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Management of Oropharyngeal Dysphagia in Laryngeal and Hypopharyngeal Cancer  [PDF]
Jose Granell,Laura Garrido,Teresa Millas,Raimundo Gutierrez-Fonseca
International Journal of Otolaryngology , 2012, DOI: 10.1155/2012/157630
Abstract: On considering a function-preserving treatment for laryngeal and hypopharyngeal cancer, swallowing is a capital issue. For most of the patients, achieving an effective and safe deglutition will mark the difference between a functional and a dysfunctional outcome. We present an overview of the management of dysphagia in head and neck cancer patients. A brief review on the normal physiology of swallowing is mandatory to analyze next the impact of head and neck cancer and its treatment on the anatomic and functional foundations of deglutition. The approach proposed underlines two leading principles: a transversal one, that is, the multidisciplinary approach, as clinical aspects to be managed in the oncologic patient with oropharyngeal dysphagia are diverse, and a longitudinal one; that is, the concern for preserving a functional swallow permeates the whole process of the diagnosis and treatment, with interventions required at multiple levels. We further discuss the clinical reports of two patients who underwent a supracricoid laryngectomy, a function-preserving surgical technique that particularly disturbs the laryngeal mechanics, and in which swallowing rehabilitation dramatically conditions the functional results. 1. Introduction Dysphagia is defined as difficulty in swallowing. It is a symptom that expresses a disorder in the transport of food and endogenous secretions (saliva) through the upper digestive tract. Oropharyngeal dysphagia (OD) is a more anatomically restricted term referred to alterations in the transfer of the bolus from the mouth to the esophagus (that means, in bolus propelling from the mouth to the pharynx, in the pharyngeal reconfiguration during the swallow, or in the opening of the upper esophageal sphincter) [1]. OD is an inescapable concern in the management of patients with laryngeal and hypopharyngeal cancer. Being as a symptom at presentation, as an adverse effect during whatever the treatment, or as sequelae compromising the quality of life of the patients, swallowing disorders have to be adequately anticipated and dealt with [2]. Swallowing is one of the vital functions that the larynx is involved in. For an outcome to be considered functional, the patient has to be able to swallow in an effective and safe manner. Actually, preserving a functional deglutition is usually the most important goal of the different function-preserving surgical techniques on the larynx and the hypopharynx, as a larynx that does not prevent aspiration cannot be preserved. Even though OD has been specifically classified in the latest versions of the
Functional organ preservation in laryngeal and hypopharyngeal cancer []  [cached]
Ambrosch, Petra,Fazel, Asita
GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery , 2012, DOI: 10.3205/cto000075
Abstract: [english] The principles of open versus laser microsurgical approaches for partial resections of the larynx are described, oncologic as well as functional results discussed and corresponding outcomes following primary radiotherapy are opposed. Over the last decade, the endoscopic partial resection of the larynx has developed to an accepted approach in the treatment of early glottic and supraglottic carcinomas thus leading to a remarkable decline in the use of open surgery. Comparing the various surgical approaches of laryngeal partial resections, the oncological outcome of the patients, as far as survival and organ preservation are concerned, are comparable, whereas functional results of the endoscopic procedures are superior with less morbidity. The surgical procedures put together, are all superior to radiotherapy concerning organ preservation. Transoral laser microsurgery has been used successfully for vocal cord carcinomas with impaired mobility or fixation of the vocal cord, supraglottic carcinomas with infiltration of the pre- and/or paraglottic space as well as for selected hypopharyngeal carcinomas. It has been well documented that laser microsurgery achieves good oncological as well as functional results with reasonable morbidity. However, patients with those tumours have been successfully treated by open partial resections of the larynx at medical centres with appropriate expertise. The initially enthusiastic assessment of study results concerning the efficacy of various protocols of chemoradiation with the intent of organ preservation for laryngeal and hypopharyngeal carcinomas are judged more cautious, today, due to recent reports of rather high rates of late toxicity complications.
Value of computed tomography for evaluating the subglottis in laryngeal and hypopharyngeal squamous cell carcinoma
Souza, Ricardo Pires de;Barros, Nestor de;Paes Junior, Ademar José de Oliveira;Tornin, Olger de Souza;Rapoport, Abr?o;Cerri, Giovanni Guido;
Sao Paulo Medical Journal , 2007, DOI: 10.1590/S1516-31802007000200002
Abstract: context and objective: subglottic involvement in squamous cell carcinoma is a determining factor for contraindicating conservative partial surgery. the subglottis is easily identified by axial computed tomography sections. the present study aimed to evaluate the occurrence of false-negative and false-positive results, and the overall accuracy of staging by computed tomography, in order to detect the involvement of the subglottic laryngeal compartment, in cases of laryngeal and hypopharyngeal squamous cell carcinoma. design and setting: retrospective, non-randomized study of patients treated at hospital heliópolis, s?o paulo, brazil. methods: computed tomography scans were performed on third-generation equipment with 5-mm slice thickness. afterwards, all patients underwent surgical and anatomopathological examinations as the gold standard procedures. results: among 60 patients, 14 were diagnosed with subglottic extension by surgical and histopathological examination. there were three false-negative and no false-positive results from computed tomography scans. the sensitivity and negative predictive value were 100.0%. accuracy was 95.0%, specificity was 93.5% and positive predictive value was 82.4%. conclusions: computed tomography could serve as a powerful auxiliary method for staging laryngeal and hypopharyngeal cancer. however, precautions should be taken in analyzing computed tomography scan data, because vegetating lesions may also be projected into the subglottic compartment, without real involvement of the subglottis, which may cause a false-positive result.
The Expression of SIRT1 and DBC1 in Laryngeal and Hypopharyngeal Carcinomas  [PDF]
Xue-Min Yu, Ying Liu, Tong Jin, Jun Liu, Juan Wang, Chao Ma, Xin-Liang Pan
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0066975
Abstract: Rationale and Objective Sirtuin 1 (SIRT1) plays an important role in tumorigenesis and is increased in many human tumors. DBC1 is a negative regulator of SIRT1 via promotion of p53-mediated apoptosis. It is necessary to investigate the expression of SIRT1 and DBC1 in laryngeal and hypopharyngeal squamous cell carcinomas (LSCC and HSCC) and its correlation with available clinical parameters. Methods The mRNA levels of SIRT1 and DBC1 were measured in 54 paired LSCC or HSCC tumors and corresponding adjacent noncancerous mucosae using quantitative RT-PCR (qRT-PCR). The protein levels of SIRT1 and DBC1 were also evaluated in 120 cases of patients with LSCC or HSCC using immunohistochemical staining. The correlation between SIRT1 and DBC1 expression and clinical parameters was analyzed with Pearson chi-square test. Results qRT-PCR assay showed that, compared with the paired adjacent noncancerous mucosae, SIRT1 mRNA was significantly decreased in tumors. The immunohistochemical results indicated that the SIRT1 protein was also downregulated in tumors compared with noncancerous mucosae. Moreover, decreased SIRT1 was significantly correlated with the tumor clinical stage and lymph node metastasis. Additionally, DBC1 mRNA was significantly increased in tumors compared with noncancerous mucosae. The immunohistochemical results indicated that the DBC1 protein was downregulated in tumors, which is inconsistent with the results obtained by qRT-PCR. Finally, decreased DBC1 protein was significantly correlated with tumor differentiation, lymph node metastasis, and p53 expression. Conclusions SIRT1 and DBC1 might be involved in the pathophysiology of laryngeal and hypopharyngeal squamous cell carcinomas and are associated with lymph node metastasis and p53 positive staining in LSCCs and HSCCs.
Larynx Organ Preservation in Patients with Hypopharyngeal-Laryngeal Cancer  [PDF]
Salvatore Conticello, Andrea Fulcheri, Salvatore Aversa, Gabriella Gorzegno, Alessio Petrelli, Giuseppe Malinverni, Simona Allis, Pietro Gabriele, Cristina Ondolo, Maria Grazia Ruo Redda
International Journal of Otolaryngology and Head & Neck Surgery (IJOHNS) , 2013, DOI: 10.4236/ijohns.2013.21008
Abstract: Object: The therapeutic options for advanced laryngeal-hypopharyngeal cancer have broadened in the last decades, in the attempt to cure the cancer sparing laryngeal functions and to improve quality of life (functional surgery, chemo- radiotherapy, combined therapy). Methods: We propose a single-centre based retrospective study on the results of the treatment of larynx-hypopharynx cancer on the basis of the different therapies offered, focusing on advanced-stage cancers. Among 146 patients with laryngeal-hypopharyngeal cancer treated in the period 1999-2006, we focused on 64 patients with advanced stage resectable cancer. In the larynx cancer group ?n = 40-, 32 patients had surgery and 8 patients had CT-RT (refusal of laryngectomy or relative contraindications to surgery). In the hypopharynx cancer group ?n = 24-, 16 patients underwent surgery and 8 patients had CT-RT. The outcome measure considered has been overall survival. Results: Larynx cancer group. Overall survival: after surgery we observed a 3-year survival of 62%, and a 5-year survival of 44%, while after CT-RT we had a 3-year survival of 25% and a 5-year survival of 12%. Hypopharynx cancer group. Overall survival: surgery: 3-year survival: 40%, 5-year survival 32%; CT-RT: 3-year survival: 50%, 5-year survival: 34%. Conclusion: The results emphasize the use of larynx-preserving approaches for appropriately selected patients without a compromise in survival; in our case series, surgery had better outcome than CT-RT in advanced-stage larynx cancer; whilst no significant differences were observed in the treatment of hypopharynx cancer.
Paediatric Blunt Laryngeal Trauma: A Review  [PDF]
J. C. Oosthuizen
International Journal of Otolaryngology , 2011, DOI: 10.1155/2011/183047
Abstract: Paediatric blunt laryngeal trauma is infrequently encountered; however, it can have fatal consequences if managed inappropriately. This paper provides an overview of the relatively limited literature available on the subject and highlights current controversies and recent advances in the management of these injuries.
Long-term results of intensity-modulated radiotherapy concomitant with chemotherapy for hypopharyngeal carcinoma aimed at laryngeal preservation
Wen-Shan Liu, Chung-Han Hsin, Ying-Hsiang Chou, Jung-Tung Liu, Ming-Fang Wu, Szu-Wen Tseng, Jong-Kang Lee, Hsien-Chun Tseng, Tzu-Hwei Wang, Mao-Chang Su, Huei Lee
BMC Cancer , 2010, DOI: 10.1186/1471-2407-10-102
Abstract: Twenty-seven patients with hypopharyngeal carcinoma (stage II-IV) were enrolled and underwent concurrent chemoradiotherapy. The chemotherapy regimens were monthly cisplatin and 5-fluorouracil for six patients and weekly cisplatin for 19 patients. All patients were treated with IMRT with simultaneous integrated boost technique. Acute and late toxicities were recorded based on CTCAE 3.0 (Common Terminology Criteria for Adverse Events).The median follow-up time for survivors was 53.0 months (range 36-82 months). The initial complete response rate was 85.2%, with a laryngeal preservation rate of 63.0%. The 5-year functional laryngeal, local-regional control, disease-free and overall survival rates were 59.7%, 63.3%, 51.0% and 34.8%, respectively. The most common greater than or equal to grade 3 acute and late effects were dysphagia (63.0%, 17 of 27 patients) and laryngeal stricture (18.5%, 5 of 27 patients), respectively. Patients belonging to the high risk group showed significantly higher risk of tracheostomy compared to the low risk group (p = 0.014).After long-term follow-up, our results confirmed that patients with hypopharyngeal carcinoma treated with IMRT concurrent with platinum-based chemotherapy attain high functional laryngeal and local-regional control survival rates. However, the late effect of laryngeal stricture remains a problem, particularly for high risk group patients.Patients with resectable, locally advanced laryngeal and hypopharyngeal carcinoma have historically been treated with surgery and adjuvant radiotherapy [1-3]. However, their quality of life is greatly impaired because the entire larynx is sacrificed. After the finding by VA Laryngeal Cancer Study Group [4] that induction chemotherapy followed by definitive radiotherapy leads to a larynx preservation rate of 68%, this method has been considered as an organ preservation treatment for laryngeal carcinoma [5-8]. The European Organization for Research and Treatment of Cancer (EORTC) conducted
Spectral CT Imaging of Laryngeal and Hypopharyngeal Squamous Cell Carcinoma: Evaluation of Image Quality and Status of Lymph Nodes  [PDF]
Aiyin Li, Hui Liang, Wei Li, Zhongzhou Wang, Tao Pang, Jun Li, Hao Shi, Chengqi Zhang
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0083492
Abstract: Purpose The purpose of this study was to evaluate image quality and status of lymph nodes in laryngeal and hypopharyngeal squamous cell carcinoma (SCC) patients using spectral CT imaging. Materials and Methods Thirty-eight patients with laryngeal and hypopharyngeal SCCs were scanned with spectral CT mode in venous phase. The conventional 140-kVp polychromatic images and one hundred and one sets of monochromatic images were generated ranging from 40 keV to 140 keV. The mean optimal keV was calculated on the monochromatic images. The image quality of the mean optimal keV monochromatic images and polychromatic images was compared with two different methods including a quantitative analysis method and a qualitative analysis method. The HU curve slope (λHU) in the target lymph nodes and the primary lesion was calculated respectively. The ratio of λHU was studied between metastatic and non-metastatic lymph nodes group. Results A total of 38 primary lesions were included. The mean optimal keV was obtained at 55±1.77 keV on the monochromatic images. The image quality evaluated by two different methods including a quantitative analysis method and a qualitative analysis method was obviously increased on monochromatic images than polychromatic images (p<0.05). The ratio of λHU between metastatic and non-metastatic lymph nodes was significantly different in the venous phase images (p<0.05). Conclusion The monochromatic images obtained with spectral CT can be used to improve the image quality of laryngeal and hypopharyngeal SCC and the N-staging accuracy. The quantitative ratio of λHU may be helpful for differentiating between metastatic and non-metastatic cervical lymph nodes.
Associations of Tobacco Use and Alcohol Drinking with Laryngeal and Hypopharyngeal Cancer Risks among Men in Karunagappally, Kerala, India -Karunagappally Cohort Study  [PDF]
Padmavathy Amma Jayalekshmi, Athira Nandakumar, Suminori Akiba, Paleth Gangadharan, Chihaya Koriyama
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0073716
Abstract: Background From among a cohort of 65,553 men aged 30–84 in Karunagappally Taluk, Kerala, India, 52 hypopharyngeal cancer cases and 85 laryngeal cancer cases were identified by the Karunagappally Cancer Registry during the period between 1990 and 2009. Methods We conduct Poisson regression analysis of grouped data, taking into account age and education. Results This study showed that the incidence rates of cancers of the hypopharynx and the larynx were strongly related to the number of bidis smoked a day (P<0.001 for both hypopharyngeal and laryngeal cancers) and duration of bidi smoking (P=0.009; P<0.001). Laryngeal cancer risk was significantly increased by bidi smoking (P<0.001), cigarette smoking (P=0.013) and regular alcohol use (P=0.005). Conclusion The present study, the first cohort study to examine the association of hypopharyngeal and laryngeal cancer incidence rates with bidi smoking in South Asia, clearly showed dose–response relationships between those cancer risks and bidi smoking; larger amounts of bidi smoked a day and longer durations of bidi smoking increased the incidence rates of those cancers. Tobacco chewing was found not related to the risk of hypopharynx or larynx cancer.
Blunt external laryngeal trauma: Two case reports  [PDF]
Mitrovi? Slobodan M.
Medicinski Pregled , 2007, DOI: 10.2298/mpns0710489m
Abstract: Introduction. External laryngeal trauma, blunt or penetrating, is rare but potentially life-threatening. Most frequently it occurs in motor vehicle accidents. The most common symptoms of external laryngeal injuries are: dysphagia, odynophagia, dysphonia, odynophonia, reduction of the laryngeal prominence, hemoptysis and neck crepitation. Two case reports. This paper reviews two cases of blunt laryngeal injury caused by a direct blow to the neck. After admission, both patients underwent clinical examination, as well as radiography of the neck, and computer tomography of the neck and larynx. GIRBAS scale was used for voice analysis. In the first case, computer tomography showed a fracture of the right thyroid cartilage in the posterior lamina where it is attached to the upper horn. In the other case, the presence of air was confirmed by radiography of the upper aperture. Computerized tomography showed the presence of air in the neck, underneath the skin, which was probably the consequence of the larygeal valve mechanism trauma. Both patients were treated conservatively. Discussion and Conclusion. The symptomatology of external larygeal trauma may include: hoarseness, swallowing difficulties and/or painful swallowing, painful phonation, neck pain, bloody sputum and breathing difficulties. The clinical symptoms of blunt laryngeal trauma may be hidden and non-specific, but also clear, indicating a larynx trauma, and vice versa. Quick diagnosis using computerized tomography, hospitalization and adequate therapy, can reduce the consequences of these injuries and increase the chances for a complete recovery of larygeal musculature and function. .
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