Vocal Cord Carcinoma Research Articles

Ultrasound as a Useful Diagnostic Tool in the Follow-up of Laryngeal Carcinoma

ABSTRACTBackgroundUsing neck ultrasound to evaluate the status of the lymph nodes of a patient with a head and neck cancer is common practice but laryngeal ultrasound could help to receive more information of the tumor.Methods and resultsWe report a case of an initially T1a N0 M0 G2 R0 squamous-cell carcinoma of the right vocal cord. Despite regular follow-up, the relapse of the tumor remained undetected. The hypopharyngoscopy and laryngoscopy were performed. The tumor was evaluated with laryngeal ultrasound and to confirm the relapse of the tumor a MRI scan was performed. Endoscopically there was no obvious presence of the tumor. Laryngeal ultrasound facilitated the visualization of the tumor in good quality.Unfortunately, a total laryngectomy was necessary to treat the relapse of the squamous-cell carcinoma (T4a N0 (0/16) M0 G2 R0).ConclusionDespite careful follow-up via laryngoscopy a relapse of the laryngeal tumor was not visible. Using laryngeal ultrasound, the relapse might have been detected sooner.

Perzeptive und maschinelle Stimm- und Sprechanalyse bei chronischer Laryngitis und T1-Stimmlippenkarzinom

Patients with chronic laryngitis and T1 vocal cord cancer were compared using perceptual and text-based objective voice and speech analyses in order to determine which group is more affected in its ability to communicate and whether a distinction between the two pathologies is possible. In all, 13 patients with histologically proven chronic laryngitis and 13 patients with T1 vocal cord cancer were compared perceptually by five speech therapists on the basis of seven criteria and objectively by a speech recognition system and prosodic analysis. Both, the data of the five speech therapists and the results of the automatic analysis revealed no significant differences between the two patient groups. A distinction between chronic laryngitis and T1 vocal cord carcinoma by mere voice and speech analysis is not possible, because the patient groups do not show significant differences in their voice quality.

Voice quality study in patients with early vocal cord carcinoma

Voice quality study in patients with early vocal cord carcinoma

Retinal angiomatous proliferation occurring after radiotherapy

To describe two cases of retinal angiomatous proliferation (RAP)-like lesion following radiation therapy for primary tumor. Retrospective evaluation of two patients with previous irradiation treatment for a pleomorphic adenoma of the lacrimal gland and a vocal cord carcinoma, respectively. Visual acuity (VA), fluorescein angiography and optical coherence tomography were performed and demonstrated a RAP-like lesion in both cases. Treatment with intravitreal injections of Ranibizumab was performed with a follow-up of 19 and 10 months, respectively. Both the patients had a positive response to the treatment with improvement in VA and reduction of intraretinal fluid. RAP-like lesions can develop following radiation treatment for a primary tumor. In patients presenting with idiopathic RAP, a history of prior radiotherapy should be considered.

Bilateral Vocal Cord Carcinoma in a Sarcoidosis Patient during Infliximab Therapy

Introduction. Although the role of TNF-α in tumor development is not fully understood, an increased risk of malignancy with TNF-α-inhibitors, such as infliximab, has been suggested. Case Presentation. We present a 54-year-old nonsmoking female sarcoidosis patient. After seven months of infliximab therapy a T1aN0M0 larynx carcinoma of the right vocal cord was found and excised. Within a year, whilst still on treatment, a second larynx carcinoma of the opposite vocal cord appeared. Discussion. A bilateral vocal cord tumor is rare, especially in a never smoker. Evidence on the role of infliximab in carcinogenesis is inconclusive. To date, there are no follow-up studies evaluating malignancy risk of infliximab therapy in sarcoidosis patients. No studies in other diseases focus on laryngeal carcinomas during infliximab use. We argue that infliximab treatment might have attributed to the rapid progression of vocal cord carcinomas in this patient with an a priori low risk tumor profile. This case illustrates that caution remains warranted in patients with previous malignancies when considering initiation of TNF-α-inhibitors.

Ultrasound as a Useful Diagnostic Tool in the Follow-up of Laryngeal Carcinoma

ABSTRACTBackgroundUsing neck ultrasound to evaluate the status of the lymph nodes of a patient with a head and neck cancer is common practice but laryngeal ultrasound could help to receive more information of the tumor.Methods and resultsWe report a case of an initially T1a N0 M0 G2 R0 squamous-cell carcinoma of the right vocal cord. Despite regular follow-up, the relapse of the tumor remained undetected. The hypopharyngoscopy and laryngoscopy were performed. The tumor was evaluated with laryngeal ultrasound and to confirm the relapse of the tumor a MRI scan was performed. Endoscopically there was no obvious presence of the tumor. Laryngeal ultrasound facilitated the visualization of the tumor in good quality.Unfortunately, a total laryngectomy was necessary to treat the relapse of the squamous-cell carcinoma (T4a N0 (0/16) M0 G2 R0).ConclusionDespite careful follow-up via laryngoscopy a relapse of the laryngeal tumor was not visible. Using laryngeal ultrasound, the relapse might have been detected sooner.How to cite this articleKlinge K, Mueller A. Ultrasound as a Useful Diagnostic Tool in the Follow-up of Laryngeal Carcinoma. Int J Otorhinolaryngol Clin 2013;5(3):154-156.

Funktionserhaltende Therapie des Kehlkopf- und des Hypopharynxkarzinoms

The principles of open vs. laser microsurgical approaches for partial resections of the larynx are described, oncological as well as functional results discussed and corresponding outcomes following primary radiotherapy are opposed. Over the last decade, the endoscopic partial resection of the larynx has developed to an accepted approach in the treatment of early glottic and supraglottic carcinomas thus leading to a remarkable decline in the use of open surgery. Comparing the various surgical approaches of laryngeal partial resections, the oncological outcome of the patients, as far as survival and organ preservation are concerned, are comparable, whereas functional results of the endoscopic procedures are superior with less morbidity. The surgical procedures put together, are all superior to radiotherapy concerning organ preservation. Transoral laser microsurgery has been used successfully for vocal cord carcinomas with impaired mobility or fixation of the vocal cord, supraglottic carcinomas with infiltration of the pre- and/or paraglottic space as well as for selected hypopharyngeal carcinomas. It has been well documented that laser microsurgery achieves good oncological as well as functional results with reasonable morbidity. However, patients with those tumours have been successfully treated by open partial resections of the larynx at medical centres with appropriate expertise. The initially enthusiastic assessment of study results concerning the efficacy of various protocols of chemoradiation with the intent of organ preservation for laryngeal and hypopharyngeal carcinomas are judged more cautious, today, due to recent reports of rather high rates of late toxicity complications.

Anterior Cervical Abscess as a Complication of CO2 Laser Surgery of the Larynx

Because of the increasing use of laser surgery, new complications appear in patients. Endoscopic procedures bring to patients a kind of surgery with benefits such as avoidance of external incisions, but complications not seen before are happening. We describe the case of a patient who had a big anterior cervical abscess 1 month after having undergone an endoscopic laser CO2 cordectomy to treat an epidermoid carcinoma of the left vocal cord. One month after the surgery, the patient came to the emergency department complaining about progressive anterior cervical inflammation, with odynophagia. Computed tomography scan revealed an extensive anterior cervical abscess. As far as we are concerned, our present case is the first reporting this extremely rare complication, an anterior cervical abscess appearing 1 month after an endoscopic laser CO2 procedure. Reporting this kind of infectious complication, the authors aim to make aware the surgeons about the possibility of this late event.

Carotid-Sparing Intensity-Modulated Radiotherapy for Early-Stage Squamous Cell Carcinoma of the True Vocal Cord

To compare radiation doses to carotid arteries among various radiotherapy techniques for treatment of early-stage squamous cell carcinoma (SCC) of the true vocal cords. Five patients were simulated using computed tomography (CT). Clinical and planning target volumes (PTV) were created for bilateral and unilateral stage T1 vocal cord cancers. Planning risk volumes for the carotid arteries and spinal cord were delineated. For each patient, three treatment plans were designed for bilateral and unilateral target volumes: opposed laterals (LATS), three-dimensional conformal radiotherapy (3DCRT), and intensity-modulated radiotherapy (IMRT), for a total of 30 plans. More than 95% of the PTV received the prescription dose (63Gy at 2.25 Gy per treatment). Carotid dose was lowest with IMRT. With a bilateral vocal cord target, the median carotid dose was 10Gy with IMRT vs. 25 Gy with 3DCRT and 38 Gy with LATS (p < 0.05); with a unilateral target, the median carotid dose was 4 Gy with IMRT vs. 19 Gy with 3DCRT and 39 Gy with LATS (p < 0.05). The dosimetric tradeoff with IMRT is a small area of high dose in the PTV. The worst heterogeneity results were at a maximum point dose of 80 Gy (127%) in a unilateral target that was close to the carotid. There is no question that IMRT can reduce the dose to the carotid arteries in patients with early-stage vocal cord cancer. The question is whether the potential advantage of reducing the carotid dose outweighs the risk of tumor recurrence due to contouring errors and organ motion and the risk of complications from dose heterogeneity.

T1 glottic carcinoma involving the posterior commissure

The posterior commissure is an uncommon site of glottic carcinoma. The aim of the study was to compare the clinical and prognostic characteristics of glottic carcinoma of the posterior commissure and the vocal cords. Retrospective case control study. The study group consisted of 40 patients aged 32 to 84 years (mean, 62.7 +/- 10.7) diagnosed with T1 glottic carcinoma involving the posterior commissure from 1960 to 2008. Data on clinical features and outcome were collected from the medical files and compared with the data for 42 patients aged 30 to 87 years (mean, 64.4 +/- 11.8) with T1 vocal cord carcinoma. : There were no significant differences in clinical characteristics between the groups except for the higher rate of smokers among the patients with vocal cord carcinoma (95% vs. 65%, P = .01). All patients were treated primarily with radiotherapy. Disease-free survival in the posterior commissure carcinoma group was 76.1% after 5 years and 72.3% after 10 years, and in the vocal cord carcinoma group, 95% after 5 and 10 years (P = .012). The risk of recurrence was higher when the tumor involved the posterior commissure (hazard ratio, 8.78; 95% CI, 1.12-68.5, P = .038). T1 glottic carcinoma involving the posterior commissure has a more aggressive biological behavior and a worse prognosis than T1 glottic carcinoma of the vocal cords. Smoking, which is an important pathogenetic factor in vocal cord carcinoma, plays a lesser role in posterior commissure carcinoma. Laryngoscope, 2009.

Acoustic voice analysis in different phonetic contexts after larynx radiotherapy for T1 vocal cord carcinoma

Radiotherapy for early vocal cord carcinoma affects quality of voice. Nevertheless, most patients refer to having a high satisfaction level with their voice. The few acoustic studies on quality of voice have been performed only in prolonged vowel production, which is not a usual speech situation. The present study has been done with the aim of establishing which phonetic situations reflect a greater alteration in voice production related to irradiation. Eighteen male patients irradiated for Tis-T1 vocal cord carcinoma and a control group of 31 non-irradiated subjects were included in a study of acoustic voice analysis. This analysis was performed one year after radiotherapy. Patients and control group voices were tape recorded in extended vowel production, oral reading of a standard paragraph, spontaneous speech and in a song. Acoustic analysis was performed by a Kay Elemetric's Computerized Speech Lab (model CSL #4300). Fundamental frequency, jitter, shimmer and harmonics-to-noise ratio were obtained in both groups. Statistical test: Lin concordance coefficient and Pearson's correlation coefficient, Student's t-test and ROC curves. Concordance and correlation studies did not allow selection of any subgroup in acoustic parameters and different acoustic situations. Acoustic parameters had higher median values in irradiated patients. Student's t-test showed significant differences for fundamental frequency in sustained vowel production and spontaneous speech; for jitter there was statistical significance in all the acoustic situations and for shimmer in oral reading and song. Jitter showed a cut-off of 2.02% with a sensitivity of 89% and specificity of 97% in classifying irradiated and non-irradiated groups. The ROC curve for jitter correctly classified 94% of subjects into irradiated or non-irradiated groups. The present study showed that jitter obtained from spontaneous speech was the most relevant parameter in discriminating voice in irradiated patients by acoustic analysis. Jitter in spontaneous speech is in need of more analysis in bigger series and in more advanced stages of larynx cancer as its relevance has been demonstrated.

Syndrome myasthénique de Lambert-Eaton associé à un carcinome épidermoïde de la corde vocale

Introduction Lambert-Eaton Myasthenic Syndrome (LEMS) is an autoimmune channelopathy in which patients produce autoantibodies directed against voltage-gated calcium channels. LEMS is paraneoplastic in 50% of patients, most frequently associated with small cell lung carcinoma. We describe a case of paraneoplastic LEMS associated with a vocal cord carcinoma. Observation A 64-year-old man developed in five months muscle weakness affecting gait. Clinical examination showed proximal muscular deficiency, areflexia and dysphonia. Electrophysiologic study showed potentiation greater than 500% after post exercise facilitation and 76 percent increment response at high-rate repetitive nerve stimulation (20 Hz). Diagnosis of LEMS was confirmed by electrophysiologic study and anti-voltage gated calcium channel antibodies (90 pM, positive value greater or equal to 70 pM). Left vocal cord lesion histology showed epidermoid carcinoma. A combination of vocal cord tumor removal by endoscopy and treatment by pyridostigmine, 3-4 diaminopyridine and intravenous human immunoglobulin improved neurological symptoms. Conclusion Paraneoplastic syndromes in association with cancers of the larynx and hypopharynx are unusual. Only two cases are reported with LEMS associated with larynx carcinoma. We describe an unusual case of LEMS associated with a left vocal cord carcinoma.

Dermohypodermite bactérienne nécrosante avec fasciite nécrosante : complication d’une installation opératoire ?

Necrotizing fasciitis is a hypodermis, muscular fascia then dermis necrotizing infection. It disseminates along fascias with a mortality sometimes within 18 hours. The average mortality, reported in the literature, is about 30%. A 65-year-old man, with a history of Vaquez disease (under hydroxurea) and a smoke addiction, had an epidermoid carcinoma of the left vocal cord (T2 N0 M0). The cancer treatment consisted of a functional lymph node excision, followed by tracheotomy then by partial laryngectomy. At the end of the intervention, after removal of operative fields, it was noticed that the Montandon cannula had slid and was between the medial side of the left upper limb and the lateral side of the chest. There was a cutaneous imprint with ecchymosis on the route of the cannula. At the second postoperative day, a necrotizing fasciitis quickly developed on the left side of the chest, the medial side of the left upper limb, and the left hip without infection of the operating site. An Escherichia coli was identified in tracheal secretions and operative samples. The presumed hypothesis of this necrotizing infection is the cutaneous contamination of the thoracic wall by tracheal secretions colonized by E. coli, whose penetration was induced by the cutaneous traumatism due to the cannula. We remind, by analyzing this unusual case, the caring principles one of which diagnosis and the surgical excision must be as premature as possible. We insist on the elementary measures of protection of the support points and the good binding of cannulas.

Improvement of obstructive sleep apnea after radiation therapy of vocal cord carcinoma

A 52-year-old gentleman presented to the sleep clinic with a history of witnessed episodes of apnea, loud snoring, and moderate subjective sleepiness (Epworth Sleepiness Scale (ESS), 10). The patient reported an average time in bed of 6.5 h per night. Physical exam revealed a weight of 206 lbs, a body mass index of 30, a Mallampati class of 2 and tonsils class 2. The diagnostic polysomnogram showed moderate obstructive sleep apnea (apnzea–hypopnea index (AHI) = 24). The patient was prescribed a continuous positive airway pressure (CPAP) device at 13 cm H2O of pressure based on a titration polysomnogram. On one-month follow-up, the patient had very low adherence to CPAP treatment and subsequently stopped using it. The patient presented to his primary physician with a new onset of intermittent hoarseness four months after his initial sleep evaluation. The patient was prescribed antibiotics and referred to an otolaryngologist, and was diagnosed with an invasive squamous cell carcinoma of the left true vocal cord (T2, N0, M0) (Fig. 1). The patient underwent an excisional biopsy and radiation therapy with 6075 centigray.

T3 and T4 True Vocal Cord Squamous Carcinomas Treated With External Beam Irradiation

The purpose of this study was to report the outcomes after external-beam radiotherapy (RT) for selected T3 and T4 vocal cord squamous cell carcinomas. One hundred nine patients with previously untreated T3 and T4 squamous cell carcinomas of the glottic larynx were treated with curative intent in this Institutional Review Board-approved outcome study using continuous-course RT alone (106 patients) or followed by a planned neck dissection (3 patients) between September 1966 and June 2002. Patients selected for such treatment had relatively low-volume, unilateral disease. Patients were staged according to the recommendations of the American Joint Committee on Cancer (AJCC) as follows: T3N0, 68 patients (62%); T3N1, 14 patients (13%); T3N2B, 5 patients (5%); T4N0, 17 patients (16%); T4N1, 4 patients (4%); and T4N2B, 1 patient. The 5-year outcomes after treatment were: local control for stage T3 and T4, 78% and 81%; locoregional control for AJCC stage III and IVa, 62% and 78%; distant metastasis-free survival for AJCC stage III and IVa, 97% and 100%; cause-specific survival for AJCC stage III and IVa, 84% and 87%; and overall survival for AJCC stage III and IVa, 52% and 67%, respectively. Severe complications occurred in 13 patients (12%). The results of this retrospective study compare favorably with those published elsewhere in the literature for T3 and T4 vocal cord carcinomas. Local control and ultimate cure probabilities will hopefully improve further with the addition of concomitant chemotherapy to RT for larger tumors.

Lymphatic vessel density in vocal cord carcinomas assessed with LYVE-1 receptor expression

Background and purpose Early stage vocal cord carcinomas are usually cured by radiation therapy despite the use of portals that exclude the cervical lymph nodes. We investigated whether the lymphatic vessel density (LVD) of vocal cord carcinomas differs from that of other head and neck carcinomas. Patients and methods Deparaffinized tissue from tumors of 60 patients diagnosed with head and neck squamous cell carcinoma (HNSCC) were immunostained for LYVE-1, a novel lymphatic vessel marker. Twenty-two had vocal cord carcinoma. Tumor blood vessel density (BVD) was assessed using immunostaining for CD31. Results Tumor overall LVD, including both intra- and peritumoral lymph vessels, was 10-fold lower than the BVD (5 counts/mm 2 vs. 52 mm −2, respectively). A high LVD was associated with a high BVD ( P=.002), but neither was associated with the tumor size. Both tumor LVD and BVD were lower in vocal cord carcinomas than in HNSCCs arising at other sites (median, 0 vs. 7 mm −2, P=.016; and median, 36 vs. 52 mm −2, P=.006, respectively). Only one vocal cord carcinoma was associated with a regional metastasis at the time of the diagnosis. Among the rest of the cases tumor size was a better predictor for the presence of regional metastases than tumor BVD or LVD in a logistic regression model (odds ratio 2.2, 95% CI 1.1–4.5). Conclusion Vocal cord carcinomas have a low lymph vessel density as compared with HNSCCs arising at other sites.

Frontolateral Vertical Partial Laryngectomy without Tracheotomy for Invasive Squamous Cell Carcinoma of the True Vocal Cord: A 25-Year Experience

On the basis of an inception cohort of 270 patients with a previously untreated invasive squamous cell carcinoma of the true vocal cord (232 T N0M0, 35 T2N0M0, and 3 T3N0M0) and a minimum of 3 years of follow-up, the authors analyze the oncological and functional outcomes following frontolateral vertical partial laryngectomy without tracheotomy. The 5-year Kaplan-Meier actuarial survival estimate ranged from 83.1% for T1 tumors to 67.2% for T2 tumors (p = .005). On univariate analysis, a significant statistical relationship was noted between reduced survival and the following variables: increased age, increased Charlson comorbidity index score over grade 0, increased tobacco intake, increased alcohol intake, increased T stage, local failure, nodal failure, and development of a metachronous second primary cancer. The hospital mortality rate was 0.4%. A significant postoperative surgical complication was noted in 49 patients (18.1%). The predominant significant surgical complication was wound infection (19 patients; 7%), followed by seroma and major subcutaneous emphysema. No significant statistical relationship was noted in a comparison of each, significant postoperative complication (including postoperative death) with the variables under analysis. The incidence of secondary tracheotomy was 0.4%. The incidence of completion laryngectomy due to functional problems was 0%. The 5-year Kaplan-Meier actuarial local control estimate was 91% for T1 tumors and 68.7% for T2 tumors (p <.0001). Within the T1 tumors, the 5-year Kaplan-Meier actuarial local control estimate ranged from 96.2% for tumors without anterior commissure involvement to 74.7% for tumors with anterior commissure involvement (p = .0002). On univariate analysis, a significant statistical relationship was noted between an increase in local recurrence and the following variables: increased T stage, anterior commissure involvement, and pathological margin involvement. The overall disease control rate and laryngeal preservation rate were 92.9% and 93.3%, respectively.

Supracricoid Partial Laryngectomies after Failure of Radiation Therapy

Conservation of laryngeal function is a key surgical objective in cases of limited recurrence after previously irradiated T1b or T2 glottic carcinoma. Only a few articles have mentioned the use of supracricoid partial laryngectomies (SCPL) to treat recurrent T1/T2 tumors that cannot be managed with vertical partial laryngectomy. To evaluate oncologic and functional results of SCPL in selected cases of T1/T2 glottic carcinoma recurrence after primary irradiation therapy. Between 1986 and 2000, 23 selected patients (T1b, 12 cases; T2, 11 cases) underwent SCPL as salvage treatment: cricohyoidepiglottopexy (CHEP) in 18 cases and cricohyodopexy (CHP) in 5 cases. The mean cannulation time was 28 (14-90) days. The mean nasogastric feeding tube time for CHP and CHEP was 55 (28-96) days and 21 (9-45) days, respectively. Four (17.4%) patients had major swallowing recovery problems. Three patients died in the postoperative period, one of intercurrent disease and two because of aspiration pneumonia. Six (26.08%) patients relapsed and underwent total laryngectomy. Three were subsequently controlled. The T stage was correlated with the onset of a new recurrence (P = .0258). The surgical margins were not correlated with recurrence (P = .0741). At 3 and 5 years, the global survival rate was 82.9% and 69.04%. The success rate for oncologic control and oncologic control with organ preservation was 74% and 66.6%, respectively. In selected cases of limited recurrence after radiation therapy for T1/T2 vocal cord carcinomas, SCPL can be an alternative to total laryngectomy when partial vertical surgery appears unsuitable.

Comparative analysis of voice in diagnostics of T1 and T2 vocal cord carcinoma

BACKGROUND: Dysphonia is the most frequent symptom of vocal cord carcinoma In the diagnostics of the disease subjective and objective methods of examination (acoustic analysis of a voice signal) and a laryngostroboscopy and aerodynamic exam?ination are used. METHODS: Our clinical prospective study consisted of 40 male patients, who had malignant tumors of one vocal cord - right or left. All the patients underwent otorhino-laryngological and phoniatric examination. The quality of voice was evaluated and estimated according to the 4-level GIRBAS scale (grade-instability-roughness-breathi-ness-asthenic-strain). Aerodynamic analysis dealt with vital capacity (VC), maximum phonation time (MPT) and phonation quotient (PQ). RESULTS: Vibration of vocal cord did not exist in 60% of cases. Instability and strained voice was present in 100% of cases. Mean average value of phonation quotient was 303.33 ml/s. The influence of roughness (R), instability (I), asthenic (A), and strain (S) on the total degree of dysphonia (G), was in all cases in a significantly positive correlation with the level of statistic significance p&lt;0.01 for I, R and S and level p&lt;0.05 for A. Nonvibration of a vocal cord had significant influence on the grade of dysphonia and strain (negative correlation, level p&lt;0.01), and on the instability (negative correlation, level p&lt;0.01). Maximum phonation time had statistically significant influence (negative correlation) on the phonation quotient. CONCLUSION: The voices of all patients who had glottal carcinoma T1 and T2 were psychoacoustically characterized by strain and instability of phonation. It is certain that a patient has glottal carcinoma if he/she has values of phonation quotient higher than 300 ml/s, nonvibration of a vocal cord in laryngostroboscopy and strained voice in psychoacoustic analysis.

770 Poster Acoustic voice analysis in different phonetic contexts after radiotherapy for T1 vocal cord carcinoma

770 Poster Acoustic voice analysis in different phonetic contexts after radiotherapy for T1 vocal cord carcinoma