CO_2激光联合低温等离子射频消融术治疗累及前联合早期声门型喉癌临床观察

目的探讨CO_2激光联合低温等离子射频消融术治疗累及前联合早期声门型喉癌的疗效。方法选取2012年3月至2015年7月间南京医科大学第一附属医院和徐州医科大学附属淮安医院收治的70例累及前联合早期声门型喉癌患者,观察组采用CO_2激光联合低温等离子射频消融术(30例)治疗,对照组采用CO_2激光(40例)治疗。对比两组患者嗓音障碍情况及术后复发率。结果术后3个月,两组患者嗓音障碍指数量表(VHI)等级分布比较,差异无统计学意义(P>0.05);观察组患者复发率为6.7%,对照组为25.0%,两组比较,差异有统计学意义(P<0.05)。结论 CO_2激光联合低温等离子射频消融术治疗累及前联合早期声门型喉癌疗效确切,对病变暴露困难者更有优势,喉部结构和喉功能保全良好。     

声门型喉癌CO2激光手术治疗后局部复发与前联合受侵犯的关系

  目的   分析CO₂激光手术治疗声门型喉癌局部复发与前联合受侵犯的关系。   方法  回顾性分析2008年1月至2010年12月中山大学肿瘤防治中心中133例激光手术治疗的早期声门型喉癌患者资料。其中包括侵犯前联合患者48例和前联合未受侵85例。133例中原位癌（T_is）40例,T_1a 58例,T_1b 19例,T₂ 5例,T₃ 1例。术后随诊6~42个月。比较前联合受累组与前联合未受累组的局部复发率。   结果  133例支撑喉镜下CO₂激光手术后21例局部复发,局部复发率为15.79%（21/133）。其中T_is复发率为17.50%（7/40）、T_1a为8.62%（5/58）、T_1b为36.84%（7/19）、T₂为13.33%（2/15）,T₃ 1例无复发,各组间复发率无显著性差异（P>0.05）。病变侵犯前联合复发率为25.00%（12/48）,病变未侵犯前联合复发率为10.59%（9/85）,两组间有显著性差异（P < 0.05）。133例激光手术治疗患者中死亡4例。   结论  激光手术治疗侵犯前联合的早期声门型喉癌复发率高,其治疗价值值得进一步研究。      

低温等离子射频消融术治疗早期声门型喉癌的疗效及影响因素分析

目的 探讨低温等离子射频消融术治疗早期声门型喉癌的疗效及相关影响因素.方法 根据手术方式的不同将120例早期声门型喉癌患者分为等离子组(n=86)和传统组(n=34),其中等离子组患者采用支撑喉镜下低温等离子射频消融术,传统组患者采用传统喉裂开声带切除术.所有患者手术结束后均采用门诊复查与电话随访相结合的方式进行3年随访.统计两组患者的术后喉功能保存率及1年、3年局部控制率,分析低温等离子射频消融术治疗早期声门型喉癌疗效的影响因素.结果 等离子组患者的术后喉功能保存率高于传统组,差异有统计学意义(P<0.05);两组患者的术后1年、3年局部控制率比较,差异均无统计学意义(P>0.05).单因素分析结果显示,性别、年龄、临床分期、肿瘤分化程度、术前卡氏功能状态(KPS)评分、浸润方向均可能与接受低温等离子射频消融术治疗的早期声门型喉癌患者的3年局部控制率有关(P<0.05);Cox多因素回归分析结果显示,年龄、临床分期、术前KPS评分、浸润方向向下累及声门下均是接受低温等离子射频消融术治疗的早期声门型喉癌患者3年局部控制率的独立影响因素(P<0.05).结论 采用低温等离子射频消融术治疗早期声门型喉癌能够在尽可能提高术后喉功能保存率的情况下,取得与传统手术相当的疗效,其治疗效果与多项因素有关,临床可按需选择适宜的手术时机及手术方案,改善手术疗效.     

低温等离子消融术对早期声门型喉癌的疗效分析

目的分析低温等离子消融手术治疗早期声门型喉癌的近期疗效。方法选择73例早期声门型喉癌患者,其中34例行低温等离子消融手术,39例行喉部分切除术。结果 34例行低温等离子术患者术后24个月出现复发1例,为T2期;39例行部分喉切除术患者复发5例,其中T1b和Tis期各1例,其余3例为T1a期,两组差异无显著性(P>0.05)。低温等离子消融术组未出现切口感染、咽瘘、吞咽和呼吸功能障碍等并发症,喉部分切除术的患者中,有4例切口感染,3例咽瘘及3例吞咽和呼吸功能障碍,低温等离子消融手术组与喉部分切除组相比,差异有显著性(P<0.05)。低温等离子消融组与喉部分切除术组相比,3年生存率无明显差异(P>0.05)。结论低温等离子消融术可显著减少早期声门型喉癌患者术后并发症的发生,减轻患者痛苦,提高患者生存质量,较传统喉部分切除术有优越性。     

低温等离子射频消融术与传统喉切开手术治疗早期声门型喉癌的疗效对比

目的 探讨低温等离子射频消融术与传统喉切开手术治疗早期声门型喉癌的临床疗效.方法 依据治疗方式的不同将125例早期声门型喉癌患者分为微创组(n=75)和传统组(n=50例),微创组患者实施低温等离子射频消融术治疗,传统组患者实施传统喉切开手术治疗.比较两组患者的手术相关指标、嗓音学评估参数、嗓音功能、并发症发生情况及术...     

低温等离子射频消融术治疗早期声门型喉癌患者的临床效果

目的探讨低温等离子射频消融术治疗早期声门型喉癌患者的临床效果。方法选取早期声门型喉癌患者68例,按手术方案不同分为观察组(n=34)和对照组(n=34),对照组予以喉部分切开术治疗,观察组予以低温等离子射频消融术治疗。对比两组围术期情况[手术时间、术中出血量、视觉模拟评分法(VAS)评分、黏膜恢复评分]、术前、术后6个月语音变化情况(基频微扰、振幅微扰)、并发症发生率。结果观察组手术时间、术中出血量、VAS评分、黏膜恢复评分较对照组低(P<0.05);术后6个月,观察组基频微扰、振幅微扰较对照组低(P<0.05);观察组并发症发生率[5.88%(2/34)]与对照组[14.71%(5/34)]对比无显著差异(P>0.05)。结论采用低温等离子射频消融术治疗早期声门型喉癌患者,可缩短手术时间,减少术中出血量,减轻术后疼痛,加快术后黏膜恢复,改善语音功能,且并发症发生率低。     

声门型喉癌的治疗

目的　分析声门型喉癌在不同治疗方式下的预后及其影响预后的因素。方法　 2 12例声门型喉癌分为三组 ,即手术组 ,放疗组和手术加放疗组 ,所有病例又按是否侵犯前联合分为两组。结果　三组的五年生存率分别为 76% ,80 %和 73 %。按是否侵犯前联合分组的分别是 65 %和 88%。结论　无论采用何种方法治疗 ,声门型喉癌都有较好的预后 ,而是否侵犯前联合则是影响预后的关键。     

声门癌术后复发危险因素分析

目的：分析声门癌术后复发的相关因素,为喉癌的治疗提供依据。方法：回顾性分析于2013年1 月至2018 年3 月在我院接受首次手术治疗的声门癌患者172例病例资料,根据病变范围的不同选取不同的手术方式,对肿瘤的TNM分期、病理分化程度、手术类型以及是否侵犯前联合等因素,与术后复发情况一起进行统计学分析。结果：21例患者出现术后复发,复发率12.21%。T1b期复发率最高20.0%（9/45）,各分期术后复发率比较差异无统计学意义（P>0.05）。组间比较发现,是否累及前联合、切缘病理及病理分化程度在术后复发率方面的差异有统计学意义（P<0.05）,而TNM分期、不同手术方式、肿瘤浸润深度的差异则无统计学意义( P> 0. 05)。多因素Logistics回归分析结果显示,肿瘤浸润深度与肿瘤的复发率无相关性（P>0.05）,而TNM分期、手术方式、是否累及前联合、切缘病理及术后病理分化程度均为肿瘤复发的危险因素（P<0.05）。结论：是否侵犯前联合、切缘病理及术后病理分化程度为喉癌术后复发的独立危险因素,而TNM分期、手术方式均为肿瘤复发的相关危险因素。     

低温等离子射频消融术治疗早期声门型喉癌患者的临床效果研究

目的 探究低温等离子射频消融术(RFA)治疗早期声门型喉癌患者的临床效果.方法 选择82例早期声门型喉癌患者,采用随机数字表法分为两组各41例.对照组采用传统手术治疗,研究组采用RFA治疗.对比两组手术相关指标、手术前后嗓音声学功能指标及并发症.结果 研究组手术时间为(15.59±2.53)min、住院时间为(5.03...     

低温等离子刀与喉部分切除术治疗早期声门型喉癌的疗效及安全性分析

目的研究低温等离子刀与喉部分切除术治疗早期声门型喉癌的疗效及安全性。方法 选取2013年2月至2016年2月我院择期手术的早期声门型喉癌患者62例为研究对象,采用随机数字表法均分为观察组和对照组各31例,分别采用低温等离子射频消融技术和喉部分切除术进行治疗,比较两组手术效果、术后康复及并发症发生情况。结果 观察组手术时间、术中出血量及住院时间均少于对照组,差异有统计学意义（P<0.05）;术后6个月时,观察组发音功能恢复情况明显优于对照组（P<0.05）,两组优良率分别为93.55%和74.19%（P<0.05）;观察组VFSS评分明显高于对照组（P<0.05）,但两组吞咽功能恢复情况无明显差异（P>0.05）;随访3年期间,观察组和对照组局部复发、淋巴结转移、远处转移及死亡发生情况均未见明显差异（P>0.05）;观察组术后肉芽增生发生率明显高于对照组（P<0.05）,两组创面感染、咽漏形成、咽喉狭窄及吸入性肺炎发生情况无明显差异（P>0.05）。结论 低温等离子射频消融技术治疗早期声门型喉癌的疗效与喉部分切除术相当,且具有创伤小、康复速度快、并发症少及术后发音和吞咽功能恢复良好等微创优势,疗效和安全性均值得肯定。     

Prognostic factors for local control of early glottic cancer: the Rabin Medical Center retrospective study on 207 patients

Purpose: Different radiation therapy schedules and devices have been used over the last 20 years at Rabin Medical Center in patients with early glottic cancer. The aim of the present retrospective analysis was to identify the subgroup of patients at high risk of failure of radiation treatment.

Materials and Methods: Between 1974 and 1994, 207 patients with squamous cell carcinoma of the glottis, 182 Stage T1 and 25 Stage T2, underwent definitive radiation therapy. During this period, treatment was administered with different radiation devices (⁶⁰Co or 6-MV X ray), using different dose/fraction protocols (1.8 or 2 Gy per day, 5 or 6 fractions per week), total doses (42–77.4 Gy), overall radiation times, and delays. These treatment variables, in addition to certain patient and tumor characteristics, were correlated with local control at a median follow-up of 57 months (range 18–265 months).

Results: The 5-year local control rates for T1 and T2 tumors were 88% and 73%, respectively. Univariate analysis showed that smoking, diabetes mellitus, anterior commissure involvement, T stage, and extension of tumor to one third or more of the vocal cord were highly significantly correlated with decreased local control. None of the treatment variables, including dosage at which complete tumor regression was noted, were found to be predictive. By multivariate analysis, only anterior commissure involvement was found to be highly significant (risk ratio 1.9, 95% CI 1.2–3.0, p = 0.027), and T stage was borderline significant (risk ratio 1.6, 95% CI 1.0–2.5, p = 0.054).

Conclusion: This study suggests that only two tumor characteristics are predictive of local failure of early glottic cancer: anterior commissure involvement and T stage. Treatment variables apparently do not influence local control.     

Surgery or radiotherapy for early stages carcinomas of the glottic larynx.

AIMS AND BACKGROUND: The choice of treatment in limited squamous cell carcinoma of the glottic larynx often depends on individual and tumor factors. Data of the literature clearly show that surgery and radiotherapy tend to give identical results in terms of survival. We examined 196 cases of T1-T2/N0 cancers of the glottic larynx. We review the literature and discuss the indications and the efficacy of the various available treatments. METHODS AND STUDY DESIGN: 196 consecutive cases of T1-T2/N0 cancers of the glottic larynx were examined. In 54.5% the tumor was confined to the vocal cord; in 38.2% it extended to the anterior commissure, in 4.6% to the arytenoid cartilage and in 2.5% to the floor of the ventricle. We performed partial laryngeal surgery in 41.3% (81 cases). Radiotherapy alone was employed in 58.6% (115 cases). RESULTS: In T1a and T1b cases there was no statistically significant difference in 5-year disease-free survival. In T2 cases the NED survival of patients who underwent partial laryngectomies (90% of cases) was significantly better (P <0.05) than among patients given radiotherapy (73%). NED survival at 5 years in patients with the primary tumor on a vocal cord, ventricle or anterior commissure was 78%, 80% and 81%, respectively, with no statistically significant difference among the various sites. It is possible that involvement of the anterior commissure exposes patients to greater risk of recurrence when radiotherapy alone is used (5 out of 23 cases, 21.7%, compared to 3 out of 52 cases, 5.7%, among our surgically treated patients). CONCLUSIONS: When the tumor is confined to the vocal cord and mobility is not impaired (T1a), surgery and radiotherapy give comparable results, and the latter yields a better functional outcome. When the anterior commissure is involved, recurrences appear to be less likely after surgery. In T2 glottic carcinoma, surgery gives better results than radiotherapy alone. In any event, the choice of treatment should be patient-specific and based on a careful analysis of the factors involved in each case.     

Definitive radiotherapy for early glottic carcinoma: Prognostic factors and implications for treatment

: Treatment and disease-related factors were analyzed for their influence on the outcome of patients treated definitively with irradiation (RT) for early glottic carcinoma.

: One hundre two patients with stage T1 or T2 glottic carcinomas were treated definitively with RT from December 1983 through September 1993. Median follow-up time was 63 months. Factors analyzed for each patients included age, sex, stage, anterior commissure involvement, surgical alternative, histologic differentiation, field size, total dose, fraction size, and total treatment time. Survival analysis methods were employed to assess the effects of these factors on local control and complication rates.

: The 5-year local control rates by stage were as follows: T1a, 92%, T1b, 80%, T2a, 94%; and T2b, 23%. by univariate analysis, factors found to have a significant impact on local control were stage, surgical alternative, fraction size, anterior commissure involvement, and overall treatment time. By multivariate analysis, stage, field size, and fraction size were the only significant factors that independently influenced local control.

: The inferior control rate for stage T2b lesions has implications for treatment. Our study supports the conclusion of reports in the literature showing that low fration size negatively influences outcome in patients with early glottic cancer.     

Prognostic factors in early glottic carcinoma implications for treatment

AIM: In this study we aimed to determine the prognostic factors affecting local control (LC) in limited glottic carcinoma treated with definitive radiotherapy (RT). MATERIAL AND METHODS: Between June 1991 and December 2001, 114 patients with early squamous-cell carcinoma of the glottis were treated with definitive RT at our institution. Only four (3.5%) patients were women. The median age was 60 (27-79). Fifteen percent, 72% and 13% of the patients had Tis, T1 and T2 tumors, respectively. Forty-three (37.7%) patients had anterior commissure invasion. Prior to RT 35 (31%) patients had undergone vocal cord stripping and two (2%) cordectomy. A median dose of 66 Gy (50-70.2) was given over a median period of 46 days (20-60). Univariate and multivariate analyses were performed for LC. The prognostic parameters analyzed for LC were T classification, anterior commissure involvement, total RT dose, and overall treatment time. RESULTS: Five-year local and regional control rates were 84.2% and 97.7%. RTOG grade 3-4 late side effects were observed only in one (0.9%) patient. In 15 patients with local failure, salvage treatment consisted of partial laryngectomy in eight patients and total laryngectomy in five. One of the remaining two patients was medically inoperable, and the other refused salvage surgery. In one of the three patients with regional failure, salvage surgery was applied and the other two were given palliative chemotherapy because of unresectable disease. Following salvage treatments, the ultimate five-year LC rate was 96.9% and the five-year larynx preservation rate was 91.1%. Second primary cancer was diagnosed in 17 (14.9%) patients. Only one patient developed distant metastases and two patients died of laryngeal cancer. While T2 disease and anterior commissure involvement were found to be unfavorable prognostic factors significantly influencing LC in univariate analyses, only T2 disease remained independent in multivariate analysis. CONCLUSION: In patients with early glottic carcinoma, T classification proved to be the only independent prognostic factor affecting LC after primary radiotherapy according to the results of this study.     

Surgical therapy of T1 and selected cases of T2 glottic carcinoma: cordectomy, horizontal glottectomy and CO2 laser endoscopic resection

AIMS AND BACKGROUND: Among the different laryngeal neoplasms, glottic carcinoma is known to be one of the most suitable for functional management. Nevertheless, the best treatment for T1 and T2 glottic carcinoma, whether an open neck procedure, endoscopy or radiotherapy, with reference to recurrence, survival, and functional results, has long been debated. STUDY DESIGN: From February 1983 to September 1997, 83 patients with well to undifferentiated glottic carcinoma (48 pT1a, 14 pT1b, and 21 selected cases of pT2 with impairment of vocal cord mobility) were submitted to surgery at the Otorhinolaryngologic Section of the Department of Surgical Sciences and Organ Transplantations of Cagliari University. Surgical treatment included 30 laryngofissures with simple or enlarged cordectomy, 22 horizontal glottectomies and 31 endoscopic laser resections. A retrospective review of the records of the patients was performed in order to obtain a better understanding of the outcome of the three different surgical procedures in our institution. RESULTS: According to the Kaplan-Meier method, the probability of remaining free of local recurrence 3 years after primary surgery was 0.90 for the T1 group and 0.85 for the T2 group. The distribution of recurrences for cordectomy, glottectomy and CO2 laser at 3 years showed a cumulative probability of remaining free of disease after primary surgery of 0.86, 0.85 and 0.88. The probability of remaining free of local recurrence 3 years after salvage surgery was 0.96 for the T1 group and 0.95 for the T2 group. Analyzing the phenomena for type of surgical procedure, local control at 3 years after salvage surgery for cordectomy, glottectomy and exclusive CO2 laser was 0.93, 0.90 and 0.92, respectively. In the endoscopic group, local control rate after any type of salvage therapy modified the percentage at 3 years to 100%. Anterior commissure spread (AC1-AC2) resulted in a difference (not statistically significant) in local control between the group of patients without and with anterior commissure involvement. Laryngeal preservation was achieved in 93.7% (45/48) of patients who survived after salvage surgery following open neck procedures and in 100% of patients originally submitted to the endoscopic approach. CONCLUSIONS: In our experience, although open laryngeal procedures can be still considered a valid option in the treatment of T1 and selected cases of T2 glottic carcinoma, endoscopic laser excision offered an oncologically adequate alternative to the traditional techniques, with minimum discomfort for the patient and satisfactory preliminary functional results.     

The influence of field size, treatment modality, commissure involvement and histology in the treatment of early vocal cord cancer with irradiation

One hundred and thirty-seven patients with TNM staged T1 glottic cancer were treated from 1966 to 1980. The patient characteristics were no different from those noted in previous studies. Patients were treated either with 60Co teletherapy units or 4 MeV linear accelerators with different daily (180-225) and weekly (4 times vs. 5 times) fractionation schemes. A recurrent-free survival was attained in 80% of the patients 2 years after primary treatment with radiation therapy. There were 27 local recurrences, of which 82% were salvaged with surgery for an overall adjusted survival of 95%. Patients treated on 60Co units with field sizes less than or equal to 30 sq. cm had a 15% increase in local recurrence compared with field size greater than 30 sq. cm, which could not be attributed to lower doses. Poorly differentiated tumors and those involving the anterior commissure were more likely to develop a local recurrence. Doses above 1900 ret were associated with a decrease in local recurrence in patients having anterior commissure involvement. Salvage with limited surgery for failure was effective in selected cases.     

Predicting the local outcome of glottic squamous cell carcinoma after definitive radiation therapy: value of computed tomography-determined tumour parameters.

BACKGROUND AND PURPOSE: The T-classification has shortcomings in the prediction of local outcome of glottic squamous cell carcinoma (SCC) treated by definitive radiation therapy. In this regard, the value of several CT-derived tumour parameters as predictors of local outcome was investigated. MATERIALS AND METHODS: The pretreatment CT studies of 119 patients with glottic SCC (T1, n=61; T2, n=40; T3, n=14; T4, n=4) treated with curative intent by radiation therapy were reviewed for tumoral involvement of specific laryngeal anatomic subsites (including laryngeal cartilages). Tumour volume was calculated with the summation-of-areas technique. Actuarial (life-table) statistical analysis was done for each of the covariates; multivariate analysis was performed using the Cox proportional hazards model. RESULTS: In the actuarial analysis tumour volume was significantly correlated with local recurrence rate (P=0.0062). Involvement of the cricoid cartilage (P=0.0052), anterior commissure (P=0.0203), subglottis (P=0.0481) and preepiglottic space (P=0.0134) and degree of involvement of the true vocal cord (P=0.0441) and paraglottic space at the level of the true vocal cord (P=0.0002) were also significantly correlated with local recurrence rate. In the multivariate analysis, only degree of involvement of the paraglottic space (at the level of the true vocal cord) (P=0.0001) and preepiglottic space (P=0.02) were found to be independent predictors of local recurrence. The T-category was significantly correlated with local outcome in the actuarial analysis (P=0.0001), but not in the multivariate analysis (P=0.5915). CONCLUSIONS: Several CT-derived parameters are powerful predictors of local outcome in glottic cancer treated with radiation therapy; some of these parameters are stronger linked to the local control rate than the T-classification.     

Hypofractionated Radiotherapy for T1N0M0 Glottic Cancer: Retrospective Analysis of Two Different Cohorts of Dose-fractionation Schedules from a Single Institution

AimsTo determine the influence of dose and fractionation on tumour characteristics, toxicity, disease control and survival outcomes in T1 glottic carcinoma.Materials and methodsBetween 1975 and 2000, treatment charts of 652 patients with T1 glottic carcinoma who received curative radiation with four hypofractionated schedules (50 Gy/15 fractions [3.3 Gy/fraction] or 55 Gy/16 fractions [3.43 Gy/fraction] or 60 Gy/24 fractions or 62.5 Gy/25 fractions [2.5 Gy/fraction]) were analysed. The patients were divided into two groups based on fraction size <3 Gy and >3 Gy. Local control and overall survival were calculated. Patient- and tumour-related factors affecting local control were analysed using univariate and multivariate analysis. Factors affecting late toxicity were also analysed.ResultsThe local control and overall survival at 10 years were 84 and 86.1%, respectively, for T1 glottic carcinoma. The response to radiation had a significant effect on local control with univariate analysis (P = 0.001). Other factors, such as beam energy, anterior commissure involvement and fractionation, did not affect local control. Persistent radiation oedema was seen in 123 patients (23.4%) and was significantly worse in patients who received radiation with a larger field size (>36 cm²) on a telecobalt machine (P < 0.001).ConclusionsRadical radiotherapy schedules incorporating a higher dose per fraction yield acceptable local control rates and late toxicity. Telecobalt therapy for early glottic cancer is a safe alternative to treatment with 6 MV photons on a linear accelerator in terms of local control and late toxicity as long as field sizes smaller than 36 cm² are used.     

T3期声门型喉癌的外科治疗选择

目的 探讨T3期声门型喉癌合适的外科治疗方式.方法 回顾性分析57例T3期声门型喉癌患者的临床病理特征、手术方式和预后,分析不同手术方式和不同年龄组患者的3年无瘤生存率.结果 57例T3期声门型喉癌患者全部行喉部手术治疗,失访7例,总的3年无瘤生存率为63.2％(36/57).采用喉全切除术24例,喉近全切除术8例,喉部分切除术25例,3年无瘤生存率分别为66.7％ (16/24)、50.0％ (4/8)和64.0％ (16/25),差异无统计学意义(P =0.694).≥70岁者和＜70岁者的3年无瘤生存率分别为70.0％ (7/10)和61.7％( 29/47),差异亦无统计学意义(P=0.621).36例患者行颈淋巴结清扫术,其中全颈淋巴结清扫2例,改良颈淋巴结清扫6例,分区性颈淋巴结清扫28例,颈部淋巴结转移率为17.5％(10/57).局部复发10例,其中喉部分切除术后7例,喉近全切除术后2例,喉全切除术后1例.结论 喉全切除术与不同的喉部分切除术均是T3期声门型喉癌的重要手术方式,应根据患者局部病变与全身状况的具体情况综合考虑,选择合适的个体化手术方式.≥70岁的T3期声门型喉癌患者,应慎行喉部分切除术,喉全切除术也可以取得满意疗效.