Survival from glottic and supraglottic laryngeal carcinoma in Mumbai (Bombay), India

Head and neck cancer burden and preventive measures in Central and South America

RATIONALE AND OBJECTIVE

Central and South America comprise one of the areas characterized by high incidence rates for head and neck cancer. We describe the geographical and temporal trends in incidence and mortality of head and neck cancers in the Central and South American region in order to identify opportunities for intervention on the major identified risk factors: tobacco control, alcohol use and viral infections.

METHODS

We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries and cancer deaths from the WHO mortality database for 18 countries. Age-standardized incidence (ASR) and mortality (ASMR) rates per 100,000 person-years were estimated.

RESULTS

Brazil had the highest incidence rates for oral and pharyngeal cancer in the region for both sexes, followed by Cuba, Uruguay and Argentina. Cuba had the highest incidence and mortality rates of laryngeal cancer in the region for males and females. Overall, males had rates about four times higher than those in females. Most countries in the region have implemented WHO recommendations for both tobacco and alcohol public policy control.

CONCLUSION

Head and neck squamous-cell cancer (HNSCC) incidence and mortality rates in the Central and South America region vary considerably across countries, with Brazil, Cuba, French Guyana, Uruguay and Argentina experiencing the highest rates in the region. Males carry most of the HNSCC burden. Improvement and implementation of comprehensive tobacco and alcohol control policies as well as the monitoring of these factors are fundamental to prevention of head and neck cancers in the region.

Treatment outcome in patients undergoing surgery for carcinoma larynx and hypopharynx: a follow-up study

CONCLUSIONS

Compared with larynx cancers salvage rates are poorer for hypopharyngeal cancers and the role of primary surgery seems to be significantly higher and more decisive in overall survival (OS). Hypopharyngeal cancers therefore warrant a closer follow-up after an organ preservation protocol, to detect recurrence at the earliest stage and plan for an effective salvage surgery.

OBJECTIVE

To evaluate the survival and morbidity of patients treated by surgery for carcinoma of the larynx and hypopharynx according to site.

PATIENTS AND METHODS

All patients who had undergone laryngectomy at the Division of Surgical Oncology Regional Cancer Center (RCC) from June 1995 to December 2005 were included in the study, which retrospectively recorded the age and sex distribution, TNM stage, indication, type of laryngectomy and reconstructive option used. The therapeutic outcome, disease-free survival (DFS), OS, voice preservation and postoperative voice rehabilitation were analysed.

RESULTS

Of a total of 167 cases, 123 (74%) had salvage surgery for failed chemoradiotherapy/radical radiotherapy and 44 (26%) had primary surgical treatment. Conservation surgery was undertaken in 4 cases, near total laryngectomy or pharyngectomy (NTL/NTLP) was done in 14 and total laryngectomy (TLPE) with gastric pull up was done in 5. Total laryngectomy (TL) or TL with partial or subtotal pharyngectomy was done in 144 cases. Concomitant neck dissection (ND) was done in 46 cases, 14 posterolateral selective, 15 radical neck dissections (RNDs), 2 extended RNDs, 12 bilateral NDs and 3 modified neck dissections (MNDs). Five patients received platinum-based neoadjuvant chemotherapy and nine had postoperative chemotherapy. In 116 patients the pharyngeal remnant was closed primarily, 21 patients had pectoralis major myocutaneous flap patch reconstruction, 18 had tubed pectoralis major myocutaneous (PMMC) flap reconstruction, 4 had folded (bipaddled) PMMC flap reconstruction, 7 had PMMC and 3 patients had deltopectoral (DP) flap for skin cover. Pathological margin positivity was seen in seven cases and perinodal disease was seen in nine. There was a statistically significant survival difference between salvage and primary surgical cases among cancers of the larynx and hypopharynx. Hypopharyngeal salvage rate was significantly lower in the present study. Sixty-two (37%) patients had postoperative leaks. Five leaks persisted to form pharyngocutaneous fistulae. All of these patients had either wound infection with or without flap necrosis or previous radiation. Two were repaired and in two cases speech prosthesis insertion was possible due its anatomical position. One patient refused further surgical closure after a partially failed repair. Fifty-six (34%) patients recurred locoregionally, 4 (2.3%) patients developed a second primary and 5 (2.9%) had distant metastasis. Thirty patients were voice rehabilitated with an electronic larynx. Seventeen patients had voice prosthesis insertion (6 primary and 10 secondary), 3 patients developed good oesophageal speech and voice preservation was possible in 18 patients. Seventy-nine patients were alive at the time of completing the study.

Therapeutic management of laryngeal cancer. Results of a study of 356 patients from the Cancer Registry of the Somme, France

CONCLUSIONS

The global survival rate was low compared to those reported in the literature, in which the analyzed populations were selected according to the tumor stage or treatment. This study should be prolonged and should also involve other cancer registries in France in order to increase the number of patients and to analyze tumors of comparable stage and therapeutic management.

OBJECTIVE

To analyze the survival rate of a non-selected laryngeal cancer population from the Cancer Registry of the Somme, a French region.

MATERIAL AND METHODS

A total of 356 patients were included in a retrospective study covering the period 1987-1997. Survival and prognostic factors were analyzed. Statistical analysis was performed using the Kaplan-Meier method, the Cox model and the chi2 test.

RESULTS

The 5-year global survival rate was 42% for males and 55% for females. Tumor localization, T, N and M stages and surgery were found to be significant prognostic factors. Sex and age were not statistically significant factors. For stage I tumors, surgery alone gave better results than radiotherapy alone in terms of global survival. No difference occurred in terms of local recurrence. A similar comparison was not possible for stage II-IV tumors owing to the small number of cases.

The epidemiology of laryngeal cancer in Brazil

The city of São Paulo exhibits one of the highest incidences of laryngeal cancer in world and Brazil presents remarkable occurrence, compared with other Latin American countries. Around 8,000 new cases and 3,000 deaths by laryngeal cancer occur annually in the Brazilian population. In the city of São Paulo, incidence rates for laryngeal cancer among males have been decreasing since the late 1980s while, among females, the rates have shown a stable trend. This phenomenon is probably the expression of changes in gender behavior related to tobacco smoking. Several risk factors are involved in the genesis of laryngeal cancer. The most important are tobacco smoking and alcohol intake, but occupational hazards have also been associated with the disease, such as asbestos, strong inorganic acids, cement dust and free crystalline silica. Additionally, salted meat and total fat intake have been linked to elevated risk of laryngeal cancer. Conversely, several studies have confirmed that fruits, raw leaf vegetables and legumes protect against this cancer. Some researchers have postulated a possible association between laryngeal squamous cell carcinoma and human papilloma virus (HPV), but this is not universally accepted. Gastroesophageal reflux disease is weakly, but consistently correlated with laryngeal cancer. Familial cancer clusters, particularly of head and neck tumors, seem to increase the risk of laryngeal cancer. Some genetic polymorphisms, such as of genes that code for xenobiotic-metabolizing enzymes, have shown elevated risk for laryngeal cancer according to recent studies. Public health policies regarding the control of tobacco smoking and alcohol consumption, and also surveillance of carcinogen exposure in occupational settings, could have an impact on laryngeal cancer. No proposals for screening have been recommended for laryngeal cancer, but one diagnostic goal should be to avoid treatment delay when suspected symptoms have been observed.

Supraglottic and glottic carcinomas: Epidemiologically distinct entities?

In the time period 1988-2000, a case-control study on laryngeal cancer was conducted in Montevideo, Uruguay. Four-hundred eighty-one (481) cases newly diagnosed and microscopically confirmed as squamous cell carcinomas were included. These cases were frequency matched with 481 nonneoplastic controls, admitted to the same hospitals as the cases. The purpose of our study was to compare odds ratios (ORs) by laryngeal subsite (supraglottis and glottis). ORs of supraglottic cancers displayed much higher risks than glottic carcinomas for most tobacco variables and for red wine intake. The differences between subsites were statistically significant, displaying heterogeneity between both subsites. Moreover, whereas black tobacco smokers displayed a significant increased risk of 1.7 (95% confidence interval [CI] 1.2-2.5) compared to smokers of blond (flue-cured) tobacco among supraglottic tumors, no effect of this type of tobacco was observed in glottic lesions. It could be suggested that concerning tobacco and alcohol effects, supraglottic and glottic squamous cell cancers are probably distinct epidemiologic entities.