[Vertical resections for larynx cancer with preservation of the thyroid cartridge plates]. / Vertikal'nye rezektsii pri rake gortani s sokhraneniem plastin shchitovidnogo khryashcha.

This article presents a method of organ-preserving surgical treatment of laryngeal cancer, which has been developed and used since 1991 at the Tsyba Medical Radiological Research Center, Branch of the National Medical Research Center of Radiology of the Ministry of Health of Russia. The indications for this method are tumors affecting the middle part of the larynx, limiting its mobility, extending to the anterior commissure, laryngeal ventricle, vestibular fold, lower larynx and one arytenoid cartilage, but retaining mobility in the scooper-cricoid articulation. OBJECTIVE: To increase the functional safety of the larynx and improve the quality of life of patients with laryngeal cancer by using the developed method of organ-preserving surgical intervention in combined treatment. MATERIAL AND METHODS: The study included 197 patients who were operated on by the same method for a primary tumor or in connection with a relapse of the disease. At the first stage, all primary patients underwent a course of radiation or chemoradiation therapy 40-50 Gy. In 78 patients with recurrent laryngeal cancer who underwent resection of the larynx, the previous treatment was carried out in the form of a full course of radiation or chemoradiation therapy with a above 60 Gy. RESULTS: Wound healing by primary intention in patients with preoperative irradiation was observed in 92.4% of cases. With resections for a primary tumor, restoration of functions was observed in 115 (96.6%) patients, and with resections of recurrent tumors - in 71 (91%) patients. Three-year disease-free survival in these patients was 74.4%. CONCLUSION: The presented data showed the high efficiency of the method. This is evidenced by the course of the postoperative period, functional and oncological results are comparable, and in some cases exceed those of other researchers.

[Neoplasms of the upper respiratory tract and ear]. / Novoobrazovaniya verkhnikh dykhatel'nykh putei i ukha.

Neoplasms of the upper respiratory tract and ear are tumors of visual localization; however, patients often go to specialized medical institutions in the presence of a widespread tumor process. This paper presents a brief overview of the most common benign and malignant tumors with localization in the oropharynx, nasopharynx, larynx and ear. The clinical picture, diagnosis and various treatment options are presented. Attention is paid to early diagnosis and the need for timely consultation with an oncologist and doctors of related specialties.

Recovering records on cancer of the larynx from anonymous health information databases / Recuperação de registros de câncer de laringe de bancos de dados anônimos de saúde

ABSTRACT: Objective: To develop a linkage algorithm to match anonymous death records of cancer of the larynx (ICD-10 C32X), retrieved from the Mortality Information System (SIM) and the Hospital Information System of the Brazilian Unified National Health System (SIH-SUS) in Brazil. Methodology: Death records containing ICD-10 C32X codes were retrieved from SIM and SIH-SUS, limited to individuals aged 30 years and over, between 2002 and 2012, in the state of São Paulo. The databases were linked using a unique key identifier developed with sociodemographic data shared by both systems. Linkage performance was ascertained by applying the same procedure to similar non-anonymous databases. True pairs were those having the same identification variables. Results: A total of 14,311 eligible death records were found. Most records, 10,674 (74.6%), were exclusive to SIM. Only 1,853 (12.9%) deaths were registered in both systems, representing true pairs. A total of 1,784 (12.5%) cases of laryngeal cancer in the SIH-SUS database were tracked in SIM with different causes of death. The linkage failed to match 167 (9.4%) records due to inconsistencies in the key identifier. Conclusion: The authors found that linking anonymous data from mortality and hospital records is a feasible measure to track missing records and may improve cancer statistics.

RESUMO: Objetivo: Desenvolver um algoritmo de vinculação de registros para parear registros de óbito por câncer de laringe (CID-10 C32X), recuperados do Sistema de Informação de Mortalidade (SIM) e do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS) do Brasil. Métodos: Foram filtrados registros de óbitos contendo códigos CID-10 C32X do SIM e do SIH-SUS, de indivíduos de mais de 30 anos, entre 2002 e 2012, no Estado de São Paulo. As bases de dados foram vinculadas por meio de um identificador único e de variáveis sociodemográficas comuns a ambos os sistemas. O desempenho da vinculação de dados foi aferido aplicando-se o mesmo procedimento em bancos de dados nominais. Os pares verdadeiros apresentavam os mesmos valores nas variáveis de identificação. Resultados: Ao todo, 14.311 registros elegíveis de óbito foram encontrados. A maioria dos registros, 10.674 (74.6%), era exclusiva do SIM. Apenas 1.853 (12.9%) óbitos foram registrados em ambos os sistemas, representando pares verdadeiros. Um total de 1.784 (12.5%) casos de câncer de laringe presentes no SIH-SUS constavam com diferentes causas de óbito no SIM. Houve falha na vinculação em 167 (9.4%) registros, devido a inconsistências na chave de identificação. Conclusão: Constatou-se que a vinculação de dados anônimos de registros hospitalares e registros de óbito é viável e pode auxiliar na melhoria de estatísticas de câncer.

Paraneoplastic Syndromes Associated with Laryngeal Cancer.

OBJECTIVES: Paraneoplastic syndromes occur rarely in association with laryngeal cancer. When present, the syndrome may be the first sign of the malignancy. The aim of the present study was to review and report on all published cases in the international literature. METHODS: A search of PubMed was conducted for "paraneoplastic syndromes in laryngeal cancer" without any restrictions on language or publication year. The full texts of all relevant articles were reviewed and all cases of paraneoplastic syndromes associated with any type of laryngeal cancer were extracted and analyzed. RESULTS: We identified 59 cases of paraneoplastic syndromes related to laryngeal cancer in the literature published from 1963 until recently. There were 46 squamous cell carcinomas and 10 neuroendocrine carcinomas. Twenty-two of the paraneoplastic syndromes involved the endocrine system, 21 were dermatologic or cutaneous, 8 neurologic, 5 osteoarticular or rheumatologic, 1 ocular, 1 muscular, and 1 hematologic. Treatment strategies included surgery, radiotherapy, chemotherapy, and often multimodal therapy, depending on the histology and stage of the laryngeal cancer. CONCLUSIONS: Because of their rarity, paraneoplastic syndromes associated with laryngeal cancer are difficult to diagnose. By presenting and systematically reviewing all published cases in the international literature, the present review may help clinicians to recognize them and to suspect the diagnosis of laryngeal cancer at an earlier stage than otherwise might be possible.

Laryngeal Cancer Attributable Factors and the Influence on Survival Rates: A Single Brazilian Institution Experience

Abstract Introduction Epidemiological studies focused on prognostic factors associated with laryngeal cancer in the Brazilian population are poorly reported in the literature. Objective To evaluate the influence of certain risk factors on the survival rates of patients with squamous cell carcinoma (SCC) of the larynx. Methods This retrospective study was conducted on adult patients who were admitted to the outpatient clinic of the head and neck department in a tertiary care hospital. Evaluation of the influence of risk factors on the survival rates of patients registered in the hospital with laryngeal SCC was performed based on age, sex, initial stage, time of evolution, habits, educational levels and relapse and death. Overall survival (OS), disease-free survival (DFS) and clinical-demographic data were analyzed using the Kaplan-Meier method, Log-rank test and Cox regression. Results A total of 107 patients with a mean age of 59.8 years (range 19-81) were included in this study. Stages III and IV were associated with decreased DFS (p = 0.02) and OS (p = 0.02). Smoking patients had a greater period of disease evolution than non-smoking patients (p = 0.003). Alcohol consumption in smokers increased the risk of death by 2.8 (p = 0.002) compared with non-drinking smokers. Male patients presented lower DFS average when compared with female patients (p = 0.04). Conclusion Our study confirms that male gender, smoking habit combined with alcohol consumption, and advanced stages were strongly associated with poor prognosis.

Laryngeal Cancer Attributable Factors and the Influence on Survival Rates: A Single Brazilian Institution Experience.

Introduction Epidemiological studies focused on prognostic factors associated with laryngeal cancer in the Brazilian population are poorly reported in the literature. Objective To evaluate the influence of certain risk factors on the survival rates of patients with squamous cell carcinoma (SCC) of the larynx. Methods This retrospective study was conducted on adult patients who were admitted to the outpatient clinic of the head and neck department in a tertiary care hospital. Evaluation of the influence of risk factors on the survival rates of patients registered in the hospital with laryngeal SCC was performed based on age, sex, initial stage, time of evolution, habits, educational levels and relapse and death. Overall survival (OS), disease-free survival (DFS) and clinical-demographic data were analyzed using the Kaplan-Meier method, Log-rank test and Cox regression. Results A total of 107 patients with a mean age of 59.8 years (range 19-81) were included in this study. Stages III and IV were associated with decreased DFS ( p = 0.02) and OS ( p = 0.02). Smoking patients had a greater period of disease evolution than non-smoking patients ( p = 0.003). Alcohol consumption in smokers increased the risk of death by 2.8 ( p = 0.002) compared with non-drinking smokers. Male patients presented lower DFS average when compared with female patients ( p = 0.04). Conclusion Our study confirms that male gender, smoking habit combined with alcohol consumption, and advanced stages were strongly associated with poor prognosis.

The Incidence of Thyroid Gland Invasion in Patients with Carcinoma of the Larynx who Underwent Total Laryngectomy

@#Introduction: Total thyroidectomy or at least hemithyroidectomy is routinely performed alongside total laryngectomy in patients with advanced carcinoma of the larynx. Life-threatening hypocalcaemia and hypothyroidism are common sequelae especially with adjuvant radiation. The study aims to determine the incidence of microscopic thyroid gland invasion and challenge the idea of routine thyroidectomy in advanced carcinoma of the larynx. Materials and Methods: This study was a retrospective observational study. It was done in two tertiary centres in Malaysia between 2003 and 2013 for a total duration of 11 years. A total of 72 patients were included in this study. Data from medical records, operative notes, and histopathological reports were collected and analysed. Results: Three patients (4.2%) had the presence of microscopic thyroid gland invasion. There were no significant associations between microscopic thyroid gland invasion and tumour subsites, histological types of a tumour nor T staging (p>0.05) Conclusion: The incidence of microscopic thyroid gland invasion in advance carcinoma of the larynx is low, disavowing routine thyroidectomy. Limitations: Some factors such as cartilage invasion on CT imaging and central lymph node treatment were not considered due to limitations in case documentation.

[Resection of recurrent neck cancers with replacement of the carotid artery]. / Résection des cancers récidivants du cou avec remplacement de l'artère carotide.

OBJECTIVES: The management of patients with recurrent neck cancer invading the carotid artery is controversial. The aim of this study was to evaluate the overall survival and healthy survival years (QALY) as well as the patency of carotid revascularization after enbloc tumor resection followed by complementary radiotherapy. METHODS: From 2000 to 2016, 42 consecutive patients with recurrent neck cancer invading the carotid artery underwent resection of the tumor associated with reconstruction of the carotid artery with a PTFE prosthesis (n=31) or with a saphenous vein graft (n=11). In 11 cases, resection was associated with musculocutaneous flap coverage. The primary tumor was a squamous cell carcinoma of the larynx (20 patients) or of the pharynx (9 patients), undifferentiated carcinoma of unknown origin (10 patients) and anaplastic thyroid carcinoma (3 patients). All patients had postoperative radiotherapy (50-70Gy) supplemented in 16 of them by chemotherapy. Nine patients had metastatic dissemination at the time of reoperation with a recurrent tumor ulcerated to the skin in 5 of them. RESULTS: The combined 30-day mortality and stroke rate was nil. Postoperative morbidity included dysphagia (n=8), vocal cord paralysis (n=6), late wound healing delay (n=2), transient mandibular claudication (n=1) and partial necrosis of the musculocutaneous flap (n=1). No infection and no thrombosis of the bypass were observed during follow-up [median: 31 months, range: 8-167 months]. Twenty-one patients (50%) died from the consequences of the spread of cancer, which had become metastatic, but without local recurrence. The 5-year survival rate was 50.9±8.3%. The median healthy survival year (QALY) was 3.38 [95% CI: 1.70-4.54] with a significant difference between patients without metastasis at the time of reoperation [n=33; QALY=4.02] and those with metastases [n=9; QALY=0.43; P=0.005]. Healthy life expectancy was also significantly longer in patients with laryngeal cancer [n=20, QALY=4.95] compared to patients with other types of tumors [n=22, QALY=1.67; P=0.032]. CONCLUSION: In the absence of metastases, enbloc resection of recurrent neck cancers invading the carotid artery improves the duration and quality of patient survival.

[Long-term results and cause of failure analysis in larynx cancer patients irradiated conventionally and with accelerated fractionation schedules in 1995-1998]. / Odlegle wyniki i analiza przyczyn niepowodzen u chorych na raka krtani napromienianych konwencjonalnie i schematem przyspieszonego frakcjonowania w latach 1995-1998.

The clinical material consists of 217 patients with squamous cell carcinoma in supraglottic and glottic larynx in clinical stage T1-3N0M0 irradiated radically in Warsaw Oncology Centre in 1995-1998. All patients were treated with Co-60, according to two schedules of fractionation, with maintenance of the consistent therapeutic protocol. The same team of doctors worked on the treatment of patients and on the follow-up as well. The clinical material is a part of a three-phased clinical trial KBN 0295. In the course of observation, the progression of cancer was not observed in 157 patients, among whom, 66% were treated conventionally and 79% with accelerated fractionation method. 60 cases of loco-regional recurrences were noted, among which 55 were regional. The majority of failure cases was observed until the 30(th) of the month after the radiotherapy ended. In conventional fractionation treatment, recurrences in T1 were 8/31 (26%), in T2 22/59 (37%) and in T3 8/20 (40%). In patients treated with AF, recurrences were T1 5/39 (13%), T2 15/55 (27%) and T3 2/13 (15%) respectively. The percentage of primary site tumour recurrences for each localization and kind of treatment was analysed. In CF 28/78 (37%) of glottic tumour recurrences and 10/34 (29%) of supraglottic tumour, recurrences were observed. In AF, 12/71 (17%) and 10/36 (28%) were observed respectively. In 48 cases salvage surgery was used, and 12 patients were not qualified because of tumour massive progression or because they refused to have a surgery. Among 34 cases (16%) of the second primary tumour or distant methastases, 25 were observed with glottic cancer, among which 23 were observed in early stages, and 9 cases with supraglottic cancer, among which, 6 showed early stage of tumour. In only 3 cases out of all the patients, distant methastases were confirmed in histopatology examination. The main cause of failure in larynx cancer patients in stage T1 is that 3N0M0 are local recurrences. Second primary or distant methastases constitute 16% of the patients in this paper.

Role of human papillomavirus in non-oropharyngeal head and neck cancers.

Accurate estimates of the fraction of head and neck cancer (HNC) attributable to human papillomavirus (HPV) infection are essential to predict the effectiveness of interventions based on vaccination against HPV or HPV-testing. In addition, if supported by currently on-going clinical trials, attribution of a HNC to HPV may allow better and less toxic treatments. Here we focused on studies in which the prevalence of molecular and serological HPV markers was similarly assessed in oropharyngeal and non-oropharyngeal HNC. Large data on HPV DNA detection by PCR and p16 expression in HNC biopsies suggests that the probability of a cancer of the oral cavity, larynx, and hypopharynx being attributable to HPV is at least 5-fold lower than that for oropharyngeal cancer. Seropositivity for HPV16 E6 or E7 shows larger differences across sites, but findings vary between studies. Because HPV DNA and p16 detection lack specificity, and E6 and E7 antibody detection lacks sensitivity, these tests are not totally satisfactory. Limited data on in situ hybridization or HPV E6/E7 mRNA, mainly from the United States, suggests that HPV-attributable HNC is rare in the oral cavity (∼3%), larynx (∼7%), and hypopharynx (∼0%). Data on HPV in other rarer HNCs are extremely limited and essentially negative. Available data do not allow the establishment of the way HPV infection and tobacco may interact in non-oropharyngeal HNC. The exclusion of oropharynx as a site of tumor origin and the identification of robust fingerprints of HPV-driven carcinogenesis are the priorities to improve the estimate of HPV-attributable non-oropharyngeal HNC.

Relationship between reflux and laryngeal cancer.

Gastroesophageal reflux disease (GERD), or its variation known as laryngopharyngeal reflux (LPR), has been recognized as a potential cause of several laryngeal disorders. Patients with laryngeal cancer have lifestyle risk factors, especially tobacco and alcohol consumption, that play an etiological role in the development of their cancer but also places them at risk for reflux. The question then arises whether there is merely an association or a causal relationship between laryngeal cancer and reflux. However, despite a number of studies, a causal relationship with laryngeal cancer is uncertain. In this article, we address the current literature in a critical manner to evaluate the relationship between reflux and laryngeal cancer. From the review of the literature, we conclude that there is insufficient evidence to support a causal role of reflux in laryngeal cancer, mainly because of the confounding effect of tobacco and alcohol consumption and the inaccuracies in the diagnosis of reflux.

Microcirugía transoral láser en cáncer de laringe: experiencia en el Complejo Asistencial Barros Luco: 2003-2009 / Transoral laser microsurgery of cancer of the larynx: Barros Luco Medical Center: experience 2003-2009

Introducción: El cáncer de laringe es la segunda neoplasia maligna más frecuente en cabeza y cuello, existiendo varias alternativas terapéuticas para su manejo entre las que destaca el uso de láser para los estadios tempranos. Objetivo: Evaluar los resultados oncológicos de los pacientes con diagnóstico de cáncer de laringe que se trataron mediante microcirugía transoral láser en el Hospital Barros Luco. Material y método: Estudio retrospectivo de 30 pacientes operados en el Hospital Barros Luco desde el año 2003 al año 2009. Resultados: Para los pacientes con tumor T1 se obtuvo una sobrevida global (ajustada), control local inicial y final de 100 por ciento. En los pacientes T2 se observó una sobrevida global de 100 por ciento con un control local inicial y final de 81,8 por ciento. Los pacientes T3 también describieron una sobrevida global de 100 por ciento pero sin lograr control local inicial y final en ninguno de los pacientes. Discusión: Los resultados de control oncológico obtenidos en nuestro Servicio para estadios tempranos son similares a lo descrito en la literatura. Conclusiones: La cirugía transoral láser es un procedimiento seguro y con resultados oncológicos aceptables para el manejo de pacientes con patología neoplásica de laringe en estadios tempranos.

Introduction: Laryngeal cancer is the second most common malignancy in head and neck, and there are several treatment options for their management, wherein the use of lasers for early stages. Aim: To evaluate the oncological results of patients with a diagnosis of laringeal cancer, they were treated by transoral laser microsurgery at Hospital Barros Luco. Material and method: Retrospective study of 30 medical records of patients operated at the Barros Luco Hospital from 2003 to 2009. Results: For patients with T1 tumor overall survival (adjusted) initial and final local control of 100 percent was obtained. In T2 patients overall survival was 100 percent with an initial and final local control of 81.8 percent. Patients T3 described a 100 percent overall survival but without achieving local control and final control in none of the patients. Discussion: Cancer control results obtained in our service for early stages are similar to those described in the literature. Conclusions: Transoral laser surgery is a safe procedure with acceptable oncological outcomes in management of patients with neoplastic disease of the larynx in early stages.

Smoking and the risk of upper aero digestive tract cancers for men and women in the Asia-Pacific region.

Although smoking is an established causal factor for upper aero digestive tract cancer (UADTC), most of the evidence originates from the West. Thus, we analysed data from 455,409 subjects in the Asia Pacific Cohort Studies Collaboration. Over a median of around six years follow-up, 371 deaths from UADTC were observed. The hazard ratio (95% confidence interval) for current smokers, compared with those who had never smoked, was 2.36 (1.76 - 3.16), adjusted for age and alcohol drinking. Tobacco control policies are urgently required in Asia to prevent millions of deaths from UADTC that smoking will otherwise cause.

Cáncer de laringe en pacientes menores de 40 años / Laryngeal cancer in patients younger than 40 years

Objetivo: describir los datos demográficos de pacientes < 40 años de edad con diagnóstico de cáncer de laringe, y los resultados obtenidos después del tratamiento. Material y métodos: se revisaron los expedientes en forma retrolectiva, de una base de datos de 500 pacientes con cáncer de laringe atendidos entre 1989 y 2004; se incluyeron los pacientes < 40 años de edad al momento del diagnóstico, en quienes se corroboró el diagnóstico de carcinoma epidermoide. Resultados: fueron encontrados 15 pacientes (4.4 % de esta serie): nueve hombres (60 %) y seis mujeres (40 %), con una relación de 1.5:1, respectivamente. El promedio de edad para el grupo fue de 35 años. El tiempo promedio de evolución a la fecha del diagnóstico fue de 14.4 meses. El tabaquismo estuvo presente en 60 % y el alcoholismo en 40 %; la disfonía fue el síntoma cardinal en 87 %. La localización más frecuente fue la glotis (73 %). Los tumores bien diferenciados representaron 53 %. El tratamiento inicial fue cirugía en cuatro (27 %) pacientes y radioterapia en cinco (33 %), con un promedio de 63.44 Gy; un paciente (7 %) fue tratado con quimiorradioterapia concomitante con gemcitabine, cuatro (27 %) con quimioterapia neoadyuvante seguida de radioterapia, y un paciente no recibió tratamiento. El tiempo promedio de recurrencia después del primer tratamiento fue de 19.57 meses; cuatro pacientes fueron catalogados con persistencia. El tiempo promedio de supervivencia fue de 32 meses. La preservación de órgano al final fue de 28.5 %. Conclusiones: el cáncer epidermoide de laringe fue una patología rara en los pacientes < 40 años revisados. La relación de acuerdo con el sexo fue similar, con ligero predominio del masculino. Los factores de riesgo clásicos estuvieron presentes en 60 %. El pronóstico de los pacientes en esta serie estuvo determinado por el estadio clínico inicial.

BACKGROUND: We undertook this study to report demographic data of laryngeal cancer patients <40 years old and treatment results. METHODS: In a retrolective study we reviewed the clinical records of 500 patients with laryngeal cancer in the period from 1989 to 2004 and included those patients<40 years of age. RESULTS: We found 15 patients, representing 4.4% of the series. Nine (60%) were men and six (40%) were women, with a 1.5:1 ratio. Average group age was 35 years (range 21-40 and median of 37 months). Average time of evolution at the time of diagnosis was 14.4 months (range 0-36 and median of 12 months); 60% of the patients were smokers and 40% admitted to drinking alcohol; dysphonia was the main symptom found in 87% of the patients. The most frequent location was the glottis in 11 (73%) patients. Well-differentiated tumors represented 53% of the cases. Initial treatment was surgery in four (27%) patients; radiotherapy in five (33%) patients receiving an average of 63.44 Gy; concomitant chemoradiotherapy in one patient (7%) using gemcitabine; four (27%) patients were treated with neoadjuvant chemotherapy followed by radiotherapy; and one patient did not receive treatment. The average time in which the patients relapsed after the first treatment was 19.57 months (range 2-63) and four were classified as persistent. Survival time was 32 months (range 2-106 and median 27 months). Finally, organ preservation rate was obtained in 28.5%. CONCLUSIONS: Squamous cell carcinoma of the larynx is rare in patients<40 years old in our study. Gender relation seems to be equal, although a slight predominance of men does still exist. Classical risk factors were present in 60% of the cases. Prognosis for these patients was determined by the initial clinical stage.