Prospective factors of T1 and T2 glottic carcinoma

The aim of our study was to estimate the probability of the neoplasm recurrence in patients with T1 and T2 glottic carcinoma operated with CO2 laser microsurgery. We analyzed the material of 171 patients treated in the Otolaryngology Department of the Collegium Medicum Nicolaus Copernicus University between 1991 and 2003. The statistical method of logistic regression was used to estimate factors disposing the local recurrence of laryngeal cancer. We studied: age, sex, extent and location of the lesion, time up to recurrence, carbon granuloma, smoking cigarettes before and after the operation. We confirmed statistically significant correlation between the local recurrence and anterior commissure involvement.     

Nasal T lymphoma

Nasal T lymphoma constitute a type of lymphoproliferative very infrequent symdrome. One of the fondamental problems it presents to bring a high probability of survival obtain a precocious diagnose. It is due that it originates inespecific histologic lesions, and to its clinic. Only the close cooperation between the otorhinolaryngologist and the anatomopathologist can arrive to obtain a very speedy diagnose and in that way the possibility of a correct treatment, because newly treatments appear, to which this type of disease every day better respond. We present the cases of nasal T lymphomas diagnosticated in the ORL Service of the Toledo area during 15 years, their symptomotology, treatment, evolution and survival. Besides a up to date bibliographic revision on this controversial syndrome.     

Conservation surgery for T2 and T3 carcinomas of the supraglottic larynx

The treatment of choice for supraglottic carcinomas of intermediate size (stages T2 and T3) remains controversial. Between 1974 and 1983 in our institution, 139 patients with supraglottic carcinoma of intermediate size were judged retrospectively to have been technically amenable to conservation surgery. Primary disease control at three years was achieved in 100% of the patients treated by supraglottic laryngectomy, 91% (34 patients) of those treated by total laryngectomy, and 69% (81 patients) of those treated by radiotherapy. Of the latter group, 62% were salvaged by total laryngectomy yielding a net three-year local control of 85%. Determinate five-year survival rates were 89% for supraglottic laryngectomy, 78% for total laryngectomy, and 70% for radiotherapy. Significant problems with aspiration occurred in four patients (16%) who were treated by conservation surgery, and two patients (8%) required a permanent tracheostomy. The results of this study show that supraglottic laryngectomy with postoperative radiotherapy as indicated is a highly effective method for the local control of supraglottic carcinoma of intermediate size that is amenable to conservation surgery.     

Clinical management for T1 and T2 external auditory canal cancer

ObjectiveThe purpose of this study was to clarify the impact of superficial parotidectomy and postoperative radiotherapy (PORT) for the surgical treatment of early stage squamous cell carcinoma (SCC) in external auditory canal (EAC).Materials and methodsThirty-seven patients with T1 (n = 14) or T2 (n = 19) SCC in EAC treated between 2000 and 2016 at Kobe University Hospital were enrolled in this study. Thirty-three patients were operated with sleeve resection or lateral temporal bone resection.ResultsThe 5-year overall survival and disease-specific survival rates were 95% and 100%, respectively. Surgical margin was positive in 4 patients, who were treated by PORT and have been alive without disease. Prophylactic superficial parotidectomy was simultaneously performed at the time of initial surgery in 15 patients, in whom no lymph node (LN) metastasis was observed. Among the other 22 patients, regional recurrence in parotid LN was observed in one patient, who was successfully salvaged by total parotidectomy. Potential parotid lymph node metastasis rates of T1 and T2 SCC in EAC was 0% (0/14) and 5% (1/19) respectively.ConclusionsComplete resection without positive surgical margins is essential for the treatment of the patients with T1 and T2 ear cancers. Prophylactic superficial parotidectomy or neck dissection is not mandatory for T1 and T2 diseases, as long as precisely extent of disease is assessed preoperatively. PORT should be performed for the patients with positive surgical margins.Levels of evidence: 4.     

Laser debulking surgery prior to radiotherapy for T1T2 carcinoma of the hypopharynx

The local control rate for T1-T2 carcinomas of the hypopharynx is rather high whereas the overall survival rate is unsatisfactory, irrespective of treatment modalities. Radical radiotherapy has yielded a local control rate of 40-70% and an overall 5-year survival of 30-50%, while surgical treatment with or without postoperative radiotherapy has yielded a local control rate of 60-90% and an overall 5-year survival rate of 30-60%. Based on these reasons, for the patients with minor hypopharyngeal lesions, such as T1-T2 carcinomas, in the Kurume University Hospital radiotherapy has often been selected as a first choice instead of partial pharyngectomy. If the primary lesion is exophytic and has a large volume, laser debulking surgery has been employed prior to radiotherapy to improve the local control rate. The purpose of the present study is to describe the details of laser debulking surgery prior to radiotherapy (LDSR) for the treatment of T1-T2 carcinomas of the hypopharynx. In addition, the preliminary results for this treatment procedure will also be compared with the results of partial pharyngectomies preserving the larynx (PPPL) that were performed in the Kurume University Hospital. In this study 20 patients (T1: 4, T2: 16) who had undergone PPPL and 16 patients (T1: 4, T2: 12) who had undergone LDSR were included. For patients undergoing PPPL, the 5-year local control rate, 5-year larynx conservation rate and disease specific 5-year survival rate were 83.6%, 70.4%, and 75.0%, respectively, whereas for patients undergoing LDSR these were 87.1%, 93.8%, 87.5% respectively. Although the treatment outcomes by LDSR did not show a significant drastic improvement compared with those by PPPL, the quality of life of the patients undergoing LDSR was not aggravated. LDSR may thus be preferable to PPPL for selected cases of T1-T2 carcinomas of the hypopharynx.     

部分喉切除术治疗喉癌T3及T4病变

为探讨部分喉切除术治疗喉癌Ｔ３，４病变的可能性，回顾总结了１９８０年６月至１９９３年１２月喉癌Ｔ３，４病变行部分喉切除术３１例。术后全部病例均恢复经口进食，均获得不同程度的会话能力。３年及５年生存率分别为６４．５％（２０／３１）及５９．３％（１６／２７）；气管套管拔除率为７１．０％。认为选择性的对部分喉癌Ｔ３，４病变行部分喉切除术是可行的，在保证根治的前提下，保全了喉功能，提高了生存质量。     

Clinico-pathological correlation of T3 glottic carcinomas

Controversy surrounds the relative merits of radiotherapy and laryngectomy for the treatment of T₃ glottic carcinoma. In this study of 82 patients with non-irradiated T₃ glottic carcinomas managed by total laryngectomy, 45% had been clinically understaged and were pT₄. There was a significant association between subglottic extension and tracheostomy with understaging. A trend to understage anterior commissure tumours was also evident. Nodal status did not influence understaging and therefore should not determine the choice of treatment of the glottic primary. Laryngectomy is recommended for patients with subglottic extension or a tracheostomy. If radiotherapy is to be used for the remaining tumours, then vigilance against understaging is required.     

保留喉功能的T4声门癌的手术治疗

目的　探讨T4声门癌喉功能保留手术的方法和临床疗效。方法　对 1982～ 1998年间2 2例T4声门癌患者进行手术治疗 ,切除肿瘤及受累的软骨和喉外组织 ,以胸骨舌骨肌筋膜瓣、颈阔肌皮瓣、颈阔肌筋膜瓣、甲状软骨膜瓣、下咽黏膜瓣等修复组织缺损 ,保留会厌或环状软骨板重建喉功能。全部患者均接受术后放射治疗 (5 0 0 0～ 6 0 0 0cGy)。结果　全组病例 3年生存率 86 4 % (19/ 2 2 ) ,5年生存率 75 0 % (15 / 2 0 )。喉功能恢复 (吞咽保护、呼吸、发音 )为 6 8 2 % (15 / 2 2 ) ,喉功能部分恢复(吞咽保护、发音 ) 31 8% (7/ 2 2 )。结论　T4声门癌尽管可累及喉软骨和喉外组织 ,但经仔细选择的病例在彻底切除肿瘤的前提下保留喉功能是可行的     

The management of glottic T3 carcinoma

In the treatment of glottic T3 carcinoma there are four possible methods (1) primary radical surgery, (2) primary radical radiotherapy, (3) radical surgery with preoperative irradiation or (4) partial surgery. This study shows that patients treated primarily by surgery achieve worse results than those treated by radiotherapy.     

T1b声门型喉癌的治疗进展

T1b期无淋巴结转移声门型喉癌属于早期喉癌,病变累及双侧声带,可包括前联合或后联合.临床治疗方法主要包括放疗、内镜下治疗及手术等.通过复习相关研究资料,对T1b期声门型喉癌各种治疗方法及进展做一综述.     

Long-term results of treatment in T1, T2 laryngeal cancer with CO2 laser microsurgery

The aim of this study was estimation the long term results of CO2 laser therapy in laryngeal cancer. 36 patients with early glottic cancer-T1 and T2 were treated with CO2 laser microsurgery in 1990-1992. The control laryngological, phoniatric and laryngovideostroboscopic examinations were conducted from six to thirty months after the operation. The next controls were done within three years and then after eight to ten years from microsurgery. The local recurrence was observed only during the first control in seven cases--19%. Four patients underwent total laryngectomy after several laser microsurgery, two were treated only with CO2 laser and one had CO-therapy. The better quality of voice was observed during following control examinations. A scar with smooth surface and marge in 29 persons and a tendency to phonatory vibration of scar in 9 patients were noticed in laryngovideostroboscopy examination during the first control. Following examinations showed a progressive improvement of voice parameters.     

Organ preservation surgery for intermediate size (T2 and T3) laryngeal cancer

This article discusses the surgical options, both open and endoscopic,developed to preserve voice, maintain swallowing, and avoid permanent tracheotomy in patients with intermediate-sized laryngeal lesions.     

Assessing the quality of the speaking voice after therapy of T1 and T2 vocal cord cancers]

All studies which analysed voice quality after T1 and T2 glottic cancer employed sustained vowels for evaluation. Sustained vowels can often be produced more clearly than expected in a severe degree of hoarseness in running speech. In this investigation voice quality was analysed by measuring the signal-to-noise-ratio (SNRc) in running speech. For evaluation these data were correlated to the scores from an auditive evaluation and from a clinical examination of the larynx considering functional parameters. 39 patients were examined after different therapies (primary radiation, chordectomy, frontolateral partial resection). The grading of the three different methods for characterisation of the voice quality correlated well. Therefore the SNRc is presumed to be a valuable additional method to the psychoacoustic voice evaluation. Comparison of voice quality after different therapies provided no significant difference between radiotherapy and chordectomy. The functional results after frontolateral partial resection were significantly less satisfying as expected.     

Primary tumour volume: important predictor of outcome for T3- and T4-staged nasopharyngeal carcinoma

OBJECTIVE: To investigate the relationship between primary tumour volumes and treatment outcomes within T3- and T4-staged nasopharyngeal carcinoma. DESIGN: Retrospective study. SETTING: Tertiary care centre. METHODS: Forty newly diagnosed T3-staged patients and 36 newly diagnosed T4-staged patients participated in the study. MAIN OUTCOME MEASURES: Computed tomography-derived primary tumour volume was obtained from the summation of areas technique. The probabilities of achieving tumour control and patient survival were estimated using the product-limit method of Kaplan and Meier. The log rank test was used to examine significance. RESULTS: In T3-staged nasopharyngeal carcinoma, the median primary tumour volume was 29.6 mL, with a range from 8.0 to 131.8 mL. After segregating the primary tumour volume into two subgroups (< 30 mL, > 30 mL), large primary tumour volume was associated with a significantly poorer disease-specific survival (p = .0001). In T4-staged cases, the median primary tumour volume was 54.07 mL, with a range from 6.7 to 223.1 mL. After segregating the primary tumour volume into two subgroups (< 60 mL, > 60 mL), larger primary tumour volume was associated with a significantly poorer disease-specific survival (p = .0022). CONCLUSION: Within the same T3- and T4-staged nasopharyngeal carcinoma, the primary tumour volume represented an important prognostic factor. To improve the treatment outcome of T3- and T4-staged nasopharyngeal carcinoma with large primary tumour volumes, more aggressive treatment is needed.     

Survivin expression correlates with nodal metastasis in T1–T2 squamous cell carcinoma of the tongue

European Archives of Oto-Rhino-Laryngology - In this study, the correlation between neck metastasis and recurrence was investigated by studying specimens of tongue squamous cell carcinoma patients...