Supervivencia de cirugía de rescate en carcinoma escamoso de orofaringe / Survival outcomes of salvage surgery in oropharyngeal squamous cell carcinoma

La recurrencia de carcinoma de células escamosas orofaríngeo (CCEOF) se asocia a mal pronóstico, particularmente en recurrencias en etapa avanzada. La cirugía en el contexto de rescate es más complicada por el tratamiento oncológico del tumor primario, por lo tanto, tiene un mayor riesgo de complicaciones y estadía hospitalaria. Sin embargo, la cirugía de rescate es la mejor oportunidad del paciente como tratamiento curativo y para supervivencia a largo plazo. La población de pacientes que reciben tratamiento para CCEOF ha cambiado en la última década, se ha reconocido que la incidencia de virus papiloma humano (VPH) asociado a CCEOF ha generado el gran aumento de CCEOF y el cambio asociado en las características de la población de pacientes, ahora los pacientes son más jóvenes y tienen menos comorbilidades. Con el aumento exponencial en la incidencia de CCEOF, la necesidad de cirugía de rescate en CCEOF podría verse en aumento. En vista del aumento de la incidencia de casos con carcinoma escamoso de orofaringe y su importante relación con el VPH, esta revisión se enfoca en la supervivencia tras cirugía de rescate con intención curativa y evaluar si con los avances en su tratamiento ha mejorado su pronóstico.

Recurrence of oropharyngeal squamous cell carcinoma (OPSCC) is associated with poor prognosis, particularly in advanced stage recurrences. Salvage surgery is complicated by previous oncological treatment of the primary tumor, therefore, it has a higher risk of complications and hospital stay. However, salvage surgery is the patient's best opportunity as a curative treatment and for long-term survival. The population of patients receiving treatment for OPSCC has changed in the last decade, it has been recognized that the incidence of human papilloma virus (HPV) associated OPSCC has generated an increase of OPSCC and changes in the epidemiology of the patient population, with younger patients and with less comorbidities. With the exponential increase in the incidence of OPSCC, the need for salvage surgery in OPSCC could increase in the future. In view of the increase in the incidence of cases with squamous oropharyngeal carcinoma and its relationship with HPV, this review focuses on survival after salvage surgery with curative intent and assessing whether the progress in its treatment has improved its prognosis.

Incidence and mortality of larynx cancer in China during 2003-2007 / 中华流行病学杂志

Objective To analyze the patterns of incidence and mortality on larynx cancer in China.Methods Data from 32 Cancer Registries in China were examined,sorted,and analyzed by the National Cancer Registry,to obtain the crude,Chinese national and world age- standardized rates (ASR) of incidence and mortality and their trends.Results The crude incidence and mortality rates of larynx cancer wcrc 2.04/105 and 1.06/105 in China during 2003-2007.The rates were higher in males than those in females,and also higher in urban areas than those in rural areas.The highest Chinese ASRs of incidence and mortality of larynx cancer in 32 cancer registries in China were 2.08/105 in Zhongshan city,Guangdong province,and 1.58/105 in She county,Hebei province respectively.The trend of incidence and mortality of larynx cancer was stable from 2003 to 2007.Conclusion Although both the incidence and mortality of larynx cancer in China were still in low level,comprehensive measures should be carried out to prevent the increase on both the incidence and mortality of larynx cancer.

Virtual Endoscopy Using Spiral CT in Patients with Carcinomas of the Hypopharynx and Larynx

PURPOSE: To compare the usefulness of virtual endoscopy using spiral CT with that of laryngoscopy in the detection and evaluation of laryngeal and pharyngeal carcinomas. MATERIALS AND METHODS: Twenty-four patients with pathologically proven laryngeal and pharyngeal carcinomas underwent laryngoscopy and virtual endoscopy using spiral CT. Eleven of the carcinomas were supraglottic, five were glottic, and eight were hypopharyngeal. Source images obtained by spiral CT were transmitted to an independent workstation and virtual endoscopic images were obtained using Navigator software. These were graded according to their quality (good, fair, bad), and were interpreted by two radiologists who were blinded to the conventional endoscopic findings. These latter were subsequently compared with the virtual endoscopic findings in terms of similarity to laryngoscopic examination and detectability of lesions. RESULTS: The overall image quality of virtual endoscopy was good in 16 cases (67%), fair in eight (33%), and bad in no case. Among the 11 supraglottic carcinomas, image quality was good in seven cases (64%), and fair in four (36%). In four of the five glottic carcinomas (80%) quality was good, and in one case (20%) it was fair, while among the eight hypopharyngeal carcinomas, quality was good in five cases (63%), and fair in three (37%). Overall, detection of the lesion was possible in 23 cases (96%). Due to the small size of the lesion, the CONCLUSION: Virtual endoscopy using spiral CT is a safe and noninvasive method, and also successfully detects laryngeal and pharygenal lesions, with good image quality. For the evaluation of laryngeal and hypopharyngeal carcinoma, its use may complement that of axial CT.

Laryngeal Schwannoma: A Case Report

Laryngeal schwannoma is extremely rare. We report the CT and MRI findings of a case occurring in a 65-year-oldwoman, and describe the pathologic correlation. Pre-contrast CT scanning revealed a right supraglot-tic mass witha slightly hyperdense central part and a hypodense peripheral part. Post-contrast CT scanning re-vealed anenhanced hyperdense central part and a rim-like hypodense peripheral part. The density of the pe-ripheral part waslower than that of muscle. The mass showed homogeneous low signal intensity on T1-weighted MR images, homogeneoushigh signal intensity on T2-weighted MR images, and an enhanced high signal intensity central part and a lowsignal intensity peripheral part on gadolinium enhanced T1-weighted images. The enhanced central part correlatedwith Antoni A areas and the peripheral part, showing low attenuation, correlated with Antoni B areas.

Dynamic Study of the Larynx with Spiral CT in the Tumors of the Pyriform Sinus and Supraglottis

PURPOSE: To evaluate the CT findings of tumor in the pyriform sinus, and to assess by functional study of thelarynx the extent the extent to which its characteristic findings differ from those of supraglottic tumor. MATERIALS AND METHODS: CT scans of 14 patients with tumor in the pyriform sinus were reviewed and compared withthose of 17 patients with supraglottic tumor. In all cases, spiral CT scanning linvolved both quiet breathing andmodified breath holding; we evaluated the images and analysed the primary site of tumors and the displacement ofair in the pyriform sinus. Extra and intralaryngeal extension of the tumors was also assessed. RESULTS: In tumorsin the pyriform sinus, CT findings were thickening of more than two walls in 14, the displacement of air in 9,extralaryngeal extension in 13, extension to the post-cricoid space in 11, invasion of the pre-epiglottic space in13, and widening of the cricothyroid space in 8 patients. In supraglottic tumors, CT findings were thickening ofthe medial wall in 17, extralaryngeal extension in 1, extension to the post-cricoid space in 1, invasion of theipsilateral paralaryngeal space in 17, and of the contralateral paralaryngeal space in 6, invasion of thepre-epiglottic space in 11, and widening of the cricothyroid space in 9 patienhts. In this type of tumor thedisplacement of air was not seen. CONCLUSION: The characteristic CT findings of tumor in the pyriform sinus werethickening of more than two walls of the pyriform sinus and the anterior or medial displacement of air. To assessthe site at which a tumor originates, spiral CT scanning is needed, together with functional study.

CT Grading of Laryngeal Cancer According to the Degree of its Extension: Emphasis on T2 and T3 Tumors

PURPOSE: To analyze the degree of tumor extension in T2 and T3 laryngeal cancer, independently of vocal cord fixation, and to introduce a new CT grading system for use in preoperative T-stage assessment. MATERIALS AND METHODS: Retrospective analysis of degree of tumor extension was performed in 36 patients with laryngeal cancer (T2 glottic, 4 ; T2 supraglottic, 12 ; T3 glottic, 12 ; and T3 supraglottic, 8). T-stage was determined according to clinical and pathologic findings, and based on the TNM classification of AJCC (1992). The degree of tumor extension seen on CT was determined by the number of involved anatomic subsites and compared with T-stage and lymph node metastasis. On the basis of statistical analysis(Fisher's exact test) of those results, we suggest new CT grading system for laryngeal cancer. RESULTS: Fifteen of 20 supraglottic cancer patients showed six or less involved anatomic subsites ; twelve of these 15 (80%) were at stage T2 and three (20%) were T3. Four of the 15 showed lymph node metastasis. The five patients whose number of involved anatomic subsites was seven or more were all T3 ; four (80%) of these showed lymph node metastasis. The difference in the number of involved anatomic subsites in T2 and T3 tumor was statistically significantly different (p<0.05) ; the incidence of LN metastasis was more prevalent in the group with seven or more involved subsites. In glottic cancer, however, no statistically significant difference was observed between T2 and T3 tumors in the number of involved subsites. CONCLUSION: In supraglottic cancer, T1 and T4 stages are determined by degree of tumor extension, irrespective of vocal cord mobility ; T2 and T3 stages are suggested by the number of involved anatomic subsites, without reference to vocal cord mobility. A new CT grading system may thus be made, based on degree of tumor extension. In glottic cancer, however, laryngoscopy or dynamic study with spiral CT are needed for T-stage assessment.

Primary Malignant Lymphoma of Larynx: A Case Report

Primary malignant laryngeal lymphoma is rare. In this case, diffuse wall thickening of the vocal cord and infraglottic larynx was seen on initial CT scan. After chemotherapy, follow-up CT neck scans showed a marked decrease of diffuse wall thickening of the vocal cord and infraglottic larynx ; diffuse laryngeal wall thickening is, however, a nonspecific finding which can be seen in other disease processes. If clinical evidence of infection and inflammation or remarkable change after antibiotics treatment is not definite, biopsy should be performed to rule out laryngeal lymphoma.

CT Evaluation of the Neck after Total Laryngectomy

PURPOSE: The purpose of this study was to determine normal CT appearance of the neck after total laryngectomy and to evaluate the role of CT in accessing recurrent neoplasm. MATERIALS AND METHODS: In 65 patients who had undergone total laryngectomy, CT findings relating to shape of the neopharynx and alterations of normal anatomic structures were retrospectively reviewed. Fifty-five patients had also undergone neck dissection, and 47 patients had had adjuvant radiation therapy. RESULTS: In 27 patients, a normal neopharynx with a round or ovoid structure connecting the base of the tongue with the cervical esophagus had even wall thickness and iso- or slight hyperdensity to muscle. Fourteen of 32 patients with recurrent neoplasm showed an ill-defined, peripherally enhancing hypodense mass. Twenty-three patients developed metastatic lymphadenopathy and five patients developed coincidental local recurrent mass and lymphadenopathy. Hypodense masses mimicking recurrence were found in six patients and two cases revealed granulation tissues in the oropharynx(n = 2) and abscesses(n = 2). Another four patients were considered to be cases of immediate postoperative fluid collection or lymphocele. CONCLUSION: Aknowledge of normal CT findings of the neck after total laryngectomy is useful in the evaluation of recurrent laryngeal carcinoma.

Fixed Vocal Cord in Laryngeal Cancers: Mechanisms and Spiral CT Findings

PURPOSE: To analyze the causes of vocal cord fixation in laryngeal cancer and to demonstrate its spiral CT findings. MATERIALS AND METHODS: We retrospectively applied the five pathologic mechanisms of vocal cord fixationto spiral CT findings and evaluated mechanisms of fixed vocal cord in 16 patients with laryngeal cancer of T3 or more on staging. CT findings of another six patients (T2) showing one or more suspicious mechanisms of vocal cord fixation in conventional CT were compared with those of the 16 patients (T3 or more). RESULTS: In 16 patients with laryngeal cancer of T3 or more, the most common finding of vocal cord fixation was the complete replacement of the true vocal cord (including the thyroarytenoid and vocalis muscle) by the tumor and tumor invasion of the paralaryngeal space (n = 16). Other findings were tumor invasion and fixation of the cricoarytenoid joint (n = 9), interference with cord mobility by the bulky mass (n = 6), tumor invasion of the thyroid cartilage, with vocalcord fixation (n = 4) and subglottic tumor spread (n = 3). In another six patients (T2) with suspicious vocal cordfixation, conventional CT showed partial vocal cord invasion and intact or minimal invasion of the paralaryngeal space (n = 3), a bulky mass without vocal cord invasion (n = 1) and subglottic extension but movable vocal cord (n= 2). CONCLUSION: Although the cause of vocal cord fixation from laryngeal cancer may be due to one of five patterns of cancer spread, or to a combination of these, the most common spiral CT finding is complete replacement of true vocal cord by the cancer and tumor invasion of the paralaryngeal space. Accurate evaluation of vocal cord fixation and the extent of the tumor could be evaluated with spiral CT using the breathing technique.

CT Findings of Laryngeal Tuberculosis: Comparison with Laryngeal Carcinoma

PURPOSE: To determine the value of CT(Computerized Tomography) in the diagnosis of laryngeal tuberculosis and to assess to what extent its characteristic findings different from those of aryngeal carcinoma. Materials and Methods : CT scans of twelve patients with laryngeal tuberculosis were reviewed and compared with those of fifteen patients with laryngeal cancer, retrospectively. Clinical symptoms, laryngoscopic examinations and the presence of pulmonary tuberculosis on chest radiographs were also reviewed. RESULTS: In laryngeal tuberculosis, bilater alsymmetric or asymmetric involvement was noted in nine(75%) patients, while unilateral involvement was seen in three(25%). This was significantly different from laryngeal cancer in which unilateral involvement was noted in twelve patients(80%). Diffuse thickening of the free margin of the epiglottis was a characteristic and frquent finding in tuberculosis(n=6, 50%). No deep submucosal infiltration of preepiglottic and paralaryngeal fat spacesis seen in tuberculosis in spite of large areas of involvement of laryngeal mucosa, while twelve patients(80%) with laryngeal cancer showed thickened deep infiltration which resulted in a submucosal mass. CONCLUSION: CT was useful in the diagnosis of laryngeal tuberculosis and its CT findings wee characterized by bilateral involvement, thickening of the free margin of the epiglottis and good preservation of preepiglottic and paralaryngeal fatspaces in spite of large areas of involvement.