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At least 433 records · Page 24Linked to original sources
PubMed1975

Control by irradiation alone of nonfixed clinically positive lymph nodes from squamous cell carcinoma of the oral cavity, oropharynx, supraglottic larynx, and hypopharynx.

The records from 1948 through 1967 of 344 previously untreated patients with squamous cell carcinoma of the oral cavity, oropharynx, supraglottic larynx and hypopharynx who had clinically positive cervical lymph node metastases staged N1, N2A, or N2B, and whose initial neck treatment consisted of external radiation therapy alone were reviewed. After appropriate exclusions the study group consists of 183 patients. The dose to the lymph node(s) was calculated retrospectively. The control rates for N1 lymph nodes are 91.5 per cent (76/83) and for N2 lymph nodes 78.5 per cent (55/70) in the patients whose lymph node(s) were well included in the irradiated volume and received a known dose. A dose response analysis shows that doses in the range of 6,500 rads to a single lymph node, 3 cm. or less in diameter, produce 90 per cent control. When a nonfixed metastatic lymph node of 3 cm. or more in diameter of multiple lymph nodes are present or there is questionable coverage, external irradiation alone cannot be relied upon for control and a neck dissection should follow.

Carcinoma, Squamous Cell↗
PubMed1979

Carcinoma of the supraglottic larynx.

Retrospective review of 160 patients with carcinoma of the supraglottic larynx was accomplished for the period 1964 to 1974. The majority were treated by low dose preoperative radiation and conservation surgery and the rest by preoperative radiation and total laryngectomy or radiation alone. Relapse-free and actuarial 5 year survival for all patients was 71% and 45%, respectively. Of primary and neck failures, 85% occurred within 2 years. Primary, nodal, and distant failures occurred in 11%, 21%, and 14% of all patients, respectively. Of 40 T and/or N failures, 33 (83%) occurred in the neck and three T and six N failures (23%) were surgically salvaged. Voice was preserved in 71% of the patients. Major complications were noted in 16% and minor complications in 26% of surgically managed patients; operative mortality was 4%. The presence of microscopic lymph node metastases best predicted those who would later develop T and/or N failure and distant metastases. Second primary tumors occurred in 26% and the leading cause of death was tumor.

Adult↗
PubMed1988

Supraglottic larynx cancer, T1-4 N0, treated by radical radiation therapy. Problem of neck relapse.

The records of 203 patients with T1-4 N0 epidermoid carcinoma of the supraglottic larynx treated at the Dr. Daniel den Hoed Cancer Center/Rotterdam Radiotherapeutic Institute (RRTI), in 1965-1979 were reviewed. This report is confined to the 165 patients treated by radiation therapy (RT) only and focuses on the problem of relapse in the neck. A comparison is made between patients treated for the primary tumor with RT portals less than or equal to 30 cm2 and patients treated with larger field sizes. Sixty patients suffered a local recurrence, which was followed by a relapse in the neck in 13 patients. Nineteen patients experienced a relapse in the neck without a previous local failure. Five of these patients experienced a local failure at a later time. A multivariate analysis showed that the risk of a regional failure was significantly higher after a local failure and also for patients treated with small radiation portals (less than or equal to 30 cm2). Patients with an advanced tumor stage did not have a higher risk of a regional failure. A recurrence in the neck carried a poor survival; nearly two thirds of these patients died of their disease. As a recurrence in the neck seems to be correlated to the control of the primary tumor as well as to the (elective) treatment of the neck, best strategies to further increase the local/regional control are discussed.

Carcinoma, Squamous Cell↗
PubMed1990

Cancer of the supraglottic larynx with neck node metastasis treated by radiation therapy only. The revised 1987 UICC classification system as prognostic indicator.

In 1987, a thoroughly renewed TNM classification was published; the revision was a conjunct effort of the International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJCC). With respect to the former UICC classification, a major change was introduced regarding the regional lymph node subcategories in head and neck cancer; that is compared to the 1978 edition the subjective subcategory of fixation was eliminated and size of the lymph node has become of paramount importance. To see whether the 1987 UICC classification system is indeed more predictive and discriminatory than the 1978 edition, we have analysed patients with supraglottic cancer with clinically detectable lymph node metastasis (T1-4, N+). All patients treated between 1965 and 1980 by radiation therapy only were staged according to both editions of the UICC classification system. From these data we conclude that the prognosis of patients with lymph nodal involvement indeed worsens from N1 to N3 when classified according to the 1987 edition; in contrast, no difference is seen between the N1, N2 or N3 subcategories when staged according to the 1978 classification rules.

Carcinoma, Squamous Cell↗
PubMed1993

A feasibility study of concomitant boost radiotherapy for patients with cancer of the supraglottic larynx.

Between February 1988 and December 1989, 65 patients with supraglottic cancer completed a course of concomitant boost radiotherapy. Cases with N3 disease, a Karnovsky performance score less than 70, age above 70 years, or a second primary cancer were not eligible for the study. Distribution of the patients was: Stage T1-T2 30%, T3-T4 70%, N0 68%, N+ 32%. The total dose ranged from 60 Gy to 76 Gy (median 66 Gy); overall treatment time ranged from 36 to 56 days with a median of 42 days. The daily dose during the first 4 weeks was 1.8 Gy, and during the last 2 weeks it was 1.6 Gy b.i.d. with a 4- or (after September 1988) 6-h interval. The clinical impression was that the early mucosal reactions were acceptable but more severe than after conventional treatment, with confluent membranous mucosal reaction being observed in 54% of the patients. Also, this reaction was significantly more frequent in patients treated with a 4-h interval (68%) than with a 6-h interval (41%) between the daily fractions. To relieve severe dysphagia, narcotics were required in 22% of the patients. The follow-up time ranged from 22 to 50 months, median 34 months. Treatment-requiring late complications were observed in 8 patients, and the 3-year actuarial risk was 17% with 95% confidence limits (6%, 27%). Two of these patients had severe complications: one of them required a temporary tracheostomy due to arytenoid edema and the other developed a laryngo-cutaneous fistula which healed after pharmacological treatment. Actuarial 3-year local-regional control was 59% (46%, 71%) and 3-year actuarial crude survival 55% (42%, 67%). There was no significant difference in the incidence of late complications or tumor control between the two groups of patients treated with a 4- or 6-h interval between the daily fractions. This study shows that the concomitant boost regimen tried here is feasible, but also stresses that the interval between dose fractions should be 6 h or more.

Adult↗
PubMed1999

[Supraglottic laryngectomy: 3-year and 5-year results].

A series of 84 patients who underwent horizontal supraglottic laryngectomy between 1980 and 1995 were analyzed. All patients were men, mean age 56 years. Neck metastases were found in 37 patients; 17 patients had stage I disease, 22 stage II, 13 stage III and 32 stage IV. One patient died in the postoperative period. Pharyngocutaneous fistula was the most frequent complication, being present in 10.7% of patients. The 3-year and 5-year survival rates were 78.9 and 74.2%, respectively. Local control was 91.6% at 3-years and 90.4% at 5-years. Local recurrences occurred in 6 patients, all of whom were salvaged by total laryngectomy and radiotherapy. Neck failure occurred in 15 patients, 2 of who were salvaged with further treatment. Second primary tumors appeared in 10 patients, 30% in the head and neck, after a mean interval of 77 months.

Adult↗
PubMed1999

Scintigraphic assessment of swallowing after horizontal supraglottic laryngectomy.

OBJECTIVE: Oral-pharyngo-esophageal scintigraphy (OPES) proved to be able to demonstrate the pharyngeal residue of the radioactive bolus after deglutition and the presence and amount of tracheobronchial aspiration, and to calculate exactly the transit time of the various swallowing phases. The aim of this study was to evaluate the real objective effectiveness of OPES in order to assess the degree of swallowing recovery after horizontal supraglottic laryngectomy (HSL). METHODS: Nineteen patients entered the study, and 17 healthy subjects were included as control group (group 1). Nineteen patients in whom HSL had been performed at least 1 year before underwent OPES. They were divided into two groups: 13 patients (group 2) in whom the tracheal cannula had been removed and swallowing, phonatory, and respiratory functions were satisfactory and 6 patients (group 3) in whom the tracheostomy tube was still in situ for aspiration of liquids and scarring of the laryngeal vestibule. RESULTS: Our results showed that in the patients who underwent HSL, all scintigraphic semiquantitative parameters and particularly aspiration percentage values and Pharyngeal Ritention Index (PRI) at 10 and 60 seconds were able to pinpoint some residual "subclinical" alteration and/or minimal surgical sequelae frequently observed after this kind of functional surgery, even though a substantially satisfactory recovery was achieved clinically (group 2 versus group 1). In addition, aspiration amounts in group 3 were markedly higher than those in group 2 (p < .0002), and mean PRI values at 10 and 60 seconds were significantly different (p < .0001) from normal mean control values (group 1). CONCLUSION: Oral-pharyngo-esophageal scintigraphy may be regarded as a noninvasive, well-tolerated technique, with a radiation body burden within satisfactory limits of radioprotection. It appeared to be also sensitive in assessing the swallowing recovery after HSL.

Adult↗
PubMed1999

[Compensatory mechanisms of food transmission and lower respiratory tract protection after classical and extended supraglottic laryngectomies. Computerized topokinetic analysis of roentgen-cinematographic images].

Studies were performed on 22 patients, aged from 17 to 78 years, in whom, owing to laryngeal cancers, partly classical or extended supraglottic laryngectomy was carried out. The evaluation involving the pharyngeal deglutition course was accomplished by resorting to computerized topokinetic analysis of the roentgen-cinematographic images. The completed observation revealed good mobility of the anatomical structures participating in deglutition, small volume and number of glossolaryngeal recesses. There were few patients in whom the contrast medium passed to the trachea. Better passage of food as well as protection of lower respiratory tract were associated with the improvement of parameters facilitating the deglutition.

Adaptation, Physiological↗
PubMed1999

[Mechanisms of formation and liquidation of glosso-laryngeal recesses after classical and extended supraglottic laryngectomies. Computerized topokinetic analysis of rentgenocinematographic images].

As many as 42 examinations of the pharyngeal phase of deglutition act were studied in patients after supraglottic classical and extended laryngectiomies, in whom the above examinations were performed by means of computerized topokinetic analysis of the rentgenocinematographic images. A swallowing group with formed glosso+-laryngeal recesses was isolated. In three among the six patients in whom the examinations were carried out twice (i.e. half a year after the procedure and 2 years after the operation) the formed recesses underwent liquidation. The parameters facilitating the liquidation of the above recesses between the first and the second examinations were analyzed. The liquidation of recesses corresponded with the restoration of good deglutition.

Adolescent↗
PubMed2000

[The development of concept of partial surgery of the larynx due to supraglottic cancer].

It has been shown the conception of partial surgery of the larynx due to cancer primary develops in the supraglottic. The evolution of this method which is a consequence of progress in anatomical and embryological knowledge as well as technical possibilities of surgeons has been introduced. The modern methods of partial removal of larynx let resume physiological function of larynx with oncological security.

Glottis↗
PubMed2000

[Horizontal supraglottic laryngectomy. Study on 41 operated cases between 1989-1996 in La Rioja].

The AA. conduct a retrospective study done with 41 patients operated upon and followed up at the Otolaryngological Department of San Millán y San Pedro Hospital complex, Logroño, between 1989 and 1996. Horizontal supraglottic laryngectomy was the performed surgery, and patients classified in stages I, II, III or IV. The fundamentals of this procedure the oncologic and functional results as well and the survival rate are analysed. Four points are stressed: 1st. The descent of the base of the tongue eases the postoperative swallow. 2nd. The survival shows that recurrences like lymph nodes metastases are the best prognostic factor, with an OR of 2.61. 3rd. More advanced stages have less survival tendency. 4th. The excellence of this technique is evident, having had only one case of local recurrence in our series resolved through totalization of the laryngectomy.

Adult↗
PubMed1998

[A modified laryngectomy combined with radical neck dissection for late-staged supraglottic carcinoma].

8 cases of supraglottic or transglottic carcinoma with neck lymphatic metastasis received a modified laryngectomy or subtotal laryngectomy combined with radical neck dissection. Laryngeal function was reconstructed in 3 of them. No postoperative complication occurred. All cases survived uneventfully through a five-year following up, except one who died of neck lymphatic and lung metastasis. The indication, procedure and advantage of this operation are discussed in this article.

Aged↗
PubMed2000

[Manometric evaluation of disorders in oral and pharyngeal phases of swallowing in patients after partial laryngectomy for localized supraglottic cancer].

Manometric examinations of swallowing were conducted on 81 patients after partial laryngectomy and on 35 subjects being a control group. Resection of piriform recess, a part of the base of the tongue, the hyoid bone or its part is the factor that causes intensified difficulty during swallowing and increase in the frequency of the occurrence of aspiration. The results of manometric examinations indicate that the shape and mobility of the tongue and the mobility of remaining after the surgery parts of the larynx have the greatest influence on the efficient swallowing in patients who have undergone partial laryngectomy due to cancer initially located in the supraglottic area. The larynx mobility is closely related to the remaining of the hyoid bone. The importance of remaining the possibly non-deformed structure and mobility of the tongue during partial laryngectomy involves the issue of reconstruction of defects occurred during the surgery. Manometric examinations confirm the effectiveness of the method involving reconstruction of defects in a part of the base of the tongue with a vascular pedicle flap of the submandibular gland.

Adult↗
PubMed2001

[Video-roentgen cinematographic evaluation of pharyngeal phase disorders during swallowing in patients after partial laryngectomy due to localized supraglottic cancer].

Videorentgenocinematographic examinations of swallowing were conducted on 81 patients after partial laryngectomy and on 35 subjects being a control group. Resection of piriform recess, a part of base of the tongue, the hyoid bone or its part is the factor that causes intensified difficulty during swallowing and increase in the frequency of the occurrence of aspiration. The results of videorentgenocinematographic examinations indicate that the shape and mobility of the tongue and the mobility of remaining after the surgery parts of the larynx have the greatest influence on the efficient swallowing in patients who have undergone partial laryngectomy due to cancer initially located in the supraglottic area. The larynx mobility is closely related to the remaining of the hyoid bone. The importance of remaining the possibly non-deformed structure and mobility of the tongue during partial laryngectomy involves the issue of reconstruction of defects occurred during the surgery. Videorentgenocinematographic examinations confirm the effectiveness of the method involving reconstruction of defects in a part of the base of the tongue with a vascular pedicle flap of the submandibular gland.

Aged↗
PubMed2001

[Supraglottic laryngectomy with arytenoidectomy].

Relearning to swallow is frequently difficult after supraglottic laryngectomy requiring arytenoid cartilage resection. We propose a surgical procedure in which a local flap is used to close the pharyngeal defect without approximating the laryngeal remnants and the base of tongue. The procedure opens the median raphe and cuts the hyoid bone along the midline. The strap muscles, the perichondrium from the thyroid cartilage and thyroid lobe on the ispilateral side to the tumor are retracted laterally to be used to close the mucosal defect. Sixty-eight patients with T1-T3 carcinomas of the laryngeal margin with extension to an arytenoid in all cases and limited extension to the medial wall and/or anterior angle pyriform fossa in 33 underwent this surgical procedure. Only 5 patients had local recurrence and 8 a lymph node recurrence. Visceral metastases occurred in 21 patients (33%) and second primary tumors were diagnosed at the time of surgery or during follow-up in 19 patients (28%). Three and 5-year actuarial survival rates were 57 and 51%, respectively. Despite post operative radiotherapy, functional success was obtained in 50 patients (75%). This technique provided good tumor control and a high rate of satisfactory functional results in patients with tumors of lateral margin extended to one arytenoid.

Aged↗
PubMed2002

[Expression of inducible nitric oxide synthase and basic fibroblast growth factor in supraglottic squamous cell carcinoma and their clinical significance].

BACKGROUND & OBJECTIVE: To the authors' knowledge, the relationship between inducible nitric oxide synthase (iNOS) and basic fibroblast growth factor (bFGF) and cervical lymph node metastasis of supraglottic squamous cell carcinoma (SGSCC) has not been addressed to date. This study was designed to investigate the effect of iNOS and bFGF on biological behavior of cervical lymph node metastasis in SGSCC. METHODS: The authors conducted a contrast analysis for 64 patients with SGSCC (experimental group) and 33 patients with chronic laryngeal mucositis (control group). Pathologic imaging analysis was used for quantitative determination. RESULTS: 1. Positive staining site of iNOS and bFGF was concentrated in cytoplasm; bFGF was also expressed in nuclei and intracellular substance. 2. The expressions of iNOS and bFGF were significantly higher in experimental group than in control group. 3. The expression in cervical lymph node positive group was significantly higher than that in negative group. However, there was no statistical significance between primary negative-follow positive group and primary positive group. CONCLUSION: The expression of iNOS and bFGF was closely associated with SGSCC, and can be considered to be a predictor for lymph node metastasis of SGSCC.

Adult↗
PubMed2003

[Inducible nitric oxide synthase and basic fibroblast growth factor expression as prognostic factors in supraglottic squamous cell carcinoma].

BACKGROUND & OBJECTIVE: The prognosis of supraglottic squamous cell carcinoma (SGSCC) was poor. To authors' knowledge, the relationship between inducible nitric oxide synthase (iNOS) and basic fibroblast growth factor (bFGF) and the prognosis of SGSCC has not been addressed to date. This study was designed to evaluate the prognostic significance of these two parameters in SGSCC. METHODS: The expression of iNOS and bFGF protein in 64 patients with SGSCC using LSAB method and pathologic imagine analysis system and their association with neck lymph node metastases, recurrence, and prognosis. RESULTS: (1) The expression of iNOS and bFGF was significantly higher in cervical lymph node positive group (33.2+/-8.8 and 36.1+/-7.8) than in negative group (27.3+/-7.4 and 24.5+/-7.5) with statistical significance. The expression of iNOS and bFGF was higher in recurrence group (36.9+/-1.7 and 34.6+/-2.0) than in no-recurrence group (29.1+/-1.3 and 27.2+/-1.4) with statistical significance. (2) Patients with positive neck lymph node had poorer 5-year survival than those with negative neck lymph node (31.0% vs. 57.1%). Patients with positive iNOS expression had poorer 5-year survival than those with the negative iNOS expression (40.0% vs. 77.8%). However, there was no statistical significance between positive bFGF expression group and negative bFGF expression group. (3) Cox model multivariate regression analysis showed that lymph node status, the expression of iNOS and postoperative radiotherapy were independent prognosis factors, whereas the T staging and the expression of bFGF were not. CONCLUSION: The expression of iNOS was one of the independent prognostic factors, but it is necessary to study further for iNOS and bFGF to predict the prognosis of patients with SGSCC using immunohistochemical technique.

Adult↗
PubMed1992

[Adjuvant chemotherapy in supraglottic epidermoid carcinoma stage T3].

92 squamous cell carcinomas of the supraglottic larynx classified as T3 were treated from 1977 through 1987 and retrospectively analyzed. All the patients of this series received chemotherapy as initial treatment (2 cycles). From 1977 through 1981 the combination of Vincristine-Methotrexate-Bleomycin (VMB) was employed; after 1981, the protocol: Cisplatinum-5 FU with or without Bleomycin (CF) was administered instead of VMB. All the patients were then surgically treated on the tumoral site and cervical lymph chains. At 5-year, there was no significative difference between the two chemotherapeutic regimen in term of locoregional recurrences and second primaries. 5-year actuarial survival rate was higher for patients treated with the CF protocol (71%) versus (54%) with the VMB regimen. Systemic metastases occurred less frequently after CF (4.5%) than after VMB (22.4%). These findings suggest that chemotherapy has substantially some activity against microscopic distant metastases.

Actuarial Analysis↗