Preliminary Study on the Effect of Supraglottic Laryngeal Carcinoma and Hypopharyngeal Carcinoma on Swallowing Function / 听力学及言语疾病杂志

Objective To explore the effects of supraglottic laryngeal carcinoma and hypopharyngeal carcino-ma on swallowing functions .Methods The data of 32 patients with supraglottic laryngeal carcinoma (laryngeal car-cinoma group) ,20 patients with hypopharyngeal carcinoma (hypopharyngeal carcinoma group) and 81 cases of nor-mal persons of the same age (50～79) as a control (normal control group) who were diagnosed and treated in our department from 2015 December to 2017 February were evaluated by repeated saliva swallowing test ,watian drink-ing water test ,and endoscopic examination of swallowing .Results In the laryngeal carcinoma group ,we found swallowing dysfunctions in 17 cases(53 .13％ ,17/32) .In the hypopharyngeal carcinoma group ,we found swallo-wing dysfunctions in 15 cases(75 .00％ ,15/20) .For 81 cases of normal persons (normal control group) ,there were swallowing dysfunctions in 11 cases(13 .58％ ,11/81) .The statistical analysis of the laryngeal carcinoma and hypo-pharyngeal carcinoma groups with abnormal swallowing functions were significantly higher than the normal control group (P<0 .001) .In the laryngeal carcinoma group ,according to the anatomic site ,the tumors were divided into two groups :from 21 cases of epiglottis and fringe group ,we found swallowing dysfunctions in 14 cases (66 .67％ , 14/21);out of 11 cases of ventricular bands + laryngeal ventricle group , swallowing dysfunctions in 3 cases(27 .27％ ,3/11) .The differences between the two groups were significant (P<0 .05) .In the hypopharyngeal carci-noma group ,out of 14 cases of pyriform sinus ,swallowing dysfunctions were in 10 cases(71 .43％ ,10/14);out of 6 cases of posterior hypopharyngeal wall carcinoma ,swallowing dysfunctions in 5 cases(83 .33％ ,5/6) .The differ-ences between the two groups were insignificant (P>0 .05) .Conclusion Supraglottic laryngeal carcinoma and hypo-pharyngeal carcinoma all have effects on swallowing functions and increase the incidence of dysphagia .In the supra-glottic laryngeal carcinoma ,the primary tumor location has influence on the swallowing functions .

Radiotherapy in Supraglottic Carcinoma: With Respect to Locoregional Control and Survival / 대한방사선종양학회지

PURPOSE: A retrospective study was undertaken to determine the role of conventional radiotherapy with or without surgery for treating a supraglottic carcinoma in terms of the local control and survival. MATERIALS AND METHODS: From Jan. 1986 to Oct. 1996, a total of 134 patients were treated for a supraglottic carcinoma by radiotherapy with or without surgery. Of them, 117 patients who had completed the radiotherapy formed the base of this study. The patients were redistributed according to the revised AJCC staging system (1997). The number of patients of stage I, II, III, IVA, IVB were 6 (5%), 16 (14%), 53 (45 %), 32 (27%), 10 (9%), respectively. Eighty patients were treated by radical radiotherapy in the range of 61.2~79.2 Gy (mean : 69.2 Gy) to the primary tumor and 45.0~93.6 Gy (mean : 54.0 Gy) to regional lymphatics. All patients with stage I and IVB were treated by radiotherapy alone. Thirty-seven patients underwent surgery plus postoperative radiotherapy in the range of 45.0~68.4 Gy (mean : 56.1 Gy) to the primary tumor bed and 45.0~59.4 Gy (mean : 47.2 Gy) to the regional lymphatics. Of them, 33 patients received a total laryngectomy (+-lymph node dissection), three had a supraglottic horizontal laryngectomy (+-lymph node dissection), and one had a primary excision alone. RESULTS: The 5-year survival rate (5YSR) of all patients was 43%. The 5YSRs of the patients with stage I+I, III+V were 49.9%, 41.2%, respectively (p=0.27). However, the disease-specific survival rate of the patients with stage I (n=6) was 100%. The 5YSRs of patients who underwent surgery plus radiotherapy (S+T) vs radiotherapy alone (RT) in stage II, III, IVA were 100% vs 43% (p=0.17), 62% vs 52% (p=0.32), 58% vs 6% (P<0.001), respectively. The 5-year actuarial locoregional control rate (5YLCR) of all the patients was 57%. The 5YLCR of the patients with stage I, II, III, IVA, IVB was 100%, 74%, 60%, 44%, 30%, respectively (p=0.008). The 5YLCR of the patients with S+T vs RT in stage II, III, IVA was 100% vs 68% (p=0.29), 67% vs 55% (p=0.23), 81% vs 20% (P<0.001), respectively. In the radiotherapy alone group, the 5YLCR of the patients with a complete, partial, and minimal response were 76%, 20%, 0%, respectively (P<0.001). In all patients, multivariate analysis showed that the N-stage, surgery or not, and age were significant factors affecting the survival rate and that the N-stage, surgery or not, and the ECOG performance index were significant factors affecting the locoregional control. In the radiotherapy alone group, multivariate analysis showed that the radiation response and N-stage were significant factors affecting the overall survival rate as well as locoregional control. CONCLUSION: In early stage supraglottic carcinoma, conventional radiotherapy alone is an equally effective modality compared to surgery plus radiotherapy and could preserve the laryngeal function. However, in the advanced stages, radiotherapy combined with concurrent chemotherapy for laryngeal preservation or surgery should be considered. In bulky neck disease, all the possible planned neck dissections after induction chemotherapy or before radiotherapy should be attempted.

Frequency and Patterns of nodal metastasis in supraglottic squamous cell carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Supraglottic larynx is a well-known primary site of the head and neck cancer with frequent nodal metastasis, but pathologically confirmed data is lacking in our country. PATIENTS AND METHODS: Pathologic reports of supraglottic squamous cell carcinoma were reviewed using the records of 73 patients who underwent surgery as an initial treatment at Severance Hospital between April 1992 and December 1999. Fifty-three patients had simultaneous bilateral neck dissection, while 13 had unilateral neck dissection. The average number of nodes investigated was 46.5 +/- 14.0 for the comprehensive neck dissection specimen and 29.4 +/- 10.9 for he lateral neck dissection. RESULTS: Seventy-one percent of the patients had patholigically proven nodal metastasis at the time of diagnosis. Ninty-percent (47/52) of patients with pathologically proven metastasis had multiple lymph node metastasis. Nodal metastasis rate according to T stages was as follows ; T1 57.1% (4/7), T2 72.0% (18/25), T3 76.0% (19/25), T4 68.8% (11/16) respectively. Metastasis rate according to subsite was as follows ; 79.3% for epiglottis, 56.5% for false cord, 76.2% for aryepiglottic fold respectively. Ipsilateral and contralateral occult metastasis rate were 28.6% (8/28) and 14.3% (4/28), respectively. The percentage of contralateral occult metastasis for clinically ipsilateral node positive patient was 27.8% (10/36). 40.4% (19/47) of the patients with tumor which involved the midline had contralateral metastasis while 11.5% (3/26) for the patients with tumor were confined to one side. CONCLUSION: Patients with supraglottic squamous cell carcinoma need aggressive treatment of neck, because nodal metastasis is very frequent at the time of diagnosis. Elective treatment of contralateral neck may be needed for ipsilateral node positive patients. Patients who were clinically proven NO also need to take elective treatments at least for the ipsilateral side.

Management of 33 cases with supraglottic carcinomas stage T3 / 中国癌症杂志

Purpose:To investigate the curative effect of T3 lesions of supraglottic carcinoma in our hospital and discuss the management of T3 lesions.Methods:33 cases of T3 supraglottic carcinoma hospitalized in Cancer Center of Sun Yat sen University of Medical Sciences from 1982 to 1991 were reviewed. All primary lesions were resected by surgery, including 27 total laryngectomy and 6 horizontal supraglottic laryngectomy. The treatment modality of the neck was as follows: Among 13 clinically positive neck 2 underwent radical neck dissection, 11 underwent selective neck dissection. Among 20 clinically N0 cases 1 underwent elective neck dissection and the rest watchful waiting. In this group 19 cases were treated by definitive surgery, the rest 14 cases managed by surgery plus radiotherapy.Results:The 5 year survival rate in our group was 63.6%(21/33), the 5 year tumor free survival rate was 57.6%(19/33) and the 5 year cumulative survival rate by Kaplan Meier was 63.9%. The 5 year survival rate in partial laryngectomy and total laryngectomy was 80% and 59.9% respectively, no significant difference was shown by Kaplan Meier analysis(Log Rank=0.82, P =0.3646). The 5 year survival rate in definitive surgery and surgery plus radiotherapy was 56.4% and 67.3% respectively. There was also no significant difference by Kaplan Meier analysis (Log Rank=0.61, P =0.4341). 5 cases presented primary relapse and 12 cases neck relapse in our group. The primary and neck control rate was 84.8%(28/33)and 63.6%(21/33)respectively.Conclusions:For T3 subtypes with pre epiglottic space or tongue base infiltration, horizontal supraglottic laryngectomy could abtain better result. One should be careful when applying partial laryngectomy in T3 with cord fixation. Although surgery plus radiotherapy could not significantly influence survival, it could have a tendency to get higher 5 year survival rate than definitive surgery. Radiotherapy and chmotherapy need to be study further.