Surgical removal followed by radiotherapy for refractory vocal process granuloma.

OBJECTIVE/HYPOTHESIS: Vocal process granuloma (VPG) is a challenging disease because of its multifactorial etiology, irrespective of treatments. Conservative treatments had shown limited effects, while surgical attempts of removing lesions were only indicated in certain conditions for high recurrent rates. However, a group of patients remained with refractory disease. The objective of this study was to describe the use of surgical removal followed by radiation therapy in the management of patients with refractory VPG. STUDY DESIGN: Retrospective reviews were conducted in patients with refractory VPG to evaluate the effects of surgical removal followed by radiation therapy and compared with that of surgical removal alone. METHODS: Twenty-one patients with refractory disease were enrolled in our study. Fifteen patients accepted surgical removal followed by radiation therapy the day after operation in a total dose of 15 Gy. Six patients who refused radiation therapy accepted surgical removal alone. All patients were followed up for 3-6 years and laryngoscope results were studied in all patients. RESULTS: All of the 15 patients treated with surgical removal followed by radiation therapy in low dose got the disease eliminated completely with mild complications. Recurrences were observed during the 2 weeks to 3 months after operation in five of the six patients who accepted surgical removal alone, whereas no recurrence was observed in the other one in whom the granuloma was believed to be caused by intubation injury. CONCLUSION: This initial study showed that surgical removal followed by radiation therapy in low dose was a safe and an effective approach to manage VPG with a potential for clinical application, but further studies in a larger cohort for a longer term were needed.

Three-dimensional conformal radiation therapy for refractory laryngeal granuloma.

AIMS AND BACKGROUND: The etiology of laryngeal granulomas is often multifactorial and the benefit of pharmacological therapy remains unclear. Anti-reflux treatment is only effective in granulomas definitely induced by gastroesophageal reflux. Steroid inhalation has shown favorable results but it is unclear whether it shortens the healing process. Surgical excision is associated with high recurrence rates. The aim of this study was to evaluate the role of 3-dimensional conformal radiation therapy (3DCRT) in the treatment of refractory laryngeal granuloma. METHODS AND STUDY DESIGN: The study was a retrospective review including all patients presenting to the Department of Radiation Oncology at Xijing Hospital from January 2004 to March 2007. We studied a total of 15 cases of refractory laryngeal granuloma that had recurred ≥2 times. Patients had previously been managed with voice rest, corticosteroids, antibiotics, antacids, surgery and botulinum toxin. All patients accepted surgical excision and immediate adjuvant 3DCRT at a total dose of 15 Gy over 5 days. RESULTS: All patients were successfully treated with surgery and 3DCRT. There has been no granuloma recurrence in 3 years of follow-up. CONCLUSIONS: 3DCRT is a safe and effective therapy for refractory laryngeal granulomas, especially when other methods have failed.

Pulsed dye laser treatment of laryngeal granulomas.

Laryngeal granulomas are effectively treated with antireflux therapy and speech therapy. Failure to respond leads to treatment with Botox or surgical excision. We report on the use of the pulsed dye laser for treating chronic granulomas that do not respond to standard therapy. We performed a retrospective review from September 2002 to September 2003. Patients identified with chronic granulomas that were not responding to standard therapy were treated in our office with the pulsed dye laser. Ten patients were identified; the mean age was 58 years. Two patients underwent more than one pulsed dye laser treatment. Five of the 10 had resolution of their lesions, and 3 had a partial response. Two were unchanged. The average follow-up was 6 months, and there were no complications. We conclude that in-office use of the pulsed dye laser is a relatively safe and effective method for treating laryngeal granulomas that do not respond to antireflux therapy and speech therapy.

Excision and low-dose radiotherapy for refractory laryngeal granuloma.

Laryngeal granulomas are uncommon lesions of an inflammatory origin. They are conventionally managed by simple excision with the occasional use of adjuvant treatment depending on the aetiological factors. Unfortunately, recurrences can occur, requiring repeated excision. Some lesions are refractory to this approach and alternative management approaches include excision and immediate adjuvant radiotherapy. The use of radiotherapy in the management of benign disease can be limited by the risk of induction of late malignancy and informed consent of a patient must include an assessment of this risk. We describe a case of refractory laryngeal granuloma successfully treated by excision and immediate radiotherapy in a patient occupationally dependent upon his voice.

Intubation granuloma of the larynx: successful eradication with low-dose radiotherapy.

Postintubation granuloma of the larynx is a well recognized entity, which has accompanied the increased use of endotracheal intubation for general anesthesia. Voice rest, corticosteroids, antibiotics, antacids, and surgical removal are generally accepted conventional therapies, although select cases are fraught with a high rate of recurrence. We recently evaluated a patient who had undergone 6 surgical excisions of a postintubation laryngeal granuloma during a 5-month interval. The larynx was treated with 1,200 cGy photon irradiation during a 4-day period, and there has been no granuloma recurrence in 36 months of follow-up. The rationale and selection criteria for patients who might benefit from low-dose radiotherapy for recurrent laryngeal granulomas are discussed.