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PubMed1984

Squamous cell carcinoma of the supraglottic larynx treated with radical irradiation: analysis of treatment parameters and results.

Eighty-one patients were treated with radical radiation therapy, with or without immediate neck dissection(s), for squamous cell carcinoma of the supraglottic larynx from October 1964 through May 1981. There is a 2-year minimum follow-up on all patients; 75/81 (93%) have a minimum 3-year follow-up, and 58/81 (72%) have at least a 5-year follow-up. Patients were staged according to the 1983 AJCC staging system. Patients were excluded from the local control analysis if they died less than 2 years from treatment with the primary site controlled. The initial local control rates and ultimate local control rates after surgical salvage of irradiation failures were as follows: T1, 11/12 (92%) and 12/12 (100%); T2, 20/26 (77%) and 23/26 (88%); T3, 9/14 (64%) and 11/14 (79%); and T4, 2/11 (18%) and 5/11 (45%). The incidence of severe complications was 3/81 (3.7%). The 5-year absolute and determinate survival rates by AJCC stage were as follows: I, 6/12 (50%) and 6/6 (100%); II, 5/6 (83%) and 5/5 (100%); III, 4/8 (50%) and 4/5 (80%); and IV, 6/32 (19%) and 6/26 (23%).

Carcinoma, Squamous Cell↗
PubMed1985

Relationship between lymph nodal status and primary tumor control probability in tumors of the supraglottic larynx.

A retrospective review of 248 patients with squamous cell carcinoma of the supraglottic larynx was undertaken to determine the relationship between the probability of control of the primary lesion, the extent of neck nodal disease at initial presentation, and its ultimate control. All patients were treated at the U.T. M. D. Anderson Hospital between 1960 and 1980, and had a minimum of 3 years follow-up. The primary lesion was staged T1 in 38 patients, T2 in 132, T3 in 50 and T4 in 28. The initial volume of neck nodal disease was scored on a scale of 0 (no palpable nodes) to 9 (bilateral neck nodes greater than 6 cm in diameter). All primary lesions were treated definitively with megavoltage radiation therapy. Treatment to the neck varied according to the extent of lymph node involvement. There was no significant difference in the range of total radiation doses delivered to the primary lesion, stage for stage, in patients who presented with clinically negative or positive nodes, or in those with controlled versus uncontrolled neck disease. Analysis of the probability of primary tumor control was made by life table methods because of the poorer survival expectation in node positive patients. For T1 and T2 primary lesions, any positive node decreased the probability of primary tumor control (p = 0.06). For T3 and T4 lesions, a single node less than 3 cm in diameter did not worsen the chance of primary tumor control, but any greater degree of lymph node involvement did (p = 0.03). For both T stage groupings, the probability of primary tumor control at 5 years decreased progressively with increasing neck nodal disease. Primary tumor control probability was also significantly associated with control of the neck disease, independent of the modality of neck treatment. No correlation could be demonstrated between the histological grade of the primary tumor and initial lymph node status or tumor control probability. Possible interpretations of this manifestation of biological heterogeneity are discussed.

Biopsy↗
PubMed1987

Squamous cell carcinoma of the supraglottic larynx treated with surgery and/or radiation therapy.

This is an analysis of 195 patients with squamous cell carcinoma of the supraglottic larynx treated with curative intent at the University of Florida between October 1964 and February 1984. The patients were staged according to the AJCC staging system. There was a minimum follow-up of 2 years, with 76% having at least a 5-year follow-up. Patients were treated with preoperative irradiation and resection (28), surgery and postoperative irradiation (35), surgery alone (26), or radiation therapy alone, with or without neck dissection(s) (106). This paper will compare the rate of local-regional control, the incidence of complications, voice preservation, and survival for radical irradiation, as opposed to surgery, with or without adjuvant irradiation.

Carcinoma, Squamous Cell↗
PubMed1988

Cancer of the supraglottic larynx treated by radiotherapy exclusively.

Seventy-six cases of squamous cell carcinoma of the supraglottic larynx treated by radiotherapy exclusively and followed for at least 3 years are reported. High doses, close to the maximum tolerable, were used with the shrinking field technique with no attempt at prophylactic whole neck irradiation. T1 and T2 cases represented 40% of the whole group and 40% of the patients presented clinically positive neck disease. This latter group had a significantly lower cure rate (42.8%) than the N0 patients (88.3%). Disease control depended also on the T stage: all 30 T1 and T2 lesions, 18/22 (81.8%) of the T3, and 6/17 (35.3%) of the T4 lesions were controlled. Cord fixation and early cartilage destruction were not a major obstacle for tumor control. Base of tongue involvement and especially the T4 and N3 association were indications of poor prognosis. Adenopathies smaller than 3 cm were controlled in 14/16 cases while nodes greater than or equal to 3 cm were controlled in 5/11 cases. Failures in neck nodes outside the treatment field were encountered in 7% of the cases but as the sole element of failure they represented 5.6%. Absolute survival at 3 years was 69.7% for the whole series while loco-regional control was 74.6%. No patient was salvaged by surgery. Three loco-regional recurrences occurred 3 years after the treatment. Although no lethal complications were encountered severe late reactions were noted in about 20% of the patients with controlled primary lesion, requiring tracheostomy in 4 cases (7%). Treatment guidelines are suggested: T1, T2, & T3 lesions associated with adenopathy smaller than 3 cm should be treated by radiotherapy. Limited extra laryngeal extension especially to cartilage can still be controlled by irradiation. More advanced cases, especially the subcategory of T4 N3 patients, should have a multidisciplinary approach. After high doses of irradiation only limited surgery is permissible.

Adult↗
PubMed1989

Hyperfractionated radiotherapy in the treatment of squamous cell carcinomas of the supraglottic larynx.

From January 1984 through December 1987, 41 patients with squamous cell carcinomas of the supraglottic larynx were treated with hyperfractionated radiotherapy at The University of Texas M. D. Anderson Cancer Center. Two patients had T1 primary tumors, 23 had T2, 15 had T3, and 1 had T4; 29 patients had no clinical evidence of nodal disease in the neck, 4 had N1, 5 had N2, and 3 had N3. Radiotherapy was delivered in 120 cGy fractions twice per day, with at least 4 hr between treatments. Total doses ranged from 7200 to 7900 cGy (median, 7680 cGy). Three patients had planned neck dissections before or after radiotherapy, and three patients with fixed vocal cord lesions were treated with preradiation chemotherapy. At the time of analysis, median follow-up was 22 months. Four patients have had failures at the primary tumor site. There has been one recurrence in the neck in a patient who also had a recurrence at the primary site. Three of the four patients with recurrences have been successfully treated with salvage surgery. Exclusive of surgical salvage, the actuarial disease-free local control rates above the clavicles in the 38 patients with T2 and T3 cancers were 96% at 1 year and 87% at 2 years. In comparison, the rates were 82% and 76% for a group of 98 patients with T2 and T3 lesions treated at this institution from 1970 to 1981 with 6500-7000 cGy given in 200 cGy fraction per day. As predicted, acute reactions were more severe but late complications were not increased in patients who received hyperfractionated radiotherapy compared with those treated by conventionally fractionated therapy. Only two patients have developed severe late complications one of whom required laryngectomy. Hyperfractionated radiotherapy appears to provide improved local control with a similar incidence of late complications when compared with conventionally fractionated therapy. To further improve the therapeutic ratio, our current protocol has been amended by reducing the large field dose per fraction to 110 cGy (with a 2 day protraction of overall time) and requiring a minimum interfraction interval of 6 hr.

Adult↗
PubMed1990

Squamous cell carcinoma of the supraglottic larynx without clinically detectable lymph node metastases: problem of local relapse and influence of overall treatment time.

From January 1965 until December 1979, 203 patients with squamous cell carcinoma of the supraglottic larynx were treated with curative intent. The mean follow-up time was 10 years. The policy was to try to aim for cure by radiation therapy (RT) only, reserving surgery (S) for radiation therapy failures. For 193 patients the treatment consisted of a first series of radiation therapy to a total dose of 40 Gy; if a good response to radiation therapy was obtained, the treatment was continued to a full course of 60-70 Gy (RT-I, n = 132). Patients with tumors considered to have responded poorly to the first series of radiation therapy but who refused surgery or were found medically unfit for operation, were also carried to a full dose of 60-70 Gy (RT-II, n = 33). Surgery was performed in 33 cases; 23 patients had a laryngectomy because of a poor response to radiation therapy and 10 were treated with surgery upfront because of severe respiratory distress. This paper focuses on the local control and survival in the defined treatment groups. In summary, with advancing T-stage a lower survival and higher local relapse rate was found; that is, a 5-year relapse-free survival (RFS) of 53% and corrected survival (CS) of 83% for T2 tumors vs 39% (RFS) and 52% (CS) for T4 tumors. Age more than 60 was associated with a 2.2 times higher risk of dying due to laryngeal cancer. A lower relapse-free survival (T3,4: 43% vs 61%) but a comparable corrected survival (T3,4: 64% vs 69%) for RT-I patients compared to the surgery treated patients was found, due to salvage of the radiation therapy failures. Although the relapse-free survival of RT-I and RT-II was similar (43% vs 38%), the corrected survival for the RT-II patients was worse (44% vs 69%). No influence of dose (Gy) per se on the local relapse rate was observed; however, a positive association between local relapse rate with overall treatment time was found. Death from intercurrent disease was almost twice as high as might have been expected for the normal Dutch population. More than half of the patients who died of intercurrent disease developed a second primary tumor.

Adult↗
PubMed1985

Adult supraglottitis.

Hospital records from 1974 through 1983 contained the cases of 20 patients over 18 years old admitted with supraglottitis (epiglottitis). Most patients presented with pharyngitis and odynophagia, and were diagnosed by laryngoscopy and neck radiographs. Four patients required tracheostomies, and one was nasotracheally intubated because of impending airway obstruction. Visualization of the hypopharynx was often necessary for diagnosis and in accordance with previously reported cases, did not precipitate airway obstruction. Adults without respiratory distress can be treated in the intensive care unit with inhaled mist, antibiotics, and corticosteroids, and such patients usually recover in a few days. Tracheostomy is being supplanted by nasotracheal intubation as the preferred means of securing an endangered airway.

Adult↗
PubMedDate not supplied

Mediastinal compression secondary to supraglottitis: a case report.

Potential fascial spaces of the neck communicate inferiorly with the mediastinum and thus provide a route for spread of infections. It is very uncommon for supraglottitis to spread to one of these spaces. In this rare case, this infection not only involved the parapharyngeal space but also followed the anatomic path down to the mediastinum. The resulting mediastinal edema increased the intrathoracic pressure and thus upset the hemodynamic. Despite being in critical condition due to pulmonary edema and hypotension, the patient recovered without the use of aggressive surgical measures recommended for such cases.

Adult↗
PubMed2006

Pharyngo-colostomy with supraglottic partial laryngectomy in caustic oropharyngeal stricture.

We present two cases of chronic caustic stricture from the oropharynx to the entire esophagus combined with laryngeal stricture in which the piriform sinuses were stenosed. The restoration of digestive continuity was accomplished by end-to-end pharyngo-colostomy at the level of the cricoid cartilage through the posterior mediastinal route. Supraglottic partial laryngectomy and pharyngoplasty were done simultaneously for the laryngeal and oropharyngeal stricture. The patients were able to swallow a soft blend diet to regular diet with negligible penetration.

Adult↗
PubMed2005

Supraglottic airway devices.

Supraglottic airway devices are developed with increasing frequency following the overwhelming success of the laryngeal mask airway (LMA). Currently, the LMA, the ProSeal laryngeal mask airway (PLMA), the laryngeal tube (LT), the laryngeal tube with integrated suctioning tube (LTS) and the oesophageal tracheal combitube (OTC) are the best evaluated and most widespread devices. Both the LMA and the PLMA have been shown to be perfectly suitable for routine anaesthesia and emergency airway management. While the LMA is limited by the lack of reliable protection against aspiration, the value of the PLMA in this respect remains undetermined yet. LT and LTS are primarily intended as emergency airway devices, but have also been successfully used during controlled ventilation in adults. The OTC, though advocated for emergency as well as routine use, is limited by high airway morbidity and possible serious complications.

Anesthesia, General↗
PubMed2004

Relationship among glottal area, static supraglottic compression, and laryngeal function studies in unilateral vocal fold paresis and paralysis.

In this study, we evaluated the relationship between laryngeal function measures and glottal gap ratio and normalized measures of supraglottic behaviors in patients with unilateral vocal fold paresis (UVFP). Thirty-one patients were found to have unilateral vocal fold paresis by videoendoscopy and laryngeal electromyography, and 13 controls participated in this study. Patients with UVFP demonstrated significantly larger glottal gap ratios (p = 0.016) than control subjects. The nonparalyzed or contralateral vocal fold was associated with significantly more static false vocal fold compression (p = 0.03) compared with the paralyzed vocal fold or with the controls. Patients with unilateral vocal fold paresis were divided into subgroups: those with normal or abnormal maximum phonation time, flow, or pressure measures. Smaller glottal gap ratios were identified in patients with normal maximum phonation times and flow measures. Greater false vocal fold activity was identified in unilateral vocal fold paresis patients with normal laryngeal function measures than in unilateral vocal fold paresis patients with abnormal measures. These findings suggest that some patients with documented unilateral paresis and glottal incompetence can compensate for vocal fold weakness such that their acoustic and aerodynamic measures are normal.

Adult↗
PubMed2003

[Results of supraglottic laryngeal cancer treatment with endoscopic surgery using CO2 laser].

A group of 253 patients with laryngeal carcinoma was treated by endoscopic laser-CO2 surgery, 50 of them presented a supraglottic localization. The follow up period ranged from 1 to 10 years. From the analysis of different parameters (age, site, stage, histopathology, etc) it could be concluded that survival and free-symptoms-time rates in patients treated with laser endoscopy were similar to those obtained in patients treated with conventional external surgery. However, the endoscopic laser-CO2 surgery reported several advantages such as: no pharyngostoma, less complications, shorter stay in hospital and, consequently, lower health costs. In addition, tracheotomy was almost never necessary. Recurrencies can be also treated endoscopically, but, when total laryngectomy is needed following recurrency, this is considered to be a bad prognostic factor.

Aged↗
PubMed2004

[More of five decades of supraglottic laryngectomy (Alonso's technique)].

In this paper we attempt to prove the relevance of the Spanish and Iberoamerican contribution, in the expansion and development of Alonso's technique for surgical treatment of supraglottic cancer, that began in Spain and South America in the fifties. We mention the most important authors and their ideas, and we explain their contribution to this surgical procedure which has been remained forgotten in the latest publications.

Glottis↗
PubMed2006

[Supraglottic laryngectomy. Still on-going].

INTRODUCTION: Horizontal supraglottic laryngectomy (HSL) allows the preservation of a functioning larynx and avoids a permanent tracheostoma. Its use and training have been conditioned by the employment of organ preservation programs and endoscopic laser surgery. OBJECTIVE: To show functional and oncological long-term results of HSL. MATERIAL AND METHOD: 110 patients treated with HSL with a minimum of 5 years follow-up. RESULTS: Local control, 89% for T1, 91% for T2, 80% for T3 and 91% for T4. Regional control 80.9%. Cause specific survival, 77.6%, 72.6% and 67% at 3, 5 and 10 years, significantly influenced by N-stage. Functional larynx preservation, 87%, with a 8.5% of non-decanulated patients. CONCLUSION: HSL is a safe surgical procedure, with similar functional and oncological results to other therapeutic options. Its indications should be considered according to own experience and results.

Adult↗
PubMed1992

Uvulitis and supraglottitis: early manifestations of Kawasaki disease.

Two children with Kawasaki disease initially had upper respiratory tract manifestations. The first was admitted with a diagnosis of uvulitis; in the second the clinical picture was characterized by supraglottic involvement, confirmed by direct laryngoscopic examination.

Child, Preschool↗
PubMed1992

Penile metastasis secondary to supraglottic squamous cell carcinoma: review of the literature.

We report an unusual supraglottic carcinoma metastasis to the penis. Review of the literature revealed more than 300 cases of metastatic lesions to the penis, excluding primary neoplasms from skin, urethra and blood. Of these metastatic neoplasms 16 originated above the diaphragm, only 4 of which were from the head and neck region. The most common neoplastic metastases to the penis in order of frequency were from the bladder, prostate, rectum and rectosigmoid areas, and kidney in 32, 30, 13 and 8% of the cases, respectively. The incidence of other primary tumor sites that metastasize to the penis is extremely rare.

Carcinoma, Squamous Cell↗
PubMed1986

Alpha/beta value and the importance of size of dose per fraction for late complications in the supraglottic larynx.

In a group of 155 cases with squamous cell carcinoma of the supraglottic larynx (T3-4N0M0), with 3-year local control after radiotherapy, 21 late complications were noted. Using two different methods, an alpha/beta value of 3.8 Gy was calculated. A strong correlation between the risk of late effect in the larynx and size of dose per fraction was found; there was no influence of overall treatment time.

Carcinoma, Squamous Cell↗
PubMed2000

Complications of postoperative radiation therapy after partial laryngectomy in supraglottic cancer: A long-term evaluation.

This retrospective study, based on a series of 90 patients with invasive squamous cell carcinoma of the supraglottis, was designed to document the functional outcome and complications after postoperative radiation therapy following partial laryngeal surgery. The surgical procedure was a standard supraglottic laryngectomy in 62 patients and a supracricoid partial laryngectomy in 28 patients. All of the patients had an unremarkable postoperative course and achieved locoregional control. The average dose delivered to the remaining larynx was 51.2 Gy (range 25-71 Gy). The average dose delivered to the neck was 50.6 Gy (range 22-70 Gy). The patients were treated at 180-cGy per fractions in a continuous course technique with a cobalt 60 beam. In 5 patients (5.5%) complications led to cessation of postoperative radiation therapy, and the total dose delivered to the remaining larynx and neck was less than 40 Gy. All patients were followed up for a minimum of 10 years or until death. The 5-, 10-, and 15-year actuarial survival estimates were 71. 5%, 44.3%, and 36.3%, respectively. The 5-, 10-, and 15-year actuarial severe complication estimates were all 11.2%. Overall, severe complications occurred in 15 patients. Severe complications led to death in 3 patients (3.3%), permanent gastrostomy in 3 (3.3%), and permanent tracheostomy in 1 (1.1%). A severe complication never resulted in completion of total laryngectomy. In univariate analysis, the mean dose delivered to the larynx was the only variable statistically related to the incidence of a severe complication. The mean dose delivered to the larynx was statistically higher (P = 0.014) in patients who had severe complications (60 Gy) than in patients who did not (50 Gy).

Adult↗