Secondary tracheoesophageal puncture with a flexible transillumination device: a new technique and its outcomes

Abstract Objectives: This study aims to describe a new secondary tracheoesophageal puncture technique with voice prosthesis insertion under local anesthesia with a low-cost device and evaluate its outcome. Methods: With a transoral flexible transillumination device of aluminum of 2.3 mm with fiberoptic light, the esophagus's anterior wall is visualized through the tracheostomy. A tracheoesophageal fistula is made with a blade and passed through the fistula. Then a bent trocar is introduced into the lumen using the device as a guidewire. Once in the lumen, a thin guide wire is passed through up to the mouth. The voice prosthesis is positioned with retrograde insertion. Then, the patient is discharged without hospitalization. Results: 15 patients submitted to this technique had a successful surgical outcome. There were no complications as pneumothorax, esophageal perforation, bleeding, or hospitalization. Conclusion: The new device is feasible under local anesthesia.

Lysyl Oxidase Like-4 (LOXL4) as a tumor marker and prognosticator in advanced stage laryngeal cancer / Proteína tipo-lisil oxidase-4 (LOXL4) como marcador tumoral e prognóstico no câncer de laringe em estágio avançado

Abstract Introduction: Lysyl oxidase-like 4 is an amine oxidase from the lysyl oxidase family that was previously shown to be overexpressed in head and neck cancer and upregulated in response to hypoxia. The possible role of lysyl oxidase-like 4 as a tumor marker in advanced stage larynx cancer was investigated. Objective: To investigate the expression of lysyl Oxidase-Like 4 protein in advanced stage laryngeal cancer and elucidate its possible role as a tumor marker, predictor of treatment response and prognosticator. Methods: Diagnostic specimens of 72 patients treated for stage III-IV laryngeal squamous cell carcinoma were evaluated for lysyl oxidase-like 4 expression by immunohistochemistry. Results: Lysyl oxidase-like 4 expression was correlated with advanced tumor stage (p = 0.041) and better differentiation (p = 0.025) but was independent of tumor diameter (p = 0.456). Response to induction chemotherapy or the need for salvage laryngectomy were not affected by lysyl oxidase-like 4 expression (p = 0.999, p = 0.070 respectively). Increased lysyl oxidase-like 4 expression was associated with better 2 year overall survival in both univariate (p = 0.036) and multivariate analyses (p = 0.014). Conclusion: Lysyl oxidase-like 4 expression emerges with advancing stages, is lost with worsening differentiation, and may have tumor suppressive properties in larynx cancer.

Resumo Introdução: A proteína tipo-lisil oxidase-4 é uma amina oxidase da família lisil oxidase cuja superexpressão em câncer de cabeça e pescoço e up-regulação em resposta à hipóxia foram previamente demonstradas. O possível papel da proteína tipo-lisil oxidase-4 como um marcador tumoral no câncer de laringe em estágio avançado foi investigado. Objetivos: Investigar a expressão da proteína tipo-lisil oxidase-4 no câncer de laringe em estágio avançado e elucidar seu possível papel como marcador tumoral, preditor da resposta ao tratamento e do prognóstico. Método: Amostras diagnósticas de 72 pacientes tratados para carcinoma espinocelular da laringe em estágio III-IV foram avaliadas quanto à expressão da proteína tipo-lisil oxidase-4 por imuno-histoquímica. Resultados: A expressão de proteína tipo-lisil oxidase-4 foi correlacionada com o estágio avançado do tumor (p = 0,041) e melhor diferenciação (p = 0,025), mas foi independente do diâmetro do tumor (p = 0,456). A resposta à quimioterapia de indução ou a necessidade de laringectomia de resgate não foram afetadas pela expressão da proteína tipo-lisil oxidase-4 (p = 0,999, p = 0,070 respectivamente). O aumento da expressão da proteína tipo-lisil oxidase-4 foi associado a melhor sobrevida global de 2 anos nas análises univariada (p = 0,036) e multivariada (p = 0,014). Conclusão: A expressão da proteína tipo-lisil oxidase-4 surge com o avanço dos estágios e desaparece com pioria da diferenciação e pode ter propriedades supressoras de tumor no câncer de laringe.

Trend of the Burden of Larynx Cancer in Brazil, 1990 to 2019

Abstract INTRODUCTION: Larynx cancer is one of the most common head and neck cancers, whose main risk factors are smoking and alcohol use, and its occurrence and prognosis depend on adequate and timely preventive measures. This study aimed to investigate the burden of larynx cancer in Brazil and its states. METHODS: Using estimates from the Global Burden of Disease Study 2019, this study analyzed the trends of incidence, mortality, and disability-adjusted life years (DALYs) for larynx cancer between 1990 and 2019, besides the mortality-to-incidence ratio and the socio demographic index. RESULTS: Incidence and mortality due to larynx cancer in Brazil, which are approximately eight-fold higher for men, showed a declining trend between 1990 and 2019 (APPC: -0.4% and -1.0%, respectively). The DALYs also showed negative variation between 1990 and 2019 for both sexes in Brazil, mainly due to the decrease in premature deaths, with the greatest reduction in the state of São Paulo. For the states of Brazil in 2019, the higher age-standardized incidence rate (Rio Grande do Sul, 3.83 cases per 100,000 inhabitants) is twice the lowest rate (Piauí, 1.56 cases per 100,000 inhabitants). CONCLUSIONS: A fall in the burden of larynx cancer was observed in Brazil over the past 30 years, which may be attributed to a reduction in smoking and to an improvement in treatment. However, the regional inequalities in the country remain evident, especially for males. This data can guide public policy priorities to control the disease in Brazil.

The Impact of Narrow-band Imaging on the Pre- and Intra- operative Assessments of Neoplastic and Preneoplastic Laryngeal Lesions. A Systematic Review

Abstract Introduction Narrow-band imaging is an endoscopic diagnostic tool that, focusing on superficial vascular changes, is useful to detect suspicious laryngeal lesions, enabling their complete excision with safe and tailored resection margins. Objectives To analyze the applications and benefits of narrow-band imaging in detecting premalignant and malignant laryngeal lesions through a comparison with white-light endoscopy. Data Synthesis A literature search was performed in the PubMed, Scopus and Web of Science databases using strict keywords. Then, two authors independently analyzed the articles, read the titles and abstracts, and read completely only the relevant studies according to certain eligibility criteria. In total, 14 articles have been included in the present review; the sensitivity, specificity, positive and negative predictive values, and accuracy of pre- and/or intraoperative narrow-band imaging were analyzed. The analysis showed that narrow-band imaging is better than white-light endoscopy in terms of sensitivity, specificity, positive and negative predictive values, and accuracy regarding the ability to identify cancer and/or precancerous laryngeal lesions. Moreover, the intraoperative performance of narrow-band imaging resulted more effective than the in-office performance. Conclusion Narrow-band imaging is an effective diagnostic tool to detect premalignant and malignant laryngeal lesions and to define proper resection margins. Moreover, narrow-band imaging is useful in cases of leukoplakia that may cover a possible malignant lesion and that cannot be easily assessed with white-light endoscopy. Finally, a shared, simple and practical classification of laryngeal lesions, such as that of the European Laryngological Society, is required to identify a shared lesion management strategy. Key Points Narrow-band imaging is useful in detecting suspicious laryngeal lesions and proper resection margins showing intraepithelial papillary capillary loops (IPCLs) that are considered a main cancer feature. Narrow-band imaging is used both pre- and intraoperatively, but it provides more precise information if used during surgery. Compared with white-light endoscopy, narrow-band imaging enables a better assessment of the lesions covered by a thick white plaque (such as in cases of leukoplakia) The classification of the European Laryngological Society is the simplest and the most practical for the identification of various laryngeal lesions compared with other classifications.

Transforming growth factor-β1 gene polymorphism as a potential risk factor in Turkish patients with laryngeal squamous cell carcinoma

Introduction: Laryngeal cancer is the most common head-and-neck malignancies with more than 20% of all cases. The vast majority of tumors are squamous cell carcinoma (SCC). Several genes encoding different cytokines may play crucial roles in host susceptibility to cancer because cytokine production capacity varies among individuals and depends on cytokine gene polymorphisms. Materials and Methods: The association between cytokine gene polymorphisms with primary laryngeal SCC was investigated. DNA samples were obtained from a Turkish population of eighty patients with primary cancer and fifty healthy controls. Results: All genotyping (interferon-gamma, transforming growth factor-β1 [TGF-β1], tumor necrosis factor-alpha [TNF-α], interleukin [IL]-6, and IL-10) experiments were performed using polymerase chain reaction sequence-specific primers. When compared to the healthy controls, the frequencies of TGF-β1 codon 25 (rs1800471) GC genotype and 25 C allele were significantly more common in the patient group. Conclusions: These results suggest that TGF-β1 gene polymorphisms may affect host susceptibility to laryngeal cancer

Cirugía transoral en cáncer de laringe estadificado T1-T2 / Transoral surgery in T1-T2 staged laryngeal cancer

Se realizó un estudio prospectivo y descriptivo, incluyendo 103 pacientes que fueron tratados por cáncer de laringe en etapa inicial (T1-T2) con cirugía transoral. De ellos, 55 se diagnosticaron en estadio T1, 16 en estadio T1-b y 32 en estadio T2. El control local inicial (CLI) en pacientes con tumores malignos de laringe estadificados T1 fue 91%, el control local con rescate (CLR) 96%, la preservación de la función de la laringe (PFL) 93% y la sobrevida específica 96%. En T1-b, el CLI fue 81%, el CLR 94%, la PFL 94% y la sobrevida específica 94%. En T2, el CLI fue 63%, el CLR 94%, la PFL 72% y la sobrevida específica 78%. La cirugía transoral en cáncer de laringe con T inicial tiene resultados oncológicos similares a otros tratamientos (cirugía externa o radioterapia), pero consideramos que es la mejor opción por su baja morbilidad, menor duración del tratamiento, y porque deja abiertas todas las posibilidades para tratar posibles recurrencias. (AU)

A prospective and descriptive study was conducted, including 103 patients who were treated for early stage laryngeal cancer (T1-T2) with transoral surgery. Of these, 55 were diagnosed in stage T1, 16 in stage T1-b and 32 in stage T2. The initial local control (CLI) in patients with malignant T1 laryngeal tumors was: 91%, local control with rescue (CLR) 96%, preservation of larynx function (PFL) 93% and specific survival 96%. In T1-b the CLI was 81%, the CLR 94%, the PFL 94% and the specific survival 94%. In T2 the CLI was 63%, the CLR 94%, the PFL 72% and the specific survival 78%. Transoral surgery in laryngeal cancer with initial T has oncological results similar to other treatments (external surgery or radiotherapy), but we consider that it is the best option because of its low morbidity, shorter duration of treatment, and because it leaves open all the possibilities to treat possible recurrences. (AU)

The role of red cell distribution width in the locoregional recurrence of laryngeal cancer / O papel da amplitude de distribuição de eritrócitos na recorrência locorregional do câncer da laringe

Abstract Introduction: Although the red cell distribution width has been reported as a reliable predictor of prognosis in several types of cancer, to our knowledge few reports have focused on the prognostic value of red cell distribution width in laryngeal carcinoma. Objective: We aimed to explore whether the pretreatment red cell distribution width predicted recurrence in laryngeal cancer patients is a simple, reproducible, and inexpensive prognostic biomarker. Methods: All laryngeal cancer patients who underwent curative surgery (n = 132) over a 7 year study period were evaluated. Data on demographics, primary tumor site, T-stage, N-stage, histological features (differentiation; the presence of perineural/perivascular invasion), treatment group (total laryngectomy or partial laryngectomy) or adjuvant therapy (chemotherapy/radiotherapy); laboratory parameters (complete blood count, including the pre-operative red cell distribution width), and disease-free survival rates were retrospectively reviewed. All cases were divided into three groups by the red cell distribution width tertile [<13% (25th percentile) (n = 31), 13-14.4% (50th percentile) (n = 72), and >14.4% (75th percentile) (n = 29)]. Results: High-red cell distribution width group included more patients of advanced age, and more of those with recurrent and metastatic tumors (p = 0.005, 0.048, and 0.043, respectively). Individuals with red cell distribution width >14.4% (75th percentile) had lower disease free survival rates than did those with red cell distribution width <13% (25th percentile) (p = 0.014). Patients with red cell distribution width >14.4% at diagnosis were at a higher risk of locoregional recurrence (hazard ratio = 5.818, 95% confidence interval (95% CI) 1.25-26.97; p = 0.024) than patients with a normal red cell distribution width (<13%). Conclusion: We found that the pretreatment red cell distribution width was independently prognostic of disease free survival rate in patients with laryngeal cancer and may serve as a new, accurate, and reproducible means of identifying early-stage laryngeal cancer patients with poorer prognoses.

Resumo Introdução: Embora a amplitude de distribuição de eritrócitos tenha sido relatada como um preditor confiável de prognóstico em vários tipos de câncer, que seja de nosso conhecimento, poucos estudos se concentraram no valor prognóstico dessa medida no carcinoma laríngeo. Objetivo: Avaliar se a amplitude de distribuição de eritrócitos pré-tratamento prevê a recorrência em pacientes com câncer de laringe como um biomarcador prognóstico simples, reprodutível e não dispendioso. Método: Foram avaliados todos os pacientes com câncer de laringe submetidos à cirurgia curativa (n = 132) durante sete anos. Dados demográficos, local do tumor primário, estágio T, estágio N, características histológicas (diferenciação; presença de invasão perineural/perivascular), grupo de tratamento (laringectomia total ou laringectomia parcial) ou terapia adjuvante (quimioterapia/radioterapia); parâmetros laboratoriais (hemograma, inclusive a amplitude de distribuição de eritrócitos pré-operatório) e a sobrevida livre de doença foram revisados retrospectivamente. Todos os casos foram divididos em três grupos pelo tercil da amplitude de distribuição de eritrócitos [< 13% (percentil 25) (n = 31), 13%-14,4% (percentil 50) (n = 72) e > 14,4% (percentil 75) (n = 29)]. Resultados: O grupo com amplitude de distribuição de eritrócitos elevado incluiu um número maior de pacientes com idade avançada e mais pacientes com tumores recorrentes e metastáticos (p = 0,005, 0,048 e 0,043, respectivamente). Os indivíduos com a amplitude de distribuição de eritrócitos > 14,4% (percentil 75) apresentaram taxas de sobrevida livre de doença menores do que aqueles com a amplitude de distribuição de eritrócitos < 13% (percentil 25) (p = 0,014). Pacientes com a amplitude de distribuição de eritrócitos > 14,4% no diagnóstico apresentaram maior risco de recorrência locorregional [Hazard Ratio = 5,818, intervalo de confiança de 95% (IC 95%) 1,25-26,97; p = 0,024] do que pacientes com a amplitude de distribuição de eritrócitos normal (< 13%). Conclusão: Verificamos que a amplitude de distribuição de eritrócitos pré-tratamento foi um fator prognóstico independente de sobrevida livre de doença em pacientes com câncer de laringe e pode servir como um novo parâmetro, preciso e reprodutível, para identificar pacientes com câncer de laringe em estágio inicial com piores prognósticos.

Uso de Láser diodo de 1470 nm en el tratamiento del carcinoma escamoso de laringe (Tis, T1 y T2) en adultos mayores / 4170 nm diode Laser use in the treatment of laringeal squamous carcinoma (Tis, T1 and T2) in elderly adults / Usando diodo laser 1470 nm, no tratamento do carcinoma de celulas escamosas da laringe (Tis, T1 y T2) em idosos

Introducción: entre las diferentes modalidades terapéuticas para el carcinoma escamoso de laringe en estadios iniciales, la cirugía transoral láser (CTL) constituye el tratamiento de elección. El láser de CO2 es aceptado universalmente como la mejor herramienta terapéutica en este sentido. En situaciones de no poder acceder a esa tecnología, es posible utilizar otros instrumentos para resección en CTL (radiofrecuencia, electrobisturí). Entre estas, nuestro equipo de trabajo ha implementado el uso del láser de diodo de 1470 nm. En el presente trabajo describimos los resultados preliminares en el tratamiento de estadios tempranos del carcinoma escamoso de laringe con CTL. Materiales y métodos: Se utilizó el láser de diodo de 1470 nm en pacientes adultos mayores realizados entre enero de 2012 y diciembre de 2015 en el Servicio de Otorrinolaringología del Hospital Dr. C. Milstein. Resultados: Se trataron 32 pacientes con cáncer de laringe, de los cuales se incluyeron 21, todos mayores de 65 años, con carcinoma escamoso de laringe estadio Tis T1 y T2 sin compromiso cervical ni metastásico y sin tratamiento oncológico previo. De los 21 pacientes incluidos, a 19 se les realizó una única intervención y dos fueron reintervenidos con la misma técnica. Conclusiones: El uso del láser diodo de 1470 nm para el tratamiento del carcinoma escamoso de laringe en estadios iniciales ha permitido controlar la enfermedad en los 21 pacientes intervenidos con esta tecnología, en un tiempo medio de seguimiento de 21 meses. La CTL con láser de diodo se presenta como una opción válida para el tratamiento del cáncer de laringe en estadios iniciales.

Introduction: among the different therapeutic modalities for squamous carcinoma of the larynx in early stages, transoral laser surgery (CTL) is the treatment of choice. Materials and methods: CO2 laser is universally accepted as the best therapeutic tool in this regard. In situations of not being able to access that technology, it is possible to use other CTL resection instruments (radiofrequency, electro-scalpel). Among these, our work team has implemented the use of 1470 nm diode laser. In the present work we describe the preliminary results in the treatment of early stages of squamous carcinoma of the larynx with CTL using 1470 nm diode laser in elderly patients performed between January 2012 and December 2015 at the Otorhinolaryngology Service of Dr. Hospital C. Milstein. Results: Thirty-two patients with laryngeal cancer were treated, including 21, all over 65 years old, with squamous carcinoma of the Tis T1 and T2 larynx without cervical or metastatic involvement and without prior cancer treatment. Of the 21 patients included, 19 were given a single intervention and two were retreated with the same techniqu Conclusions: The use of laser 1470 nm diode for the treatment of squamous carcinoma of the larynx in early stages has allowed the control of the disease in the 21 patients operated with this technology, in an average follow-up time of 21 months. The CTL with diode laser is presented as a valid option for the treatment of laryngeal cancer in initial stages.

Introdução: entre os vários tratamentos para o carcinoma de células escamosas da laringe em modalidades estágios iniciais, laser cirurgia transoral (CTL) é o tratamento de escolha. O laser de CO2 é universalmente aceito como a melhor ferramenta terapêutica a este respeito. Em situações de não ter acesso a essa tecnologia, é possível usar outros instrumentos para CTL ressecção (radiofreqüência, eletrocautério). Materiais e métodos: Entre estes, a nossa equipa implementou o uso de diodo laser 1470 nm. Neste artigo descrevemos os resultados preliminares no tratamento do carcinoma de células escamosas da laringe, com CTL estágios iniciais utilizando o laser de diodo 1470 nm em pacientes idosos realizadas entre Janeiro de 2012 e Dezembro de 2015, Otorrinolaringologia do Hospital Dr. C. Milstein. Resultados: 32 pacientes com câncer de laringe, das quais 21 foram incluídos, todos com mais de 65 anos com carcinoma epidermóide de laringe Tis T1 e T2 sem ou compromisso de cancro cervical metastático e sem tratamento foram tratados. Dos 21 pacientes incluídos, 19 pacientes foram submetidos a uma única intervenção e dois eram reintevenidos com a mesma técnica. Conclusão: O uso de 1.470 nm diodo laser para o tratamento de carcinoma de células escamosas da laringe em estágios iniciais ajudou a controlar a doença em 21 pacientes tratados com esta tecnologia, em um seguimento médio de 21 meses. CTL diodo laser é apresentado como uma opção válida para o tratamento de carcinoma da laringe, em fases iniciais.

Cirugía conservadora de laringe. Experiencia del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández. 2005-2012 / Larynx conservative surgery. Experience of the Teaching Clinical Surgical Hospital Comandante Faustino Pérez Hernández. 2005-2012

La implementación en Cuba de técnicas quirúrgicas para el tratamiento del cáncer laríngeo con conservación del órgano ha ganado adeptos en los últimos años. La morbilidad por esta entidad en la provincia de Matanzas manifestó una incidencia ascendente en la quinta década de la vida, lo que justifica adoptar posiciones que permitan cambiar el curso de los acontecimientos y restaurar la salud, minimizando la mutilación, el sufrimiento y la sensación de amenaza vital. El objetivo de la presente investigación fue evaluar los resultados obtenidos con las técnicas de cirugía conservadora de laringe en el período comprendido de 2005 al 2012. Se realizó un estudio descriptivo de tipo transversal. El universo estuvo constituido por pacientes portadores de cáncer de laringe que cumplieron los criterios de inclusión, exclusión y salida. Treinta y cinco pacientes fueron sometidos a cirugía parcial de laringe. Se apreció un predominio de pacientes con cáncer de laringe del sexo masculino, blancos y con edades comprendidas entre 45 y 60 años. Se reiteró la estrecha relación entre el cáncer de laringe y los hábitos tóxicos. El sitio de más frecuente de localización del tumor fue la glotis. El carcinoma de células escamosas es el diagnóstico histopatológico más representado. La técnica quirúrgica más empleada en nuestro centro y la de mejores resultados oncológicos fue la cordectomía. La evolución postquirúrgica fue favorable en un 74,3 %.

The use of surgical techniques for the larynx cancer treatment with that organ conservation has got adepts in the last years in Cuba. Morbidity caused by this entity in the province of Matanzas showed an increasing incidence in the fifth decade of life. It validates the adoption of positions that allow changing the disease course and restoring health, minimizing mutilation, suffering and the sense of life threatening at the same time. The aim of the current research was assessing the results obtained with the larynx conservative technique in the period from 2005 till 2012. A cross-sectional, descriptive study was carried out. The universe was formed by patients with larynx cancer fulfilling the inclusion, exclusion and exit criteria. Thirty-five patients were object of larynx partial surgery. It was appreciated an increase of male, white patients, aged 45-60 years, with larynx cancer. It was stated again the tight relation between larynx cancer and toxic habits. The most common cancer location was the glottis. The squamous cell carcinoma was the most represented histopathologic diagnosis. Cordectomy was the most used surgical technique in our hospital and the one showing the best oncologic results. The postsurgical evolution was favorable in 74.3 % of the cases.

Evaluación endoscópica de la deglución. Resultados en pacientes con tumores benignos y malignos de laringe y hipofaringe, tratados con cirugía transoral con láser de CO2 / Functional endoscopic evaluation of swallowing. Results inpatients with benign and malignant tumors of the larynx and hypopharynx treated with transoral CO2 laser surgery / A avaliação endoscópica da deglutição. Os resultados em pacientes com tumores benignos e malignos da laringe e hipofaringe tratados com cirurgia transoral laser de CO2

La utilización del LASER de CO2 en laringología comenzó en la década del ‘80, permitiendo la exéresis de tumores por vía transoral. Su indicación se basa en los excelentes resultados oncológicos. La función deglutoria postquirúrgica es un factor importante en la calidad de vida de los pacientes con cáncer del tracto aerodigestivo superior. Los resultados de la deglución son relevantes para elegir la modalidad terapéutica, la cual debe ser no sólo efectiva en controlar el cáncer sino también en preservar la función del órgano. El grado y el tipo de alteración deglutoria deben ser determinados en forma precisa, para establecer el tratamiento postoperatorio adecuado. Esto es posible mediante estudios como la videodeglución y la evaluación endoscópica de la deglución (FEESST)...

The CO2 laser have been used for treatment of laryngeal cancers since 1980, with excellent oncological results. The swallowing plays an important roll in superior aerodigestive cáncer patient. Swallowing results are relevant to choose the therapeutic modality, which must be effective in controlling not only cancer but also in preserving organ function. The degree and type of swallowing impairment must be determined precisely, to establish the appropriate postoperative treatment. This is possible through studies like videodeglucion and endoscopic evaluation of swallowing (FEESST)...

O uso do laser de CO2 laringologia começou nos anos 80, permitindo a excisão tumor transoral. A indicação baseia-se nos excelentes resultados oncológicos. Função de deglutição pós-cirúrgico é uma importante qualidade de vida de pacientes com câncer do fator trato aerodigestivo superior. Engolindo resultados são relevantes para escolher a modalidade terapêutica, que deve ser eficaz no controle não só do câncer, mas também em preservar a função do órgão. O grau e tipo de comprometimento da deglutição deve ser determinada com precisão, para estabelecer o tratamento pós-operatório adequado. Isso é possível através de estudos como videodeglucion e avaliação endoscópica da deglutição (FEESST)...

Utilidad de la videonasofibroscopía en el diagnóstico histológico del cáncer de laringe / Videolaringoscopy utility in histological diagnosis of laryngeal cancer

Introducción: La laringoscopía directa (LD) se considera indispensable en el estudio del cáncer de laringe, tanto para precisar la extensión como para tomar biopsia. Objetivo: Demostrar que el resultado de biopsias tomadas por videonasofibroscopía (VFC) en cáncer de laringe es equivalente al de la biopsia definitiva. Material y método: Revisión de fichas de 53 pacientes del Servicio de Otorrinolaringología HBLT con sospecha de cáncer de laringe con biopsia realizada por VFC y definitiva, durante julio 2007 a diciembre 2011. Resultados: La muestra se compone mayormente por hombres de edad promedio 66 años, con consumo de tabaco en 63% y alcohol en 55,3%. Con correlación positiva entre biopsias para cáncer en 32 pacientes, 8 falsos negativos y 2 falsos positivos. Todas las muestras con cáncer fueron carcinoma escamoso. El 55% moderadamente diferenciado. Los falsos negativos no se encontraban en un estadio en particular. La sensibilidad de biopsia por VFC fue de 0,8 y la especificidad de 0,85. El LR fue de 5,2. Conclusión: Debe incluirse como parte del estudio ambulatorio ante la sospecha, ya que orienta el tratamiento inicial. Permite realizar la LD en el acto del tratamiento quirúrgico, así como evitarla en pacientes sin opción curativa quirúrgica, vía aérea difícil o alto riesgo anestésico.

Introduction: Direct laryngoscopy (DL) is considered essential in the study of the larynx cancer, both to specify local extension and in order to perform a biopsy. Aim: Show that the result of biopsies taken by videolaringoscopy (VL) in larynx cancer is equivalent to the definitive biopsy. Material and methods: Review of 53 patients charts of HBLT Otorhinolaryngology Service with suspected larynx cancer where the biopsy is performed by VL, during July 2007 to December 2011. Results: The patients included, are characterized by being mostly men with an average age of 66 years, with tobacco consumption by 63% and alcohol by 55.3%. There was a congrunence between positive biopsies for cancer in 32 patients, 8 false negatives and 2 false positives. All samples which tested positive for cancer were squamous cell carcinoma, 55% moderately differentiated. The patients that had false-negative results were not in a particular stage. The sensitivity was 0.8 and the specificity 0.85. The LR was 5.2. Conclusion: VL must be included as part of the ambulatory studies orienting the initial treatment when larynx cancer is suspected. VL allows to perform the DL in the act of surgical treatment, and avoid it in patients without surgical curative option, difficult airway or high anesthetic risk.

Role of Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Preoperative Staging of Early Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) has been widely used to detect regional and distant metastasis or second primary cancers at initial evaluation. The aim of this study was to evaluate the role of combined FDG-PET/CT in detecting early glottic cancers, which has low incidence of regional or distant metastasis. SUBJECTS AND METHOD: We enrolled in our study 551 patients who had previously untreated glottic cancer between 2001 and 2008. Of these, 124 patients with early glottic cancer underwent FDG-PET/CT. Retrospectively, we compared the detection rates of regional, distant metastasis or second primary cancer by FDG-PET/CT with those after neck computed tomography (CT), chest X-ray, and liver sonography. RESULTS: In detecting regional metastasis, the sensitivity and specificity of FDG-PET/CT were 66.67% and 97.25%, respectively, with the positive predictive value (PPV) of 40%, the negative predictive value (NPV) of 99.16%, and the accuracy of 96.77%. The sensitivity, specificity, PPV, NPV and accuracy of neck CT were 66.67%, 96.69%, 33.33%, 99.15%, and 95.96%, respectively. The suspicious distant metastasis (n=1) and second primary cancers (n=7) were observed in FDG-PET/CT. The true second primary cancers occurred at the colon (n=1) and the prostate (n=2). The other cases were proved to be false positive. Distant metastasis and second primary cancers were not detected by the conventional work-up tests. CONCLUSION: The regional metastasis detection rate of FDG-PET/CT was similar to those of the conventional work-up tests. However, compared to the conventional tests, FDG-PET/CT is useful for detecting distant metastasis or second primary cancers in patients with early glottic cancer.

Detección precoz del cáncer de laringe en Cuba / Early detection of laryngeal cancer in Cuba

La laringe constituye un órgano anatómicamente complejo. Glotis, supraglotis y subglotis son, en orden de importancia relativa, los sitios más frecuentes de asentamiento de tumores, los cuales se distinguen clínicamente por el modo en que afectan las principales funciones de la laringe: fonación y deglución. Describir la frecuencia, características sociodemográficas y tumorales correspondientes a los casos incidentes de cáncer de laringe en Cuba según subsitio anatómico dentro de la laringe. Se realizó un estudio descriptivo a partir de los casos nuevos de cáncer de laringe reportados al Registro Nacional de Cáncer durante el período 1988-2003. Se analizó información sociodemográfica de los casos y otras variables relacionadas con el diagnóstico y la enfermedad tumoral. Se utilizó la prueba Chi-cuadrado de independencia para determinar asociación entre las variables en estudio con un nivel de significación de 0,05. El cáncer de laringe ocupa una de las primeras causas de incidencia y mortalidad por cáncer en Cuba, fundamentalmente en hombres entre 50-74 años de edad. Mientras que el cáncer de subglotis es poco frecuente, el cáncer de glotis es hasta tres veces más frecuente que el de supraglotis. El cáncer de glotis da síntomas tempranamente pudiendo ser detectado mediante un examen relativamente sencillo. Considerando las características del sistema nacional de salud cubano, este hecho puede abrir una expectativa al diagnóstico temprano, por lo que es recomendable evaluar la factibilidad y eficacia del examen otorrinolaringológico -como parte del examen periódico anual- fundamentalmente en hombres de 50 años y más, con historia de tabaquismo o alcoholismo, con el fin de detectar y tratar tempranamente la enfermedad.

Larynx is an anatomically complex organ. Glottis, supraglottis and subglottis are, in order of relative importance, the most frequent tumor locations, which are clinically characterized by the way they affect the main functions of the larynx: phonation and deglutition. Objectives the present paper describes the frequency, socio-demographic and tumorous characteristics of laryngeal cancer cases in Cuba. A descriptive study was conducted, taking the new laryngeal cancer cases reported to the National Register of Cancer from 1988 to 2003 as a basis. Social and demographic information of cases and other variables related to diagnosis and to the tumorous disease were analyzed. Chi-square test of independence determined the association of variables under study, with significance level equal to0,05. Laryngeal cancer is one of the first causes of incidence and mortality due to cancer in Cuba, mainly in males aged 50-74 years. Although subglottis cancer is rare, glottis cancer is up to three times as frequent as that of supraglottis. Glottis cancer shows early symptoms, so it can be detected on a relatively simple examination. Considering the Cuban health system characteristics, this event could open up possibilities for early detection, therefore, it would be advisable to evaluate the feasibility and efficacy of the otorhinolaryngology test -as part of the annual systematic examination -mainly in men aged 50 years and more, with history of smoking/alcoholism, in order to detect and treat the disease early.

The CT Evaluation of Neoarytenoid Soft Tissue after an Arytenoidectomy during a Supracricoid Partial Laryngectomy

OBJECTIVE: To evaluate the postoperative laryngeal CT findings of neoarytenoid soft tissue at an arytenoidectomy site during a supracricoid partial laryngectomy, and to compare its thickness to the mucosa over the spared arytenoid cartilage. MATERIALS AND METHODS: Thirty-one patients underwent a supracricoid partial laryngectomy with (n = 14) or without (n = 17) an arytenoidectomy. A postoperative laryngeal CT examination was performed to statistically compare the thickness of the neoarytenoid soft tissue to the mucosa over the spared arytenoids. RESULTS: The neoarytenoid soft tissue revealed an eccentric prominence in all 14 arytenoidectomy sites. Further, the neoarytenoid soft tissue was consistently thicker than the mucosa over spared arytenoids cartilage (p < 0.01), however did not exceed 11 mm. CONCLUSION: The eccentric prominence of neoarytenoid soft tissue at the arytenoidectomy site during a supracricoid partial laryngectomy should be identified and distinguished from a recurrent mass when compared to spared arytenoid cartilage on a postoperative laryngeal CT.

DNA Gains and Losses of Chromosome in Laryngeal Squamous Cell Carcinoma Using Comparative Genomic Hybridization

PURPOSE: A larynx squamous cell carcinoma (LSCC) is one of the most common forms of cancer and may exhibit various complex karyotypes. MATERIALS AND METHODS: We used comparative genomic hybridization (CGH) to analyze DNA gains and losses in 15 squamous cell carcinomas that consisted of 4 glottic, 10 supraglottic, and 1 transglottic localization samples. RESULTS: The majority of the chromosomal alterations detected were gains: 3 samples of LSCCs revealed high level amplification, while 6 samples displayed gains in various chromosomal regions (17p, 3p, 4p, 5p, 6q, 8p, 9p, 14q, 18p and Xq). One sample was found to have losses (chromosomes 15q and 22q) and 5 had normal CGH profiles. CONCLUSION: Many of these gained regions (4p, 5p, 8p, 10q, 18q and Xq) were novel sites, which may harbor oncogene(s) that potentially play an important role in squamous cell tumorigenesis and progression at supraglottic localizations.

Salvage Surgery for Radiation Failures in Early(T1N0, T2N0) Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was undertaken to analyze the complications, recurrences, functional results and survival in patients undergoing salvage surgery for recurrent glottic cancers after previous radiotherapy. SUBJECTS AND METHOD: Records of twenty-seven patients were retrospectively reviewed. There were 26 men and 1 woman with the median age of 63 years. The stage at initial treatment was T1a in 16 patients, T1b in 5 patients and T2 in 6 patients. Fifteen patients underwent total laryngectomy, and 12 patients had partial laryngectomy. Neck dissection was combined for 2 patients who had recurred neck metastasis and for 3 patients electively. All patients have been followed up for at least 1 year or until their death (6-159 months, median 31 months). RESULTS: Overall voice preservation was achieved in 29.6% of the patients. The 5-year overall survival and disease-specific survival rates were 75.0% and 81.2%, respectively. Early and late complications, duration of hospital stay, local recurrences, neck recurrences and disease-specific survival were not significantly different between partial and total laryngectomy. Duration of tube feeding was shorter in partial laryngectomy (p=0.016). Neck recurrence was the most common cause of death, and it occurred in patients with recurred tumor that was locally advanced or re-recurrent after salvage surgery. CONCLUSION: In selected cases, recurrences after failure to radiotherapy in T1-T2 glottic cancer could be salvaged with partial laryngectomy with adequate tumor control and acceptable morbidity. Elective neck dissection is recommended in locally advanced recurrent or re-recurrent glottic cancer.

Clinical Outcome of Supraglottic Laryngectomy in Supraglottic Cancer : Open vs Transoral Laser Supraglottic Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: When treating the supraglottic cancer, we must consider functions such as respiration, phonation, swallowing, aspiration as well as the complete eradication of the disease. Open supraglottic laryngectomy is an oncologically safe procedure that can preserve the laryngeal function. However, in immediate perioperative time, supraglottic laryngectomy requires tracheostomy and L-tube insertion. On the other hand, transoral laser supraglottic laryngectomy, while it is debated whether or not it is oncologically safe, it doesn't require tracheostomy and L-tube insertion. We compared and analyzed the outcomes and morbidity of both treatments. SUBJECTS AND METHOD: Patients who have been diagnosed as supraglottic cancer between January 1995 through December 2004 and who were treated with either open supraglottic laryngectomy or transoral laser supraglottic laryngectomy for the primary treatment were included in the study. We analyzed the overall survival and treatment results through retrospective chart review and the statistical analysis was carried out by the SPSS 10.0. RESULTS: Five-year overall survival rate was 88.5% in open surgery and 78.2% in transoral surgery. But the p-value of 0.216 indicates that there is no statistically significant differences among two groups. Five-year disease free survival rates were 83.4% in open surgery and 68.0% in transoral surgery. The p-value of 0.221 again indicates that there is no statistically significant differences among two groups. Tracheostomy and L-tube insertion were conducted in all of the patients in open surgery but conducted in 20% and 6.7% of the patients, respectively, in transoral surgery. CONCLUSION: There are no differences between the 5-year overall survival rate and 5-year disease free survival rate between the two groups. However, morbidity is lower in the transoral group, so it would be preferable to conduct transoral laser supraglottic laryngectomy in supraglottic cancer patients in the future. Further studies using more cases are recommended.

Investigation of Study Items for the Patterns of Care Study in the Radiotherapy of Laryngeal Cancer: Preliminary Results / 대한방사선종양학회지

PURPOSE: In order to develop the national guide-lines for the standardization of radiotherapy we are planning to establish a web-based, on-line data-base system for laryngeal cancer. As a first step this study was performed to accumulate the basic clinical information of laryngeal cancer and to determine the items needed for the data-base system. MATERIALS AND METHODS: We analyzed the clinical data of patients who were treated under the diagnosis of laryngeal cancer from January 1998 through December 1999 in the South-west area of Korea. Eligibility criteria of the patients are as follows: 18 years or older, currently diagnosed with primary epithelial carcinoma of larynx, and no history of previous treatments for another cancers and the other laryngeal diseases. The items were developed and filled out by radiation oncologist who are members of Korean Southwest Radiation Oncology Group. SPSS v10.0 software was used for statistical analysis. RESULTS: Data of forty-five patients were collected. Age distribution of patients ranged from 28 to 88 years (median, 61). Laryngeal cancer occurred predominantly in males (10:1 sex ratio). Twenty-eight patients (62%) had primary cancers in the glottis and 17 (38%) in the supraglottis. Most of them were diagnosed pathologically as squamous cell carcinoma (44/45, 98%). Twenty-four of 28 glottic cancer patients (86%) had AJCC (American Joint Committee on Cancer) stage I/II, but 50% (8/16) had in supraglottic cancer patients (p=0.02). Most patients (89%) had the symptom of hoarseness. Indirect laryngoscopy was done in all patients and direct laryngoscopy was performed in 43 (98%) patients. Twenty-one of 28 (75%) glottic cancer cases and 6 of 17 (35%) supraglottic cancer cases were treated with radiation alone, respectively. The combined treatment of surgery and radiation was used in 5 (18%) glottic and 8 (47%) supraglottic patients. Chemotherapy and radiation was used in 2 (7%) glottic and 3 (18%) supraglottic patients. There was no statistically significant difference in the use of combined modality treatments between glottic and supraglottic cancers (p=0.20). In all patients, 6 MV X-ray was used with conventional fractionation. The fraction size was 2 Gy in 80% of glottic cancer patients compared with 1.8 Gy in 59% of the patients with supraglottic cancers. The mean total dose delivered to primary lesions were 65.98 Gy and 70.15 Gy in glottic and supraglottic patients treated, respectively, with radiation alone. Based on the collected data, 12 modules with 90 items were developed for the study of the patterns of care in laryngeal cancer. CONCLUSION: The study items for laryngeal cancer were developed. In the near future, a web system will be established based on the items investigated, and then a nation-wide analysis on laryngeal cancer will be processed for the standardization and optimization of radiotherapy.

Occult Neck Metastasis in Larynx and Hypopharynx Squamous Cell Carcinomas Confirmed with Simultaneous Bilateral Elective Neck Dissection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Neck metastasis is one of the most important prognostic factor in treating head and neck squamous cell carcinomas. Recently, elective neck dissection has been widely accepted for accurate pathologic staging and elective treatment of neck. Occult metastasis rate of laryngeal and hypopharyngeal cancer varies widely depending upon authors. However, occult metastasis rate confirmed with simultaneous bilateral elective dissection is rare. MATERIALS AND METHODS: Fifty patients (100 necks) who underwent surgery for laryngeal and hypopharyngeal squamous cell carcinomas as an initial treatment from 1992 to 1997 were evaluated. All had bilateral elective neck dissection at the time of surgery for the primary treatment. Charts and pathologic reports were reviewed. RESULT: Occult neck metastasis rate by primary site were as follows. Supraglottis ipsilateral 40% (8/20) contralateral 15% (3/20), glottis ipsilateral 18% (4/22), contralateral 0% (0/22), hypopharynx ipsilateral 88% (7/8), contralateral 25% (2/8). CONCLUSION: Supraglottic and hypopharyngeal cancer may need elective neck treatment bilaterally. Contralateral neck occult metastasis from glottic cancer was minimal.