Treatment of early-stage laryngeal cancer: A comparison of treatment options.

Over the course of the last several decades, the treatment options for early laryngeal cancers (T1 and T2) have evolved; however, simultaneously the mortality rate has increased. As larynx preservation approaches have become the standard of care, the selection of the proper treatment modality has become paramount. Radiation therapy or transoral laser microsurgery are the most common options for treatment of these early lesions. Oncologic and functional outcomes are considered equivalent between the two modalities for early glottic cancers; however, no direct comparisons exist for robust analysis. In terms of larynx preservation, there also is not compelling data favoring one treatment option or another. For early stage lesions, the goal for any larynx-sparing technique, either radiation or surgery, should be the intent to cure with single modality treatment and minimal short- and long-term toxicity. This article is designed to create a frame of reference for managing early stage disease with respect to lesions of the glottis and supraglottis while weighing treatment implications from an oncologic, functional, and cost perspective.

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Radiation-associated carotid artery atherosclerosis: case report and review of contemporaneous literature.

Radiation therapy (RT) is a component of the treatment of patients with head and neck malignancies. This therapy may damage the nearby carotid arteries, thereby initiating or accelerating the atherosclerotic process (atheroma formation). Dentists treating patients who have been irradiated should examine the patient's panoramic radiograph for evidence of atheroma-like calcifications, which appear 1.5 to 2.5 cm posterior and inferior to the angle of the mandible. Patients with evidence of such lesions should be referred to their primary care physician with the suggestion that an ultrasound examination of the carotid arteries is indicated.

[Treatment of laryngeal cancer: cordectomy or crico-hyoido-epiglottopexy versus radiotherapy]. / Traitement du cancer laryngé: cordectomie ou crico-hyoïdoépiglottopexie versus radiothérapie.

INTRODUCTION: Both radiotherapy and endoscopic or open functional surgery are recognised treatments for laryngeal cancer stage I and II. A comparison between two groups of patients treated with either modality may clarify the indications for both treatments. METHODS: Over a period of 13 years two separate series of patients were treated for laryngeal cancer (stage I and II) by either surgery (n = 72) or radiotherapy (n = 81). We have analysed and compared the two groups. RESULTS: Statistical analyses show a better local control among patients treated with surgery, when the anterior commissure was involved (p < 0.01) or with extension of the tumour (T2). However, long-term survivals were not significantly different in the two groups. As postradiation recurrence was diagnosed at an early stage, salvage (requiring total laryngectomy in many cases) was efficient but contributed to an appreciable difference in the long-term laryngeal preservation rate between the two groups (91% after radiotherapy and 99% after surgery). CONCLUSION: The treatment of laryngeal cancer must always compromise between oncological efficiency and functional preservation. With anterior commissure involvement (T1b) or more extensive disease (T2), surgery appears to be better. Therefore, preservation of perfect laryngeal function should be subordinate to oncological safety.

Epiglottitis following preparation for allogeneic bone marrow transplantation.

We describe a 7-year-old boy who developed acute, airway-threatening, non-infectious epiglottitis following high-dose cytosine arabinoside and total body irradiation preparative regimen for allogeneic BMT. Unlike gastrointestinal symptoms and oropharyngeal mucositis, acute epiglottitis is a previously unreported early complication following allogeneic BMT preparation. The pathogenesis of epiglottitis in our patient was presumably multifactorial, resulting from the combination of chemotherapy and irradiation. We recommend that this diagnosis be considered in the differential diagnosis of patients with significant upper airway symptoms following BMT preparation.

[Results of the treatment of laryngeal cancer by a conventional method]. / Wyniki leczenia raka krtani napromienianiem metoda konwencjonalna.

The authors described the results of 3-, 5-, and 10-years survival rate after conventional radiotherapy in laryngeal cancer patients in connection to localization and clinical development (International classification). The 3 years survival rate was found in 61% of patients, 5 years in 51.6% and 10 years in 38%. The best results were found in I and II stage of clinical development, and in glottic localization. In case of recurrencies after radiotherapy the surgery was applied. These procedures elongated the survival rate of 6-10%.

Soft-tissue changes after head and neck radiation: CT findings.

To identify possible soft-tissue changes of the head and neck after radiation therapy, 102 CT scans from 78 patients with head and neck tumors were reviewed to assess (1) skin thickening, (2) epiglottic thickening, (3) stranding of subcutaneous fat, and (4) stranding of deep cervical fat. Scans were obtained after radiation therapy alone (10 cases), after radiation and surgery (27 cases), after surgery alone (24 cases), or before either surgery or radiation (41 cases). Skin thickening, epiglottic thickening, and stranding of subcutaneous fat were seen more frequently after radiation therapy than before such treatment. However, skin thickening and stranding of subcutaneous fat were sometimes also associated with tumor involvement and/or previous surgery, while epiglottic thickening was only occasionally associated with tumor involvement. Stranding of deep cervical fat was noted with increased frequency after radiation or surgery, but postradiation effects could not be reliably distinguished from postsurgical or tumor effects. We conclude that soft-tissue changes of the head and neck on CT may commonly be associated with previous radiation therapy, but these postradiation effects are not always distinguishable from postsurgical effects or tumor.

Epiglottic enlargement following radiation treatment of head and neck tumors.

This article describes delayed noninfectious epiglottic enlargement in two children, one with rhabdomyosarcoma of nasopharynx and the other with undifferentiated anaplastic carcinoma of the neck. The pathogenesis is assumed to be delayed laryngeal injury following radiotherapy alone or combined with chemotherapy. The radiographic findings in these cases were identical to those of acute epiglottitis.