Recurrence as a mode of determining efficacy in treatment of carcinoma of the larynx

A study population of 374 patients with cancer of the larynx was evaluated, treated, and followed at yearly intervals up to a maximum of 18 years post-diagnosis. Of these, 348 received definitive therapy to attempt to eradicate their disease and were followed for recurrence and presence of cancer at death. In Stages I, II, and III recurrence of disease appears to be a very good indicator of therapeutic efficacy. Stage I carcinomas of the larynx should be treated with radiation as the proportions of patients with recurrences were the same for both primary surgical or radiation therapy. In Stages II and III, primary surgical therapy significantly lowered the proportion recurring when compared with primary radiation therapy. In Stage IV carcinomas of the larynx, both survival and recurrence accurately reflect therapeutic efficacy since most patients suffer recurrence of their carcinoma and die of the disease.     

Metastases of cancer of the vestibule of the larynx to the regional lymph nodes of the neck and their treatment

Clinical data about cancer metastases of the vestibule of larynx to neck regional lymph nodes are presented. Indications for Crile's operation and fascial excision of neck mucosa and lymph nodes during combined therapy are described. A modification of the excision based on a temporary section of m. sternocleidomastoideus at the sternum is proposed. Remote results of therapy of cancer metastases of the vestibule of larynx to neck regional lymph nodes are discussed.     

Photodynamic therapy and the treatment of neoplastic diseases of the larynx

Photodynamic therapy (PDT) is an innovative treatment involving the use of light-sensitive drugs to selectively identify and destroy diseased cells. Therefore, photodynamic therapy has the potential to treat and cure precancerous and early cancerous lesions (carcinoma in situ [CIS], T1 and T2) of the larynx while preserving normal tissue. Eleven patients with recurrent leukoplakia and carcinomas of the larynx were treated with PDT with follow-up to 27 months. One patient with a Tl verrucous carcinoma, 5 patients with T1 squamous cell carcinomas of the vocal cord failing radiotherapy, 1 patient with a T2 squamous cell carcinoma of the vocal cord failing radiotherapy, and 3 patients with CIS and severe atypia were treated with PDT and obtained a complete response and are disease free. One patient with a T3 carcinoma of the larynx was treated with PDT but died 4 weeks post-treatment of unrelated causes and could not be assessed. Photodynamic therapy is a promising therapy for treatment of precancerous and cancerous lesions of the larynx. This therapy may be particularly beneficial for the treatment of recurrent carcinomas of the larynx that have failed conventional radiotherapy, thereby preserving voice and eliminating the need for destructive laryngeal surgery.     

Remote results of laryngeal cancer treatment T1-2N0M0

We have analyzed results of special treatment 187 patients with cancer of a larynx T1-2N0M0. The patients were parted into four clinical groups. 45 patients of the first group have received combined treatment, including a partial resection of the larynx and preoperative radial therapy in a general dose up to 40 Gr. 47 patients of the second group have received a course of the radial therapy under the radical program in total dose 70 Gr. 63 patients of the third group have passed a course of combined treatment, including the partial resection of the larynx and pre- and postoperative radial therapy in total dose, equivalent 60 Gr of a standard procedure. 32 patients of the fourth group have passed the extremely surgical treatment (partial resection of the larynx). The obtained results speak about large efficiency of combined treatment. As contrasted to with radial therapy under the radical program quantity of relapses considerably has decreased in the field of the primary center. As contrasted to with surgical treatment statistically quantity of recurrence of disease in area of regional lymphatic nodes authentically has decreased.     

Postirradiation malignant fibrous histiocytoma of the larynx: a case report

A 63-year-old man presented with malignant fibrous histiocytoma of the larynx occurring 16 years after radiation treatment for squamous cell carcinoma of the larynx. Postirradiation sarcoma of the larynx is an unusual tumor. The location, the histopathologic and immunohistochemical appearance of the tumor, and the time elapsed since the initial treatment make it probable that this tumor is associated with prior radiation treatment. The possibility of postirradiation sarcomas after radiation therapy should not be a major factor influencing treatment decisions in the patients with head and neck cancer. Wide surgical resection of the tumor seems to be an efficient means in the management of this tumor.     

pSilencer2.0-c-Met-siRNA基因在裸鼠体内对人喉癌Hep2细胞生长的影响

目的探讨pSilencer2.0 c Met siRNA重组质粒对人喉癌Hep 2细胞裸鼠移植瘤生长的影响。方法采用裸鼠喉癌皮下荷瘤模型模拟c Met siRNA基因治疗实验,观察c MetsiRNA重组质粒的抗瘤疗效,Western blot法检测重组质粒对c Met基因及MMP 2、MMP 9、VEGF基因表达的影响。结果肿瘤接种后第35?d,重组质粒组肿瘤体积为13?827?mm3,与对照组相比差异有统计学意义（P＜0.01）;重组质粒组瘤体内c Met、MMP 2、MMP 9、VEGF基因表达率比对照组明显降低（P＜0.05）。结论pSilencer2.0 c Met siRNA重组质粒能明显抑制人喉癌Hep 2细胞移植裸鼠成瘤后的生长,siRNA表达质粒介导的基因治疗有希望成为喉癌靶向性c Met治疗的新策略     

Squamous cell carcinoma antigen in patients with cancer of the larynx

The purpose of this study was to evaluate the clinical usefulness of squamous cell carcinoma antigen (SCC Ag) in patients with squamous cell carcinoma of the larynx. Plasma specimens were obtained from 70 patients with cancer of the larynx before and after treatment and during follow-up. Disease status and the marker levels were determined blind to each other. Microparticle enzyme immunoassay (IMx SCC) was used to measure the SCC Ag level. Applying standard normal limits the sensitivity of the marker at diagnosis was 25.7%. SCC Ag levels were generally lower after therapy than before. Relapse occurred more often in patients with an abnormal pretreatment SCC Ag level, which was more frequent in those with nodal invasion. The marker level increased in 70% of the patients with relapse before the clinical detection of recurrence. SCC Ag is of limited usefulness in the primary diagnosis of cancer of the larynx, but is useful in detecting recurrence of cancer.     

Squamous cell carcinoma antigen in patients with cancer of the larynx.

The purpose of this study was to evaluate the clinical usefulness of squamous cell carcinoma antigen (SCC Ag) in patients with squamous cell carcinoma of the larynx. Plasma specimens were obtained from 70 patients with cancer of the larynx before and after treatment and during follow-up. Disease status and the marker levels were determined blind to each other. Microparticle enzyme immunoassay (IMx SCC) was used to measure the SCC Ag level. Applying standard normal limits the sensitivity of the marker at diagnosis was 25.7%. SCC Ag levels were generally lower after therapy than before. Relapse occurred more often in patients with an abnormal pretreatment SCC Ag level, which was more frequent in those with nodal invasion. The marker level increased in 70% of the patients with relapse before the clinical detection of recurrence. SCC Ag is of limited usefulness in the primary diagnosis of cancer of the larynx, but is useful in detecting recurrence of cancer.     

The anatomic bases of the surgical treatment of pharyngo-laryngeal cancers

It is essential to recognize certain laryngeal and hypopharyngeal landmarks in order to choose the most appropriate surgical approach for excision of a tumor in any given site: that the larynx has two embryological origins, branchial and non-branchial, separated by the glottis, that the cartilaginous skeleton and the ossification of the thyroid cartilage provide a means for the spread of endolaryngeal cancer, that the pre-epiglottic region is divided in two by a medial wall and is closely connected to the endolarynx through the hollow vascular channels of the fibro-cartilage of the epiglottis, that the connective intralaryngeal tissue - conus elasticus, anterior commissure ligament, conoid ligament, and the articular capsule of the crico-arytenoid joint - must be taken into consideration to explain the spread of the tumor, that there exists the concept of arytenoid unity, that element of the branchial larynx which must be conserved in any functional oncologic surgery to the larynx and pharynx.     

Testosterone--an etiological factor in the development of laryngeal carcinoma?

To evaluate the etiological connection between the development of hyperplastic lesions of the laryngeal mucosa (including cancer) and the male sex hormones, the authors determined the level of testosterone in the serum of patients with cancer of the larynx (25 women and 25 men) and patients with hyperplastic lesions of the mucous membrane of the larynx (15 women and 15 men). In patients who suffered from cancer of the larynx the serum level of testosterone was significantly increased compared to the control group. In the patients who had hyperplastic lesions (including precancerous lesions) of the laryngeal mucosa the differences in the concentration of the serum testosterone were not statistically significant from the control group. The same was also true of the testosterone-estradiol index. The results of the study do not help to explain the success of hormonal therapy for hyperplastic lesions of the laryngeal mucosa. The authors consider that endogenous factors, especially the male sex hormones, should be taken more into account, alongside exogenous factors, in the genesis of laryngeal cancer.     

Evaluation of advanced laryngeal cancer extension in clinical and pathomorphologic examination

The method of choice in larynx cancer treatment is surgery. The radical surgical procedure must be based on the proper assessment of loco-regional tumor extenstion. The aim of the study was the estimation and comparison of immensity of larynx cancer during clinical, pathological and microscopic examination, as well as the defining of anatomical and functional conditions which impede laryngoscopy. 180 patients with larynx cancer treated surgically in the Department of Otolaryngology of the University School of Medical Sciences in Poznań and in the Otolaryngology Ward in Pi?a. In group of 123 patients total laryngectomy and in 57 patients partial laryngectomy was performed. To conduct the analysis of discrepancies between cT and pT as well as cT and mT assessment "big" and "small" immensity features were used. The big immensity was thought to be two-grade difference of locoregional advancement, the small one-one-grade. Discrepancies between cT, pT and mT were stated in transglottic tumors the most often and in multifocal-rarely. The biggest differences in cT, pT and mT assessment occurred in supraglottic tumor localisation. The high correlation between pT and mT local tumor extension assessment was observed.     

Combined pre-operative irradiation and surgery for advanced cancer of the larynx and laryngopharynx. (A 14 year correlative statistical and histopathological study).

A carefully planned clinical program of combined pre-operative radiation and surgery has been conducted by the Department of Otolaryngology at The Mount Sinai Hospital for 14 years in an effort to improve the survival rate for advanced cancer of the larynx and laryngopharynx. An extensive histopathological study of resected larynges and radical neck specimens was undertaken in 1961 in order to determine the effects of pre-operative radiation. A very careful statistical analysis has been made of the survival experience of this series of cases. The three and five year survival rates have been computed by the actuarial method. The histopathological study entailed a serial section study of 26 larynges and 21 radical neck dissection specimens. These studies have been most informative as to the nature of the radiobiologic process involved in the destruction of laryngeal cancer. In addition, the study has been revealing as to the ability of radiation to sterilize cancer in the neck specimens. The clinical correlate of this histologic finding has been the observation of reduced cervical recurrences in patients treated with combined therapy. In conclusion, our statistics seem to indicate that our combined therapy method has improved the survival rates of patients with advanced cancer of the larynx and laryngopharynx.     

喉气管狭窄治疗方法的选择

目的：探讨喉气管狭窄的治疗方法。方法：根据喉气管狭窄的范围和程度，选用气管镜扩张、激光切除、喉气管切开成形和支撑器置入扩张等方式，对３６例后天性喉气管狭窄患者进行治疗。结果：３２例患者拔管治愈，成功率为８８．８％。结论：喉气管狭窄病情复杂多变，术中应根据病变的范围和程度，选择适当的治疗方法，方能获得满意的效果。     

Laser Doppler flux-metry in laryngeal squamous cell carcinoma

Tumour angiogenesis has recently attracted a great deal of attention as a critical part of oncogenesis and a necessary prerequisite for a malignant phenotype. Novel antiangiogenic therapy for solid tumours including laryngeal cancer is entering clinical trials. Quantifying microvessel density is considered the gold standard for measuring baseline angiogenesis and indeed 'the response to intervention'. We hypothesize that laser Doppler flux-metry could provide a non-invasive reliable method of quantifying blood flux within tumours. The aims were to determine whether a laser Doppler flux meter could be used as a reliable and reproducible method of estimating blood flux in the human larynx and to establish baseline Doppler flux recordings for the human larynx. The method used was a validation study in patients with laryngeal squamous cell cancer and normal controls. Statistical analysis was performed using SPSS software. We have demonstrated good reproducibility of laser Doppler measurements in human laryngeal mucosa (correlation coefficient 0.956 @P = 0.01). We have also derived arbitrary means of laser Doppler flux-metry in normal laryngeal mucosa and in squamous cell carcinoma of the larynx. Comparisons between normal and tumour laser Doppler flux-metry (LDF) readings showed no significant difference. We suggest that Laser Doppler flux-metry is a potentially useful tool with which to study blood flow in the larynx and propose arbitrary LDF levels for the normal and diseased human larynx.     

Laryngeal preservation in cases of advanced laryngeal cancer treated with platinum based induction chemotherapy before local treatment.

In this study we analyse our preliminary results after treating 28 patients with locally advanced laryngeal cancer with platinum based induction chemotherapy followed by radiation therapy or surgery. The median age of our patients was 60 (46-75) years and median performance status was 80 (60-100). In 18 of the 28 patients locoregional treatment was radiation therapy with an overall response of 94.4 per cent. After a median follow-up of 26 (15-40) months 39.3 per cent of the whole group of patients are alive and disease-free and six (21.4 per cent) patients are alive and disease-free preserving their larynx. We conclude that although more extensive studies with large groups of patients and longer follow-up is needed to reach definite conclusions, it seems that platinum based induction chemotherapy can be used successfully in locally advanced laryngeal cancer followed by radiotherapy. In those cases who respond well, the patient's larynx is preserved without compromizing the overall survival.     

Expression of glutathione-S-transferase isoenzymes in larynx cancer

Carcinoma planoepitheliale of larynx is the most common cancer present in the upper part of the respiratory system. The molecular mechanism of this cancer generation is unknown and there is no a specific marker for its early diagnosis. The properties, physiological function, as well as the results of studies on genetic polymorphism indicate that glutathione-S-transferase (GST) may play an important role in etiology of this cancer. In the present work the studies on expession of GST isoenzymes pi, alfa, mu4, and mu5 in larynx cancer (carcinoma planoepitheliale laryngis) were performed. Specimens of larynx cancer and their corresponding normal adjacent tissues were obtained from patients by surgery. Expression was studied on the level of mRNA using RT-PCR method. The results indicated raised expression of GST pi (the major isoform in larynx) and lowered expression of GSTs mu4 and alfa in cancer as compared with the control tissue. No expression of GST mu5 was observed in tumor and normal larynx tissues. Obtained results indicate various mechanism in regulation of GSTs expression in cancerous and normal larynx tissues. They also indicate a special role of GST pi in larynx carcinogenesis.     

喉癌及下咽癌手术后咽瘘的治疗及预防

目的 探讨喉癌、下咽癌手术后并发咽瘘的治疗和预防措施。方法 喉癌手术后并发咽瘘5例,其中2例行胸大肌皮瓣修补术;下咽癌手术后并发咽瘘11例,其中2例行咽瘘缝合术。结果 喉癌术后咽瘘5例,3例经换药愈合,2例巨大咽瘘,其中1例行胸术肌皮瓣修补术,未愈合又行咽瘘缝合愈合,另1例第1次胸大肌皮瓣修补后失败,安装硅橡胶管后恢复正常饮食,6个月后行二次胸大肌皮瓣修补愈合。下咽癌术后咽瘘11例,经换药2～4周愈合9例,另2例经换药4周,局部炎症已控制,瘘口缩小为1～2cm,行咽瘘缝合术愈合。结论 喉癌、下咽癌术后并发咽瘘,是该手术的严重并发症之一。多数经换药治愈,少数病例必须行咽瘘修补术。应在手术前、手术中及手术后采取一些必要措施预防咽瘘。     

Levels of nonenzymatic antioxidants depending on stage of laryngeal cancer

The goal of this study was to check if there is any connection between nonenzymatic antioxidant system and larynx cancer staging. Levels of retinol, alpha- and gamma-tocopherol were measured in blood of 28 patients with larynx cancer. The conclusion is that the levels of measured substances were significantly lower in patients with more advanced larynx cancer.     

Radiotherapy of the neck influences the distribution of laryngeal secretory glands

To elucidate the influence of radiation therapy on the larynx in patients who receive radiotherapy to the neck, we observed the changes in the distribution of the laryngeal glands. Human adult larynges from patients with either laryngeal or hypopharyngeal cancer were histopathologically examined, and the changes in the glandular distribution as well as in the ratio of serous or mucous type cells were surveyed using an image analysis system. The mean ratio of the area occupied by glandular acini in the subglottic larynx was 0.182 in the non-radiation group and 0.098 in the radiation group (p < 0.001). Although no statistical difference was observed, the average density of the glands decreased and the average ratio of serous-type/mucous-type glandular cells decreased in the irradiated larynx. The glandular acini are often replaced with fibrous connective tissue and the ratio of serous-type glandular cells decreases. These results indicate that not only the voice function but also the local defence function of the larynx might be impaired after radiotherapy.     

Factors influencing the hormonal function in patients after the treatment of larynx cancer

It has been revealed that the hypothyreosis (subclinical as a rule) can be found after every method applied in treatment of the larynx cancer. Correlation of data obtained with the time function allowed to specify survival probability of patients in euthyreosis after therapy termination. Among the factors supposed to be involved in keeping patient's normal thyroid gland function the following have been taken into account: sex, age, stage of the neoclassic process, scope of the surgical intervention on the larynx and lymph nodes of the neck, thyroid gland surgery and dose of irradiation given in Gy/T at the time of radiotherapy. Substantial impact on hypothyreosis was attributed to: method of laryngeal cancer, treatment, the range of its structures removal and surgical intervention on thyroid gland (excision of the thyroid lobe or its translocation for larynx reconstruction). It was found that the probability of survival in euthyreosis in patients treated by surgery and by combined method was the least after laryngopharyngectomy. In 3 years follow up period after such a therapy it amounted to 75% for surgical method and 48% for combined one. It was evident that the dysfunction of the thyroid gland resulted mostly from combined method of laryngeal cancer therapy (even without surgical intervention on thyroid glad). The probability of survival in euthyreosis in those patients was the least of all and amounted to 78.7% after 1 year of therapy termination and 42.9% after 6. In patients treated with combined method and intervention on thyroid gland, the survival probability in euthyreosis was 25% after excision thyroid lobe and 20% after its translocation for larynx reconstruction. After exclusive surgical therapy the probability amounted to 96% and after radiotherapy 88.6%. Prolongation of the follow up after radiotherapy (over 1 year) didn't increase the number of patients with hypothyreosis. The necessity of the evaluation of the thyroid gland hormonal function in every one patient has been stressed. This should be done before treatment and 1, 6, and 12 months after the termination of the therapy, and then once a year.