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Carcinoma of the right vocal cord: (a) endoscopic view; (b) CT image: the paraglottic space seems preserved (green indicator) without cartilaginous alterations; (c) T2w MR image: the paraglottic space seems involved with focal invasion of the thyroid cartilage (green indicator).
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Introduction:
Clinical staging is the most important time in management of glottic cancer in early stage (I-II). We have conducted a prospective study to evaluate if magnetic resonance imaging (MRI) is more accurate than computed tomography (CT) about tumoral extension, to exactly choose the most appropriate surgical approach, from organ preservat...
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Background
Transoral laser microsurgery (TLM) for early to intermediate laryngeal squamous cell cancer (SCC) can be technically challenging when adequate exposure of the posterior laryngeal compartment is required due to the presence of the orotracheal tube. The goal of our study was to analyze the efficacy of high frequency jet ventilation (HFJV)...
Citations
... The type of the treatment for laryngeal cancer depends on the stage of the disease at diagnosis and can benefit from different modalities, including transoral laser microsurgery, open partial horizontal laryngectomy, and (chemo)radiotherapy, with good oncological and functional outcomes [2][3][4] . In the last two decades, organ preservation strategies have increased; this can be attributed to improvements in preoperative staging and follow-up as a result of enhanced imaging techniques [5][6][7] . Organ preservation surgery is aimed at preventing the highly mutilating intervention of total laryngectomy (TL) and maintaining laryngeal function in light of oncological radicality. ...
Objective:
This study aimed to evaluate olfactory function in patients rehabilitated with oesophageal (ES) voice or tracheo-oesophageal (TES) prosthesis to further verify whether there were differences in smell alterations depending on voice rehabilitation modality.
Methods:
A total of 40 patients who had undergone total laryngectomy participated in the study. Speech rehabilitation was achieved through TES in 20 patients (Group A) or ES in 20 patients (Group B). Olfactory function was evaluated using the Sniffin' Sticks test.
Results:
At olfactory evaluation, in Group A, 4/20 patients (20%) were anosmic, whereas 16/20 patients (80%) were hyposmic; in Group B, 11/20 patients (55%) were anosmic whereas 9/20 patients (45%) were hyposmic. A significant difference (p = 0.04) was found at global objective evaluation.
Conclusions:
The study shows that the rehabilitation with TES contributes to maintaining a functioning, albeit limited, sense of smell.
... Laryngeal carcinoma is one of the most common malignancies of the head and neck region, most of which are squamous cell carcinoma. 1 Glottic squamous cell carcinoma (GSCC) accounts for around two-thirds of all laryngeal carcinomas. GSCC is usually diagnosed at an early stage, owing to typical symptoms such as hoarseness caused by vocal cord invasion. ...
Background
Glottic squamous cell carcinoma (GSCC) is the most prevalent type of laryngeal carcinoma. The value of prophylactic lymph node dissection (LND) in resected GSCC remains controversial. This study aims to quantitatively assess the probability of occult lymph node metastasis (LNM) for GSCC patients and devise individualized postoperative radiotherapy strategies.
Methods
A total of 1319 patients with GSCC were retrospectively analyzed.
Results
GSCC patients with T1‐T2 stages showed significantly lower LNM rate than those with T3‐T4 stages. For patients with T3‐T4 GSCC, multivariate logistic analyses indicated that three factors—maximum tumor diameter (MTD) of more than 2.0 cm, relatively low differentiation, and tumor invasive depth of no less than 1.0 cm—were independent risk factors for the existence of LNM. A predictive nomogram was established based on these factors. The accuracy and validity of our model were verified by 0.716 and remained at 0.717 after 1000 bootstrapping. The calibration curve was also plotted and showed a favorable agreement. The patients were stratified into two groups based on their individual LNM risk points. Possible LNM rates for low‐risk and high‐risk subgroups were 4.7% and 25.2%, respectively.
Conclusions
A new post‐operative strategy selection flow chart was established based on our newly created nomogram which can effectively predict the individualized possibility of occult LNM for GSCC patients. For clinical T3‐4N0 patients in the high‐risk subgroup, prophylactic dose post‐operative radiation therapy is recommended. However, for all those clinically diagnosed as T1‐2N0 stage, regular follow‐up is sufficient in view of the low occult LNM rate.
Level of Evidence: 2a
... 57 Nevertheless, some authors have pointed out that MR imaging is clearly superior to CT in the preoperative staging of early glottic cancer. 58 It has even been suggested that DWI may detect changes in tumor size and shape before they become apparent at laryngostroboscopy and may help to distinguish laryngeal SCC from precursor lesions. 59 ...
... administration of gadolinium chelates and ADC values less than 1.3 Â 10 À3 mm 2 /s Careful analysis of multiparametric MR imaging signal intensity allows distinction between tumor and peritumoral inflammation as inflammation has a higher signal intensity on T2 and T2 STIR and a stronger contrast enhancement than the tumor itself. 11,34,58 Also, on DWI, peritumoral inflammation shows no restriction of diffusion and ADC values are in general above 1.3 Â 10 À3 mm 2 /s. ...
State-of-the-art MR imaging of the larynx and hypopharynx with high-resolution surface coils, parallel imaging techniques, and DWI has several advantages over CT for assessing submucosal tumor spread, in particular neoplastic involvement of the paraglottic space, laryngeal cartilages, and extralaryngeal soft tissues. Current diagnostic MR imaging criteria based on a combination of distinct imaging features on morphologic sequences combined with DWI allow improved discrimination between tumor, peritumoral inflammation, and fibrosis and, ultimately, an increased precision for submucosal tumor delineation, which is a key prerequisite for tailored treatment options. Multiparametric MR imaging with DWI has a higher diagnostic performance than CT.
... However, the specificity of CT and MRI for cartilage invasion is similar (approximately 70-80%) and both can overestimate cartilage invasion (17), although this has been improved with dynamic contrast-enhancement studies or dual-energy CTs (18,19). CT and MRI together have a high negative-predictive value for cartilage invasion and MRI particularly can be a more helpful modality for early-stage tumours where soft tissue assessment of the vocal cord or anterior commissure is necessary (20). ...
Early-stage squamous cell cancer (SCC) of the glottis has a good prognosis. Therefore, patients have long survival outcomes and may potentially suffer from late toxicities of radiotherapy. Radiotherapy with a conventional parallel-opposed-pair or anterior-oblique beam arrangements for stage 1 and 2 glottic SCC have field borders that traditionally cover the entire larynx, exposing organs-at-risk (e.g. carotid arteries, contralateral vocal cord, contralateral arytenoid and inferior pharyngeal constrictor muscles) to high radiation doses. The potential long-term risk of cerebrovascular events has attracted much attention to the dose that carotid arteries receive. Swallow and respiratory motion of laryngeal structures has been an important factor that previously limited reduction of the radiation treatment volume. Motion has been evaluated using multiple imaging modalities and this information has been used to calculate PTV margins for generation of more limited target volumes. This review discusses the current literature surrounding dose-effect relationships for various organs-at-risk and the late toxicities that are associated with them. This article also reviews the currently available data and effects of laryngeal motions on dosimetry to the primary target. We also review the current limitations and benefits of a more targeted approach of radiotherapy for early-stage glottic SCCs and the evolution of CT-based IGRT and MR-guided radiotherapy techniques that may facilitate a shift away from a conventional 3D-conformal radiotherapy approach.
... From our experience when performing a resection of a carcinoma of the anterior commissure, it is necessary to obtain a correct exposure of the surgical field, and the Laryngoscore scoring system could help in selecting the appropriate candidates for operative microlaryngoscopy [12]. In all these cases, we strongly suggest a pre-operative MRI to exclude the involvement of the thyroid cartilage; in fact, the early carcinoma of the anterior commissure can penetrate the cartilage transforming a T1 tumor into a T4 which represents a contraindication for CO 2 TOLMS [13]. ...
PURPOSE: The aim of this retrospective study is to evaluate the results obtained with CO2 laser transoral microsurgery (TOLMS) in patients with Tis, T1 and T2 glottic tumors at our Department from 2004 to 2016.
METHODS: One-hundred-eighty-five patients median age 67 years [range 42-88] were included in the present analysis. The tumor stages of the patients included 17 pTis, 117 pT1a, 12 pT1b, and 39 pT2 cases. Median duration of follow-up for the whole study cohort was 55 months (range 24–108 months).
RESULTS: At Five-Years follow up, Local Control was 100%, 88,8%, 83%, 79,4% for Tis, T1a, T1b and T2 respectively. Disease Specific Survival was 100%, 94,8%, 91,6%, 92,3%. Overall Survival was 94,1%, 70,9%, 91.6%, 82% and Larynx Preservation was 100%, 95,7%, 83% and 84,6%.
CONCLUSION: This study confirms that CO2 TOLMS is a safe and effective procedure for selected T1 and T2 glottic carcinoma, and our review on T2 glottic cancer suggests that CO2 TOLMS represents a reliable option in terms of overall survival, disease specific survival, and laryngeal preservation. However, it is important to underline the importance of adequate patient selection and of a multidisciplinary management of each patient.
... Lesions invading the paraglottic space should be correctly classified as T3 during the preoperative evaluation with a transnasal flexible videofiberscope and magnetic resonance imaging. 78 Poorer prognosis seems to be associated mainly with tumor infiltration of the posterior paraglottic space resulting in fixation of the arytenoid joint and not with impaired mobility from vocal fold muscle infiltration or pure tumor bulk. 6 ...
Introduction
The aim of the current systematic review is to update the pooled survival outcome of patients with T2 glottic carcinoma treated with either laser surgery (CO 2 transoral laser microsurgery [CO 2 TOLMS]), radiotherapy (RT), or open partial laryngectomy (OPL).
Methods
A systematic search was performed using the MEDLINE database, Scopus, and Google scholar. The inclusion criteria were studies of patients with T2N0 glottic tumor, treated with either primary CO 2 TOLMS, definitive curative RT, or primary OPL, and with reported oncological outcome at 5 years calculated with a Kaplan-Meier or Cox regression method.
Results
The results of the current review show that local control (LC) is higher with OPL 94.4%, while there are no differences in LC at 5-year posttreatment for patients treated with RT, compared to those treated with CO 2 TOLMS (respectively, 75.6% and 75.4%). Primary treatment with OPL and CO 2 TOLMS results in higher laryngeal preservation than primary treatment with RT (respectively 95.8%, 86.9%, and 82.4%).
Conclusion
First-line treatment with OPL and CO 2 TOLMS should be encouraged in selected T2 patients, because it results in higher laryngeal preservation and similar LC compared to primary treatment with RT. The involvement of the anterior commissure in the craniocaudal plane and T2b impaired vocal cord mobility have a poorer prognosis and LC compared to patients with T2a tumors for both CO 2 TOLMS and RT.
... Also, Yamauchi et al., who analyzed the vibratory characteristics of the vocal fold mucosa with leukoplakia and early carcinoma in HSDI, presented results identifying segments without vibrations in 50% of laryngeal cancer and 8.3% of mild leukoplakia, emphasizing that they are comparable with stroboscopic results [9]. infiltration [15]. However, other authors are pointing that the diagnosis of cartilage invasion is overestimated in MR; this could be associated with incorrect assessment of the tumor-associated inflammation, which widens the margins of abnormal tissues [16]. ...
This article is a review of literature and a summary of the current guidelines in the diagnosis of hypertrophic vocal folds suspected of malignancy. It gives a detailed overview both of initial diagnosis, as well as the methods of in-depth intraoperative diagnostics and proposals for careful evaluation during post-treatment follow-up examinations.
... All patients preoperatively underwent videolaryngoscopy with flexible endoscopy and videolaryngostroboscopy. A preoperative CT (Computed Tomography) or MRI (magnetic resonance imaging) scan was performed in both groups to confirm tumor extension [24], except for small superficial lesions limited to the middle third of the vocal cords. All patients underwent TLM under general anesthesia using a Co2 Laser (GA-0000560B N • 284, Lumenis, Yokneam, Israel) mounted on a Zeiss surgical microscope that was provided by a video camera with a recording system. ...
Background and objectives: Transoral laser microsurgery (TLM) is widely accepted for its advantages, which consist of a brief hospital stay, rapid functional recovery, low management costs and the fact that it can be easily repeated in cases of recurrence. However, a high incidence of positive or narrow surgical margins has been reported in the literature, even if controversy still exists on the prognostic significance of positive resection margins. The aim of the study was to evaluate the utility of toluidine blue staining in defining the resection margins of early glottic cancer (T1a–T2) treated with TLM. Materials and Methods: This retrospective study was conducted on patients with early glottic cancer (T1a–T2) managed by TLM. A group of patients treated between 2010 and 2014 underwent toluidine blue staining (TB group) of the lesions before starting the cordectomy by TLM, and a group of patients treated by TLM between 2006 and 2009 was considered the control group. Results: A total of 44 subjects were included in this study: 41 were men, and 3 were women. The mean age was 58 ± 9.0 years (median 59.0, range 41–77). Twenty-three of the 44 patients were included in the TB group and 21 in the case control group. In the TB group, only the positivity of the deep margin was a predictor of local recurrence (p = 0.037), while in the control group, positive or close margins and the type of cordectomy were predictive factors of local recurrence (p = 0.049). Considering the TB group and control cases, the 5-year local recurrence-free survival was 95.6% and 80.9%, respectively (p = 0.14). Conclusions: From this first study, toluidine blue staining seems to be a useful modality to improve the rate of the negative resection margins of early glottic cancer (T1a–T2) treated by TLM.
... The presence of peritumoural inflammation can confuse the limits of involved tissue, and as a result the neoplasm can be overstaged. 22 On the other hand, although thyroid cartilage involvement in the early stages is less than 9%, cartilage involvement must be discerned within the process of diagnosis. ...
The choice of the most appropriate treatment in early-stage glottic cancer with anterior commissure involvement remains controversial. Its therapeutic management is complex because it is a significant prognostic indicator of local control with 37% recurrence, due to the difficulty in establishing tumour extension with understaging of up to 40%, and due to the comparison of results in series on tumours that behave variably as they progress, such as T1a, T1b and T2a with commissure involvement. Furthermore, the complexity of the surgical approach using transoral CO2 laser microsurgery requires surgical skill, appropriate equipment and experience. Aspects to be reviewed in this document are: an updated anatomical definition of the anterior commissure, tumour progression based on histopathological studies, usefulness of videostroboscopy and NBI in diagnostic accuracy, validity of imaging tests, oncological results published in series reviews, systematic reviews and meta-analyses, tumour margin treatment and voice evaluation. Finally, by way of a summary, the document includes a series of recommendations for the treatment of these tumours.
... La resonancia magnética utilizada para el estudio de la invasión de la comisura anterior es más sensible que la tomografía computarizada, aunque menos específica. La presencia de inflamación peritumoral puede confundir los límites del tejido afecto, y como resultado se puede realizar una sobreestadificación de la neoplasia 22 . Por otro lado, aunque la afectación del cartílago tiroides en los estadios precoces es inferior al 9%, es necesario dentro del proceso diagnóstico poder discernir si el cartílago se encuentra afecto. ...
Resumen
La elección del tratamiento más adecuado en el cáncer glótico en estadio precoz con afectación de la comisura anterior sigue siendo controvertida. La complejidad en su manejo terapéutico está justificada por ser un significativo indicador pronóstico de control local, con un porcentaje de recidiva del 37%, por la dificultad en establecer la extensión tumoral con una infraestadificación que llega a alcanzar el 40%, y por la comparación de resultados en series formadas por tumores de diferente comportamiento evolutivo, como son T1a, T1b y T2a con afectación comisural. A estos datos se suma la complejidad del abordaje quirúrgico mediante microcirugía transoral con láser CO2 que requiere habilidad quirúrgica, equipamiento adecuado y experiencia.
Los aspectos a revisar en este documento son: definición anatómica actualizada de la comisura anterior, progresión tumoral en función de estudios histopatológicos, utilidad de la videoestroboscopia y la NBI en la precisión diagnóstica, validez de las pruebas de imagen, resultados oncológicos publicados en revisión de series, revisiones sistemáticas y metaanálisis, tratamiento de los márgenes y evaluación de la voz.
Finalmente, y a modo de resumen, el documento incluye una serie de recomendaciones para el tratamiento de estos tumores.
