Search

AbstractBackground: The mortality rates of laryngeal squamous cell carcinoma cancer (LSCC) have not significantly decreased in the last decades.Objectives: We primarily aimed to compare the predictive performance of DeepTables with the state-of-the-art machine learning (ML) algorithms (Voting ensemble, Stack ensemble, and XGBoost) to stratify patients with LSCC into chance of overall survival (OS). In addition, we complemented the developed model by providing interpretability using both global and local model-agnostic techniques.Methods: A total of 2792 patients in the Surveillance, Epidemiology, and End Results (SEER) database diagnosed with LSCC were reviewed. The global model-agnostic interpretability was examined using SHapley Additive exPlanations (SHAP) technique. Likewise, individual interpretation of the prediction was made using Local Interpretable Model Agnostic Explanations (LIME).Results: The state-of-the-art ML ensemble algorithms outperformed DeepTables. Specifically, the examined ensemble algorithms showed comparable weighted area under receiving curve of 76.9, 76.8, and 76.1 with an accuracy of 71.2%, 70.2%, and 71.8%, respectively. The global methods of interpretability (SHAP) demonstrated that the age of the patient at diagnosis, N-stage, T-stage, tumor grade, and marital status are among the prominent parameters.Conclusions: A ML model for OS prediction may serve as an ancillary tool for treatment planning of LSCC patients. [ABSTRACT FROM AUTHOR]

The risk of head and neck cancers (HNCs) and ear, nose, and throat (ENT) diseases due to second-hand smoke (SHS) have not been fully assessed. To determine which ENT diseases or HNCs are associated with SHS. Data from a survey of a cross-sectional sample of ENT patients (n = 1228) on SHS exposure were compared to control-subject data (n = 6598) from a Japan National Health Survey. Multivariate logistic regression and estimated odds ratios (ORs) determined whether SHS-disease associations were related to exposure location and disease occurrence. SHS was significantly associated with acute tonsillitis (OR in workplaces, 2.24 [95% CI, 1.34–3.75]; OR in restaurants, 4.24 [95% CI, 2.50–7.19]; OR in leisure places, 4.72 [95% CI, 2.93–7.62]); recurrent tonsillitis (OR in restaurants, 4.24 [95% CI, 2.52–7.13]; OR in leisure places, 5.29 [95% CI, 3.31–8.46]); facial palsy (OR in home, 2.18 [95% CI, 1.25–3.81]; OR in leisure places, 3.41 [95% CI, 1.97–5.89]); hypopharyngeal cancer (OR in home, 2.51 [95% CI, 1.18–5.36]; OR in workplaces, 2.53 [95% CI, 1.24–5.15]); and laryngeal cancer (OR in home, 2.44 [95% CI, 1.04–5.68]; OR in leisure places, 2.25 [95% CI, 1.00–5.07]). SHS may contribute to HNCs and ENT diseases, suggesting that merely being in the presence of smokers could increase the risk of head and neck morbidities. [ABSTRACT FROM AUTHOR]

Background: Endoscopic laryngo-pharyngeal surgery (ELPS), which is a transoral minimally invasive surgery using a gastrointestinal endoscope and a curved laryngopharyngeal retractor, is effective to treat primary lesions of superficial laryngopharyngeal cancers. To extend concepts of ELPS to invasive laryngopharyngeal cancers, we developed end-flexible-rigidscopic transoral surgery (E-TOS) from ELPS by changing a gastrointestinal endoscope to a flexible-tip rigid endoscope. Aims/Objectives: To retrospectively evaluate oncological outcomes and laryngopharyngeal functional preservation of E-TOS in patients with T1-selected T3 laryngopharyngeal cancers. Material and methods: In 47 patients T1-selected T3 pharyngeal and supraglottic cancers were resected by E-TOS using the flexible-tip rigid endoscope and curved instruments. Negative resection margin was histopathologically evaluated. The survival, preservation of larynx, and disease control rates were estimated using Kaplan-Meier method. Results: Curative resection was achieved in 94% of patients. No patient complained prolonged swallowing dysfunction or hoarseness after E-TOS. Postoperative bleeding, stenosis of the pharynx and esophageal entrance, and local recurrence was observed each in one patient. The 3-year overall survival, disease-specific survival, laryngeal preservation, local control, and locoregional control rates were, 86%, 93%, 100%, 98%, and 79%, respectively. Conclusion: E-TOS is an effective minimally invasive surgery for T1-selected T3 pharyngeal and supraglottic cancers with preserving laryngeal function. [ABSTRACT FROM AUTHOR]

Background: Laryngeal squamous cell carcinoma (LSCC) is rare in the young. Objectives: We characterized the clinical behavior of LSCC and assessed the presentation of second primary tumors (SPCs) in this patient population. Materials and methods: Data from the Finnish Cancer Registry (FCR) were used to identify an epidemiological series of LSCC patients diagnosed at the age of 40 years or under, during 1953-2012 in Finland. Data regarding primary treatment, survival, and SPCs were available. To further characterize the comorbidity and lifestyle factors of young patients with LSCC, institutional data were collected of patients treated at the Helsinki University Hospital during 1967-2012. Results: We identified 151 patients, with a mean follow-up of 252 months. The 10-year overall survival (OS) was 75% and the disease-specific survival was 84%. SPCs were diagnosed in 26% (n = 39), with a median delay of 28 years. Of the 35 patients in the institutional series from Helsinki, 22 (63%) were current or former smokers. LSCC recurred in 28% of patients. Conclusions and Significance: The delay to SPCs in young patients was significantly longer compared with the general LSCC population. As factors underlying this phenomenon cannot be identified by this retrospective study, further studies are warranted. [ABSTRACT FROM AUTHOR]

Objectives: To examine the ability of comorbidity indices to predict the prognosis of laryngopharyngeal cancer and their association with treatment modalities. Methods: This retrospective study included 198 patients with laryngeal, hypopharyngeal, and oropharyngeal cancers. The effect of comorbidity indices on overall survival between surgery and (chemo)- radiation therapy ((C)RT) groups was analyzed. The cumulative incidence rates for cancer mortality and other mortalities according to the age-adjusted Charlson Comorbidity Index (ACCI) and Charlson Comorbidity Index (CCI) were compared. Results: Univariate survival analyses showed a significant association between the ACCI and overall survival in the (C)RT group, but not in the surgery group. The association between the CCI and overall survival was not significant in either group. In multivariate analyses, a high ACCI score was an independent prognostic factor in the (C)RT group (HR 2.89, 95% confidence interval (CI) 1.28-6.49), but not in the surgery group (HR 1.39, 95%CI 0.27-5.43). The higher ACCI group had increased mortality from other causes compared with the lower ACCI group (5-year cumulative incidence, 8.5% and 17.8%, respectively, p=.003). Conclusion: The ACCI was a better prognostic factor than the CCI. Surgery may be more beneficial than radiation for patients with a high ACCI. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the treatment results of late course accelerated hyperfractionation (LCAHF) compared with conventional fractionation (CF) for stage II laryngeal cancer. Methods: Fifty-nine consecutive patients treated for stage II laryngeal cancer were retrospectively reviewed. Thirty-two patients underwent LCAHF, twice-daily fractions during the latter half with a total dose of 69 Gy. Twenty-seven patients received CF of 70 Gy. Results: The local control rates (LCRs), overall survival (OS), and disease-specific survival (DSS) at 5 years were 80.6%, 74.0%, and 90.4%, respectively, after LCAHF and 64.7%, 68.2%, and 90.5%, respectively, after CF. There were no significant differences in LCR, OS, and DSS (p =.11, 0.68, and 0.69, respectively). In a small number of patients with supraglottic cancer, LCAHF was associated with a significantly higher LCR at 5 years compared with CF (100% vs. 41.7%; p =.02). Conclusions: This is the first report that compared the results of LCAHF and CF for stage II laryngeal cancer. We could not find significant differences in LCR, DSS, and OS rates between LCAHF and CF groups. Although in a small number of patients with supraglottic cancer, LCAHF may improve the LCR compared with CF. [ABSTRACT FROM AUTHOR]

Conclusion: A prognostic model was obtained for LC. Several critical genes were unveiled. They could be potentially applied for LC recurrence prediction. Objective: Gene expression data of laryngeal cancer (LC) were analyzed to identify critical genes associated with recurrence. Methods: Two gene expression datasets were downloaded from the Gene Expression Omnibus. Dataset GSE27020 is used as the training set, containing 75 non-recurred LC cases and 34 recurred LC cases. Results: A total of 725 DEGs were identified from the training set. A total of 4126 gene pairs showed significant correlations in non-recurred LC only, corresponding to 533 genes. A total of 7235 gene pairs showed significant correlations in recurred LC only, corresponding to 608 genes. Besides, 1694 gene pairs showed significant correlations in both non-recurred and recurred LC, corresponding to 322 genes. Functional enrichment analysis was performed for the three groups of DEGs. Seven overlapping biological functions were revealed: positive regulation of chondrocyte differentiation, autoimmune thyroid disease, focal adhesion, linoleic acid metabolism, drug metabolism, organic cation transport, and ECM-receptor interaction. Eight feature genes (PDIA3, MYH11, PDK1, SDC3, RPE65, LAMC3, BTK, and UPK1B) were identified. Their prognostic effect was validated by independent test set as well as survival analysis. [ABSTRACT FROM AUTHOR]

Conclusions:The results suggest that gender-specific differences in health-related quality-of-life (HRQoL) exist in patients with larynx carcinoma. In previous studies these differences might have been concealed by predominantly male subject groups. Future studies should consider a gender-specific analysis that suits the patient’s idiosyncrasies associated with laryngeal cancer. Objectives:There is little research concerning gender differences in quality-of-life (QoL) in patients with larynx carcinoma. Since laryngeal cancer is predominantly found in males, most studies examining HRQoL are based on a mainly male subject group. HRQoL needs to be assessed to determine the impact of disease and treatment and to evaluate possible treatment regimes. This study examined gender differences concerning HRQoL in 53 patients using EORTC QLQ-C30, and QLQ-H&N35 questionnaires. Methods:Patients treated with larynx carcinoma were given two questionnaires to assess HRQoL. The questionnaires were analyzed for each sex separately, as well as for the entire population. Results:Female patients report significantly worse HRQoL than males. Age could not be identified as a significant predictor for HRQoL when males and females were analyzed together, and does not significantly predict HRQoL in men. However, age was found to be a significant predictor for HRQoL when only females were analyzed. [ABSTRACT FROM PUBLISHER]

Background: Preoperative psychologic distress is common in head and neck cancer patients and related to deleterious effects in patient treatment and recovery. Routine screening and appropriate referral of all patients with cancer for psychiatric assessment is now a part of the medical treatment. Objects: The aim was to assess the level of preoperative psychologic distress in laryngeal cancer patients scheduled for surgical treatment. Methods: After the Institutional Review Board approval and informed written consent, 211 patients scheduled for total or partial laryngectomy were interviewed preoperatively. Each patient was asked to fulfil the Hospital Anxiety and Depression Scale. Demographic characteristics that may relate to psychologic distress were also recorded. Results: The mean age (+/−SD) was 62.1 (8.2) years. The surgical type was total laryngectomy (n = 79) and partial laryngectomy (n = 132). Median (first/third quartile) HADS score was 6 (3/10). A total of 39.6% patients had psychologic distress. The HADS score was higher for total laryngectomy patients than partial laryngectomy patients [7 (4/10) versus 5 (3/10), p < .05]. Age was negatively correlated with HADS score (p = .049). Conclusions: Our study showed that laryngeal cancer patients scheduled for total laryngectomy had higher level of psychologic distress. Age was a predictive factor for psychologic distress. [ABSTRACT FROM AUTHOR]

Conclusion: Down-regulation of ECD may associate with infiltrative tumor growth and result in poor prognosis. However, ECD expression is not significantly associated with tumor metastasis.Aim: To investigate the prognostic role of E-cadherin (ECD) expression in laryngeal cancer.Methods: In a clinical study, a total of 79 laryngeal cancer patients who received surgery were included in this study. The expression of ECD in laryngeal cancer tissue was detected by immumohistochemical staining. In anin vitrostudy, ECD up-regulated cells (Ad-ECD) and ECD down-regulated cells (sh-ECD) were cultured, along with interference by siRNA. Cell apoptosis was detected by flow cytometry. In anin vivostudy, nude mice were injected with Ad-ECD, sh-ECD, and Hep-2 cells. The ECD expression and tumor metastasis in the brain, liver, and lung tissues were detected.Results: Clinical data showed that expression of ECD was statistically correlated with survival rate (p < 0.05), but not with other clinical characteristics, such as age, gender, lymphatic metastasis, and TNM staging. ECD was down-regulated in sh-ECD cells and the down-regulation significantly reduced apoptosis of Hep-2 cells. Tumor growth was significantly inhibited in the Ad-ECD group. Except the tumor tissue, no positive ECD expression or significant tumor cells were found in the brain, liver, and lung tissues. [ABSTRACT FROM PUBLISHER]

Conclusion: Superselective intra-arterial chemotherapy is a safe and useful treatment that preserves the vocal, swallowing, and feeding functions of the larynx in T3 cancer supplied by the superior laryngeal artery and T4a cancer not extending beyond the thyroid cartilage. Objective: To evaluate the outcomes of superselective intra-arterial chemotherapy for squamous cell carcinoma of the glottic larynx. Methods: Sixty-four patients with squamous cell carcinoma of the glottic larynx underwent treatment of the primary tumor using induction chemotherapy with two cycles of intra-arterial docetaxel and cisplatin, plus continuous intravenous infusion of 5-fluorouracil for 120 h starting on day 2; followed by two cycles of concurrent chemoradiation therapy. Residual neck lymph node metastases were treated by neck dissection. Results: The overall 5- and 10-year survival rates were 70.4% and 62.9%, respectively. The 5- and 10-year survival rates were 96.3% and 89.9%, respectively, in the 29 patients with T3 cancer, and 50.4% and 44.1%, respectively, in the 35 patients with T4a cancer. The overall 5- and 10-year laryngeal preservation rates were 71.0% and 60.6%, respectively. The 5- and 10-year laryngeal preservation rates were 92.5% and 87.4%, respectively, in patients with T3 cancer, and 48.6% and 35.6%, respectively in patients with T4a cancer. No irreversible adverse effects were reported. [ABSTRACT FROM AUTHOR]

Conclusion: Patients who received concurrent chemoradiation therapy or radiation therapy alone were followed over a long term. The complete response (CR), 10-year survival, and 10-year larynx preservation rates were 87.5%, 95.3%, and 75.1%, respectively. Statistically, concurrent chemoradiation therapy contributes to laryngeal preservation but not to the survival rate. Objective: To determine the additive and synergistic effects of anticancer chemotherapy combined with chemoradiation therapy for squamous cell carcinoma (SCC) of the glottic larynx. Methods: Eighty-nine patients with untreated T2N0M0 SCC of the glottic larynx were included. Thirty-two patients received treatment cycles consisting of intravenous cisplatin (CDDP) on day 1 (80 mg/m2) and intravenous 5-fluorouracil (5-FU) over 120 h on days 2-6 (600 mg/m2/day) every 4 weeks. Radiotherapy was delivered by a 4 MV linac X-ray machine at a dose of 66 Gy. Fifty-seven patients received radiotherapy alone. Results: After chemoradiation therapy, the overall response, CR, 10-year survival, and 10-year larynx preservation rates were 100%, 87.5%, 95.3%, and 75.1%, respectively. Side effects included leukopenia, neutropenia, mucositis, and dermatitis. Seven patients (21.9%) required salvage surgery. Pathological findings confirmed that the treatment regimen caused marked cancer tissue degeneration. Histologic examination of surgical specimens suggested that the safety margin for partial laryngectomy was 4 mm from the gross tumor. [ABSTRACT FROM AUTHOR]

Conclusion: Concurrent chemoradiation therapy with docetaxel (DOC) at a dose of 10 mg/m2 twice a week contributed to laryngeal preservation. Objective: To determine laryngeal preservation following concurrent chemoradiation therapy with DOC. Methods: A total of 141 patients with untreated T2N0M0 squamous cell carcinoma of the glottic larynx were included in the study. The treatments were either radiation therapy alone or DOC intravenously administered at a dose of 10 mg/m2 once or twice a week during radiotherapy with 4 MV linac X-ray (total of 66 Gy for 33 days). Results: The response and CR rates were 100% and 90.5% in the once-weekly combination group, and 100% and 97.6% in the twice-weekly combination group, respectively. The 5-year survival rates were 76.8% in the once-weekly combination group and 96.8% in the twice-weekly combination group. The 5-year laryngeal preservation rates were 83.8% in the once-weekly combination group and 97.6% in the twice-weekly combination group. The most common side effects were mucositis, dermatitis, and alopecia. The patients who received DOC twice a week showed more severe cancer tissue degeneration, and pathological examination of serial sections indicated that the safety margin for partial laryngectomy was considered to be 3 mm from the gross tumor with good glottal closure. [ABSTRACT FROM AUTHOR]

Conclusion. Our results showed that the behavior of moderate dysplasia lesions was more like that of severe dysplasia lesions, while severe dysplasia was very different from carcinoma in situ (CIS). CIS should be managed more aggressively than the other lesions. Mild dysplasia could not be viewed as a precancerous lesion of the larynx. Objective: This study aimed to identify the possibilities of the precancerous lesions of larynx (including mild dysplasia, moderate dysplasia, severe dysplasia, and CIS) progressing to invasive carcinomas and to highlight the importance of adequate management and follow-up strategies for these patients. Methods: A retrospective study of patients who had these preinvasive lesions in the larynx over a 10-year period was performed. Results: These patients were followed for a minimum period of 2 years from the initial diagnosis. In all, 86 patients were identified the cohort. Of these, 17 (19.8%) patients developed carcinoma: 0 of 22 with mild dysplasia, 5 of 25 (20%) with moderate dysplasia, 2 of 14 (15%) with severe dysplasia, and 10 of 25 (40%) patients with CIS progressed to invasive cancers ( p == 0.001). Over 50% of cases progressed 3 years after the original biopsy. Only 1 of 86 (1%) died of the disease. [ABSTRACT FROM AUTHOR]

Conclusion: MASPIN subcellular location can be considered a prognostic marker that is potentially useful for identifying elderly patients with laryngeal carcinoma at higher risk of early loco-regional recurrence, who may benefit from more aggressive therapy. In a targeted treatment setting, re-activated nuclear MASPIN in combination with anti-angiogenic and/or cytotoxic drugs may be effective in treating laryngeal carcinoma in elderly patients. Objectives: Aging is associated with molecular, cellular, and physiological changes that influence carcinogenesis and cancer growth. MASPIN has multifaceted anti-tumor effects and available evidence supports the hypothesis that its subcellular location influences its functions. The aim of the present study was to firstly assess the potential prognostic role of subcellular MASPIN location in elderly patients (>65 years old) with laryngeal carcinoma. Methods: MASPIN expression and location were immunohistochemically determined in 68 consecutive elderly patients with laryngeal carcinoma. Results: Nodal involvement and pathological stage correlated strongly with the prognosis for laryngeal carcinomas in elderly patients, in terms of disease recurrence rate and disease-free survival. The loco-regional recurrence rate was significantly lower ( p == 0.041) and the disease-free survival after treatment was significantly longer ( p == 0.045) in cases with a nuclear pattern of MASPIN subcellular expression. [ABSTRACT FROM AUTHOR]

Conclusion. Neither elective selective neck dissection nor any conservative treatment option in pT2cN0 glottic cancer showed a significant advantage on survival. This should be the basis for future treatment standardization. Obligatory documentation of the R status and cause of death in the cancer registries will improve the data interpretation in the future. Objectives. Optimal adjuvant treatment of pT2cN0 glottic cancer is not well defined. The impact of neck dissection or radio(chemo)therapy for better outcome is unknown. Methods: In a retrospective cancer registry study we analyzed the survival of 73 patients with pT2cN0 glottic cancer in Thuringia, Germany, treated surgically between 1996 and 2005. Results: In all, 35 patients had undergone elective neck dissection, the remaining 38 patients had not. Histopathology revealed occult lymph node metastasis in three patients. Adjuvant radiotherapy was delivered to 17 patients and radiochemotherapy to 4. Overall, 52 patients received an adjuvant treatment. The 5-year recurrence-free survival rate was 60.8% and the 5-year overall survival rate was 56.5%. Multivariate but not univariate analysis revealed age >62 years ( p == 0.05) and neck dissection ( p == 0.033) as significant negative risk factors for tumor recurrence. Looking at overall survival, the site of primary surgery and radiotherapy were significant univariate risk factors, whereas multivariate analysis did not reveal any independent risk factor. No adjuvant treatment or combinations of adjuvant treatment resulted in better recurrence-free or overall survival ( p == 0.253; p == 0.279). [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to compare the radiologic findings with histological results of anatomically matched whole organ sections and to analyze the accuracy of pretherapeutic radiologic staging of glottic cancers. Methods: The histologic findings of surgical specimens of 30 patients who had undergone total or conservative partial laryngectomy for glottic cancers were matched and compared with the pretherapeutic radiologic findings using CT and MR imaging. The accuracy of pretherapeutic radiologic staging was assessed for specific subsites for staging of glottic cancers. Results: The overall accuracy of pretherapeutic staging with CT and MR imaging was 84.9%; 12.1% associated with false positive and 3% associated with false-negative assessments. For all subsites, the overall sensitivity was 88%, specificity 84%, positive predictive value 65%, and negative predictive value 95%. Subsites such as the anterior commissure, paraglottic space, and preepiglottic space showed lower specificity (42%, 65%, and 79% respectively) than the overall specificity. The radiologic evaluation for cartilage invasion showed the accuracy of 84.8% and yielded acceptable specificity (89%) and high negative predictive value (98%). Conclusion: Although pretherapeutic radiological examination is a very useful technique for the evaluation of tumor invasion into specific laryngeal subsites, the pretherapeutic radiologic staging can be challenging when distinguishing tumor from peritumoral inflammation. [ABSTRACT FROM AUTHOR]

Conclusions: In survival analysis, the combined Charlson comorbidity index (CCI) can be considered as a prognostic factor independent of the tumor node metastasis (TNM) classification, tumor stage, and tumor location. Severe comorbidity was the factor that had the greatest impact on prognosis in cases of initial tumor. Objective: To study the influence of comorbidity on the survival of patients undergoing surgery for larynx cancer. Methods: This was a retrospective study of the survival of 231 patients with laryngeal cancer who underwent surgery between 1995 and 2002. The CCI was used to assess comorbidity, the Kaplan--Meier method was used for survival analysis, and the Cox proportional risk regression model was used to identify independent prognostic factors. Results: The multivariate analysis of specific mortality showed that patients classified as having severe comorbidity (CCI) were more likely to die (adjusted hazard ratio (adjHR) 1.85, 95% confidence interval (CI) 1.07--3.17). This difference was more important in patients with early tumor stages than in those with advanced stages. [ABSTRACT FROM AUTHOR]

Conclusion: Matrix metalloproteinase (MMP)-20 is overexpressed in laryngeal squamous cell carcinoma (LSCC) compared with the adjacent normal laryngeal epithelium and MMP-20 plays a role in lymph node metastasis. Overexpression of MMP-20 may be used as a significant prognostic factor for lymph node metastasis. All the findings indicate that MMP-20 may play a role in the initiation and progression of LSCC. Objective: The MMPs are a gene family of zinc-dependent endopeptidases that have been implicated in tumor invasion and metastasis, and MMP-20 is a new member of the MMP family. The purpose of this study was to investigate whether MMP-20 is overexpressed in human LSCC and, if so, the significance of its overexpression in relation to clinical parameters. Methods: We analyzed 33 cases of LSCC with RT-PCR and 73 cases of LSCC with immunohistochemistry compared with normal laryngeal epithelium. Results: We found that MMP-20 is overexpresssed in LSCC compared with the adjacent normal laryngeal epithelium. [ABSTRACT FROM AUTHOR]

Conclusion: Down-regulating human telomerase reverse transcriptase (hTERT) expression will significantly suppress the cell viability of laryngeal squamous cell carcinoma Hep-2, which was mainly due to the inhibition of cyclin D1 and thus G1/S phase transition. Objective: Small-interfering RNA (siRNA) targeting hTERT can arrest the cell cycle of cancer cells, as well as inhibit telomerase activity and cell viability. However, the precise mechanisms still remain unclear. Here, we investigate the regulatory role of hTERT in cyclin D1 in laryngeal squamous carcinoma. Methods: Short hairpin RNAs (shRNAs) specifically targeting hTERT were constructed and expressed in Hep-2 cells. Cell proliferation was measured by CCK-8 assay. Expression of hTERT, cyclin D1, cyclin E, c-myc, and GAPDH was detected by RT-PCR and Western blot; cyclin D1 and hTERT proteins in laryngeal squamous carcinoma tissue microarray were analyzed by quantum dots immunofluorescence. Results: hTERT silence by shRNAs decreased the proliferation of Hep-2 cells by 76.8% at day 4 (96 h). Furthermore, transfection with hTERT shRNA for 48 h also significantly reduced expression of hTERT, cyclin D1, and c-Myc, but not cyclin E. Quantum dots immunofluorescence analysis of 36 laryngeal squamous carcinoma tissue samples found that hTERT expression was highly correlated with cyclin D1 expression. [ABSTRACT FROM AUTHOR]

Conclusion: PCR-quality DNA could be extracted from formalin-fixed paraffin-embedded (FFPE) samples with amplicons of at least 390 bp. Paraffin removal was not a necessary step. Proteinase K digestion was as efficient as the commercial kit for DNA extraction with a lower cost. Objectives: To compare different DNA extraction protocols for FFPE samples and to describe the suitability of the extracted DNA for PCR reactions. Methods: For deparaffinization the following techniques were compared: alkaline heat, xylene, and no removal. For DNA extraction, proteinase K digestion and organic extraction were compared. A commercial extraction kit was included as standard. DNA quality was assessed by PCR amplification of the HFE gene, for amplicons of 208 and 390 bp. Results: Extraction with the commercial kit and proteinase K digestion were more efficient than other techniques, with no statistical difference between them for both amplicons. The proteinase K digestion buffer had a cost of U$$ 0.2 per sample and the commercial kit of U$$7 per sample. [ABSTRACT FROM AUTHOR]

Conclusion: Duffy antigen receptor for chemokines (DARC), as a negative regulator, could attenuate the potential growth and metastasis of laryngeal squamous cell carcinoma (LSCC); hence it could be considered as a basis for a new prognostic aid and molecular therapeutic target in treating LSCC. Objectives: To analyze the role of DARC in LSCC progression using LSCC clinical samples. Methods: A total of 65 LSCC tissues were examined immunohistochemically for DARC protein expression. The microvessel density (MVD) was determined by the endothelial cells immunostained using anti-CD34 antibody. Results: It was found that DARC was expressed in the LSCC samples, with a high expression in 32 of our cases (49.2%), and in lymph node-negative and -positive groups of 24 (72.7%) and 8 cases (25%), respectively ( p < 0.01). MVD was (24.75 ± 5.45)/High power field (HP) and (32.58 ± 5.23)/HP in the cases with high and low expression of DARC, respectively ( p < 0.01). More importantly, the DARC expression presented a strong negative correlation with nodal metastasis, with pTNM stage, and with recurrence, and the cases with a high DARC expression indicated a higher survival rate. In addition, the multivariate analysis showed that the DARC expression was an independent prognostic factor ( p = 0.032; hazard ratio, 21.476; 95% confidence interval, 1.297-355.68). [ABSTRACT FROM AUTHOR]

Conclusion: In this study we found that inflammatory cells may be a source of MMP-9 in laryngeal cancer. MMP-9 was correlated with blood vessel density. MMP-9 may be a potential target to disrupt tumor neovascularization. Objective: To study the expression of MMP-9 in laryngeal cancer and determine a possible relation with blood vessel density. Methods: Immunohistochemistry was used for MMP analysis and for blood vessel detection in 83 laryngeal cancer samples. The density of blood vessels was analyzed with a stereological tool. Results: MMP-9 was detected in inflammatory cells. Positivity for MMP-9 correlated significantly with the grade of differentiation ( p = 0.025). Expression of MMP-9 was not correlated with T stage, nodal metastasis, or tumor recurrence. The mean blood vessel density was 51.4 vessels/mm2. Specimens were more likely to exhibit higher density of blood vessels when MMP-9 expression was also present ( p = 0.014). [ABSTRACT FROM AUTHOR]

Conclusion: Patients showed improved quality of life following tracheal shaving and the carcinoma was well controlled locally, as long as invasion had not progressed to the mucosal surface of the trachea. However, compared with papillary thyroid carcinoma (PTC) with no tracheal invasion, metastasis was common and invasion of organs other than the trachea was frequent, putting many patients into the high-risk group. The clinical course for such patients thus requires careful monitoring, with particular attention to metastasis to other locations. Tracheal shaving can be recommended for patients with PTC with tracheal invasion. Objectives: Macroscopically, in cases where invasion into the trachea has not reached the tracheal mucosa surface, we perform tracheal surface resection (tracheal shaving). We retrospectively investigated rates of local control, metastasis and survival in patients who had undergone tracheal shaving. Patients and methods: Subjects comprised 22 patients with PTC who underwent tracheal shaving between January 1994 and December 2005. Results: Local control was achieved in 21 patients (95%), and metastasis was seen in 6 patients (27%). With two patients dying from causes other than cancer, 5- and 10-year survival rates were 93% and 41%, respectively. The two surviving patients are still cancer-bearing. [ABSTRACT FROM AUTHOR]

Conclusions: Compared with larynx cancers salvage rates are poorer for hypopharyngeal cancers and the role of primary surgery seems to be significantly higher and more decisive in overall survival (OS). Hypopharyngeal cancers therefore warrant a closer follow-up after an organ preservation protocol, to detect recurrence at the earliest stage and plan for an effective salvage surgery. Objective: To evaluate the survival and morbidity of patients treated by surgery for carcinoma of the larynx and hypopharynx according to site. Patients and methods: All patients who had undergone laryngectomy at the Division of Surgical Oncology Regional Cancer Center (RCC) from June 1995 to December 2005 were included in the study, which retrospectively recorded the age and sex distribution, TNM stage, indication, type of laryngectomy and reconstructive option used. The therapeutic outcome, disease-free survival (DFS), OS, voice preservation and postoperative voice rehabilitation were analysed. Results: Of a total of 167 cases, 123 (74%) had salvage surgery for failed chemoradiotherapy/radical radiotherapy and 44 (26%) had primary surgical treatment. Conservation surgery was undertaken in 4 cases, near total laryngectomy or pharyngectomy (NTL/NTLP) was done in 14 and total laryngectomy (TLPE) with gastric pull up was done in 5. Total laryngectomy (TL) or TL with partial or subtotal pharyngectomy was done in 144 cases. Concomitant neck dissection (ND) was done in 46 cases, 14 posterolateral selective, 15 radical neck dissections (RNDs), 2 extended RNDs, 12 bilateral NDs and 3 modified neck dissections (MNDs). Five patients received platinum-based neoadjuvant chemotherapy and nine had postoperative chemotherapy. In 116 patients the pharyngeal remnant was closed primarily, 21 patients had pectoralis major myocutaneous flap patch reconstruction, 18 had tubed pectoralis major myocutaneous (PMMC) flap reconstruction, 4 had folded (bipaddled) PMMC flap reconstruction, 7 had PMMC and 3 patients had deltopectoral (DP) flap for skin cover. Pathological margin positivity was seen in seven cases and perinodal disease was seen in nine. There was a statistically significant survival difference between salvage and primary surgical cases among cancers of the larynx and hypopharynx. Hypopharyngeal salvage rate was significantly lower in the present study. Sixty-two (37%) patients had postoperative leaks. Five leaks persisted to form pharyngocutaneous fistulae. All of these patients had either wound infection with or without flap necrosis or previous radiation. Two were repaired and in two cases speech prosthesis insertion was possible due its anatomical position. One patient refused further surgical closure after a partially failed repair. Fifty-six (34%) patients recurred locoregionally, 4 (2.3%) patients developed a second primary and 5 (2.9%) had distant metastasis. Thirty patients were voice rehabilitated with an electronic larynx. Seventeen patients had voice prosthesis insertion (6 primary and 10 secondary), 3 patients developed good oesophageal speech and voice preservation was possible in 18 patients. Seventy-nine patients were alive at the time of completing the study. [ABSTRACT FROM AUTHOR]

Conclusion. Reconstruction after radical resection for advanced laryngeal and hypopharyngeal cancer can be carried out with low mortality, acceptable morbidity, and a promising functional outcome. Objectives. To evaluate the functional outcome of reconstruction by a free vascularized ileocolic flap after concurrent chemoradiotherapy (CCRT) and surgery for advanced laryngeal and hypopharyngeal cancer. Patients and methods. Fifteen patients (all male, mean age 49.8 years) with squamous cell carcinoma of larynx (n=1) or hypopharynx (n=14) received a circumferential pharyngolaryngectomy and resection of the proximal esophagus followed by postoperative CCRT (60-65 Gy, cisplatin and 5-fluorouracil). A single-stage reconstruction was performed with a free vascularized ileocolic flap using a microsurgical technique. Results. The course of all operations was uneventful. Eight patients were alive at a follow-up of 24 months after operation, while seven patients died from local recurrence, distant metastasis, and suicide. Relief of dysphagia was achieved in 14 cases. Speech intelligibility was recorded in five patients. [ABSTRACT FROM AUTHOR]

Conclusions. In the past 20 years, the level of laryngeal carcinoma treatment in our country has been significantly improved. Early diagnosis is the key for increasing the ratio of larynx preservation surgeries and improving survival rates. The main causes of death within 5 years are local recurrence and metastasis. Objective. To describe the main treatment methods for laryngeal carcinoma in China in the 1980s and 1990s and their prospective effects and investigate the prognostic factors. Patients and methods. A retrospective investigation was performed on the 1115 laryngeal carcinoma patients receiving treatment in the department of ENT of the First Affiliated Hospital of China Medical University during 1983-1996 and the survival rates and causes of death were analyzed statistically. Results. There were 780 patients surviving for more than 5 years, 260 dead patients, and 75 patients lost to follow-up. According to the cumulative survival rate curve, the 5-year survival rate was 77% (94% for stage I, 89% for stage II, 82% for stage III, and 66% for stage IV). Glottic cancer has the highest 5-year survival rate, followed by supraglottic cancer, subglottic cancer, and transglottic cancer. The 5-year survival rate of patients receiving partial laryngectomy was 85%, while the 5-year survival rate of those receiving total laryngectomy was 68%. The leading causes of death within 5 years were local recurrence and metastasis (70%), and the causes of death were unknown in 14% of cases. [ABSTRACT FROM AUTHOR]

Conclusion. While most results concerning DNA and nucleolar organizer region (AgNOR) parameters fit with previous studies, the percentage of aneuploidy looks like a promising prognostic parameter. The observed intratumoral heterogeneity could represent a possible source of conflicting and inconsistent results. Objectives. The aims of our study were to determine the prognostic relevance of different DNA and AgNOR parameters in laryngeal squamous cell carcinoma (SCC) and compare these findings with established prognostic factors including tumor stage and grade, as well as the detection of possible intratumoral heterogeneity. Materials and methods. Sections from 62 laryngeal SCCs were analyzed for DNA content, DNA index, S-phase, percentage of aneuploidy, and AgNOR. Of 62 samples, 31 morphologically similar tumor samples were analyzed for the same parameters in three different tumor areas defined as tumor center, invasive tumor margin, and transformation margin between tumor and normal-appearing mucosa. Results. Our study showed that DNA and AgNOR parameters correlated with T stage, lymph node involvement, and histologic grade regardless of tumor areas. Significant correlation was found between mean number of AgNOR per nucleus and percentage of aneuploidy. Clinical stage and percentage of aneuploidy correlated with survival (p<0.02). Heterogeneity DNA study revealed aneuploidy in central portions of 90% of tumors, while in margins aneuploidy was demonstrated in about half of the patients. [ABSTRACT FROM AUTHOR]

Conclusions: The inducible nitric oxide synthase (iNOS) expression leading to vascular endothelial growth factor (VEGF) overexpression may be useful as a factor for predicting recurrence after initial treatment and prognosis in laryngeal squamous cell carcinoma (SCC). Objective: We analyzed expression of iNOS, p53, and VEGF in various laryngeal lesions. Materials and methods: The study samples consisted of 63 SCC, 20 dysplasia, 7 polyp, and 5 normal epithelium of the larynx. The expression of iNOS, p53, and VEGF was identified by immunohistological methods. Results: No positive immunostaining for iNOS, p53, and VEGF was observed in normal epithelium and polyps. In contrast, with the progression from mild/moderate dysplasia to severe dysplasia to carcinoma, their expression levels increased. In dysplasia, there was a significant positive correlation among expression of iNOS, p53, and VEGF. In SCC, iNOS expression correlated with VEGF overexpression and microvessel density, but not with p53 overexpression. In SCC, the expression of iNOS and VEGF significantly increased in patients who developed local recurrence and/or metastases after initial treatments. Kaplan-Meier analysis showed that disease-free survival was significantly shorter in patients with iNOS or VEGF expression. Multivariate analysis showed expression of iNOS and VEGF as independent indicators for poor disease-free survival. [ABSTRACT FROM AUTHOR]

Human papilloma virus (HPV) has a role in benign and malignant pathology of the larynx. In this review we present the biological and epidemiological aspects related to these issues. [ABSTRACT FROM AUTHOR]

Conclusion. Contrary to most reports, our study shows that the expression of cyclin D1 is not an independent prognostic factor in patients with laryngeal cancer (LC). No correlation between cyclin D1 expression and survival rates in LC was found in a multivariate analysis. Objectives. The aim of this study was to determine the possible relevance of the expression of cyclin D1 protein in LC as prognostic criteria and to analyse correlation of the expression with clinicopathological features and survival rates. Materials and methods. Immunohistochemistry staining was used to detect the expression of cyclin D1 in 130 samples of laryngeal cancer and in 22 specimens of laryngeal nodules. Results. Cyclin D1 expression was found in 52 (40%) LC samples and in 3 (13.6%) samples of laryngeal nodules. There was no significant correlation between cyclin D1 expression and clinicopathological features of LC. A multivariate analysis of survival confirmed that cyclin D1 expression was not an independent prognostic factor in LC. [ABSTRACT FROM AUTHOR]

Conclusion: Modified reconstructive laryngectomy (MRL) with excision of both arytenoid cartilages will expand the range of indications for conservative surgery in the management of cancer of the larynx. Objective: The present work describes a modification of the standard reconstructive laryngectomy procedure, in order to address problems related to aspiration, and to improve functional results. Patients and methods: The study was conducted in Cairo University Hospital. MRL was performed on 14 patients who were scheduled for total laryngectomy. This technique allows for preservation of the superior laryngeal nerves, by fashioning folds of the pharyngeal mucosa to replace the arytenoids. This is followed by reconstruction of the airway through elevation and attachment of the remaining tracheal rings and/or cricoid to the hyoid bone and epiglottis. Results: MRL was successful in all of the 14 patients included in this preliminary study. All of the patients maintained comprehensible speech, and only one required a speaking type of tracheotomy tube. [ABSTRACT FROM AUTHOR]

Conclusions. The incidence rate of hypothyroidism after treatment for laryngeal and hypopharyngeal cancer is high, especially after combination treatment. An association between hypothyroidism and autoantibodies was found. Objectives. The incidences of hypothyroidism and autoantibodies were assessed retrospectively in 156 patients with laryngeal and hypopharyngeal carcinoma who were treated with surgery and/or radiotherapy between 1977 and 2002. Patients and methods. Patients treated for T2–T4 carcinoma or a recurrence after T1 who visited the outpatient clinic for their regular follow-up visit were included. All patients were evaluated for the development of hypothyroidism, defined as increased thyroid-stimulating hormone level (>4.5 mU/L) and the presence of autoantibodies. A questionnaire regarding symptoms was administered. Results. The prevalence of undiagnosed hypothyroidism following treatment of laryngeal carcinoma was 28.2%: 18.6% subclinical hypothyroidism and 9.6% clinical hypothyroidism. The prevalence of circulating antithyroid antibodies (anti-thyreoperoxidase and/or anti-thyreoglobulin) was 10.5%. Univariate analysis showed that patients with laryngectomy, hemithyroidectomy, ipsilateral neck dissection and autoantibodies had a higher risk of hypothyroidism. The combination of surgery and radiotherapy increased the risk. Symptoms such as weight gain and cold intolerance were significantly associated with hypothyroidism. Multivariate analysis showed hemithyroidectomy, autoantibodies, weight gain and cold intolerance to be prognostic factors for the development of hypothyroidism. [ABSTRACT FROM AUTHOR]

Conclusion. This update will enable us to precisely address the involvement pattern of level VI and to standardize treatment procedures in order to refine their indications and eventually improve their results and avoid treatment morbidity. Background. The neck level classification is being used worldwide to describe the lymph nodes status of the neck. It provides standardized data to properly evaluate and then improve our protocols for the management of neck metastasis in an evidence-based medical manner. Although level VI treatment is challenging in cancer of the larynx, pharynx, trachea, esophagus, and thyroid, our knowledge about its involvement relies on few non-standardized data, due to the inadequate definition of this region. Method. We propose an updated radiological and surgical definition of level VI, with the introduction of two sublevels which fulfill surgical, radiotherapy, radiological, and pathological concerns. Results. Level VIa encompasses prelaryngeal, intercricothyroidal, pretracheal, and perithyroidal nodes. Level VIb encompasses inferior laryngeal nodes. Within the traditional limits of level VI, all lymph nodes lying between the inferior border of the hyoid bone and the inferior border of the cricoid cartilage belong to level VIa. Between the inferior border of the cricoid cartilage and the top of the suprasternal notch, lymph nodes lying in front of the posterior face of the thyroid gland belong to level VIa; those lying behind this boundary belong to level VIb. We also discuss the definition of the superior mediastinal lymph nodes, which should not be mistaken for level VI. [ABSTRACT FROM AUTHOR]

Conclusion: It is important to prevent regional lymph node recurrence and distant metastasis to achieve better survival of laryngeal cancer. Objective: Therapeutic outcomes of 130 cases with laryngeal cancer treated at Kyoto University Hospital between 1995 and 2004 were reviewed. Patients and methods: In all, 121 males and 9 females were involved. Their ages ranged from 40 years to 92 years (average 66 years). All tumors were squamous cell carcinoma - arising at the glottis in 111 cases, the supraglottis in 18, and the subglottis in 1 case. Most glottic cancers (77.5%) were classified as stage I or II, while most supraglottic cancers (77.8%) were at stage III or IV. Stage I/II cancers were basically treated by conventional radiotherapy (60-66 Gy) and twice-daily hyperfractionated radiotherapy (70-74 Gy), respectively, attempting to preserve the larynx. Total laryngectomy with neck dissection was performed in the treatment of stage III/IV cases. Results: Five-year disease-specific survival rates were 100%, 96%, 100%, and 68% for stage I, II, III, and IV, respectively. Five-year laryngeal preservation rates were 98%, 100%, 86%, 0%, and 0% for T1a, T1b, T2, T3, and T4 of glottic cancer, respectively. Local recurrence occurred in five cases of stage I/II glottic cancer, which was successfully salvaged. Regional lymph node recurrence occurred in five cases including four patients with glottic cancer and one with supraglottic cancer. Two of them died of disease despite undergoing salvage therapy. Distant metastasis occurred in the lung in four cases including one glottic and three supraglottic cancer patients after initial treatment. [ABSTRACT FROM AUTHOR]

Conclusion. In laryngeal cancer, arachidonic acid may be metabolized to PGE 2 via the cooperative actions of COX-2 and mPGES, which are induced in response to various stimuli. The COX-2-mPGES-PGE 2 system may induce differentiation of cancer cells and prevent metastasis, thus improving the survival rate. Objective. To examine the expression of COX-1, COX-2, and two downstream enzymes – microsomal PGE synthase (mPGES) and PGD synthase (PGDS) – using immunohistochemistry in human laryngeal squamous cell carcinoma (SCC). Patients and methods. Patients with laryngeal carcinoma were referred to the Department of Otolaryngology for treatment. Formalin-fixed, paraffin-embedded laryngeal carcinoma specimens were obtained from 24 patients. Immunohistochemical expression of COX-1, COX-2, mPGES, LPGDS, and HPGDS was investigated in 24 laryngeal carcinoma samples. Results. Among the carcinomas, cytoplasmic immunoreactivity for COX-2 was found in tumor cells in 18 of 24 cases (72%) and that for mPGES in tumor cells in 23 of 24 cases (92%). The localization of mPGES was very similar to that of COX-2. COX-2 in well-differentiated SCCs was higher than in poorly/moderately differentiated SCCs. In terms of lymph node metastasis, there was a significant difference in COX-2 expression. [ABSTRACT FROM AUTHOR]

Conclusion. Cancer of the larynx in elderly patients should be treated with curative intention, if the extension of the primary tumour allows safe resection. Transoral CO 2 laser microsurgery is associated with a low rate of major complications and can be regarded as suitable even for elderly patients. Age itself should never be the sole factor in deciding which therapy should be undertaken. Objectives. In the industrialized nations the age group beyond 75 years will grow steadily, requiring special attention by medical professionals in the future. Nowadays laryngeal cancer is often treated by transoral CO 2 laser microsurgery. Because of a variety of comorbidities, the incidence of perioperative complications in the group of elderly patients is of increasing interest. To date, no references in the literature have discussed complications after transoral CO 2 laser microsurgery in this age group. Patients and methods. Twenty-four patients over the age of 75 suffering from squamous cell carcinoma of the larynx and treated by transoral CO 2 laser microsurgery since 1998 were analysed for intraoperative and postoperative complications. Results. There was no evidence of surgery-related complications at all. Postoperatively, 6 of 24 patients complained about dysphagia. Due to intraoperative placement of nasogastric feeding tubes in these six cases further complications such as pneumonia resulting from aspiration could have been avoided. [ABSTRACT FROM AUTHOR]

Conclusions. This regimen of concurrent chemoradiotherapy was safe and well tolerated. In terms of larynx preservation, the present regimen appears to be useful for patients with advanced resectable squamous cell carcinoma (SCC) of the larynx and hypopharynx. Objectives. To evaluate the efficacy and toxicity of concurrent chemoradiotherapy in patients with advanced resectable SCC of the larynx and hypopharynx, and to demonstrate the feasibility of larynx preservation. Patients and methods. Forty-six eligible patients were treated. The chemotherapy regimen consisted of a combination of four drugs: cisplatin (60 mg/m2, day 4), 5-fluorouracil (5-FU) (600 mg/m2 given continuously for 120 h, days 1–5), methotrexate (MTX) (30 mg/m2, day 1), and leucovorin (LV) (20 mg/m2, days 1–5). Two cycles of this regimen were given every 4 weeks during radiotherapy. Radiotherapy was delivered 5 days a week using a single daily fraction of 1.8–2.0 Gray, to a total dose of 66.6–70.2 Gray. Results. The 3-year disease-specific survival rates of patients with laryngeal or hypopharyngeal SCC were 81.3% and 78%, respectively. The 3-year disease-specific survival rates with larynx preservation of patients with laryngeal or hypopharyngeal SCC were 46.7% and 59%, respectively. The main toxicities were neutropenia, dermatitis, mucositis, and infection. [ABSTRACT FROM AUTHOR]

Conclusion . In patients with early glottic squamous cell carcinoma (SCC) submitted to CO 2 laser endoscopic resection, local disease recurrence was significantly correlated with the presence of positive additional surgical margins on permanent sections. Objectives . To evaluate the rate of cancer recurrence in patients with early glottic SCC submitted to CO 2 laser endoscopic resection according to margin status after resection, stage of disease and postoperative radiotherapy. The rate of larynx preservation and the length of hospital stay were also evaluated. Material and methods . Forty consecutive patients with early glottic cancer were subjected to laser endoscopic resection surgery of glottic cancer followed by frozen-section control of margins, with intraoperative enlargement of margins when positive. Adjuvant radiation therapy or enlargement of previous margins was indicated in the case of positive additional surgical margins on permanent section. Results . Local recurrence occurred in three patients (7.5%), all with positive additional surgical margins on permanent section. Positive additional surgical margins on permanent section were related to 37.5% of recurrences and negative additional surgical margins with 0% of recurrences ( p =0.006). All patients spent at most 1 day at the hospital. [ABSTRACT FROM AUTHOR]

Conclusion. Nuclear expression of survivin should be studied as a promising marker of higher-risk laryngeal basaloid squamous cell carcinomas (BSCCs), which can then be treated more aggressively and followed more closely. Objective. BSCC is an uncommon bimorphic variant of SCC. The hypothesized greater aggressiveness and poorer prognosis of head and neck BSCC compared to SCC are still under debate. The regulation of apoptotic cell death has a profound effect on the pathogenesis and progression of malignancies. Survivin is the smallest member of the inhibitor of apoptosis gene family. The aim of this study was to investigate for the first time the expression of the inhibitor of apoptosis protein survivin in laryngeal BSCCs and their neck lymph node metastases and to compare the results with those obtained with conventional SCCs. Material and methods. Immunoreactivity to survivin was determined in nine laryngeal BSCCs and nine site- and stage-matched SCCs. Results. A nuclear subcellular localization of survivin dominated in both primary laryngeal BSCCs and SCCs and in their lymph node metastases. There was no significant difference in mean survivin expression between primary laryngeal BSCCs (25.1%) and SCCs (25.6%) ( p =0.86). Nuclear survivin expression was significantly higher in BSCCs associated with disease recurrence and poor prognosis ( p =0.02). [ABSTRACT FROM AUTHOR]

Conclusions . The global survival rate was low compared to those reported in the literature, in which the analyzed populations were selected according to the tumor stage or treatment. This study should be prolonged and should also involve other cancer registries in France in order to increase the number of patients and to analyze tumors of comparable stage and therapeutic management. Objective . To analyze the survival rate of a non-selected laryngeal cancer population from the Cancer Registry of the Somme, a French region. Material and Methods . A total of 356 patients were included in a retrospective study covering the period 1987–1997. Survival and prognostic factors were analyzed. Statistical analysis was performed using the Kaplan–Meier method, the Cox model and the χ 2 test. Results . The 5-year global survival rate was 42% for males and 55% for females. Tumor localization, T, N and M stages and surgery were found to be significant prognostic factors. Sex and age were not statistically significant factors. For stage I tumors, surgery alone gave better results than radiotherapy alone in terms of global survival. No difference occurred in terms of local recurrence. A similar comparison was not possible for stage II–IV tumors owing to the small number of cases. [ABSTRACT FROM AUTHOR]

Conclusions . Human papillomavirus (HPV) DNA was detected in 32% of laryngeal carcinoma biopsy samples studied. The genotypes identified were high-risk types, the most frequent being HPV 16. Viral DNA was integrated into the host genome (genotype HPV 16), providing supporting evidence for a role of HPV in the carcinogenic pathway of laryngeal squamous cell carcinoma. Objective . HPV has been detected in laryngeal lesions, both benign and neoplastic, with a variable frequency (8–60%). These viral agents have been proposed as an adjuvant or cofactor in head and neck carcinogenesis because of their oncogenic properties. The aims of this study were to identify HPV in laryngeal carcinoma samples and to describe the physical state of the viral genome, i.e. its integration to the host DNA. Material and methods . Formalin-fixed, paraffin wax-embedded tumor samples from patients with newly diagnosed laryngeal carcinomas were collected. The HPV genome was identified using polymerase chain reaction (PCR) with primers complementary to the conserved region L1 (MY09-11). Genotyping was accomplished by restriction fragment length polymorphism. Samples positive for HPV 16 were assayed by PCR with primers complementary to region E2, interrupted during viral genome integration. Results . Ten of the 31 samples (32%) were positive for HPV DNA and all of the samples were positive for human β-globin. The genotypes identified were HPV 16 ( n =3), HPV 58 ( n =2) and HPV 39, 45, 51, 59, 66 and 69 ( n =1 for each). The three samples positive for HPV 16 had lost region E2, meaning that the viral DNA had been integrated into the host genome. [ABSTRACT FROM AUTHOR]

In most patients with advanced or recurrent laryngeal or hypopharyngeal cancer, total laryngectomy is indicated. This means the loss of three main functions: phonation; respiration; and the prevention of aspiration during deglutition. Laryngectomy patients have various options to restore phonation: an oesophageal voice; an electrolaryngeal voice; or a tracheo-oesophageal voice. In the last case a silicone rubber shunt valve is placed in the tracheo-oesophageal wall and phonation is generated when exhaled air is forced through the oesophagus and neopharynx. This method is widely applied in Western Europe. In this paper we review the literature on fixation problems with shunt valves, tracheostoma valves and heat and moisture exchange (HME) filters. Tracheo-oesophageal speech without a valve is not considered. Despite 22 years of experience with the implantation of tracheo-esophageal shunt valves and many improvements in the design, problems still remain, such as biofilm formation with subsequent leakage through the valve, the need for frequent and inconvenient replacements, fistula enlargement leading to leakage around the device and reduced fixation, and infections. The high cost of shunt valves is a drawback to their use worldwide. To enable hands-free speech, different types of tracheostoma valve have been developed. These valves are fixed to the skin or to the tracheostoma by means of an intra-tracheal device. An HME filter is used to protect the airway and maintain physiological balance. Such devices are only suitable for a selected group of patients as fixation to the skin or trachea can be a major problem. Speaking and coughing cause pressure increases, which often result in mucous leakage and disconnection of the valve and/or HME filter. Recommendations are made for future improvements in fixation techniques. [ABSTRACT FROM AUTHOR]

Conclusions These results suggest that, in selected cases, SCL-CHP may be used to treat laryngeal carcinomas after radiation failure, with good oncological and functional results. Objectives Radiotherapy and surgery are believed to be equally effective and highly successful in the management of T1-staged glottic carcinomas. An almost normal post-therapy voice is considered the main advantage of irradiation over the surgical approach. On the other hand, when a tumour recurs after radiotherapy, it is more likely to extend beyond its original site, making total laryngectomy necessary in most cases. However, in selected cases, conservative laryngeal surgery is possible. At present only a few reports in the literature have documented the oncological and functional outcome of supracricoid laryngectomy with cricohyoidopexy (SCL-CHP) in the treatment of laryngeal recurrence after irradiation. Material and methods We describe seven cases of rT2-T3 laryngeal squamous cell carcinomas that recurred after radiotherapy and were treated with salvage SCL-CHP between 1989 and 1997 at the Department of Otolaryngology, University of Ferrara. The disease-free interval following initial radiotherapy ranged from 13 to 132 months (mean 54 months) in 6 patients; 1 patient underwent 2 courses of irradiation treatment 103 and 8 months prior to surgery. Results The mean post-SCL-CHP follow-up period exceeded 10 years (range 72-173 months). Only the patient who underwent 2 courses of radiation therapy before surgery experienced laryngeal recurrence 48 months after surgery. All patients were decannulated and recovered the ability to swallow. Vocal quality was significantly rough and breathy but was satisfactorily intelligible in all patients. Four patients had wound healing problems; 1 of them developed a laryngotracheocutaneous fistula 15 months after SCL-CHP as a consequence of chondronecrosis, prompting total laryngectomy. [ABSTRACT FROM AUTHOR]

Laryngeal paragangliomas are rare submucosal lesions that arise from paraganglion cells located in the false vocal fold and subglottic larynx. To date, 76 recognized cases have been reported in the world literature. Symptoms arise when the lesions become large enough to impair function. Supraglottic paragangliomas cause hoarseness and deglutition disorders, whereas subglottic tumors become symptomatic when they obstruct the airway. Evaluation of these tumors includes obtaining a complete history. Familial paragangliomas and hypertension should be sought but are rarely, if ever, associated with laryngeal paragangliomas. MRI can detect these lesions and permit characterization of the vascularity of the lesion. Adding 111 In pentetreotide scanning can distinguish neuroendocrine tumors from other submucosal laryngeal lesions, making the preoperative diagnosis clearer and obviating the need for biopsy. The biggest dilemma regarding laryngeal paragangliomas is making the correct pathologic distinction between paraganglioma, typical carcinoid, atypical carcinoid and medullary thyroid cancer. Immunohistochemical markers, supplementing standard histopathologic evaluation, can distinguish paragangliomas from the aforementioned tumors. This distinction is critical as the prognosis for treated paragangliomas is excellent compared to that for other neuroendocrine neoplasms. Almost all alleged malignant paragangliomas of the larynx are in reality atypical carcinoid tumors that have been misdiagnosed. Treatment should always comprise excision. Thyrotomy has the best chance of achieving a sustained cure without damaging phonation or deglutition. Laser excision has been used successfully but there is no great experience with this modality. Surgery is preferable to radiation for paragangliomas in all locations but especially so in the larynx, due to issues such as swelling, airway protection and destruction of cartilage. With increased clinical suspicion and the use of modern imaging techniques, laryngeal paragangliomas should be routinely diagnosed and treated without loss of laryngeal functions. [ABSTRACT FROM AUTHOR]

Objective Among detractors of elective neck (N0) treatments, most suggest that lymphadenectomy removes a barrier to the spread of disease with deleterious immunologic consequences. To test this hypothesis we performed a retrospective comparison of the survival results of N0 laryngeal cancer patients who received unnecessary elective neck treatments (N0-) and those of N0 patients subjected to close and regular follow-up. Material and Methods A retrospective chart review of 749 N0 laryngeal cancer patients treated at the Institute of Otolaryngology--Head and Neck Surgery, University of Florence between January 1980 and January 1993 was performed. Of these, 245 (33%) received elective neck dissection (ED), while the remaining 504 (67%) N0 patients were subjected to close and regular follow-up (wait-and-see policy; WS). Results Of the 245 ED patients, 43 (17.5%) showed an occult neck disease, while of the 504 WS subjects, 83 (17%) developed neck metastases during follow-up. Moreover, 15 ED patients subsequently experienced a contralateral occult failure despite a unilateral negative neck specimen (N0-). Thus, ultimately 187 ED (164 of whom were treated unilaterally and 23 bilaterally) and 421 WS patients were used for survival analysis. No differences in terms of postoperative complications, local or distant failure or disease-free or overall actuarial survival were found between the two groups analyzed. Conclusions These data indicate that unilateral or bilateral removal of cervical lymphatics in the absence of histologically proven lymph node metastases does not negatively affect the prognosis of N0 laryngeal cancer patients who were overtreated to the neck. [ABSTRACT FROM AUTHOR]

Objectives To calculate recurrence, mortality and complication rates and evaluate postoperative voice quality after laser resection of T 1a glottic carcinoma. Material and Methods Since 1995 we have treated 118 patients with a T 1a glottic carcinoma with laser surgery. In order to evaluate postoperative voice quality, patients who were alive and free of recurrence were sent the Voice Handicap Index (VHI) questionnaire containing 30 questions concerning how their voice affects their daily life physically, emotionally and socially. Results Twelve patients (10%) had a local recurrence and received further treatment, either a second laser treatment, radiotherapy or a total laryngectomy. One patient (0.84%) died due to the laryngeal cancer. Ninety-nine patients were sent the VHI questionnaire and 94 of the completed questionnaires were included in the study and analyzed. The mean total score was 13.2, with mean subscores of 6.5 (physical), 4.1 (functional) and 2.5 (emotional). Conclusions The results indicate that these patients as a group do not consider that their voice has a negative impact on their daily life. Good surgical technique is essential to obtain a good functional result. The laser strength should be kept low and the surgical margins small in order to minimize scarring and vocal cord stiffness. [ABSTRACT FROM AUTHOR]

Osseous or chondroid metaplasias are uncommonly found adjacent to laryngeal squamous cell carcinoma (SCC). These findings are less unusual in the spindle cell variant. We describe a moderately differentiated laryngeal SCC associated with osteocartilaginous metaplasia of the adjacent stroma which exhibited very similar morphologic changes and mitoses to an osteosarcoma. These uncommon findings can be more clearly understood if they are viewed as changes determined by the microenvironment of the tumour-host interface, as indicated in recent studies. Tumour cells seem able to regulate stromal development and differentiation via the release of growth factors and the induction of growth factor receptor expression on the cell surface. Irrespective of the limited number of reported cases, the association of SCCs of the larynx with osteocartilaginous metaplasia does not seem to support the adoption of treatments of choice that differ in approach to those for site- and stage-matched SCCs without osteocartilaginous metaplasia. [ABSTRACT FROM AUTHOR]

Open supraglottic laryngectomy is an oncologically sound surgical procedure for selected cases of laryngeal cancer which maintains physiologic speech and swallowing without the need for a permanent tracheostoma. The oncologic principles, techniques for resection and reconstruction, postoperative management and complications are discussed. [ABSTRACT FROM AUTHOR]

Objective To investigate the outcome of surgically managed laryngeal carcinoma patients attending an outpatient clinic over a 5-year period. Material and Methods This was an analytical, retrospective, cross-sectional study. A total of 36 laryngeal carcinoma patients who were managed surgically with or without radiotherapy were analyzed. Results A total of 32 patients (89%) were found to be disease-free during follow-up for up to 5 years. Two patients (5.5%) died because of intercurrent infection and recurrence of the disease and two (5.5%) were lost to follow-up 5 and 7 months after surgery, respectively. Conclusions The results indicate that the best disease-free rates can be achieved by managing laryngeal carcinoma surgically with or without radiotherapy depending on the advancement and aggressiveness of the disease. [ABSTRACT FROM AUTHOR]