 1.25%(1), adenocarcinoma 1.25%(1). Symptoms of presentation has a significant association with site of involvement. The symptoms of presentation of supraglottic carcinoma occurred more frequently at the advanced stage.&#x0D; Bangladesh J Otorhinolaryngol; April 2020; 26(1): 37-40

Screening of molecular markers of induced chemotherapy in supraglottic laryngeal squamouscell carcinoma.

ObjectiveTo investigate the expressions of MAPK10, c-Jun and Itga6 in laryngeal carcinoma and its influence on the sensitivity to docetaxel, cisplatin and 5-fluorouracil (TPF) chemotherapy.MethodsFifty-seven patients with supraglottic squamous cell carcinoma, who were treated by two cycles of TPF induction chemotherapy in our hospital, were enrolled in this study and divided into groups by chemotherapy resistance or chemotherapy sensitivity. The expressions of mRNA and protein of MAPK10, c-Jun and Itga6 in tumor tissues were evaluated by immunohistochemistry. The consistency of mRNA and protein expressions was tested, and the relation with the clinicopathological features was analyzed.ResultsThe positive rates of MAPK10 andc-Jun in the tumor tissues of the sensitive group were significantly higher than those of there assistant group, which was 90.48% and 100.00%, respectively. The expression rate of Itga6 was significantly higher in the resistant group, which was 83.33% (P < 0.05). The mRNA levels of MAPK10 and c-Jun were significantly lower in the resistant group than in the sensitive group, whilethemRNA levelof Itga6was significantly higher in the resistant group (P < 0.05). The protein expressions of MAPK10, c-Jun and Itga6 were consistent with their mRNA expressions (P < 0.05). The expressions of MAPK10, c-Jun and Itga6 were not correlatedwithage, gender and tumor diameter (P > 0.05). However, the expressions of MAPK10 and c-Jun were negatively correlated withclinical stage and pathological grading (P < 0.05). Negative correlations between MAPK 10 and Itga6, and between c-Jun and Itga6in tumor tissues were found by Spearman'srank correlation coefficient (P < 0.05). The correlation was also negative in the resistant tumor tissues (P < 0.05).ConclusionThe MAPK10 and c-Jun expressions were down-regulated, while the Itga6 expression was up-regulated in the chemo-resistant laryngeal carcinoma, and the expression levels of different factors were correlated witheach other. These factorsmight be important biomarkers for predicting outcomes of TPF chemotherapy in laryngeal carcinoma in the future.

Distinct Biomarker Profiles and Clinical Characteristics in T1-T2 Glottic and Supraglottic Carcinomas.

BackgroundIn early stage laryngeal squamous cell carcinoma (LSCC) radiotherapy with curative intent is a major treatment modality. TNM classification is used to define patients eligible for radiotherapy. Studies in early stage glottic LSCC identified several predictive biomarkers associated with local control. However, we recently reported that this predictive value could not be confirmed in supraglottic LSCC.ObjectiveTo examine whether clinical behavior and protein expression patterns of these biomarkers differ between glottic and supraglottic LSCC.Study DesignRetrospective cohort study.MethodsTumor tissue sections of 196 glottic and 80 supraglottic T1‐T2 LSCC treated primarily with RT were assessed immunohistochemically for expression of pAKT, Ki‐67 and β‐Catenin. Expression data of HIF‐1α, CA‐IX, OPN, FADD, pFADD, Cyclin D1, Cortactin and EGFR in the same cohort of glottic and supraglottic LSCC, were retrieved from previously reported data. The relationship between glottic and supraglottic sublocalization and clinicopathological, follow‐up, and immunohistochemical staining characteristics were evaluated using logistic regression and Cox regression analyses.ResultsGlottic LSCC were correlated with male gender (P = .001), hoarseness as a primary symptom (P < .001), T1 tumor stage (P < .001), negative lymph node status (P < .001), and an older age at presentation (P = .004). Supraglottic LSCC patients developed more post‐treatment distant metastasis when adjusted for gender, age, and T‐status. While supraglottic LSCC was associated with higher expression of HIF‐1α (P = .001), Cortactin (P < .001), EGFR (P < .001), and Ki‐67 (P = .027), glottic LSCC demonstrated higher expression of CA‐IX (P = .005) and Cyclin D1 (P = .001).ConclusionDifferences in clinicopathological and immunohistochemical staining characteristics suggest that T1‐T2 glottic and supraglottic LSCC should be considered as different entities.Level of EvidenceN/A. Laryngoscope, 2020

Topographical Distribution of Carcinoma Larynx

The larynx is the most common site for primary tumour of the head and neck region. It represents world wide approximately 1-2% of all cancers. A cross sectional study of 154 cases of laryngeal carcinoma was carried out in the in-patient department of Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College during the period of two years with an aim to find out the frequency of site and subsite involvement of carcinoma of the larynx. The age range is 33-80 years and the over all male to female ratio is 29.8:1. Smoking and chewing habit are the most important associated factors. Majority of growths are found to be exophytic and most of the patients present at advanced stage. The commonest site of laryngeal carcinoma is supraglottic region and occurrence of supraglottic carcinoma than glottic carcinoma is statistically highly significant.&#x0D; Bangladesh J Otorhinolaryngol; April 2018; 24(1): 56-61

Complications of Total Laryngectomy

Objective: To observe Post-operative complications of Total Laryngectomy in advanced Laryngeal Carcinoma Patients.&#x0D; Methods: This prospective observational study was conducted in National Institute of ENT, Tejgaon, Dhaka. Study duration 3 years, from January 2015 to December 2017. 17 patients were selected who underwent total laryngectomy for histologically proven advanced carcinoma larynx. Patients were followed up monthly for 3 months &amp; then after 6 months for life long.&#x0D; Results: The age of the patients ranged from 39 to 66 years. The mean age was 47 years. Most of the cases are supraglottic carcinoma 12 (70.59%), Glottic carcinoma in 5 (29.41%) &amp; no subglottic carcinoma. In this study, out of 12 supraglottic cases, 4 patients were presented in stage III &amp; 8 in stage IV. Among the glottic cases 1 patient presented in stage I, 2 in stage III &amp; 2 patients presented in stage IV. Patients were followed up monthly for 3 months &amp; then after 6 months for life long. 2 patients (11.76%) developed pharyngocutaneous fistula within 7th to 15th post-operative day &amp; these patients were managed conservatively which involved adequate drainage, frequent dressing &amp; fresh blood transfusion. With these conservative management fistula healed completely within 3 to 4 weeks. 3 patients (17.65%) developed wound infection. Wound swab was sent for culture &amp; sensitivity and antibiotics changed accordingly. Wound healed within 2-3 weeks with conservative treatment &amp; adequate aseptic dressing. 1 patient (5.88%) developed postoperative hematoma which was drained immediately. This patient developed wound infection later on &amp; was managed conservatively. 2 patients (11.76%) developed stomal recurrence 4 months after surgery, which was confirmed by biopsy. The cases were inoperable &amp; were sent for radiotherapy. 2 patients (11.76%) developed dysphagia due to pharyngeal stenosis 4 months after surgery.&#x0D; Conclusion: The most frequent troublesome immediate complication is pharyngocutaneous fistula all of which have been treated conservatively with satisfactory result. Preoperative radiotherapy is an important risk factor for the development of pharyngocutaneous fistula in total laryngectomy.&#x0D; Bangladesh J Otorhinolaryngol; April 2019; 25(1): 10-18

Pattern of Nodal Metastasis in Laryngeal Carcinoma

Aims: To find out the occurrence of lymph node metastasis, level of neck node involvement and the pattern of clinical presentation of patients suffering from laryngeal carcinoma.&#x0D; Methods: A cross-sectional study on 90 cases of laryngeal carcinoma was carried out in the inpatient department of Otolaryngology- Head and neck surgery of Dhaka Medical College Hospital, Dhaka during a period of two years. Smoking and chewing betel leaf and tobacco are the most important predisposing factors.&#x0D; Results: Most of the cases presented with more than one symptom. Change of voice was the commonest symptom. Cervical lymphadenopathy are significantly associated with supraglottic carcinoma. Level IV and level III is the commonest level of the lymph node involvement in laryngeal carcinoma.&#x0D; Bangladesh J Otorhinolaryngol; October 2017; 23(2): 109-114

Patterns and risk factors of lymph node metastasis in locally advanced supraglottic squamous cell carcinoma

Objective To investigate the pattern of lymph node metastasis (LNM) in patients with locally advanced (T3, T4) laryngeal squamous cell carcinoma (LALSC) and provide reference for the delineation of clinical target volume. Methods Clinical data of 272 patients with LALSC treated in our hospital from 2000 to 2017 were retrospectively analyzed. All patients underwent bilateral neck dissection (at least level Ⅱ-Ⅳ). The LNM ratio of each node level was calculated. The risk factors of LNM were identified by univariate and multivariate logistic regression analyses. Results LNM was found in 156 of 272 patients (57.1%). According to the location of primary lesions, all patients were divided into group A (n=72; unilateral without midline involvement), group B (n=86; unilateral with midline involvement) and group C (n=114; giant or central). In group A, the LNM ratio at ipsilateral level Ⅱ, Ⅲ and Ⅳ was 36.3%, 26.4% and 6.9%, whereas 13.9%, 8.3% and 1.4% at the contralateral level, respectively. In group B, the LNM ratio at ipsilateral level Ⅱ, Ⅲ and IV was 1.9%, 29.1% and 11.6%, whereas 18.6%, 14.0% and 1.2% at the contralateral level, respectively. In group C, the LNM ratio at the left neck level Ⅱ, Ⅲ and Ⅳ was 24.6%, 23.7% and 2.6%, whereas 21.9%, 26.3% and 6.1% at the right neck, respectively. Bilateral LNM ratio did not significantly differ between group A and group B/C (15.3%, 25.0%, P=0.093). Ipsilateral level Ⅲ metastasis (OR=2.929, 95%CI 1.041-8.245, P=0.042) and clinical N stage (OR=0.082, 95%CI 0.018-0.373, P=0.001) were associated with contralateral LNM. Ipsilateral level Ⅱ(P=0.043) or Ⅲ(P=0.009) metastasis were risk factors of the ipsilateral level Ⅳ metastasis. Conclusions Neck levels Ⅱ and Ⅲ are the high-risk LNM regions, whereaslevels Ⅳ and V are the low-risk areas. Ipsilateral level Ⅱ or Ⅲ metastases are the risk factors of ipsilateral level Ⅳ and contralateral cervical LNM. Contralateral neck LNM rarely occurs in cN0 stage patients. Key words: Locally advanced laryngeal cancer; Squamous cell carcinoma; Lymph node metastasis; Risk factor

The Flex robotic system compared to transoral laser microsurgery for the resection of supraglottic carcinomas: first results and preliminary oncologic outcomes.

Transoral robotic surgery (TORS) has the potential to improve some inherent disadvantages of transoral laser microsurgery (TLM). Here, we retrospectively assessed the application of the Medrobotics Flex system for the resection of supraglottic carcinomas compared to TLM. 84 patients underwent surgery for supraglottic carcinomas with the Flex robotic system (n = 19, T-stage distribution in %: T1 42, T2 47, T3 11, T4 0) or TLM (n = 65, T-stage distribution in %: T1 40, T2 44, T3 14, T4 2). Clinical and oncologic parameters were compared. All surgeries were successfully completed with the Flex system and tracheostomy rate was 13%. For patients with adequate follow-up, 24-month disease-free survival was 71.4% (n = 5/7) after TORS compared to 64.9% (n = 24/37) after TLM. Local recurrence rates were 0% for TORS and 11% for TLM. Initial results for supraglottic carcinoma resection using the Medrobotics Flex system are encouraging with excellent local tumor control.

Pattern of Neck Node Metastasis in Laryngeal Carcinoma

Background: Cancer continues to be a major health problem despite advances in medical technology for its diagnosis and treatment. Cancer of the larynx is the eleventh most common cancer in the world. Carcinoma larynx is a multifactorial disease. Smoking, betel-nut, betel-leaf chewing habit and drinking alcohol are the most important factors associated with carcinoma larynx.&#x0D; Objective: To detect the rate and level of cervical lymph node metastasis in laryngeal carcinoma&#x0D; Methods: Detailed information was obtained in each cases according to protocol. Complete history was taken from accompanying attendants. Thorough clinical examination was done. All the information’s were recorded in the fixed protocol. Patients were randomly assigned to one of three groups by card sampling. Collected data were classified, edited, coded and entered into the computer for statistical analysis by using updated computerized program SPSS-19&#x0D; Results: Out of 50 cases the mean average age was found 58.5±11.9 years with range from 39 to 78 years. Majority (70.0%) patients presented with supraglottic carcinoma followed by 13(26.0%) glottic carcinoma and 2(4.0%) subglottic carcinoma. More than three fourth (78.0%) patients had difficulty in swallowing followed by 17(34.0%) had hoarseness of voice, 12(24.0%) had discomfort in throat, 10(20.0%) had earache, 6(12.0%) had hemoptysis and 4(8.0%) had cough. Majority (42.0%) patients were found N0 followed by 15(30.0%) N1, 13(26.0%) N2 and 1(2.0%) N3 of neck node. Majority (42.0%) patients was found in stage T3 followed by 7(14.0%) in stage T1, 18(36.0%) in stage T2 and 4(8.0%) in stage T4. Majority (56.0%) patients was found in level-II of neck nodes followed by 12(24.0%) level III, 4(8.0%) level IV, 3(6.0%) level II+III, 2(4.0%) level III+IV and 1(2.0%) level III+IV+V of neck nodes.&#x0D; Conclusion: Laryngeal carcinoma is a common clinical entity in otolaryngology practice. Male were more predominant and the highest age group was 51-60 years. In our study most common Laryngeal carcinoma was supraglottic in nature. T3 was the commonest stage of involvement. Common clinical presentation was difficulty in swallowing and hoarseness of voice. N 0 and N1 was the most common pattern of neck node metastasis. In our series majority of them were in level II&#x0D; Bangladesh J of Otorhinolaryngology; October 2018; 24(2): 115-124

Transoral Robot-Assisted Surgery in Supraglottic and Oropharyngeal Squamous Cell Carcinoma: Laser Versus Monopolar Electrocautery.

Background: Monopolar electrocautery (EC) is the surgical cutting and haemostatic tool most commonly used for transoral robotic surgery (TORS). The aim of this study was to retrospectively compare EC efficacy in the treatment of patients affected by T1 or T2 oropharyngeal and supraglottic squamous cell carcinomas with the more recently introduced laser fibres. Methods: We considered all TORS patients admitted to our department from January 2010 to June 2019. The outcomes of patients treated with Thulium: yttrium aluminium garnet (YAG) laser (TY-TORS), CO2 laser (CO2-TORS) and EC (EC-TORS) were analysed in order to assess surgical performances, functional outcomes and postoperative complications. Results: Twenty patients satisfied the enrolling criteria, of which nine underwent laser-TORS, and the remaining 11 underwent EC-TORS. In all candidates, TORS procedures were completed without the need for microscopic/open conversion. Close or positive margins were significantly more frequent in EC-TORS (p = 0.028). A considerable difference was found in overall functional parameters: times of nasogastric tube and tracheostomy removal and time of hospital discharge were significantly shorter in laser-TORS (p = 0.04, p = 0.05, p = 0.04, respectively). Conclusions: Laser-TORS showed better results in comparison with EC-TORS in term of tumour resection margins and patient functional outcomes. Our findings can be justified with the greater tissue thermal damage caused by EC-TORS, despite prospective randomized trials and increased patient numbers being needed to confirm these preliminary conclusions.

Survival differences between definitive radiotherapy and surgery followed by adjuvant radiotherapy in supraglottic and hypopharyngeal carcinoma.

Background:Organ preservation has long been a consideration in the treatment of supraglottic and hypopharyngeal carcinoma to improve the quality of life (QOL). Definitive radiotherapy (DRT) with or without systematic treatment, such as chemotherapy, is always the first choice to achieve improved QOL. This retrospective study focused on the survival differences between DRT and surgery followed by adjuvant radiotherapy (S + RT) in supraglottic and hypopharyngeal carcinoma.Methods:This study included adult patients with supraglottic or hypopharyngeal carcinoma undergoing single-modality treatment with either DRT or S + RT between January 2012 and August 2016. A total of 59 patients were identified, of whom 31 were treated with DRT, and 28 were treated with S + RT. In the 31 cases of DRT, 23 cases were treated with concurrent chemoradiotherapy (CRT), one case was treated with DRT plus cetuximab, and seven cases were treated with DRT alone. Of the other 28 cases of S + RT, 15 cases were treated with adjuvant concurrent CRT. Survival analysis was used to compare the overall survival (OS), local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) between DRT and S + RT groups.Results:The median follow-up was 20 months (range, 4–67 months). The patients of the two groups were similar with respect to mean age, original sites, and tumor stages. The 1-, 2-, and 5-year OS rates were 80.6%, 53.4%, and 24.7% for the DRT group and 85.7%, 67.1%, and 24.7% for the S + RT group, respectively. There was no significant difference between the two groups (χ2 = 3.183, P = 0.074). The 1-, 2-, and 5-year LRFS and DMFS were 90.4%, 61.7%, and 18.0% and 87.4%, 49.2%, and 9.9%, respectively, and no statistical difference was observed between the two groups (LRFS: χ2 = 0.028, P = 0.868; DMFS: χ2 = 3.347, P = 0.067). No significant difference was found between the two groups in acute radiotoxicity.Conclusion:Without loss of laryngeal function, the survival of DRT is comparable to that of S + RT in supraglottic and hypopharyngeal carcinoma.

Rational choice of neck dissection in clinically N0 patients with supraglottic cancer.

The mainstay treatment of the neck for clinically negative neck (cN0) supraglottic laryngeal carcinoma (SGLC) is neck dissection. However, the optimal extent remains controversial. This study's purpose is to determine whether ipsilateral level II-III neck dissection is appropriate for cN0SGLC patients. The records of 220 consecutive untreated cN0SGLC patients were retrospectively reviewed. Relevant factors related to occult and contralateral neck metastasis were analyzed and the distribution of metastasis was described. Seventy-seven and 143 patients underwent unilateral and bilateral neck dissection, respectively. The rate of occult neck metastases was 21.4%. The histologic differentiation was an independent risk factor for occult neck metastasis. In the bilateral neck dissection group, the incidence of contralateral neck metastasis of patients with noncentral tumors was 0.7%. Moreover, only 1.7% of patients had positive nodes at level IV, and no isolated nodal metastases existed in level IV. Ipsilateral level II-III neck dissection is feasible for patients with noncentral cN0SGLC.

Predictors of Occult Lymph Node Metastasis and Prognosis in Patients with cN0 T1–T2 Supraglottic Laryngeal Carcinoma: A Retrospective Study

Background: This work aimed to explore the predictors of lymph node metastasis (LNM) and analyze the prognosis of patients with clinically node-negative (cN0) T1–T2 supraglottic laryngeal carcinoma (SGLC). Methods: Data for 130 patients with cN0 T1–T2 SGLC who initially underwent surgery were retrospectively reviewed. Occult LNM incidence, relevant factors, and prognosis were analyzed. Results: Of the 130 patients with cN0 T1–T2 SGLC, 21 (16.2%) had occult LNM. Based on univariate and multivariable regression analyses, male sex and poor tumor differentiation predicted the incidence of occult LNM. The incidence of occult LNM was 20.9% in males and 5.1% in females (p = 0.035). Patients with poorly differentiated tumors had a higher incidence of occult LNM (42.9%) than patients with well-differentiated (10.3%) and moderately differentiated tumors (14.3%; p < 0.05). Thirteen patients (10%) had cervical recurrence, and all had T2 tumors (p = 0.02). The 5-year disease-specific survival rates were 70 and 90% for patients with and without LNM, respectively (p = 0.000). Conclusions: Sex and tumor differentiation are potential predictors of occult nodal disease. Female patients with cN0 T1–T2 SGLC are less likely than male patients to have neck metastasis. Poorly differentiated tumors are associated with the frequency of neck metastasis, and selective neck dissection is strongly recommended for these tumors.

Frequency of Lympnode Metastasis in Supraglottic Ca Larynx

Introduction: To observe the association between the level of lymph node metastasis and the T- stage and to evaluate the N- stage in supraglottic carcinoma of larynx.&#x0D; Materials and Methods: A prospective cross-sectional study was carried out on 80 consecutive cases of supraglottic carcinoma larynx in three tertiary level hospital in Dhaka during July'2009 to March 2011.&#x0D; Results: The highest number of patients were in the age group 5th and 6th decades. Male to female ratio was 9:1. Topographically 70 cases (87.5%) had lesions involving epiglottis, 5 cases (6.25%) in aryepiglottic fold and 5 cases (6.25%) had lesions at false cord. Majority cases were histopathologically confirmed squamous cell carcinoma (95%) and among them 46 cases (57.5%) had well differentiated. Cervical metastatic lymph nodes were found 40% (32 cases) where level-II was most common. This was most frequent in early supraglottic(T1&amp;T2) carcinoma of larynx (86.25%), P=0.008. A positive correlation was found between the T stage of primary tumours and frequency of cervical lymphadenopathy. Lymph node metastasis were 4.77% in T1, 37.50% in T2, 71.43% in T3 and 91.67% in T4. In early stage lymph node involved 93.75% in Level- II, 6.25% in Level- III &amp; in advanced stage 100% in Level - II, 62.5% in Level - III and 25.0% in Level - IV. Distribution of study cases (31.25%) in stage-II, 25% in stage-I, 22.50% in stage-Ill and 21.25% were in stage-IV.&#x0D; Conclusion: Result of this study may help the clinician for planning of treatment of this malignant diseases as well awareness.&#x0D; Medicine Today 2019 Vol.31(2): 72-75