Definitive radiotherapy for squamous carcinoma of the larynx

Definitive radiotherapy for T1 or T2 laryngeal carcinoma offers good local control and quality of voice. Recent clinical trials with hyperfractionated radiotherapy and concurrent chemoradiotherapy demonstrated improved rates of local control for advanced laryngeal cancer treated with primary radiotherapy and provides the opportunity for organ preservation. The use of amifostine and pilocarpine may prevent or ameliorate radiation-induced xerostomia. Recent advances in 3-D conformal radiotherapy and IMRT lead to a better dose distribution for sparing normal organs while treating target volumes with full dose.     

肿瘤浸润抑制因子在喉癌复发及转移中的作用

目的 :研究肿瘤浸润抑制因子 (E cadherin)在喉癌复发、转移中的作用 ,以探讨喉癌复发转移的机制。方法 :利用PCR、PCR SSCP等分子生物学方法 ,检测E cadherin基因第 5、7对外显子在喉癌组织中的基因突变。结果 :正常喉组织有E cadherin基因表达 ,无基因突变 ;癌旁组织第 5对外显子突变率为 2 .5 %。第 5、7对外显子在喉复发癌组织中的基因突变率分别为 2 8.5 7%、0 % ;淋巴结转移阳性组分别为 4 7.0 6%、64.71% ,淋巴结转移阴性组分别为 0 %、6.2 5 % ;且基因突变率随肿瘤TNM临床分期而增高。结论 :通过对喉癌组织中E cadherin基因突变的检测 ,可以判断肿瘤复发、转移的倾向性 ;E cadherin基因突变可能是喉癌复发、转移的分子机制之一     

p53,c-myc,nm23癌基因蛋白在喉复发癌的表达及其意义

目的：研究p53,c-myc,nm23癌基因蛋白的表达与喉癌复发的关系，对预后作出估计。方法：回顾分析喉癌手术标本574例，术后随访3年，确诊术后复发56例。正常喉对照标本39例。标本制成组织芯片，采用免疫组化SABC法对芯片标本进行染色。结果：p53,nm23、c-myc在喉癌组织中有表达，其阳性率各有不同，其中c-myc在喉癌复发组的表达明显增强，与未复发组的表达差异有极显著性意义（P＜0．01）；而nm23在喉癌复发组的表达明显减弱，与未复发组的表达差异有极显著性意义（P＜0．01）。p53在喉癌复发组与复发组的表达差异无显著性意义（P＞0．05）。c-myc的表达与喉癌复呈正相关，nm23癌基因蛋白的表达与喉癌复发呈负相关。结论：c-myc,nm23癌基因蛋白的表达可作为预测喉癌术后复发的指标。     

Stomal recurrence following total laryngectomy: clinical and molecular analysis of a series

The aim of the present study was to analyze the risk features and to discuss the preventive measures and treatment of stomal recurrence (SR) after total laryngectomy (TL), and to investigate the clonal relationship between the primary and recurrent lesions. We reviewed a series of 25 patients affected by SR after TL for laryngeal squamous cell carcinoma. A subset of 7 coupled primary and recurrent carcinomas were examined for microsatellite alterations that were used as a marker of genetic lineage. The incidence of SR was higher in patients with initial subglottic lesions (subglottic, transglottic, or glottic-subglottic tumors) than in those with other locations of laryngeal cancer (p = .013). In addition, the frequency of SR was significantly higher in patients who underwent preoperative tracheotomy, performed 48 hours or more before the TL, than in the group of patients who did not receive preoperative tracheotomy (23.3% versus 0.46%, p < .001). According to microsatellite analysis, of the 5 informative patients, 2 demonstrated discordant alterations in the recurrent tumor indicative of clonal heterogeneity, 2 demonstrated identical alterations, and 1 showed an additional alteration in the recurrent tumor. Our analysis supports the hypothesis that a subset of SRs after TL may be second primary tumors, genetically unrelated to the primary laryngeal lesion.     

Minimally invasive surgery for recurrent neuroendocrine carcinoma of the supraglottic larynx

Calcitonin-secreting neuroendocrine carcinomas of the supraglottic larynx are infrequent tumors, making it difficult to agree on treatment plans for recurrent tumors. Furthermore, this rare malignancy is often confused with the more common medullary thyroid carcinoma, resulting in inappropriate thyroidectomies. We present a case report of a calcitonin-secreting recurrent neuroendocrine carcinoma of the supraglottic larynx, in which surgery and pentagastrin stimulation were performed repeatedly at various stages of the disease. The recurrent laryngeal tumor was ultimately identified and, after construction of a protective tracheostomy, resected transorally en bloc with the underlying arytenoid cartilage. Postoperatively, the patient did well and stimulated calcitonin levels never exceeded double baseline values. Laryngoscopic removal of smaller laryngeal carcinomas is both technically feasible and safe, even when tumors are recurrent. In calcitonin-secreting malignancies, pentagastrin stimulation may facilitate the distinction between laryngeal and medullary thyroid carcinoma and thus help avoid unnecessary thyroidectomies. Received: 17 August 1998 / Accepted: 24 November 1998     

Association of laryngeal and pulmonary malignancies: a continuing challenge

Over a 10-year period, 790 patients with squamous cell carcinoma of the head and neck were treated at The Medical College of Wisconsin Affiliated Hospitals and were followed for a minimum of 7 years. Of the 218 patients with index primary laryngeal tumors, 43 (19.7%) developed additional malignancies in the head and neck, esophagus, or lung. Secondary lung tumors were the most common, occurring in 23 patients (10.6%). Of the 218 patients with index primary laryngeal carcinoma, 113 were treated successfully and never developed a recurrence of the original tumor. Twenty-one second primary lung malignancies developed in this group of successfully treated laryngeal tumor patients. The occurrence of these pulmonary malignancies was distributed fairly evenly over time. Three patients developed second primary lung tumors more than 7 years after initial treatment. The appearance of a secondary malignancy in the lung had a devastating effect upon survival. None of our patients survived more than 2 years after detection of the lung lesion. The relatively high incidence and delayed onset of second primary lung tumors in this group call into question the concept of 5-year "cures." Our challenge for the future should be the prevention and early detection of these second primary lung tumors.     

喉癌组织及手术切缘P53和P16蛋白表达与局部复发的关系

目的 用免疫组织化学方法监测Ｐ１６和Ｐ５３蛋白在喉癌手术切缘中表达情况及其与肿瘤局部复发的关系。方法 选择ＨＥ染色病理学检查手术切缘为阴性但术后肿瘤局部复发的５２例喉癌作为复发组,并按照患才的年龄、性别、临床分型、ＴＮＭ分期、病理分级、术前放疗剂量等可能影响因素选择４８例随访５年以上无肿瘤局部复发者为无复发组。对２组手术切缘和肿瘤标本同时行Ｐ１６和Ｐ５３蛋白 免疫组织化学检查。结果 在１００例喉癌组织中Ｐ５３蛋白的表达率和Ｐ１６蛋白的丢失率分别为５４％和４０％,喉癌组织中Ｐ１６和Ｐ５３蛋白表达同时异常的喉癌患者当其手术切缘粘膜中Ｐ１６和Ｐ５３蛋白表达也同时异常时,其术后肿瘤局部复发率为８５％。Ｐ１６和Ｐ５３蛋白表达与喉癌的临床分型和Ｔ分期无关。结论 采用免疫组化方法联合检测Ｐ１６和Ｐ５３蛋白在喉癌组织和手术切缘     

Integration of human papilloma virus type 26 in laryngeal cancer of a child

Squamous cell carcinoma (SCC) in larynx is rare with children and adolescents. Usually larynx cancer is common with male smokers in the 7th decade. Among patients with no history of tobacco and/or alcohol consumption several factors have can play a role in the outbreak of laryngeal cancer: such as individual predisposition, radiation, gastroesophageal reflux, viral infection, dietary factors and environmental influences. In literature only few cases of laryngeal cancer with children are reported. Recent studies show that the most frequent laryngeal malignancy is the embryonal rhabdomyosarcoma. Besides the recurrent respiratory papillomatosis (RRP) based on an infection with human papilloma virus (HPV) types 6 and 11 (low risk) and types 16 and 18 (high risk) is known for a possible malignant transformation towards a SCC. HPV type 26 is only reported as low risk type HPV associated with cervical cancer. Final diagnosis often takes a long time. Initial symptoms such as hoarseness, cough or shortness of breath are often referred to more typical pediatric diseases or laryngeal development.     

喉部分切除术后复发癌的外科挽救治疗

目的 分析喉部分切除术后喉复发癌的外科治疗方法、预后及影响预后的因素.方法 回顾分析中国医学科学院肿瘤医院头颈外科77例喉部分切除患者术后喉复发癌再行外科挽救治疗的临床资料.其中51例行喉全切除术,26例行喉部分切除术,其中19例无放疗史者行手术加放疗的综合治疗.Kaplan-Meier法统计生存率,Cox多因素分析影...     

Supracricoid partial laryngectomy with cricohyoidoepiglottopexy and cricohyoidopexy for glottic and supraglottic carcinomas

OBJECTIVES: To review the patients operated in our department with supracricoid partial laryngectomy with either cricohyoidoepiglottopexy (CHEP) (59 cases) or cricohyoidopexy (CHP) (10 cases) technique, for primary or recurrent glottosupraglottic squamous cell carcinoma and compare the technique with other surgical or conservative approaches for treatment of laryngeal carcinoma. METHODS: From hospital charts, we retrospectively reviewed 69 patients who had undergone supracricoid partial laryngectomy with the CHEP or CHP technique between 1983 and 1996 for primary or recurrent glottosupraglottic squamous cell carcinoma in our department. Statistical evaluation of oncological and functional results were conducted. Results were compared with other surgical and conservative treatment for glottosupraglottic carcinoma of the larynx that were published previously in the literature. RESULTS: Sixty-nine patients had CHEP or CHP for glottosupraglottic carcinoma of the larynx. Thirteen percent of the patients received adjuvant radiotherapy. Minimum follow-up was 2 years or until death. Five-year actuarial survival (Kaplan-Meier method) was 68%. Global local control was achieved in 84% of cases. Among previously untreated patients (n = 54), local control rate was 94.5%. After 1 year, 92.7% of patients achieved normal swallowing and respiration. Salvage total laryngectomy had to be performed in four patients (5.7%) for persistent aspiration and in five patients (7.2%), who were previously treated with radiotherapy, for local recurrence. No permanent tracheostomy or gastrostomy was required. CONCLUSIONS: Our experience with supracricoid partial laryngectomy with either CHP or CHEP suggests that this technique is a valuable alternative to radiotherapy for T2-T4 glottosupraglottic carcinomas, particularly those with extension and invasion of the anterior commissure. It allows for preservation of a good laryngeal function without altering the long-term survival, keeping total laryngectomy as a salvage procedure.     

Thyroid surgery in children and adolescents: A series of 65 cases

ObjectivesTo describe the specificities and complications of thyroid surgery in children and adolescents.Material and methodsThis retrospective study was based on 64 patients under the age of 18 who underwent thyroid surgery between January 2004 and March 2012, with two operations in one case. The following data were analysed: anatomical variants of the recurrent laryngeal nerve, postoperative recurrent laryngeal nerve paralysis rate, postoperative hypoparathyroidism rate, and histological results.ResultsTwo cases of right non-recurrent inferior laryngeal nerve were observed (2.2% of the 93 recurrent laryngeal nerves dissected). One case of persistent left recurrent laryngeal nerve paralysis was observed (1.1%) despite intraoperative recurrent laryngeal nerve monitoring. Eight cases of immediate postoperative hypocalcaemia were observed (23.5% of the 34 total thyroidectomies) and permanent hypocalcaemia was observed in 5 cases (14.7%) with a significantly lower immediate postoperative serum calcium than in the case of transient hypocalcaemia (P = 0.035). Among the 11 patients operated for familial medullary thyroid carcinoma (MTC), 36.3% presented one or more sites of C-cell carcinoma. Among the 32 patients operated for thyroid nodule, 6.3% presented papillary adenocarcinoma. Histological results were benign in all other cases.ConclusionsThyroid surgery in children and adolescents is part of global multidisciplinary management of thyroid disorders in children. Recurrent laryngeal nerve paralysis is a rare complication, but may occur despite the use of intraoperative recurrent laryngeal nerve monitoring. Permanent hypoparathyroidism is the most common complication and is correlated with immediate postoperative serum calcium. Systematic prophylactic total thyroidectomy in patients with a RET proto-oncogene mutation allowed early diagnosis of MTC in one-third of cases. In view of the low rate of malignant nodules in our series, the malignant thyroid nodule rates reported in children in the literature may be overestimated.     

Association of Head and Neck Oncologists of Great Britain

Anti-Thrombin 111 as an Indicator of Advanced Head and Neck Malignancy Whether to use laser surgery or radiotherapy in the primary treatment of stage 0 and 1 glottic carcinomas. An evaluation based on long-term results after radiotherapy of 151 cases Phase Ill randomized trial of chemotherapy in end stage head and neck cancer Cisplatin Concentration in Tumours of the Head and Neck Repair of Oral-Oropharyngeal Defects with Masseter Crossover Flap The efficiency of voice production after successful irradiation of laryngeal carcinoma Thyroid disease and recurrent nerve paralysis The effect of tracheostomy on survival and peristomal recurrence after primary laryngectomy. Tumour clearance at resection margins in total laryngectomy-A clinicopathological study Patterns of spread of squamous cell carcinoma within the mandible     

Thyroid carcinoma invading the upper aerodigestive system

Well-differentiated thyroid carcinoma infrequently invades the upper aerodigestive tract. However, when invasion occurs it is the source of significant morbidity and excess mortality. The most common structures invaded by thyroid carcinoma are the recurrent laryngeal nerves, larynx, pharynx, and esophagus, which can produce symptoms of airway insufficiency, dysphagia, and hemoptysis. Locally invasive thyroid carcinoma can often be successfully treated while preserving function of the upper airway. If the tumor involves only the wall of the larynx or trachea without intraluminal extension, "shaving" the tumor from the trachea or larynx will produce local control rates comparable to more radical and destructive procedures. Intraluminal extension is a more serious problem that usually requires resection of a portion of the aerodigestive tract. Even in this situation, partial laryngeal or tracheal resection with preservation of function might be possible and should be used. Adjuvant therapy using radioiodine or external beam radiotherapy should be considered an integral part of any treatment plan for these tumors. These modalities will significantly reduce the rate of local recurrence and control symptomatic local disease.     

Changes in expression of p53, proliferating cell nuclear antigen and bcl-2 in recurrent laryngeal cancer after radiotherapy

The biological changes in recurrent laryngeal cancer following radiotherapy are not fully understood. The authors investigated differences in the expression of p53, proliferating cell nuclear antigen (PCNA) and bcl-2 in laryngeal cancer specimens before radiotherapy and in recurrent laryngeal cancer specimens following radiotherapy in the same patients. The authors investigated the expression of p53, PCNA and bcl-2 by immunohistochemical stain in 30 specimens from 15 patients with primary laryngeal cancer and recurrent laryngeal cancer after radiotherapy. The expression of p53 protein was significantly different in laryngeal cancer before radiotherapy (4/15, 26.7 per cent) compared with recurrent laryngeal cancer after radiotherapy (8/15, 53.3 per cent) (p<0.05). The PCNA index was also significantly different in laryngeal cancer specimens before radiotherapy (mean, 11.9 per cent) compared with recurrent laryngeal cancer after radiotherapy (mean, 18.0 per cent) (p<0.05). However, there was no statistically significant alteration of bcl-2 expression in primary compared with recurrent laryngeal cancer. The expression of p53 and PCNA increased in recurrent laryngeal cancers after radiotherapy, compared with that in laryngeal cancers before radiotherapy. Recurrent laryngeal cancers arising following radiotherapy became biologically aggressive.     

Brachial plexus neuropathy resulting from a massively enlarged papillary thyroid carcinoma

Well‐known complications of thyroid enlargement and papillary carcinoma include compression or invasion of the trachea, esophagus, and/or vascular structures. Recurrent laryngeal nerve invasion by thyroid carcinoma is not uncommon, and phrenic nerve invasion has also been described. Preoperative dysfunction of a vocal cord, which often implies invasive carcinoma, may necessitate recurrent laryngeal nerve sacrifice and is therefore rreversible. We present an unusual case of reversible brachial plexus compression in a patient with massive thyroid enlargement and papillary carcinoma. Laryngoscope, 2009     

原发于喉部的非鳞状细胞癌11例并文献复习

目的 探讨除鳞状细胞癌外其他特殊病理类型的喉恶性肿瘤的临床表现及病理特点,提高其诊断和治疗水平。方法 回顾性分析366例原发性喉恶性肿瘤中11例非鳞状细胞癌患者的临床资料,采用HE染色和免疫组化法,观察其组织病理学改变及免疫表型,并复习有关文献。结果 11例中腺癌2例,腺样囊性癌1例,恶性淋巴瘤2例,神经内分泌癌1例,肉瘤样癌5例。其中声门区病变5例,声门上区病变4例,声门下区病变2例。均经活检或手术病理证实,活检 1 次即明确诊断者仅 2 例,其余病例经多次重复活检甚至最后手术切除方才确诊。确诊前的诊断多为慢性炎症、炎性息肉、增生性改变、坏死性肉芽肿、鳞癌等,除1例恶性淋巴瘤未行手术外,其余病例均首选手术治疗,部分联合放射治疗和(或)化学治疗。死亡2例,失访3例,其他患者均存活至今。结论 该病的临床表现缺乏特征性,检查所见肿物形态不一,与常见的良、恶性喉肿瘤不易鉴别,病理检查、免疫组化检查有助于确诊,临床上应根据组织病理学特点选用手术切除、放射治疗、化学治疗或综合性治疗。     

Chronic cough as a sign of laryngeal sensory neuropathy: diagnosis and treatment

Chronic cough is often attributed to reflux, postnasal drip, or asthma. We present 28 patients who had chronic cough or throat-clearing as a manifestation of sensory neuropathy involving the superior or recurrent laryngeal nerve. They had been identified as having sudden-onset cough, laryngospasm, or throat-clearing after viral illness, surgery, or an unknown trigger. Cough and laryngospasm were the most common complaints. Seventy-one percent of the patients had concomitant superior laryngeal nerve or recurrent laryngeal nerve motor neuropathy documented by laryngeal electromyography or videostroboscopy. After a negative workup for reflux, asthma, or postnasal drip, these patients were treated with gabapentin at 100 to 900 mg/d. Symptomatic relief was achieved in 68% of the patients. Sensory neuropathy of the recurrent laryngeal nerve or superior laryngeal nerve should be considered in the workup for chronic cough or larynx irritability. Symptomatic management of patients with cough and laryngospasm due to a suspected sensory neuropathy may include the use of antiseizure medications such as gabapentin.     

Cervical osteophytes presenting as unilateral vocal fold paralysis and dysphagia.

Any process involving either the vagus nerve, its recurrent laryngeal branch or the external branch of the superior laryngeal nerve may cause paralysis of the vocal fold. The most common cause is neoplasm. Clinically, the patients often present with a hoarse, breathy voice as well as symptoms of aspiration. The following represents a unique case of unilateral vocal fold paralysis and dysphagia caused by a degenerative disease of the cervical spine, resluting in extrinsic compression of the recurrent laryngeal nerve.     

Functional laryngeal abduction following reimplantation of the recurrent laryngeal nerves

Functional reinnervation was established in a patient following complete laryngo-tracheal separation with avulsion of both recurrent laryngeal nerves. Following reattachment of the larynx to the trachea, the severed stumps of the recurrent laryngeal nerves were implanted into the laryngeal abductors (the posterior crico-arytenoid muscles). One year later the patient had good abduction and adduction of her vocal cords. The abduction is thought to be a result of reinnervation by the recurrent laryngeal nerves, the adduction due to the action of crico-thyroid muscle whose innervation was undisturbed by the original injury.     

MicroRNA-107抑制喉癌细胞的迁移及侵袭能力的临床分析

目的通过观察microRNA 107（miR 107）在喉癌及癌旁组织中的表达,并且在喉癌细胞系选择性上调及敲减miR 107,检测其对喉癌细胞迁移及侵袭能力的影响。方法收集40例喉癌及其邻近癌旁组织标本,运用RT qPCR检测miR 107的表达,并分析其在喉癌中的临床意义。在人喉癌细胞TU212及TU686中过表达或敲减miR 107,通过Transwell法检测其对喉癌细胞迁移及侵袭能力的影响。结果MiR 107在喉癌组织中的表达显著低于癌旁组织,差异具有统计学意义（P<0.05）,miR 107的表达水平与肿瘤细胞分化程度、淋巴结转移及原发部位相关（P<0.05）。细胞实验显示,过表达miR 107后喉癌细胞迁移及侵袭能力明显下降（P<0.05）,而敲减miR 107后细胞迁移及侵袭能力明显增强（P<0.05）。结论MiR 107在喉癌中表达显著下调,它能够抑制喉癌细胞的迁移和侵袭能力。