Radiation vs surgery for early-stage laryngeal verrucous carcinoma: A population-based propensity score matched-study.

BACKGROUND: Verrucous carcinoma (VC) is a rare variant of squamous cell carcinoma. Although VC is considered radioresistant, concrete evidence for this is absent. METHODS: We obtained data on VC treated with surgery or radiation from the Surveillance, Epidemiology, and End Results database. Treatment selection bias was reduced by propensity score matching. Overall survival (OS) and disease-specific survival (DSS) rates were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were estimated using Cox proportional hazards models. RESULTS: Five-year OS rates in the radiation and surgery groups were 72.7% and 72.0%, respectively (P = 0.111); five-year DSS rates in the same were 86.7% and 88.4%, respectively (P = 0.234). HRs of radiation compared with surgery were 1.68 (95% confidence interval (CI), 0.96-2.95) for OS and 1.95 (95% CI, 0.69-5.53) for DSS. CONCLUSIONS: Similar prognoses were observed in patients with VC treated with radiation and surgery. VC can be treated using radiation.

Postoperative Radiation Therapy in Oral Cavity Verrucous Carcinoma.

OBJECTIVES/HYPOTHESIS: We investigate the clinicopathologic and treatment factors associated with the use of postoperative radiation therapy (PORT) and its effect on overall survival (OS) for patients with oral cavity verrucous carcinoma (VC). STUDY DESIGN: Retrospective cohort study. METHODS: A retrospective cohort study of the National Cancer Database (NCDB) from 2006 to 2015 was performed. Multivariable logistic regression was used to identify independent predictive factors associated with the use of PORT. Cox Regression survival and propensity score analyses were used to evaluate the effect of PORT on mortality. RESULTS: A total of 356 adult patients with primary oral cavity VC who underwent definitive surgical resection were identified. A total of 10.7% of patients underwent definitive surgical resection followed by PORT. Variables associated with PORT included distance to the hospital per 10 miles (adjusted odds ratio [aOR], 0.81 [95% confidence interval (CI), 0.70-0.95]) and stage III-IV disease (aOR, 12.13 and 23.92, respectively). Multivariable Cox regression survival analysis indicated no evidence of survival benefit in patients undergoing PORT compared to surgery alone (adjusted hazard ratio 1.50 [0.74-3.05], P = .23). Propensity score analysis also showed no OS benefit with the use of PORT (P = .41). CONCLUSIONS: Variables associated with the use of PORT on multivariable analysis included closer distance to hospital and stage III-IV disease. No clear survival benefit with PORT was identified on either multivariable survival analysis or propensity score analysis. These results suggest that surgery alone with negative margins may be the optimal treatment for patients with oral cavity VC. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:1953-1961, 2022.

Adjuvant radiotherapy is not supported in patients with verrucous carcinoma of the oral cavity.

OBJECTIVE: To analyze the impact of adjuvant radiation therapy (RT) on overall survival (OS) and disease-specific survival (DSS) in patients with verrucous carcinoma (VC) as compared to squamous cell carcinoma (SCC) of the oral cavity. STUDY DESIGN: Cross-sectional population analysis. METHODS: Cases of nonmetastatic VC/SCC of the oral cavity were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (1988-2013). Kaplan-Meier survivals, stratified according to T stage, were compared between VC and SCC for treatment with or without adjuvant RT. RESULTS: A total of 18,819 VC/SCC cases were identified. There were 581 (3.1%) VC (mean age 69.6 years, 48.9% female) versus 18,238 (97.0%) SCC (mean age, 65.3, 37.1% female) patients. Verrucous carcinoma patients receiving surgery alone (N = 539) demonstrated a trend toward improved OS versus VC patients receiving surgery and RT (N = 40) (117.0 vs. 71.4 months, respectively, P = 0.119). There was a statistically significant improvement in DSS in VC patients receiving surgery alone (217.2 vs. 110.9 months, P = 0.05). Verrucous carcinoma patients treated with adjuvant RT demonstrated a trend toward a worse OS (71.4 vs. 93.0 months, P = 0.992) and DSS (110.9 vs. 162.3 months, P = 0.275) compared to SCC treated with adjuvant RT, suggesting a different biology and radiosensitivity between VC and SCC. CONCLUSION: Verrucous carcinoma treated with adjuvant RT had a worse OS and DSS compared to both VC treated with surgery alone and SCC treated with surgery and adjuvant RT. Consideration should be given to surgical re-section rather than adjuvant RT in patients with positive margins or local recurrence. LEVEL OF EVIDENCE: 2C. Laryngoscope, 127:1334-1338, 2017.

Treatment results and prognostic factors of patients with vulvar cancer treated with postoperative or definitive radiotherapy.

PURPOSE: Vulvar cancer is a relatively uncommon type of gynecologic cancer. The aim of this study is to analyze the treatment results and prognostic factors of vulvar cancer. METHODS: Forty-four vulvar cancer patients treated between 2000 and 2011 at the Department of Radiation Oncology, Ege University Faculty of Medicine, were retrospectively reviewed. External radiotherapy (RT) was applied with 6-18 MV linear accelerators with 1.8 Gy daily fractions with a median total dose of 50.4 Gy (45-59.4 Gy) for postoperative cases and 64.8 Gy (range 54-66 Gy) for definitive cases. Statistical analyses were performed with SPSS 13.0. RESULTS: Among 44 patients with a median age of 68 years (range 28-86), 14 (31.8%) were treated with curative and 30 (68.2%) were treated with postoperative RT or radiochemotherapy (RCT). According to International Federation of Gynecology and Obstetrics staging, 11 (25%) had stage IB, 10 (22.7%) had stage II, 6 (13.6%) had stage IIIA, 5 (11.4%) had stage IIIB, and 12 (27.3%) had stage IVA disease. Within a median of 24 months (range 6-135) of follow-up, 11 (27.3%) patients had local recurrence, 8 had regional recurrence, 2 had both local and regional recurrence, and 6 had distant metastases. Five-year locoregional, disease-free, and overall survival rates were 45%, 40%, and 54%, respectively. Older age, poor tumor differentiation, positive surgical margin, and lymphovascular space invasion were found to be important prognostic factors for disease-related outcomes. CONCLUSIONS: Prognosis of vulvar cancer remains poor even with a multidisciplinary approach. Molecular prognostic factors need to be defined for individualized treatment options to achieve better treatment results.

Radioprotectant and Cytotoxic Effects of Spirulina in Relapsed Verrucous Vulvar Cancer: A Case Report.

CONTEXT: The treatment of relapsed verrucous vulvar cancer (VVC) is difficult. When vulvar cancer relapses, the treatment response is low for second-line treatments. Conversely, toxicity is high. Therefore, scientists need to identify different treatment methods. OBJECTIVES: The case study was intended to examine the benefits of combining treatment with microalgae and metronidazole with radiotherapy to increase the response to treatment. SETTING: The study took place in the Department of Radiation Oncology at Bezmialem Vakif University, in Istanbul, Turkey. PARTICIPANT: The case study involved an 81-y-old female patient whose vulvar tumor was excised and who came to the research team's radiation oncology service for postoperative radiation. She had 2 comorbid disorders: Alzheimer's disease and cardiovascular disease. INTERVENTION: A relapse had occurred in the 15-d postoperative period. Because of the patient's age and comorbid disorders, the research team decided to treat the new tumor only with concurrent radiochemotherapy and a weekly dose of cisplatin that contained chemoradiotherapy, for a total of 25 mg. At the 52.2 Gy dose level, grade 3 radiation skin toxicity occurred in the radiated area, although the research team had obtained an 80% response to the radiochemotherapy. The treatment was interrupted because of toxicity but also due to a deterioration in the patient's general health. Progression of the tumor continued, and the tumor's diameter increased to 7 cm after a 4-mo period. The research team then initiated radiotherapy again, combining it with spirulina in a 750 mg/dose at 2 doses/d and metronidazole in a 500 mg/dose at 3 doses/d, to decrease radiation toxicity and increase radiosensitivity. Radiotherapy was applied at 200 cGy per fraction with a total dose of 2400 cGy, with only 1 anterior local-tumor field. RESULTS: The patient showed a complete response to radiotherapy, and the tumor disappeared at the 2400 cGy radiation dose. No toxicity occurred related to the skin or the woman's general health. Her Karnofsky performance score increased to 90% from 50%, which was the initial score of the second treatment.

Soft tissue reconstruction in the sacro-gluteal region after excision of a large verrucous carcinoma.

Verrucous carcinoma is a slow-growing malignancy which, if neglected, can seriously affect local tissues. We present the case of a 55-year-old male with a 12 9 cm nodular ulcerated lesion in the sacro-gluteal region, poorly defined, with acytologic scrape smear pozitive for squamous cell cacinoma,infiltrating on MRI both gluteal muscles. The initial radiotherapeutic treatment significantly improved local condition facilitating the radical excision of the tumor. The resulting defect, 17 14 cm in size, was covered by V-Y advancement of two fasciocutaneous triangul are flaps based on transmuscular perforators from superior and inferior gluteal arteries. The patient healed completely and the tumor didn't relapse in the past 42 months.

Exclusive radiotherapy for stage T1-T2N0M0 lanryngeal cancer: retrospective study of 59 patients at CFB and CHU de Caen.

OBJECTIVE: Study of patients with stage T1N0M0 or T2N0M0 glottic cancer treated by exclusive radiotherapy and comparison of the survival and functional results of this series with those of the literature. METHOD: Retrospective study of stage T1N0M0 or T2N0M0 glottic cancers diagnosed between 1st January 2000 and 31st December 2010 and treated by exclusive radiotherapy. Evaluation of survival, recurrence and larynx preservation rates. STUDY CENTRES: CLCC François-Baclesse and CHU de Caen. PATIENTS: Fifty-nine patients (53 men and sixwomen) treated for glottic cancer (57 squamous cell carcinomas, two verrucous carcinomas) comprising 51 T1N0M0 and eight T2N0M0 tumours. Treatment with exclusive radiotherapy (mean dose of 70 Grays limited to the thyroid cartilage for 57 patients, with lymph node irradiation for two patients). RESULTS: In this series, five (9.8%) patients with stage T1N0M0 glottic cancer and three patients (37.5%) with stage T2N0M0 glottic cancer relapsed, corresponding to a global recurrence rate of 13.6%. Three of the eight recurrences involved lymph nodes exclusively (N), two patients relapsed exclusively at the primary tumour site (T) and three patients presented local and lymph node recurrence (T and N). Treatment consisted of salvage total laryngectomy with bilateral cervical lymph node dissection in three cases, bilateral cervical lymph node dissection and sensitized radiotherapy in two cases, exclusive chemotherapy in one case, cervical lymph node dissection and cervical radiotherapy in one case. The last patient with recurrence died prior to salvage therapy. The larynx preservation rate was 94.9%. CONCLUSION: In comparison with the literature, treatment of stage T1-T2N0M0 glottic cancer by exclusive radiotherapy gives very good results, with a larynx preservation rate of 95%.

Giant verrucous carcinoma of the lower extremity in women with dementia.

We present the case of an 81-year-old woman with dementia and a giant exophytic ulcerated tumour, which covered most of the lower leg and the dorsum of the foot and emitted a foul smell. The patient had chronic venous insufficiency for 30 years, and previously (appr. 20 years ago) had a squamous cell carcinoma in the same location (right lower leg) that could be treated surgically. The dermatopathological examination of a large excisional biopsy revealed a highly differentiated verrucous carcinoma (formerly referred to as papillomatosis cutis carcinoides). Pathologically modified lymph nodes (suspicious of lymphatic metastases) were observed. Possible treatment options (surgery, intralesional and systemic treatment) were discussed. Finally, due to extension, location of the tumour and the age and co-morbidities of the patient, a decision was made to perform radiation therapy.

Management of a post-radiotherapy xerostomic patient--a case report.

OBJECTIVE: The objective of the study was to fabricate complete denture with palatal reservoir filled with artificial saliva for a post radiotherapy edentulous patient. BACKGROUND: Xerostomia is a subjective complaint rather than a disease. It is caused by irradiation, medication, Sjogren's syndrome & neurological factors such as stress. Radiotherapeutic treatment of head and neck cancer patients often causes long term dysfunction involving their salivary function, swallowing capabilities & taste. All three of these domains are affected by radiation- induced damage to the salivary glands. This in turn results in poor retention of complete denture, frequent trauma to alveolar ridge & other oral infections. All these events drastically affects quality of life of ageing patients. MATERIAL AND METHOD: A complete denture in heat cure acrylic resin was fabricated in which a palatal reservoir was made on the palatal side. RESULTS: Problems arising due to xerostomia were reduced to a great extent. CONCLUSION: Prosthodontic management of Xerostomic patient include several techniques. This paper presents a case report of post radiotherapy edentulous patient in which complete denture with palatal reservoir filled with artificial saliva was fabricated.

Verrucous carcinoma of the paranasal sinuses: a case report.

Verrucous carcinoma is a low-grade variant of squamous cell carcinoma reported to occur in all anatomic sites in the head and neck region, most commonly the oral cavity. The tumor grows locally invasive but is histologically benign and metastasizes rarely. To date, 22 cases of verrucous carcinoma involving the nasal cavity and/or the paranasal sinuses have been reported. We present a case of verrucous carcinoma involving the paranasal sinuses, nasal cavity, cranium, and orbit. This case highlights the difficulty of pathologic diagnosis and management options for a rare neoplastic lesion.

Carbon dioxide laser cordectomy for verrucous carcinoma of vocal folds.

BACKGROUND: Verrucous carcinoma occurs infrequently in the vocal folds. This tumour has an excellent prognosis with proper treatment. Management strategies include surgery, radiotherapy or both. AIM: To evaluate the long-term results of type I and II laser cordectomy for the treatment of verrucous carcinoma of the vocal folds. MATERIALS AND METHODS: We reviewed the files of 18 patients with verrucous carcinoma of the vocal folds treated by type I or II laser cordectomy in our department from 1989 to 2006, and recorded clinical and outcome data. RESULTS: None of the patients had any major post-operative complications. All had a subjectively satisfactory quality of voice, with no morbidity. Patient follow up ranged from three to 228 months (mean, 48 months). Five patients were treated with post-operative radiotherapy for persistent disease, of whom four underwent repeated surgery due to recurrence. CONCLUSION: Type I or II laser cordectomy is a safe, feasible, secure method of treating verrucous carcinoma of the vocal folds. There were no major complications in our patient series. Most recurrent disease was manageable locally with repeated surgery.

Truths and myths about radiotherapy for verrucous carcinoma of larynx.

PURPOSE: The role of primary radiotherapy (RT) for laryngeal verrucous carcinoma (LVC) is controversial because of concerns about anaplastic transformation, an increased incidence of metastases, and poorer local control after RT. To address these concerns, we report our experience. METHODS AND MATERIALS: All patients with pathologically diagnosed LVC treated with primary RT at our institution between 1961 and 2004 were reviewed. The local control, overall survival, and disease-specific survival rate were established. The outcome after salvage treatment and the incidence of metastases and anaplastic transformation were determined. RESULTS: Of 62 LVC patients with a minimal follow-up of 2 years, 20 local and 1 nodal recurrence were identified. Salvage surgery was undertaken in 18 of the 21 patients, and disease control was achieved in 17; the eighteenth patient died of a complication after surgery. Ultimate laryngeal preservation was achieved in 50 patients (81%), including 42 after initial RT and an additional 8 after salvage surgery. Distant failure and anaplastic transformation were not observed. Second cancers after RT were identified in 4 patients, only 1 of which was a head-and-neck cancer detected 11 years later. Of the 39 deceased patients, only 3 died of LVC. The local control, overall survival, and disease-specific survival rate at 5 years was 66% (95% confidence interval, 52-77%), 87% (95% confidence interval, 75-93%), and 97% (95% confidence interval, 87-99%), respectively. CONCLUSION: The results of our study have shown that the initial control of LVC with RT is less reliable compared with reports from surgical series; however, local recurrence was almost always salvaged successfully, resulting in disease-specific survival rates equivalent to those of surgical series. Neither anaplastic transformation nor unusual metastasis development was observed in this series.

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

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

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

Radiotherapeutic management of laryngeal carcinoma.

Authors discuss laryngeal lesions, metastases, and relevant anatomy. Outcome of surgical and radiotherapy in terms of voice preservation is discussed. Radiation techniques and outcomes for laryngeal cancer are presented along with discussion of interdisciplinary treatment. Authors review studies and quality of life outcomes of surviving laryngeal cancer patients.

Acute visual loss in a head and neck cancer patient with ocular metastasis and sphenoid pyocele.

We report an extremely rare case of head and neck cancer patient with right acute visual loss by ocular metastasis after excluding compressive optic neuropathy by endoscopic decompression of the sphenoid pyocele. The ocular metastasis from head and neck cancer had been reported only once in English literatures. Besides, the patient combined with sphenoid pyocele increases the difficulty in differentiating the etiologies. In this article, we describe the history of this patient and discuss the possible cause of acute visual loss and the treatment strategy. Although to differentiate the etiology of acute visual loss between metastatic malignancy and compressive optic neuropathy remain difficult, treatment strategy should focus on rescuing visual acuity. Ocular metastases should always keep in mind when acute visual loss is encountered in patients with previously treated head and neck squamous cell carcinoma.

Verrucous carcinoma of the larynx: determining the best treatment option.

BACKGROUND: Verrucous carcinoma (VC) of the larynx is a rare variant of well-differentiated squamous cell carcinoma, characterized by locally invasive, exophytic warty growth. The purpose of the present study was to evaluate the experience with this rare disease in Slovenia over a 23-year period and to weigh the potential for cure of different treatment options against the functional outcome. MATERIALS AND METHODS: The databases of the Cancer Registry of Slovenia as well as of the registries of all three departments licensed for the treatment of laryngeal cancer in the country were used for the identification of patients. Presentation, diagnosis, treatment and outcome were reviewed retrospectively. RESULTS: From 1980 to 2002, 30 patients were diagnosed with VC of the larynx, representing 1.23% of all laryngeal malignancies. The most frequent site of origin was the glottis. Twenty-three patients had surgery (functional 13; total laryngectomy 10), three patients had radiotherapy, and a combination of irradiation and concomitant chemotherapy was used in four patients. Only one tumor recurred, six months after primary radiation treatment, but was successfully salvaged with a total laryngectomy. The 5-year overall survival rate of 75% was not significantly different from an age- and sex-matched cohort from the Slovenian population (P=0.071). CONCLUSIONS: In VC of the larynx, determination of treatment options should be dictated by voice preservation strategies. Surgery remains the gold standard of treatment. However, concomitant radiochemotherapy emerges as an attractive alternative to mutilating surgical procedures.