Can I treat this small larynx lesion with radiation alone? Update on the radiation management of early (T1 and T2) glottic cancer

Clinical and pathologic predictors of recurrence and survival in spindle cell squamous cell carcinoma

OBJECTIVE

To determine clinicopathologic predictors of recurrence and survival in patients with spindle cell squamous cell carcinoma (SpSCC).

STUDY DESIGN

Historical cohort study.

SETTING

Tertiary care hospital.

SUBJECTS AND METHODS

Forty-eight patients (mean age, 65.2 years; 35 men, 13 women) who underwent definitive treatment for pathologically confirmed SpSCC between 1987 and 2009 were identified and reviewed. The main outcome measures were time to recurrence and overall survival, while controlling for clinical and pathologic parameters (age, sex, TNM classification, stage, tumor subsite, smoking status, treatment modality, margin status).

RESULTS

Of 48 patients, there were 25 oral cavity, 15 laryngeal, 7 oropharyngeal, and 1 maxillary sinus tumors. Treatment included surgery in 32, radiation in 9, and concurrent chemoradiation in 7 patients. The 3-year overall survival for the cohort was 62% with a median follow-up of 59 months; 52.1% (25/48) of patients developed a recurrence, and 88% (22/25) recurred locally or locoregionally. Recurrence occurred within 2 years in 72% (18/25) of patients. Age, sex, initial T and N classification, overall stage, tumor subsite, smoking status, treatment modality, and margin status were not predictive of recurrence or overall survival.

CONCLUSION

Patients with SpSCC are at high risk of developing locoregional recurrence, but no measured clinical or pathologic parameter was predictive of survival. Although overall survival is similar to that of patients with conventional SCC, closer follow-up should be considered in these patients to allow earlier detection and treatment of these locally aggressive tumors.

Structures constituting the sound source after the treatment of early glottic cancer

INTRODUCTION

We indicate the exclusive radiation therapy as initial approach for T1a glottic tumors, and the frontolateral laryngectomy for the tumors staged as T1b and selected T2 glottic tumors. The videolaryngostroboscopy is a useful tool to analyze the laryngeal structural changes and compensatory motion after the therapeutic approach.

OBJECTIVES

To evaluate the endolaryngeal structures of patients who participate in the vibratory sound source after the early glottic cancer treatment through the videolaryngostroboscopy.

METHODS

It was a retrospective transversal study in which 20 patients who underwent exclusive radiation therapy and 25 patients who underwent frontolateral laryngectomy were analyzed by means of videolaryngostroboscopy. The radiation doses ranged from 5000 to 7020 cGy in the radiation therapy group. The mucosal wave and the vibratory source components were evaluated.

RESULTS

All of the irradiated patients presented vibratory behavior, and hyperfunction was occasionally observed in four cases. The mucosal wave source was glottic in 18 cases and mixed in two cases. In the laryngectomy group, 10 supraglottic sources, 10 glottic sources, and five mixed sources were identified. Among the 10 cases of supraglottic source, eight patients presented global constriction and two patients presented medial constriction. Among the five cases of mixed source, two patients presented global constriction, one patient presented medial constriction, and one patient presented anteroposterior constriction. Regarding the number of anatomical structures presenting vibratory pattern, five patients had two structures, four patients had three structures, and one patient had four structures.

CONCLUSION

Patients who underwent radiation therapy recruit less supraglottic structures as vibratory source than the patients undergoing vertical laryngectomy.

Endoscopic laser surgery of early glottic cancer: involvement of the anterior commissure

BACKGROUND

Early glottic cancer can be cured with transoral laser resection, but in cases with anterior commissure involvement, there is still controversy concerning the best treatment modality.

METHODS

The impact of anterior commissure involvement on local control was analyzed in a retrospective review of 444 patients with early glottic cancer (pT1a-pT2a) treated between 1986 and 2004 with transoral laser microsurgical resection.

RESULTS

The anterior commissure was involved in 153 cases; the 5-year local control rate with and without anterior commissure involvement was 73% versus 89% for T1a and 68% versus 86% for T1b tumors. For T2a lesions, the 5-year local control rate was 76%, irrespective of anterior commissure involvement.

CONCLUSION

In early glottic cancer treated by transoral laser microsurgery, a decrease in local control is evident in case of anterior commissure involvement for T1a and T1b but not for T2a tumors.

Organ preservation surgery for laryngeal cancer

The principles of management of the laryngeal cancer have evolved over the recent past with emphasis on organ preservation. These developments have paralleled technological advancements as well as refinement in the surgical technique. The surgeons are able to maintain physiological functions of larynx namely speech, respiration and swallowing without compromising the loco-regional control of cancer in comparison to the more radical treatment modalities. A large number of organ preservation surgeries are available to the surgeon; however, careful assessment of the stage of the cancer and selection of the patient is paramount to a successful outcome. A comprehensive review of various organ preservation techniques in vogue for the management of laryngeal cancer is presented.

State of head and neck surgical oncology research--a review and critical appraisal of landmark studies

Surgical literature has been criticized for the lack of high-quality research. The present review examines methodological quality of literature published in head and neck surgical oncology. We focus on landmark studies published on topics of best practice controversy, namely (1) the role of chemotherapy and organ-preservation protocols in the management of head and neck mucosal malignancies; (2) the role of selective neck dissection versus radical neck dissection; and (3) the role of laser microsurgery in the management of larynx cancer. Similar flaws were evident in selected landmark studies with the major issue being multiplicity in the form of multiple outcome analysis, comparison of multiple treatment groups, repeated measures over time, planned interim analyses, and subgroup analyses. The open nonrandomized controlled trial may be a feasible option in head and neck surgical research allowing for standardization, uniformity, consistency, and blinded outcome assessment.