Plasmocitoma extramedular de laringe: a propósito de un caso / Extramedullary plasmacytoma of the larynx: a case report

Resumen Los plasmocitomas solitarios son una rara forma de presentación de neoplasias de células plasmáticas. Deben ser diferenciados del mieloma múltiple en el momento del diagnóstico y realizar un seguimiento estricto por el riesgo de transformación a mieloma. La localización de los mismos en la laringe es muy inusual, dado que sólo se han publicado 56 casos. Se presenta el caso de una paciente con un plasmocitoma extramedular de laringe que se trató mediante cirugía y radioterapia. Se revisan los criterios diagnósticos y los problemas terapéuticos.

Abstract Solitary plasmacytomas are a rare form of plasma cell neoplasms. They should be differentiated from multiple myeloma at the time of diagnosis and strictly monitored for the risk of transformation to myeloma. Their location in the larynx is very unusual, since only 56 cases have been published. We present the case of a patient with extramedullary plasmacytoma of the larynx that has been treated with surgery and radiotherapy. We reviewed the literature for diagnostic criteria and therapeutic problems.

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)

Momento de inicio de radioterapia posoperatoria como factor pronóstico en pacientes con cáncer de laringe avanzado / Time to initiation of postoperative radiotherapy as a prognostic factor in patients with advanced laryngeal cancer

RESUMEN Introducción: Dentro de los factores que juegan un rol en la supervivencia y recidiva de enfermedad de los pacientes con cáncer laríngeo escamoso operados se encuentra el tiempo de inicio de la radioterapia (RT) posoperatoria. Objetivo: Determinar el impacto del retraso de inicio de RT posoperatoria en la supervivencia y recidiva de enfermedad en pacientes con cáncer de laringe escamoso avanzado operado. Material y método: Estudio tipo cohorte retrospectiva. Recolección de datos mediante revisión de fichas clínicas. Análisis de supervivencia y recidiva de enfermedad mediante el método de Kaplan-Meier, comparación de curvas con prueba de Log-Rank y modelo de regresión de Cox para análisis de factores pronósticos. Resultados: El tiempo de espera entre la cirugía y el inicio de la RT en nuestras realidades hospitalarias fueron 11 semanas. La supervivencia específica a 5 años en los pacientes que comienzan la RT ≤6 semanas desde la cirugía es de 33,3% y disminuye a 20% en aquellos que la comienzan >6 semanas (p =0,20). Conclusión: Los pacientes que inician la RT en más de 6 semanas desde la cirugía no presentan una diferencia estadísticamente significativa en el pronóstico.

ABSTRACT Introduction: Among the factors that play a role in the survival and recurrence of disease of patients with operated squamous laryngeal cancer is the time to initiation of postoperative radiotherapy (RT). Aim: To determine the impact of delayed onset of postoperative RT on survival and disease recurrence in patients with advanced operated squamous laryngeal cancer. Material and Method: Retrospective cohort study. Collection of data through review of clinical records. Analysis of survival and disease recurrence using the Kaplan-Meier method, comparison of curves with Log-Rank test and Cox regression model for analysis of prognostic factors. Results: The waiting time between surgery and the initiation of RT in our hospital realities was 11 weeks. The 5-year specific survival in patients who start RT ≤ 6 weeks after surgery is 33.3% and decreases to 20% in those who start > 6 weeks (p = 0.20). Conclusion: Patients who start RT in more than 6 weeks after surgery do not present a statistically significant difference in prognosis.

Rehabilitación vocal en un paciente con cáncer de laringe tratado con radioterapia / Vocal rehabilitation in a patient with laryngal cancer treated with radiotherapy / Reabilitação vocal em paciente com câncer de laringe tratado com radioterapia

INTRODUCCIÓN: La mayoría de la población con cáncer de laringe experimenta alteraciones persistentes en la voz por causa de los efectos fisiopatológicos de la radioterapia, provocando un gran impacto a nivel funcional y psicosocial. Los objetivos son: Determinar los momentos de la intervención fonoaudiológica en pacientes con cáncer de laringe tratados con radioterapia, describir la metodología de evaluación clínica y objetiva de la función fonatoria, identificar los factores que colaboran en la mejoría de la calidad vocal, comunicación y calidad de vida del paciente. MATERIAL Y MÉTODO: Diseño: Caso clínico. Paciente femenino, de 78 años con diagnóstico de carcinoma escamoso moderadamente diferenciado, infiltrante de laringe EI (T1bN0M0). Realizó radioterapia de intensidad modulada. Entrevista pre e intratratamiento, postratamiento de radioterapia y rehabilitación vocal propiamente dicha. Estudio objetivo de la voz (PRAAT). Valoración perceptual de la voz (GRBAS). Encuesta de calidad de vida (VHI).

INTRODUCTION: The majority of the population with laryngeal cancer experiences persistent alterations in the voice because of the pathophysiological effects of radiotherapy, provoking a great impact at functional and psychosocial level. The objectives are to determine the moments of the speech-language intervention in patients with laryngeal cancer treated with radiotherapy, describe the methodology of clinical and objective evaluation of phonatory function, identify the factors that contribute to the improvement of vocal quality, communication and quality of life of the patient. MATERIAL AND METHOD: Design: Clinical case. Female patient, 78 years old with diagnosis of moderately differentiated squamous carcinoma, infiltrating larynx EI (T1bN0M0). She performed modulated intensity radiotherapy. Pre and intra-treatment interview, post-treatment of radiotherapy and vocal rehabilitation proper. Objective study of voice (PRAAT). Perceptual perception of voice (GRBAS). Quality of Life Survey (VHI).

INTRODUÇÃO: A maioria da população com câncer de laringe sofre alterações persistentes na voz devido aos efeitos fisiopatológicos da radioterapia, causando um grande impacto no nível funcional e psicosocial. Os objetivos são determinar os momentos da intervenção fonoaudiológica em pacientes com câncer de laringe tratados com radioterapia, descreva a metodologia de avaliação clínica e objetiva da função fonatória, identificar os fatores que contribuem para a melhoria da qualidade vocal, comunicação e qualidade de vida do paciente. MATERIAL E MÉTODO: Design: Caso clínico. Paciente do sexo feminino, 78 anos com diagnóstico de carcinoma escamoso moderadamente diferenciado, infarto da laringe EI (T1bN0M0). Eu executo radioterapia de intensidade modulada. Entrevista pré e intra-tratamento, pós-tratamento de radioterapia e reabilitação vocal própria. Estudo objetivo da voz (PRAAT). Percepção perceptiva da voz (GRBAS). Inquérito à qualidade de vida (VHI)

Oncological results of surgical treatment versus organ-function preservation in larynx and hypopharynx câncer / Resultado oncológico de tratamento cirúrgico versus protocolo de preservação de órgão em câncer de laringe e hipofaringe

Summary Introduction: Since the beginning of the 1990s, non-surgical radiochemotherapy treatment has become popular with the prospect of maintaining oncological results and preserving the organ in patients with advanced squamous cell carcinoma of the larynx and hypopharynx. However, subsequent studies demonstrated increased recurrence and mortality after the non-surgical treatment became popular. Objective: To compare the oncological results of surgical and non-surgical treatments of patients with larynx and hypopharynx cancer and to evaluate the variables associated with disease recurrence. Method: This is a retrospective cohort study of 134 patients undergoing surgical (total or partial laryngectomy) or non-surgical (isolated radiotherapy, chemotherapy or induction chemotherapy followed by radiotherapy and chemotherapy) treatment, with 62 patients in the surgical group and 72 in the non-surgical group. Results: Disease-free survival rates were higher in the surgical group (81.7% vs. 62.2%; p=0.028), especially in III/IV stages (p=0.018), locally advanced tumors T3 and T4a (p=0.021) and N0/N1 cases (p=0.005). The presence of cervical lymph nodes, especially N2/N3, was considered a risk factor for disease recurrence in both groups (HR=11.82; 95CI 3.42-40.88; p<0.0001). Patients not undergoing surgical treatment were 3.8 times more likely to develop recurrence (HR=3.76; 95CI 1.27-11.14; p=0.039). Conclusion: Patients with larynx or hypopharynx cancer non-surgically treated had a poorer disease-free survival, especially in cases with locally advanced tumors (T3 and T4a) and in which the neck was only slightly affected (N0/N1).

Resumo Introdução: A partir de estudos do início dos anos 1990, popularizou-se o tratamento não cirúrgico com radioquimioterapia, com a perspectiva de manutenção do resultado oncológico e preservação do órgão em pacientes com carcinoma espinocelular avançado de laringe e hipofaringe. Entretanto, estudos posteriores demonstraram aumento da recorrência e da mortalidade com a difusão do tratamento não cirúrgico. Objetivo: Comparar o resultado oncológico dos tratamentos cirúrgico e não cirúrgico de pacientes com câncer de laringe e hipofaringe e avaliar as variáveis associadas à recidiva de doença. Método: Estudo de coorte retrospectiva de pacientes submetidos ao tratamento cirúrgico (laringectomia total ou parcial) e não cirúrgico (radioterapia isolada, radioterapia concomitante a quimioterapia ou quimioterapia de indução seguida de radioterapia e quimioterapia) de 134 pacientes, sendo 62 no grupo cirúrgico e 72 no não cirúrgico. Resultados: As taxas de sobrevivência livre de doença foram maiores no grupo cirúrgico (81,7% vs. 62,2%; p=0,028), principalmente em estádios III/IV (p=0,018), tumores localmente avançados T3 e T4a (p=0,021) e casos N0/N1 (p=0,005). A presença de linfonodos cervicais, principalmente N2/N3, foi considerada fator de risco para recidiva de doença nos dois grupos (HR=11,82; IC95% 3,42-40,88; p<0,0001). Pacientes não submetidos ao tratamento cirúrgico apresentaram 3,8 vezes mais chance de desenvolvimento de recidiva (HR=3,76; IC95% 1,27-11,14; p=0,017). Conclusão: Pacientes com câncer de laringe ou hipofaringe tratados de forma não cirúrgica tiveram menor sobrevivência livre de doença, especialmente nos tumores localmente avançados (T3 e T4a) e com pescoço pouco comprometido (N0/N1).

Carotid blowout syndrome in patients treated by larynx cancer / Síndrome da ruptura da artéria carótida em pacientes tratados para câncer de laringe

Abstract Introduction: Carotid blowout syndrome is an uncommon complication for patient treated by head and neck tumors, and related to a high mortality rate. Objective: The aim of this study was to study the risk of carotid blowout in a large cohort of patients treated only by larynx cancer. Methods: Retrospective analysis of patients older than 18 years, treated by larynx cancer who developed a carotid blowout syndrome in a tertiary academic centre. Results: 197 patients met the inclusion criteria, 192 (98.4%) were male and 5 (1.6%) were female. 6 (3%) patients developed a carotid blowout syndrome, 4 patients had a carotid blowout syndrome located in the internal carotid artery and 2 in the common carotid artery. According to the type of rupture, 3 patients suffer a type I, 2 patients a type III and 1 patient a type II. Five of those patients had previously undergone radiotherapy and all patients underwent total laryngectomy. We found a statistical correlation between open surgical procedures (p = 0.004) and radiotherapy (p = 0.023) and the development of a carotid blowout syndrome. Conclusion: Carotid blowout syndrome is an uncommon complication in patients treated by larynx tumours. According to our results, patient underwent radiotherapy and patients treated with open surgical procedures with pharyngeal opening have a major risk to develop this kind of complication.

Resumo Introdução: A síndrome da ruptura da carótida é uma complicação incomum no paciente em tratamento para tumores de cabeça e pescoço, relacionada com uma alta taxa de mortalidade. Objetivo: O objetivo deste estudo foi estudar o risco de ruptura da carótida em uma grande coorte de pacientes tratados isoladamente por um câncer de laringe. Método: Análise retrospectiva de pacientes com mais de 18 anos, tratados por câncer de laringe em um centro de assistência terciária, que desenvolveram a síndrome da ruptura da carótida. Resultados: Ao todo, 197 pacientes atenderam aos critérios de inclusão, 192 (98,4%) eram do sexo masculino e 5 (1,6%) eram do sexo feminino. 6 (3%) desenvolveram síndrome da ruptura da carótida, 4 tiveram síndrome da ruptura da carótida localizada na artéria carótida interna e 2 na artéria carótida comum. De acordo com o tipo de ruptura, 3 pacientes apresentaram síndrome da ruptura da carótida tipo I, 2 pacientes, síndrome da ruptura da carótida Tipo III e um tipo II. Cinco desses pacientes haviam sido previamente tratados com radioterapia e todos os pacientes foram submetidos a laringectomia total. Encontrou-se uma correlação estatística entre procedimentos cirúrgicos abertos (p = 0,004) e radioterapia (p = 0,023) e o desenvolvimento de síndrome da ruptura da carótida. Conclusão: A síndrome de ruptura da carótida é uma complicação rara em pacientes tratados para tumores de laringe. De acordo com nossos resultados, pacientes submetidos a radioterapia e pacientes tratados com procedimentos cirúrgicos abertos com abertura da faringe apresentam um risco maior de desenvolver essa complicação.

Condroradionecrose de laringe após radioterapia / Laryngeal chondroradionecrosis following radiotherapy

RESUMO Objetivo: estudar a condroradionecrose de laringe por complicação de radio-quimioterapia para tratamento do câncer de laringe e propor um fluxograma de tratamento com a utilização de câmara hiperbárica. Métodos: estudo retrospectivo de pacientes portadores de carcinoma de laringe admitidos em dois hospitais terciários num período de cinco anos. Resultados: de 131 pacientes portadores de câncer de laringe, 28 foram submetidos à radio e quimioterapia exclusiva e destes, três evoluíram com condroradionecrose. O tratamento destes pacientes foi realizado com câmara hiperbárica e com desbridamento cirúrgico, conforme proposição do fluxograma. Todos os pacientes tiveram a laringe preservada. Conclusão: a incidência de condroradionecrose de laringe por complicação de radioterapia e quimioterapia em nossa casuística foi de 10,7% e o tratamento com oxigenoterapia hiperbárica, com base no nosso fluxograma, foi efetivo no controle desta complicação.

ABSTRACT Objective: to study larynx chondroradionecrosis related to radiotherapy and chemotherapy treatment and provide a treatment flowchart. Methods: retrospective study with clinical data analysis of all larynx cancer patients admitted in a two tertiary hospital in a five years period. Results: from 131 patients treated for larynx cancer, 28 underwent chemoradiotherapy with curative intent and three of them presented chondroradionecrosis. They were treated with hiperbaric oxigen therapy and surgical debridment following our flowchart, preserving the larynx in all. Conclusions: the incidence of chondroradionecrosis as a complication of chemoradiotherapy in our series was 10,7% and the treatment with hiperbaric oxigen therapy, based in our flowchart, was effective to control this complication.

La radiothérapie postopératoire du cancer du larynx: Étude clinique et résultats thérapeutiques à propos de 164 cas

But:Étudier les caractéristiques épidémiologiques, cliniques et anatomopathologiques, ainsi que les résultats thérapeutiques des cancers laryngés traités par radiothérapie postopératoire.Méthodes: Une étude rétrospective a été menée entre Janvier 1995 et Décembre 2010 colligeant 164 patients atteints d'un cancer laryngé traités à Sousse (Tunisie).Résultats :L'âge médian était de 60 ans. La prédominance masculine était marquée avec un sex- ratio de 26,4. Il s'agissait d'un carcinome épidermoïde dans 98,2%. Tous les patients ont eu une laryngectomie totale ou partielle associée à un curage cervical uni ou bilatéral. Tous les patients ont eu une radiothérapie postopératoire. La dose totale délivrée variait de 50 à 74 Gy avec une fraction de 1,8- 2 Gy/ séance. Avec un recul moyen de 55 mois, 49,4 % des patients étaient en vie en situation de rémission complète. Les probabilités de survie globale à trois, cinq et dix ans étaient respectivement de 77 % et 73 %, 69%. Les facteurs pronostiques de survie globale et de survies sans récidive locorégionale retenus, en analyse uni-variée, étaient : La radicalité du curage ganglionnaire, l'atteinte ganglionnaire histologique et l'effraction capsulaire.Conclusion :Le cancer du larynx est un cancer fréquent occupant la première place des cancers des voies aéro-digestives chez l'homme en Tunisie. Notre étude présume que l'absence d'atteinte ganglionnaire, la sélectivité de l'évidement ganglionnaire et l'absence d'effraction capsulaire sont des facteurs pronostic favorables de survie globale et de contrôle local

Partial laryngectomy in glottic cancer: complications and oncological results / Laringectomia parcial no câncer glótico: complicações e resultados oncológicos

ABSTRACT INTRODUCTION: Most patients with laryngeal carcinoma present tumors in the glottis that can be treated by different treatment modalities. Some authors consider open partial laryngectomy as obsolete, while others still deem this as a viable and cost-efficient option. OBJECTIVES: To compare the oncological and functional results of a series of patients undergoing partial laryngectomy vs. external radiotherapy for the treatment of glottic cancer. METHODS: Historical cohort study with a series of glottic carcinoma patients undergoing partial laryngectomy or external radiotherapy during a period of ten years. RESULTS: Sixty-two patients with glottic carcinoma were included. Group A comprised those submitted to partial laryngectomy (n = 30), and Group B, those who underwent radiotherapy (n = 32). They were homogeneous in the comparison of mean age, 56.4 vs. 60.4 years (p = 0.12) and distribution in pathological stage (p = 0.91). With regard to oncological outcome, there were no differences in distant metastasis rates, or second primary tumor between groups (p = 1.0), as well as in disease-free time, laryngeal rescue-free time, and overall five-year survival. Severe complication rates were also similar between groups. CONCLUSION: Open partial laryngectomy had complication rates and oncological results similar to those of radiotherapy for patients with glottic carcinomas and should still be considered among the main available therapeutic options.

Resumo Introdução: A maioria dos pacientes com carcinoma de laringe apresentam tumores na região glótica suscetíveis a diferentes modalidades de tratamento. Alguns autores consideram a laringectomia parcial aberta em desuso enquanto outros ainda a indicam como uma opção viável e custo eficiente. Objetivos: Comparar os resultados oncológicos e funcionais de uma série de pacientes submetidos à laringectomia parcial versus radioterapia externa para o tratamento do câncer glótico. Método: Estudo tipo coorte histórica com uma série de pacientes com carcinoma glótico submetidos à laringectomia parcial ou radioterapia externa em período de 10 anos. Resultados: Foram incluídos 62 pacientes com carcinoma glótico distribuídos em Grupo A: submetido à laringectomia parcial (n = 30) e Grupo B submetido a radioterapia (n = 32) que se mostraram homogêneos na comparação de média de idade de 56,4 vs. 60,4 (p = 0,12) e distribuição em estadios patológicos (p = 0,91). Com relação ao desfecho oncológico, não foram observadas diferenças nas taxas de metástase à distancia, ou segundo primário entre os grupos (p = 1,0) assim como no tempo livre de doença, tempo livre de resgate laríngeo e sobrevida geral em 5 anos. As taxas de complicações severas também foram semelhantes entre os grupos. Conclusão: A laringectomia parcial aberta apresentou taxas de complicações e resultados oncológicos semelhante àqueles do tratamento radioterápico para pacientes com carcinomas glóticos e ainda deve ser considera entre as principais opções terapêuticas disponíveis.

Laryngeal chondrosarcoma - Ten years of experience / Condrossarcoma da laringe - 10 anos de casuística

INTRODUCTION: Laryngeal involvement by cartilaginous tumors is rare. However, although accounting for only 1% of laryngeal tumor pathology, they are the most frequently occurring non-epithelial neoplasms. The most probable location is the endolaryngeal surface of the cricoid cartilage. Their symptoms are variable, depending on the size and location, and may include hoarseness, stridor, and dyspnea. Treatment is based on surgical excision. Some centers take into account the degree of differentiation and whether it is a case of relapse when deciding to perform a radical resection. AIM: To evaluate this disease in a sample of the Portuguese population. METHODS: A review of the medical records from 2002 to 2012 by assessment of clinical processes was performed. Data on demographics, clinical treatments, and outcomes were collected. RESULTS: Six patients were included in the study. Five of them underwent total laryngectomy, and in one case, partial excision of the thyroid cartilage was performed. None of the patients had either metastases or tumor-related death. CONCLUSION: Laryngeal chondrosarcomas remain a rare disease of unknown etiology, with slow and insidious symptoms. The treatment is surgical, with favorable prognosis, and metastases rarely occur. The main concern regards their propensity to relapse. .

INTRODUÇÃO: O acometimento laríngeo por tumores cartilaginosos é raro. No entanto, apesar de representarem 1% da patologia tumoral laríngea, são as neoplasias não epiteliais mais frequentes. Localizam-se mais frequentemente na face endolaríngea da cartilagem cricóide. Tem sintomatologia variável consoante o tamanho e a localização, podendo incluir disfonia, estridor e dispneia. O tratamento é essencialmente cirúrgico. Alguns centros levam em conta o grau de diferenciação e de se tratar ou não de recidiva, quando da decisão de ressecção mais ou menos radical. OBJETIVO: Avaliar esta patologia numa amostra da população portuguesa. MÉTODO: Revisão da casuística no intervalo de tempo 2002-2012, através de consulta dos processos clínicos. Foram coligidos os dados demográficos e clínicos relevantes, os tratamentos efetuados e os resultados. RESULTADOS: Foram incluídos seis pacientes. Cinco foram submetidos à laringectomia total e um foi submetido à excisão da asa esquerda da cartilagem tiroide. Nenhum apresentou metástases ou morte relacionada com o tumor. CONCLUSÃO: Os condrossarcomas laríngeos permanecem como patologia rara, de etiologia desconhecida, com crescimento lento e clínica insidiosa. O tratamento é cirúrgico, com prognóstico favorável, com a metastização a ocorrer raramente. A maior preocupação decorre da sua propensão à recidiva. .

Outcome analysis of benign vocal cord tumors treated by laryngeal endoscopy under low temperature-controlled radiofrequency.

OBJECTIVE: This study aimed to evaluate the outcome of benign vocal cord tumors treated using a laryngeal endoscopy under low temperature‑controlled radiofrequency and to elucidate the application of a dynamic laryngoendoscopy in the operation. MATERIALS AND METHODS: 85 patients with benign vocal cord tumors were treated by laryngeal endoscopy under low temperature‑controlled radiofrequency from September 2011 to October 2013. A XION electronic dynamic laryngoendoscopy (Germany) was used to observe curative effects 3 months after operation. Wave images were recorded with larynx‑wave recording software to analyze tumor characteristics. RESULTS: Among the 85 patients, 81 showed smooth surface of operation wounds without any residue. The mucosal wave was also basically normal. Sound was generally recovered after 1–3 months. Three cases presented improved pronunciation function after the operation, whereas 1 patient with residual tumor at the front of vocal chords underwent another operation after 6 months.CONCLUSION: Low temperature‑controlled radiofrequency exhibited many advantages, including minimal trauma, minimal bleeding, high safety, and few complications. Moreover, treatment of benign vocal cord tumors with a laryngeal endoscopy presented satisfactory outcomes. Therefore, this technology has broad application prospects.

Efficacy of radical radiotherapy alone for functional preservation of larynx in laryngeal carcinoma: A retrospective analysis.

PURPOSE: Concurrent chemoradiation is the current standard of care in locally advanced head and neck cancer. But, in our setup, many patients of carcinoma larynx are treated with only radical radiotherapy because of poor general condition of the patients. This study was performed to assess the influence radical radiotherapy alone on functional preservation of larynx. MATERIALS AND METHODS: 110 previously untreated patients with invasive squamous cell carcinoma of larynx were treated with radical radiotherapy alone between January 2006 and June 2009. Conventional one daily fraction of 2 Gy with total doses of 60–66 Gy was used. Voice preservation and local control at median follow-up period of 2 years were analyzed. Several host, tumor, and treatment parameters were also analyzed. RESULTS: Among 110 patients, preservation of larynx was possible in 78 patients (71%). With radical radiotherapy alone, excellent preservation of larynx was achieved in stage I (88.9%) and stage II (75%) disease, while in advanced stages, results were not so encouraging. In stage III and stage IVA, larynx preservation was only 72.4% and 65.3%, respectively. Patients without any cartilage invasion had significantly better laryngeal preservation rate as compared to patients with cartilage invasion. (78.9% vs. 35.3%; P = 0.008). CONCLUSION: Though concurrent chemoradiation is the standard of care in preservation of voice in laryngeal cancer, definitive radiotherapy alone may also be a good option in terms of preservation of larynx in patients of laryngeal cancer in community practice in the developing world where most of the patients cannot tolerate concurrent chemoradiation.

Radiotherapy for early glottic cancer and salvage surgery after recurrence / Radioterapia para câncer glótico inicial e resgate cirúrgico após recorrência

Early glottic cancer can be effectively treated with radiation or surgery, but recurrence is a possibility when using any of the treatment modalities. AIM: To assess the outcome of radiotherapy as initial treatment in the control of squamous cell carcinoma of vocal cord (T1) and the effectiveness of salvage surgery (endoscopic or open) after treatment failure. MATERIALS AND METHODS: A retrospective study was based on the analysis of medical records from 43 patients with T1 squamous cell carcinoma of the glottis, radiotherapy as initial treatment and follow-up period of five years. RESULTS: The rate of recurrence after radiotherapy was 30.2 percent of the cases, mean diagnosis interval was 29.5 months. As an option for salvage treatment, patients underwent open partial laryngectomy or endoscopic surgery with control rates of 77.7 percent and 25 percent respectively. CONCLUSION: Our cases showed high rates of recurrence after radiotherapy and open partial laryngectomy was more effective for the salvage surgery.

O câncer glótico inicial pode ser efetivamente tratado com radioterapia ou com cirurgia, contudo a recidiva é uma possibilidade quando utilizada qualquer uma das formas terapêuticas. OBJETIVO: Avaliar o resultado da radioterapia como tratamento inicial no controle do carcinoma epidermoide de prega vocal (T1) e a eficácia do resgate cirúrgico (endoscópico ou externo) após a falha deste tratamento. MATERIAL E MÉTODO: Foi realizado estudo retrospectivo a partir da análise de prontuários de 43 pacientes portadores de carcinoma epidermoide da glote com estadiamento T1, submetidos à radioterapia como tratamento inicial e com seguimento mínimo de cinco anos. RESULTADOS: A taxa de recidiva após radioterapia foi de 30,2 por cento dos casos, com intervalo médio de diagnóstico de 29,5 meses. Como opção para tratamento de resgate, os pacientes foram submetidos à laringectomia parcial externa ou endoscópica com taxa de controle de 77,7 por cento e 25 por cento, respectivamente. CONCLUSÃO: Nossos casos apresentaram altas taxas de recidiva após radioterapia e a laringectomia parcial externa mostrou-se mais eficaz para o resgate cirúrgico.

Chest wall metastasis of squamous cell carcinoma of larynx.

Distant metastases in squamous cell carcinoma of head and neck are most often to the lung, liver and bone. They rarely metastasise to chest wall. We report a 60-year-old male patient who initially presented with an abscess over the anterior chest wall that was initially treated for infective pathology. Due to lack of response, cytological examination was performed that turned out to be metastasis from carcinoma larynx.

Deglutição após tratamento não cirúrgico (radioterápico/ radioquimioterápico) do câncer de laringe / Swallowing after non-surgical treatment (radiation therapy / radiochemotherapy protocol) of laryngeal cancer

O tratamento radioterápico/ radioquimioterápico para tumores de laringe pode ocasionar sequelas na deglutição. OBJETIVO: Avaliar características da deglutição de pacientes tratados por radioterapia/ radioquimioterapia para tumores de laringe. MATERIAL E MÉTODO: Estudo prospectivo com 20 indivíduos, idade média de 62 anos, após término do tratamento oncológico. Destes, 6 (30 por cento) foram tratados por radioterapia exclusiva e 14 (70 por cento) por radioquimioterapia. O tempo médio decorrido do tratamento médico ao momento da avaliação fonoaudiológica foi de 8,5 meses. Foi realizada avaliação videofluoroscópica da deglutição orofaríngea e analisados eventos das fases preparatória, oral e faríngea da deglutição. RESULTADOS: Todos os pacientes se alimentavam com via oral exclusiva. Apenas 25 por cento da amostra apresentavam deglutição dentro dos limites da normalidade. A videofluoroscopia da deglutição identificou os seguintes eventos alterados: formação do bolo (85 por cento), ejeção do bolo (60 por cento), estases na cavidade oral (55 por cento), alteração no início da fase faríngea (100 por cento), redução da elevação da laringe (65 por cento) e estase em hipofaringe (80 por cento). A penetração laríngea foi diagnosticada em 25 por cento dos casos e 40 por cento penetrações seguidas de aspirações traqueais. O grau de penetração/ aspiração foi considerado discreto em 60 por cento, porém em 35 por cento da amostra a aspiração foi silenciosa. Embora 75 por cento da amostra apresentassem algum grau de disfagia, apenas 25 por cento dos pacientes referiam queixa de deglutição. CONCLUSÃO: Pacientes com câncer de laringe tratados com radioterapia/ radioquimioterapia podem apresentar alterações em todas as fases da deglutição, mesmo na ausência de sintomas.

Radiation therapy and radiochemotherapy protocols can cause swallowing difficulties. AIM: To evaluate swallowing in patients undergoing radiation therapy and radiochemotherapy protocol only for the treatment of laryngeal tumors. METHODS: A prospective study of 20 patients, with a mean age of 62 years, at the end of oncological therapy. Six patients (30 percent) underwent radiation therapy, and 14 patients (70 percent) underwent combined therapy. The mean time between treatment and an evaluation of swallowing was 8.5 months. Videofluoroscopy was done to assess the preparatory, oral and pharyngeal phases of swallowing. RESULTS: All patients had only an oral diet. Normal swallowing was present in only 25 percent of patients. The swallowing videofluoroscopic examination identified the following changes: bolus formation (85 percent), bolus ejection (60 percent), oral cavity stasis (55 percent), changes in the onset of the pharyngeal phase (100 percent), decreased laryngeal elevation (65 percent), and hypopharyngeal stasis (80 percent). Laryngeal penetration was observed in 25 percent of the cases; 40 percent presented tracheal aspiration. The grade of penetration/aspiration was mild in 60 percent of cases. Aspiration was silent in 35 percent of patients. Although 75 percent of patients had dysphagia, only 25 percent complained of swallowing difficulties. CONCLUSION: Patients with laryngeal cancer that underwent radiation therapy/combined treatment can present changes in all swallowing phases, or may be asymptomatic.

Avaliação da sobrevida livre de doença em pacientes com carcinoma epidermoide de laringe submetidos à tratamento radioterápico exclusivo ou associado à quimioterapia / Assessment of disease-free survival in patients with laryngeal squamous cell carcinoma treated with radiotherapy associated or not with chemotherapy

No carcinoma epidermoide de laringe em estádios clínicos precoces (I e II), tanto a cirurgia quanto a radioterapia resultam em controle loco-regional significativo. Nos tumores avançados (III e IV), a radioterapia exclusiva tem índices de 32-43 por cento de controle loco-regional. OBJETIVO: É avaliar a sobrevida livre de doença dos pacientes com CEC de laringe submetidos à radioterapia exclusiva e/ou associada à quimioterapia. CASUÍSTICA E MÉTODOS: Estudo retrospectivo de 84 casos de CEC de laringe tratados com radioterapia ou quimioterapia concomitante à radioterapia. Cinquenta e três casos foram tratados com intenção curativa e 31 por irressecabilidade da doença. Quanto ao estádio clínico (EC), 12 eram de EC I, 15 II, 21 III e 5 IV. No segundo grupo, 11 casos eram EC III e 20 IV. RESULTADOS: Idade média foi de 60 anos, sendo 84,5 por cento homens. Cinquenta e oito (69,1 por cento) casos tiveram resposta completa e 26 (30,9 por cento) apresentavam doença persistente ou residual. A sobrevida livre de doença há cinco anos foi de 42,5 por cento, sendo de 62,5 por cento nos pacientes com indicação de preservação de órgãos e 9,75 no grupo de doença irressecável. CONCLUSÃO: A sobrevida livre de doença a cinco anos dos pacientes submetidos à radioterapia por CEC de laringe foi de 62,5 por cento.

In early stage (I and II) laryngeal squamous cell carcinoma, both surgery and radiotherapy results in significant local and regional control. In advanced tumors (III and IV), radiotherapy alone has local-regional control rates of 32-43 percent. AIM: To assess disease-free survival in SCC laryngeal carcinoma patients submitted to radiotherapy alone and/or associated with chemotherapy. MATERIALS AND METHODS: Retrospective study involving 84 cases of laryngeal SCC treated with radiotherapy or chemotherapy together with radiotherapy. Fifty-three cases were treated with intension to cure and 31 because of impossibility to resect the disease. As to clinical stage (CS), 12 were CS I, 15 II, 21 III and 5 IV. In the second group, 11 cases were EC III and 20 IV. RESULTS: Mean age was 60 years, 84.5 percent were men. Fifty-eight (69.1 percent) cases had complete response and 26 (30.9 percent) had persistent or residual disease. Five-year disease-free survival was of 42.5 percent; 62.5 percent of the patients with organ preservation indication and 9.75 in the group of irressecable disease. CONCLUSION: disease-free survival of those patients submitted to radiotherapy because of laryngeal SCC was of 62.5 percent

Análise videolaringoestroboscópica de pacientes submetidos à radioterapia para tratamento de câncer glótico / Videolaryngostroboscopic analysis of patients submitted to radiation therapy for the treatment of glottic cancer

Sendo a radioterapia oncologicamente adequada no tratamento do câncer precoce da laringe, é importante estudar o padrão vibratório, que é componente crítico para os resultados vocais. Objetivo: Analisar os achados videolaringoestroboscópicos em um grupo de pacientes submetidos à radioterapia para o tratamento do câncer glótico precoce. Métodos: Estudo retrospectivo realizado através da avaliação de 20 pacientes estadiados como T1a glótico de 1995 a 2005. Um protocolo videolaringoestroboscópico foi aplicado. Resultados: O fechamento glótico foi completo em 17 pacientes. A amplitude foi normal em 14 pregas vocais tratadas e em 18 pregas contralaterais. O padrão da onda vibratória mucosa foi sempre totalmente presente, normal ou discretamente diminuído em ambas as pregas vocais, com melhores resultados para a prega vocal contralateral em comparação com aqueles verificados nas pregas vocais com o tumor. A periodicidade foi sempre regular em todos os casos. A simetria e os movimentos das pregas vestibulares e das aritenoides foram normais. Houve constrição supraglótica lateral ocasional em quatro casos. O aspecto da mucosa foi edematoso em seis pacientes. Formação de bola de muco foi observada em 12 pacientes. Conclusões: O padrão vibratório foi normal ou discretamente diminuído para ambas as pregas vocais após tratamento radioterápico para câncer glótico T1a.

Radiation therapy is an adequate treatment for early laryngeal cancer, and it is important to study the vocal fold vibratory pattern, which is essential for a favorable voice outcome. AIM: To analyze laryngostroboscopic findings in a group of patients who underwent radiation therapy for the treatment of early glottic cancer. Methods: A retrospective study was conducted in order to evaluate 20 patients staged as T1a glottic tumors in the period from 1995 to 2005. A laryngostroboscopic protocol was applied. Rsualtados: Glottic closure was complete in 17 patients. The amplitude was normal in 14 treated vocal folds and in 18 contralateral vocal folds. The mucosa wave vibratory pattern was totally present in all vocal folds. The periodicity was always regular in all cases. The vestibular fold and arytenoid symmetry and movements were normal. There was occasional supraglottic lateral constriction in 4 cases. The mucosal appearance was normal in 14 and edematous in 6 patients. Mucus build up was observed in 12 patients. Conclusions: The vibratory pattern was normal or slightly diminished in both vocal folds after radiation therapy for early glottic cancer.

Radioterapia y el carcinoma verrucoso de laringe: [revisión] / Radiotherapy and verrucous carcinoma of the larynx: [revision]

El carcinoma más común en las vías aéreo-digestivas superiores (VADS) es el carcinoma de células escamosas (>90%). Es difícil precisar la prevalencia de las denominadas variantes del carcinoma de células escamosas (CCE). El diagnóstico diferencial es necesario dadas sus diferencias no sólo en el manejo sino también en su pronóstico. El carcinoma verrucoso es una de las variantes del carcinoma de células escamosas bien diferenciado no metastizante, caracterizado por ser una neoplasia de un crecimiento lento, de patrón exofítico verrucoso. El rol de la radioterapia (RDT) en el tratamiento del carcinoma verrucoso es motivo de discusión por su posible transformación en carcinoma anaplásico. A través de la siguiente revisión bibliográfica se busca aclarar dicha controversia.

Squamous cell carcinoma is the most common upper aerodigestive tract (UAT) carcinoma (>90%). Precising the prevalence of the so-called varieties of squamous cell carcinoma has proved difficult. Differential diagnosis is necessary, on account of the differences between varieties both in management and prognosis. One of such varieties, verrucous carcinoma of the larynx, is a well-defined, no-metastatic tumor, characterized as a slow-growth neoplasm, of verrucous exophyitic pattern. Since laryngeal verrucous cancer may transform into anaplastic carcinoma, the role of radiotherapy in its treatment has been discussed. The aim of the present literature review was to shed light on this controversy.

Evaluación de la deglución en pacientes con cáncer precoz de laringe tratados con cirugía o radioterapia / Swallowing assessment in early laryngeal cancer patients treated either with surgery or radiotherapy

Introducción: La deglución es un proceso neuromuscular complejo, que requiere de indemnidad anatómica y de una adecuada coordinación de varios órganos. El tratamiento del cáncer laríngeo puede ocasionar trastornos de la deglución. Tradicionalmente se ha reportado una mayor frecuencia de esta alteración con los tratamientos quirúrgicos, sin embargo no existe información adecuada sobre su incidencia en pacientes sometidos a radioterapia por cáncer laríngeo precoz. Objetivo: Comparar la frecuencia de alteraciones de deglución postratamiento en cáncer laríngeo precoz Material y método: El presente es un estudio transversal de dos grupos de pacientes con cáncer laríngeo precoz, unos tratados con cirugía parcial vertical (CP) y otros con radioterapia exclusiva (RT). A cada paciente se le realizó una evaluación otorrinolaringológica, nasofibroscópica y videofluoroscópica postratamiento. Las diferencias entre los grupos se compararon utilizando el test Xi cuadrado. Resultados: Ingresaron veinte pacientes por grupo, la mayoría de género masculino y de edades similares. Ambos grupos presentan una alta incidencia de síntomas aspirativos (55% en RT y 35% en CP) y alteraciones en nasofibroscopía y videofluoroscopía (35% en RTy 30% en CP). No hubo diferencias significativas entre ambos grupos. Discusión y conclusiones: Se demuestra una elevada incidencia de trastorno de la deglución en pacientes tratados por cáncer precoz de laringe, debiendo considerarse como una alteración frecuente en este grupo de pacientes, ya hayan sido tratados con RT o CP.

Introduction. Swallowing is a complex neuromuscular process that requires anatomical indemnity and an adequate coordination of several organs. Laryngeal cancer treatment may cause swallowing disorders. Traditionally, a high frequency of this type of disorder after surgery has been reponed, but no actual data concerning its incidence in patients undergoing radiotherapy for early laryngeal cancer has been published. Aim. To compare swallowing disorders frequency posterior to treatment in early laryngeal cancer patients. Material and Method. Two groups of early laryngeal cancer patients were transversally studied, one treated with vertical partial surgery (CP), and the other treated exclusively with radiotherapy. Each patient had otorhinolaryngological, nasofibroscopic and videofluoroscopic evaluations after treatment. Differences between groups were compared using the _-square test. Results. Twenty patients per group were entered in this study predominantly males of similar age. Both groups presented a high incidence of aspiration symptoms (55% in RT and 35% in CP). There were no significant differences between both groups. Discussion and Conclusion. A high incidence of swallowing disorders in patients treated for early laryngeal cancer was found. It should then be considered as a frequent alteration in this group of patients, either treated with RT or CP.