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PubMed1986

Twice-a-day radiation therapy for supraglottic carcinoma.

This is a report of a group of 106 patients with supraglottic carcinomas treated by the twice-a-day radiation therapy program at the Massachusetts General Hospital from October 1979 through April 1984. The program consisted of 1.6 Gy per fraction, 2 fractions a day, 5 days a week for a total of 64 Gy with 2 weeks rest after the twelfth b.i.d. day. The local control of this group of patients was compared to that of 79 patients treated by the conventional once-a-day program with a daily fraction of 1.8 Gy for a total of 65 Gy, at the same institution during the 4 years immediately prior to the b.i.d. program. The 3 year actuarial local control rate for the entire group following the twice-a-day program was 76% as compared to 50% after the once-a-day program. The difference was significant, p = 0.001. For the T1 and T2 lesions, the corresponding rates were 88 and 63%, respectively, with a p value of 0.029. The rates for T3 and T4 lesions were 66 and 33%, respectively, p = 0.0037. The study indicated that the twice-a-day radiation therapy program as outlined is effective in treatment of supraglottic carcinoma, and is more markedly effective in advanced lesions. Late radiation effects are minimal and salvage surgery is possible for radiation therapy failures. To date, no patient developed radiation myelitis following the b.i.d. program with the dose to the spinal cord limited to 38.4 Gy in 2.5 weeks.

Female↗
PubMed1987

The problem of neck relapse in early stage supraglottic cancer--results of different treatment modalities for the clinically negative neck.

We reviewed the records of patients with Stage I and II epidermoid carcinoma of the supraglottic larynx treated at the Memorial Sloan-Kettering Cancer Center (MSKCC), New York, and at the Rotterdam Radio-Therapeutic Institute (RRTI), The Netherlands, between 1965 and 1979. At the MSKCC the treatment modality of choice for the primary tumor as well as for the neck had been surgery; of the 79 patients treated by surgery an elective neck dissection was performed on 31 patients. At the RRTI, however, the initial treatment for the primary tumor and the neck is radiation therapy. One-hundred and one patients were treated of whom 79% (80/101) had radiation therapy to the primary tumor as well as to both sides of the neck. This paper focuses on the problem of relapse in the neck, thus comparing patients treated in two large cancer centers by different treatment philosophies, that is elective neck dissection on one side of the neck versus elective radiation therapy to both sides of the neck. Twenty-nine percent of the patients from MSKCC (23/79) relapsed in the neck. The relapse rate was identical between the patients who did not have an elective radical neck dissection, and those who did. Among the patients who relapsed in the neck 65% (15/23) have died of the cancer, while among those who did not, none has died of supraglottic larynx cancer. Twenty-three percent (23/101) of the patients of the RRTI relapsed in the neck. Those who received radiation therapy to the primary tumor only relapsed regionally in 38% (8/21); treatment of both sides of the neck reduced the incidence of nodal recurrence to 19% (15/80). The majority of patients who relapsed in the neck eventually died of the cancer, that is 57% (13/23). Data from both institutions once again demonstrate the impact on survival of a relapse in the neck. Best strategies for decreasing the relapse rate in the neck are discussed; the conclusion was reached that, so far, elective radiation to both sides of the neck is the preferable treatment.

Adult↗
PubMed1987

The prognostic significance of lymph node involvement in pyriform sinus and supraglottic cancers.

Three hundred and thirty-three patients with carcinoma of the pyriform sinus or supraglottis were reviewed with regard to lymph node involvement and prognosis. All patients were treated with curative intent and had a minimum follow-up of 3 years. Every patient was restaged according to the AJCC, 1983 recommendations. In addition, nodal fixation to cervical fascia or muscle was evaluated with regard to prognosis. Seventy-five percent (89/119) of the pyriform sinus cancer and 47% (101/214) of the supraglottic cancer patients presented with clinically palpable cervical nodes. The distribution of patients according to N stage was 143 (43%), 84 (25%), 58 (17%), 48 (14%) for N0, N1, N2, N3 respectively. In patients where information on nodal fixation was available, 29% had fixed nodes. No difference in prognosis was noted between N0 and N1 or N2 and N3 stages, and these groups were therefore combined. The 3-year survival was 85% for T1 (N0/N1), 77% for T2 (N0/N1), 63% for T3 (N0/N1), and 65% for T4 (N0/N1) cases compared to 19% for T1 (N2/N3), 34% for T2 (N2/N3), 33% for T3 (N2/N3), and 32% for T4 (N2/N3) cases demonstrating that N stage predominates over T stage with respect to survival. Both the local recurrences and distant metastases increased as N stage advanced. A noteworthy difference between patients with fixed nodes and mobile nodes was found with regard to neck recurrence (35% versus 17%), distant metastases (33% versus 19%) and survival (27% versus 58%). In conclusion, nodal stage is a highly significant determinant of survival independent of T stage in cancers of the pyriform sinus and supraglottis. N0, N1 status and mobility were predictive of a favorable prognosis as opposed to N2, N3 status and fixation. These findings were consistent when the pyriform sinus cancers and supraglottic cancers were analyzed separately.

Humans↗
PubMed1990

Irradiation alone for supraglottic larynx carcinoma: can CT findings predict treatment results?

Between January 1982 and December 1986, 54 patients with squamous cell carcinoma of the supraglottic larynx were treated for cure with radiation therapy alone; all had a minimum 2-year follow-up. For 31 patients, high-quality pretreatment CT scans were available for review. Scans were retrospectively evaluated by a single radiologist for the percentage of preepiglottic space involvement by tumor, the percentage of paralaryngeal space involvement, and the total tumor volume in cubic centimeters (cc). Volume was measured using a computer digitizer for each CT slice showing tumor. Results showed a significant difference in local control for tumors less than 6 cc versus tumors greater than or equal to 6 cc (15/18 or 83% vs 6/13 or 46%; p = .038). This difference was independent of both T stage and primary site. For T3 lesions, there was a trend toward decreased local control with increasing percentage of preepiglottic space involvement (0-25% = 85% local control; greater than 25% = 60% local control; p = .384); in most cases, however, the amount of preepiglottic space involvement reflected tumor volume (0-25%, 8/12 or 67% of tumors were less than 6 cc; greater than 25%, 7/10 or 70% of tumors were greater than or equal to 6 cc). There was no clear association between degree of paraglottic space involvement and local control. Tumor volume did not correlate with complications of treatment. Because of the limited number of patients in the current study, conclusions should be considered preliminary. However, the data do suggest that pretreatment CT findings, particularly tumor volume, can predict the likelihood of local control with radiation therapy alone for squamous cell carcinoma of the supraglottic larynx.

Carcinoma, Squamous Cell↗
PubMed1995

Salvage surgery following radiation failure in squamous cell carcinoma of the supraglottic larynx.

PURPOSE: We analyzed the clinical course of patients who developed local (primary) recurrence following high-dose irradiation of squamous cell carcinoma of the supraglottic larynx. METHODS AND MATERIALS: Between October 1964 and July 1991, 206 patients with previously untreated squamous cell carcinoma of the supraglottic larynx underwent radiotherapy with curative intent. Local failure occurred in 46 (22%) patients. Successful surgical salvage was defined as no evidence of recurrent cancer for at least 2 years after salvage surgery and continuously thereafter. RESULTS: Sixteen patients did not undergo salvage surgery because of refusal (7 patients), severe medical illness (2 patients), concurrent distant metastasis (5 patients), or unresectable neck disease (2 patients). Twenty-six patients underwent total laryngectomy, and 4 patients had a voice-sparing procedure. Successful salvage was achieved in 50% of patients who underwent surgery. The rate of successful salvage did not correlate with preirradiation T-stage or time to failure after irradiation. Most of the failures after surgery were because of failure to control the primary cancer. The overall rate of postsurgical complications was 37%. No operative or perioperative deaths occurred. The 5-year survival rate for all 46 patients, calculated from the date of irradiation failure, was 20%, while the 5-year survival rate after salvage surgery for the 30 patients who underwent the procedure was 29%. CONCLUSION: There are few data in the literature regarding the clinical outcome in patients whose tumors are not controlled by initial radiotherapy. In the current and previous series, one-half to two-thirds of patients who developed primary failure underwent salvage surgery, which was successful in approximately half of the operated patients, leading to a 25-30% rate of long-term disease-free survival among the entire group of patients who developed failure.

Adult↗
PubMed2004

Traumatic supraglottitis.

Traumatic supraglottitis may occur after mechanical, thermal, chemical, or other airway injury. It can be managed following the principles used for managing the airways of patients with infectious supraglottitis. A protocol for evaluation and management is described.

Airway Obstruction↗
PubMed2004

c-met overexpression in supraglottic laryngeal squamous cell carcinoma and its relation to lymph node metastases.

BACKGROUND: The c-met oncogene encodes the receptor for the hepatocyte growth factor/scatter factor (HGF/SF), which is known to have the effects of stimulation of cell motility, dissociation of epithelial sheets, invasion of cellular matrix, and induction of angiogenesis. Many studies in solid tumors have indicated a role for c-met and HGF/SF in the progression of the disease. METHODS: The expression of c-met in tissue specimens was studied by immunohistochemical examination in 60 patients with supraglottic laryngeal squamous cell carcinoma. Patients were chosen such that there were 30 with lymph node metastases in the neck and 30 without metastases. TNM staging, differentiation, lymphovascular and perineural invasion, and growth pattern for tumors were also recorded, and their relation to lymph node metastases was analyzed. RESULTS: Overexpression of c-met was observed in 90% of the cases at the primary site and in 83% of the cases with lymph node metastases in the neck. Lymphovascular invasion (P = 0.005) and the N stage (P = 0.001) were found to be related to lymph node metastases, but other variables-c-met overexpression, the T stage, perineural invasion, and growth pattern-were found to have no relation to lymph node metastases in multivariate analysis of the data with linear regression. CONCLUSIONS: c-met overexpression is observed in both the primary site and the neck in supraglottic laryngeal squamous cell carcinoma. We believe that it may have a role in the progression of malignancy, but we were unable to find a definite relation between c-met expression and lymph node metastases.

Carcinoma, Squamous Cell↗
PubMed2004

c-myc and bcl-2 Expression in supraglottic squamous cell carcinoma of the larynx.

OBJECTIVES: To evaluate the expression and prognostic significance of c-myc and bcl-2 oncogenes in squamous cell carcinoma (SCC) of the supraglottic larynx. Study design A retrospective cohort study of 61 patients who underwent surgery for SCC of the supraglottic larynx. Gender, age, TNM status, operative procedure, recurrences, and disease-free survival periods were recorded. METHODS: Hematoxylin and eosin-stained sections were reexamined for grade, invasion of tumor margins, lymphovascular invasion, lymphocyte infiltration, and perineural invasion. Immunohistochemical detection of c-myc and bcl-2 oncogenes was performed using monoclonal antibodies. RESULTS: No correlation was observed between either c-myc or bcl-2 and the clinical and histopathologic parameters. Survival analysis revealed no correlation of either c-myc (P = 0.88) or bcl-2 (P = 0.85) with the disease-free survival. c-myc expression was found to be significantly higher in bcl-2-positive patients (P = 0.001). CONCLUSION: Neither c-myc nor bcl-2 had shown to be prognostic factor for laryngeal carcinoma in this present study. Correlation between c-myc and bcl-2 supports the experimental observations of cooperative action between these two genes in tumorigenesis.

Adult↗
PubMed2005

Antigen challenge induces a supraglottic but not a subglottic edema in the rat larynx.

OBJECTIVE: To examine the reaction of mast cells in the larynx of sensitized rats after allergen challenge and determine whether a type I hypersensitivity reaction can elicit a supraglottic and subglottic edema. STUDY DESIGN: Rats were sensitized with ovalbumin (OA) and challenged 3 weeks later by intravenous injection of either OA or NaCl and perfused with glutaraldehyde. The larynges were removed and processed for light and electron microscopy. Sections from the epiglottis and subglottic region were examined. RESULTS: In challenged animals, the connective tissue mast cells (CTMC) in the epiglottic submucosa, but not the mucosal mast cells (MMC) in epithelium, were significantly reduced compared with the case of controls, and the connective tissue was edematous. In the subglottic region, the number of both MMC and CTMC was reduced (albeit not significantly), and there was no edema in the lamina propria. CONCLUSIONS: Allergen challenge induces a marked edema in the epiglottis but not in the subglottic area. SIGNIFICANCE: The results indicate that the supraglottic and subglottic regions react differently to allergen challenge.

Animals↗
PubMed2004

Molecular profiles as predictive marker for the effect of overall treatment time of radiotherapy in supraglottic larynx squamous cell carcinomas.

BACKGROUND AND PURPOSE: Reduction of the overall treatment time of radiotherapy increases the probability of local tumour control, but it does not benefit all patients. Identification of molecular marker profiles may aid in the selection of patients likely to benefit from accelerated radiotherapy. PATIENTS AND METHODS: Two hundred and nine patients with SCC of the supraglottic larynx received primary radiotherapy in the randomised DAHANCA trials to 66-68 Gy, 2 Gy/fx but with different overall treatment times of 9.5 week, 6.5 week and 5.5 week. Formalin-fixed paraffin embedded tumour slides were assessed by immunohistochemistry for expression of EGFr, E-cadherin, KI-67 and Bcl-2 and the TP53 mutation profile was determined using PCR-amplification, DHPLC and sequencing. The profiles were established using a hierarchical clustering algorithm with a Bayesian information criterion for cluster number optimisation. RESULTS: Full data-set were available for 158 patients and four almost equally sized clusters were identified. One of these clusters differed significantly with respect to local control compared to the other clusters: the cluster (n=36) characterised by wild type TP53, low expression of E-cadherin and Bcl-2, moderate KI-67 and EGFr, was not influenced by a reduction in the overall treatment time (P=0.6) whereas the other clusters showed an increase in local control when the overall treatment time of radiotherapy was reduced. This was also partially seen with disease specific survival as the endpoint. CONCLUSIONS: Molecular marker profiling may aid in the selection of patients that will benefit of a reduction in overall treatment time of radiotherapy in SCC of the supraglottic larynx.

Algorithms↗
PubMed2002

[Prognostic significance of the expression of adhesion molecules E-cadherin, Cd44s and CD44V6 in supraglottic squamous carcinoma].

OBJECTIVE: To establish the prognostic significance of the expression of adhesion molecules E-cadherin, CD44s and CD44v6 in squamous cell carcinomas of the supraglottic larynx. MATERIAL AND METHODS: The expression of the studied molecules was determined by immunohistochemistry in paraffin-embedded tissue specimens from 101 patients. RESULTS: The expression of the three molecules was reduced in carcinomas compared to normal epithelium. The cases with recurrence showed an E-cadherin and CD44s expression significantly lower than those cases without recurrence. Reduced expression of any of the three molecules correlated with a decrease in survival, although the differences were not significant. In multivariate analysis only nodal stage (N) was an independent prognostic factor. CONCLUSIONS: Although reduced expression of E-cadherin, CD44s and CD44v6 seems to be related to a poor prognosis in supraglottic squamous cell carcinomas, these changes do not offer a useful adjunct to current prognostic indicators.

Adult↗
PubMed2005

[Functional outcomes of transoral laser surgery of supraglottic carcinoma].

OBJECTIVES: To analyse the functional outcome of patients with supraglottic carcinomas treated by transoral laser surgery. METHODS: The clinical records of 55 patients who underwent transoral laser surgery were reviewed. Swallowing capacity, surgical complications, requirements for tracheotomies, percentage of decannulations, laryngeal paralysis, stenosis, aspiration associated pneumonia, time to remove the nasogastric tube and postsurgical stay in hospital were the studied variables. RESULTS: 52% of the patients had a normal or within functional limits swallowing performance. 18% suffered aspiration pneumonia. 13% developed a laryngeal stenosis. 7% suffered of laryngeal palsy. 18 tracheostomies were performed, of them 10 could be reverted. The mean time to remove the nasogastric tube was 9 days. The mean hospital stay was 23 days. CONCLUSIONS: The main functional advantages of transoral laser surgery for supraglottic carcinoma, when compared with the conventional approach, are a lower incidence of temporary tracheotomies, a faster removal of the nasogastric feeding tube, and a lower incidence of pharyngocutaneous fistulas (0%).

Adult↗
PubMed2003

Occult supraglottic lymphatic malformation presenting as obstructive sleep apnea.

Sleep disordered breathing and obstructive sleep apnea is commonly encountered in the pediatric population. In many cases, it is the result of oropharyngeal obstruction secondary to adenoidal or adenotonsillar hypertrophy. We describe an unusual case of a child with adenoidal hypertrophy who had an occult supraglottic lymphatic malformation that manifested as obstructive sleep apnea. The management of this lesion is discussed including the use of endoscopy, carbon-dioxide laser, and the decision to avoid a tracheotomy. Occult supraglottic lymphatic malformations (LMs) are a rare cause of obstructive sleep apnea, the diagnosis of which will be missed without fiberoptic laryngeal examination. They are challenging to manage because of the airway involvement and propensity to recur.

Child, Preschool↗
PubMed1997

Horizontovertical laryngectomy for supraglottic carcinoma.

Recent decades have seen the expansion of indications for partial laryngectomy. This study focused on the application of horizontovertical laryngectomy for T2 and selected T3 and T4 supraglottic carcinomas. An osteomuscular flap was designed to reconstruct the laryngeal defect to preserve all the essential laryngeal functions. Seventy-six patients treated between November 1979 and October 1990 were reviewed retrospectively. All but two were followed up for at least 5 years. There were 11 cases of T2, 57 cases of T3, and 8 cases of T4 tumors. The survival rates of 7 cases of stage II, 56 cases of stage III, and 13 cases of stage IV carcinoma were 100%, 84.3%, and 74.3%, respectively. The functional recovery was satisfactory; 78.4% of 74 patients underwent decannulation, and all but one patient resumed a normal diet. This study showed that conservation surgery is reliable for selected supraglottic cancers, even for those lesions that extend beyond the confines of the supraglottis.

Adult↗
PubMed1997

Endoscopic laser resection of supraglottic carcinoma.

Forty-six patients with infiltrating supraglottic carcinoma were treated prospectively for cure between 1986 and 1992 with transoral laser resection of the primary. Nine primaries were classified as T1, and 37 as T2. Thirty-three had staged unilateral or bilateral neck dissections, and 16 had postoperative radiotherapy. All patients were followed up for 2 to 8 years unless they died. Of the 46 patients, 33 are alive without disease, 8 died with disease, and 5 died of intercurrent disease. Among the 8 patients who died with disease, 4 had uncontrollable local or regional recurrences, and 4 had distant metastases but were free of local or regional recurrence. Calculated overall survival was 59% and adjusted survival was 72% after 5 years. Four patients had tracheostomies perioperatively, and 2 required temporary postoperative tracheostomies. The remaining 40 patients needed no artificial airway other than orotracheal intubation for the endolaryngeal intervention. Thirty-seven patients relearned undisturbed deglutition within 2 weeks from surgery, and 4, within 4 weeks. However, 5 (10.9%) patients failed to relearn swallowing and consecutively underwent "completion" total laryngectomy. Among them were the two patients who had previously had unsuccessful surgical or radiologic treatment of their primaries and the patient with a history of oral cavity carcinoma. This study confirms that transoral laser resection can effectively control early supraglottic carcinoma. Tracheostomies are not routinely required, and phonatory function is not compromised. However, transoral laser resection could not steadily preserve undisturbed deglutition in the patients included in this study. Patients with histories of unsuccessful attempts of other larynx-sparing therapeutic modalities or of previous major head and neck interventions were not successfully managed with transoral laser resection in this series. Criteria for patient selection remain to be established.

Adult↗
PubMed1980

Acute infectious supraglottitis in adults.

We report two cases of acute infectious supraglottitis in adults seen recently in our emergency department. The recent literature appropriate to the diagnosis and treatment of the entity is reviewed. In each of our cases the diagnosis was established with indirect laryngoscopy in the emergency department and appropriate therapy instituted without delay. Supraglottitis in adults is increasing in prevalence and emergency physicians must be familiar with the diagnosis and early management of such patients.

Acute Disease↗
PubMed2002

Supraglottic carcinoma: patterns of failure and salvage treatment after curatively intended radiotherapy in 410 consecutive patients.

PURPOSE: In a series of consecutive patients with squamous cell carcinoma of the supraglottic larynx, in which almost all were treated by primary radiotherapy, the study describes the path from diagnosis to cure or death, and evaluates the patterns of failure and the treatment of recurrences. METHODS AND MATERIALS: The analysis included 410 patients, 104 females and 306 males, treated between 1963 and 1991. Most patients were in Stage I (33%), and the remaining were in Stage II (18%), III (23%), and IV (26%). Primary intended curative treatment was delivered in 398 (radiotherapy, 394; surgery, 4) of 410 cases (98%). RESULTS: Initial radical treatment resulted in 173 cured patients and 225 patients with a recurrence. Curatively intended salvage could be applied in 158 patients: surgery in 154 patients (74 cured) and radiotherapy in 4 (none cured). Overall, 247 patients (60%) obtained tumor control, 179 (44%) without a laryngectomy. Sixty-three patients had a total laryngectomy, and five had a partial laryngectomy. The 5-year locoregional tumor control, disease-specific survival, and overall survival rates were 43%, 61%, and 47%, respectively. With a follow-up of 20 years posttreatment, 91 new primary malignant tumors were detected. CONCLUSIONS: Radiotherapy is effective in the treatment of supraglottic laryngeal carcinoma, and the patients have a relatively good prognosis. Many patients retained their larynx intact. Recurrence after primary radiotherapy can be treated by surgery, with a high success rate even in advanced stages. Development of second primary cancer is a growing problem.

Adolescent↗
PubMed1998

Primary radiotherapy of carcinoma of the supraglottic larynx--a multivariate analysis of prognostic factors.

PURPOSE: The aim of this study was to analyze the importance of different possible prognostic factors in cancer of the supraglottic larynx. METHODS AND MATERIALS: Nine hundred thirty-two patients with carcinoma of the supraglottic larynx were consecutively treated at The Finseninstitute in Copenhagen between 1966 and 1991. Of the patients, 768 treated with radiotherapy only were eligible for a multivariate Cox regression analysis of prognostic factors with local-regional control as endpoint. Of these, 73% (561) were men and 27% (207) women. Twelve factors: Age; gender; tumor size; site; T category (UICC78); nodal involvement (UICC 78); stage (UICC78); treatment period; tumor surface appearance; histopathologic differentiation; cord mobility; and hemoglobin level were tested. RESULTS: Only gender, T, N, and size proved to have independent significant prognostic importance in the multivariate analysis. A hazard index including these four factors for each patient was calculated, and eight risk groups formed. When the relative risks (RR) for these groups were plotted against the corresponding 5-year local-regional control failure rates, a very simple equation for the risk of failure could be derived as: 5-year local failure risk = 0.2 + 0.1 RR. CONCLUSION: We recommend that this estimation of an individual patient's risk of failure should be implemented in future clinical decision making.

Adult↗