Clinical Outcome of Salvage Treatment for Recurrent Supraglottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is difficult to treat recurred supraglottic cancer safely and preserve physiologic function of the larynx. This study was designed to review the clinical manifestations of recurrent supraglottic cancer and compare the results of each salvage treatments. SUBJECTS AND METHOD: During the period from Jan 2000 to Sep 2007, thirty recurrent supraglottic cancers were reviewed retrospectively. Their mean follow-up period was 30.8+/-20.1 months. We investigated initial treatment methods, stage, recurrent sites and salvage methods, and analyzed the oncological results including disease-specific survival and overall survival. RESULTS: Ninety-seven percent of all recurrence occurred within 3 years and 76.7% of all recurrence were diagnosed at stage III-IV when recurrence was detected. Five-year disease-specific survival rate was 28.4% and five-year overall survival rate was 73.4%. Recurrence at the primary site showed significantly better overall survival rate than that at the lymph node, primary and lymph node recurrence, or distant metastasis (p=0.008). Patients who were salvaged with total laryngectomy had significantly better disease-specific survival rate and overall survival rate (p< 0.001). CONCLUSION: With careful selection of salvage treatment for recurrent supraglottic cancer, acceptable oncological result can be achieved. Further study for laryngeal preservation for recurrent cases is necessary.

Treatment Results and Prognostic Factors of T3 Supraglottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To analyze results of treatment and prognostic factors in patients with T3 supraglottic carcinoma and to compare results of treatment in patients with T3 transglottic carcinoma with T3 pure supraglottic carcinoma. MATERIALS AND METHOD: A retrospective study was done on thirty-two patients who underwent a surgery or surgery with postoperative radiation therapy from 1990 to 2000. Neck dissection was performed in 27 patients and 24 patients received postoperative radiation therapy. RESULTS: The 3-year overall survival rate was 81.6%. The 3-year overall survival rate of T3 pure supraglottic carcinoma and T3 transglottic carcinoma were 91.7% and 73.2%, respectively (p<0.05). The univariate analysis revealed a prognostic significance for vocal cord fixation and statistical trend to age, dyspnea, clinical and pathological metastasis of cervical lymph node and postoperative radiation therapy (p<0.2). T3 transglottic carcinoma was significantly correlated with vocal cord fixation. CONCLUSION: Surgery or surgery with postoperative radiation therapy provides acceptable rates of cancer control and survival rate for patients with T3 supraglottic carcinoma. Transglottic involvement and vocal cord fixation shown by the fiberoptic laryngoscopy were significant prognostic factors. T3 transglottic cancer needs more aggressive management.

p53 Mutations in Advanced Supraglottic Cancer / 대한방사선종양학회지

PURPOSE: To determine the prognostic significance of p53 mutations in advanced supraglottic cancer patients. MATERIALS AND METHODS: Twenty-six patients with pertinent tissue materials among 60 patients diagnosed as advanced supraglottic cancer in Kyung Hee university hospital and received total or partial laryngectomy followed by radiation therapy were enrolled. Immunohistochemical staining using DO7 monoclonal antibody was performed. Tumor specimens were analyzed for p53 mutations in exons 5 through 8 by using PCR-SSCP analysis followed by DNA sequencing of all variants. RESULTS: p53 mutations were present in 8 cases among 26 patiets. Mutations within exon 5 were 3 cases, exon 6 were 4 cases, and exon 7 was 1 case. Mean survival time was 70.2 months in patients without mutations, 61.3 months with mutations but there was no statistically significant differences (p=0.596). Mutations were 25% in stage III and 36% in stage IV but there was no statistically significant differences (p=0.563). Mutations were 25% in lymph node negative group and 42% in lymph node positive group but there was no statistically significant differences (p=0.437). CONCLUSION: The presence of a p53 mutation detected by PCR-SSCP is not associated with survival, stage and lymph node status.

A New 'Y' Shape Partial Laryngectomy for Supraglottic Carcinoma with Anterior Commissure Invasion or Encroachment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Supraglottic partial laryngectomy (SPL) is contraindicated when lower margin of the tumor invades the anterior commissure or encroaches on it. Those cases are usually treated with supracricoid laryngectomy or near- total or total laryngectomy. But all these procedures have to sacrifice innocent true vocal cords, not because of oncological concerns but because of reconstruction concerns. We designed a new Y-shape partial laryngectomy with preserving vocal cords for this particular situation. PATIENTS AND METHODS: Thyrotomy consists of two incisions, upper and lower. The upper incision was made oblique from superior cornu down to the anterior commissure. When this incision was made 5 mm lateral to the midline, it went down to the inferior border of thyroid cartilage. This modification enables resection enbloc anterior commissure region with SPI. specimen. At closure, both ends of the true cord is anchored to the thyrotomy margin. Each lamina is connected with one miniplate with 6 holes. Then the closure is reinforced with elevated thyroid perichondrium and strap muscles. RESULTS: Two patients were treated with this type of surgery. Both had negative surgical margins. In the postoperative period, no specific complications were noted. Roth of them could decannulate and swallow without aspiration on the 20th day following the surgery. They retained their voices from the true vocal cords. CONCLUSION: This new partial laryngectomy technique could apply to supraglottic carcinoma cases with anterior commissure invasion or encroachment without sacrificing true cords. This procedure provides satisfactory swallowing and postoperative phonatoty function even with resection of the supraglottic structure.

The Role of Primary Radiotherapy for Squamous Cell Carcinoma of the Supraglottic Larynx / 대한방사선종양학회지

BACKGROUND: First of all, this study was performed to assess the result of curative radiotherapy and to evaluate different possible prognostic factors for squamous cell carcinoma of the supraglottic larynx treated at the Pusan National University Hospital. The second goal of this study was by comparing our data with those of other study groups, to determine the better treatment policy of supraglottic cancer in future. METHODS AND MATERIALS: Thirty-two patients with squamous cell carcinoma of the supraglottic larynx were treated with radiotherapy at Pusan National University Hospital, from August 1985 to December 1996. Minimum follow-up period was 29 months. Twenty-seven patients (84.4%) were followed up over 5 years. Radiotherapy was delivered with 6 MV photons to the primary laryngeal tumor and regional lymphatics with shrinking field technique. All patients received radiotherapy under conventional fractionated schedule (once a day). Median total tumor dose was 70.2 Gy (range, 55.8 to 75.6 Gy) on primary or gross tumor lesion. Thirteen patients had induction chemotherapy with cisplatin and 5-fluorouracil (1-3 cycles). Patient distribution, according to the different stages, were as follows: stage I, 5/32 (15.6%); stage II, 10/32 (31.3%); stage III, 8/32 (25%); stage IV, 9/32 (28.1%). RESULTS: The 5-year overall survival rate of the whole series (32 patients) was 51.7%. The overall survival rate at 5-years was 80% in stage I, 66.7% in stage II, 42.9% in stage III, 25% in stage IV ( p= 0.0958). The 5-year local control rates after radiotherapy were as follows: stage I, 100%; stage II, 60%; stage III, 62.5%; stage IV, 44.4% ( p=0.233). Overall vocal preservation rates was 65.6%, 100% in stage I, 70% in stage II, 62.5% in stage III, 44.4% in stage IV ( p=0.210). There was no statistical significance in survival and local control rate between neoadjuvant chemotherapy followed by radiotherapy group and radiotherapy alone group. Severe laryngeal edema was found in 2 cases after radiotherapy, emergent tracheostomy was done. Four patients were died from distant metastsis, : three in lung, one in brain. Double primary tumor was found in 2 cases, one in lung (metachronous), another in thyroid (synchronous). Ulcerative lesions were revealed as unfavorable prognostic factor ( p=0.0215), and radiation dose (more or less than 70.2 Gy) was an important factor on survival ( p=0.0302). CONCLUSIONS: The role of radiotherapy in the treatment of supraglottic carcinoma is to improve the survival and to preserve the laryngeal function. Based on our data and other studies, early and moderately advanced supraglottic carcinomas could be successfully treated with either conservative surgery or radiotherapy alone. Both modalities showed similar results in survival and vocal preservation. For the advanced cases, radiotherapy alone is inadequate for curative aim and surgery combined with radiotherapy should be done in operable patients. When patients refuse operation or want to preserve vocal function, or for the patients with inoperable medical conditions, combined chemoradiotherapy (concurrent) or altered fractionated radiotherapy with or without radiosensitizer should be taken into consideration in future.

Association of p53 Protein Expression with Clinical Outcome in Advanced Supraglottic Cancer / 대한방사선종양학회지

PURPOSE: To determine the incidence and prognostic effect of p53 expression in patients with advanced supraglottic cancer. MATERIALS AND METHODS: Twenty-one cases of total 48 advanced supraglottic cancer patients who received postoperative adjuvant radiation therapy were evaluated by immunohistochemical staining employing p53 monoclonal antibody. RESULT: Three out of six stage III patients and four out of fifteen stage IV patients showed p53 expression without statistically significant difference (P=0.608). Five year survival rates are 93% in p53 negative, 86% in p53 positive patients and there was no significant difference (P=0.776). p53 expression does not show statistically significant correlation with primary tumor status (P=0.877), lymph node status (P=0.874) and age (P=0.64). CONCLUSION: There was no statistically significant correlation between traditionally known risk factors and p53 expression.

Curative Radiotherapy of Supraglottic Cancer / 대한방사선종양학회지

PURPOSE: The purpose of this study was to evaluate the efficacy of curative radiotherapy in the management of supraglottic cancer. MATERIALS AND METHODS: Twenty-one patients with squamous cell carcinoma of the supraglottis were treated with radiotherapy at Gyeongsang National University Hospital between 1990 and 1994. Median follow-up period was 36 months and 95% were observed for at least 2 years. RESULTS: Actuarial survival rate at 5 years was 39.3% for 21 patients. The 5-year actuarial survival rate was 75.0% in Stage I, 42.9% in Stage II, 33.3% in Stage III, and 28.6% in Stage IV (p=0.54). The 5-year local control rate was 52.0% for 21 patients. The 5-year local control rate was 75.0% in Stage I, 57.1% in Stage II, 66.7% in Stage III, and 28.6% in Stage IV (p=0.33). Double primary cancer was developed in 3 patients and those were all esophageal cancers. CONCLUSION: In early stage (Stage I and II) supraglottic cancer, curative radiotherapy would be a treatment of choice and surgery would be better to be reserved for salvage of radiotherapy failure. In advanced stage (Stage III and IV), radiotherapy alone is inadequate for curative therapy and combination with surgery should be done in operable patients. This report emphasizes the importance of esophagoscopy and esophagogram at the follow-up of patients with supraglottic cancer.

Curative Radiotherapy of Supraglottic Cancer / 대한방사선종양학회지

PURPOSE: The purpose of this study was to evaluate the efficacy of curative radiotherapy in the management of supraglottic cancer. MATERIALS AND METHODS: Twenty-one patients with squamous cell carcinoma of the supraglottis were treated with radiotherapy at Gyeongsang National University Hospital between 1990 and 1994. Median follow-up period was 36 months and 95% were observed for at least 2 years. RESULTS: Actuarial survival rate at 5 years was 39.3% for 21 patients. The 5-year actuarial survival rate was 75.0% in Stage I, 42.9% in Stage II, 33.3% in Stage III, and 28.6% in Stage IV (p=0.54). The 5-year local control rate was 52.0% for 21 patients. The 5-year local control rate was 75.0% in Stage I, 57.1% in Stage II, 66.7% in Stage III, and 28.6% in Stage IV (p=0.33). Double primary cancer was developed in 3 patients and those were all esophageal cancers. CONCLUSION: In early stage (Stage I and II) supraglottic cancer, curative radiotherapy would be a treatment of choice and surgery would be better to be reserved for salvage of radiotherapy failure. In advanced stage (Stage III and IV), radiotherapy alone is inadequate for curative therapy and combination with surgery should be done in operable patients. This report emphasizes the importance of esophagoscopy and esophagogram at the follow-up of patients with supraglottic cancer.

Angiogenesis, Cellular Proliferation Index and Expression of nm23, p53 according to Lymph Node Metastasis in Supraglottic Cancer / 대한이비인후과학회지

BACKGROUND: Squamous cell carcinoma of the supraglottic larynx have a propensity to metastasize earlier to the regional lymph nodes compared to their glottic counterpart owing to their unique embryological origin and abundant lymphatic tissues. However, reliable biological markers for predicting lymph node metastasis with its associated poor outcome is lacking. OBJECTIVES: As a search for biologic markers related to nodal metastasis in supraglottic cancer, the authors have performed immunohistochemical staining of various gene products and tissue factors. The results were analysed to see if these markers influenced the metastatic capability of supraglottic cancers. MATERIALS AND METHODS: Twenty-nine cases of supraglottic cancers were subdivided into node negative group(group I, N=13) and node positive group(group II, N=16). Tumor angiogenesis was assessed by counting the peritumoral microvessels in which the endothelial cells are selectively stained by von Willebrand factor. PCNA-proliferation index(PI) was obtained, and the positivity of nm23 protein, a metastasis suppressor gene product and p53 protein, a tumor suppressor gene product were assessed. RESULTS: The mean vessel counts per high power fields(X 200) were 16.6 and 27.3 for node negative and node positive groups respectively(p=0.001). The mean PCNA-PI was 8.1 in node negative group and 18.4 in the node positive group(p=0.001). The expression of nm23 was 30.8% in the node negative group and 50.0% in the node positive group. p53 expression rate was higher in the node positive group; 50.0% compared to the node negative group; 38.5%, however there was no statistical significance. CONCLUSION: We conclude that the number of new vessels and PCNA-proliferation index, but not the nm23 and p53 expression rate, may be related to the lymph node metastasis in squamous cell carcinoma of the supraglottic larynx.