Optimal Postoperative Treatment for Composite Laryngeal Small Cell Carcinoma

Small cell carcinoma (SmCC) most commonly occurs in the lung and rarely arises from the head and neck region. Further, composite SmCC is extremely rare. Therefore, no postoperative treatment strategy has been established. We report a 59-year-old male patient referred to our outpatient clinic for further examination and treatment of a laryngeal tumor. Biopsy from the tumor revealed squamous cell carcinoma (SCC). The preoperative diagnosis was supraglottic SCC (T3N2bM0), and total laryngectomy and bilateral neck dissection were performed. Pathological examination revealed 2 individual cancer components: SmCC and SCC. Postoperative chemoradiotherapy (2 courses of cisplatin (CDDP) and etoposide (VP-16)) was indicated. Following the postoperative chemoradiotherapy, 2 courses of adjuvant chemotherapy were administered. The patient is currently alive with no evidence of disease at 36 months following the completion of therapy. Postoperative chemoradiotherapy and adjuvant chemotherapy are optimal treatment strategies for laryngeal composite SmCC. 1. Introduction Small cell carcinoma (SmCC) most commonly occurs in the lung and rarely arises from the head and neck region. SmCC combined with another carcinoma is classified as combined or composite SmCC and is extremely rare. SmCC arising in the larynx accounts for only 0.5% of all laryngeal cancers, and composite SmCC arising in the larynx accounts for less than 10% of laryngeal SmCC [1]. Therefore, clinical experiences are very limited. The standard treatment for laryngeal and laryngeal composite SmCC is chemotherapy and radiotherapy [2–4]. However, it is difficult to diagnose laryngeal composite SmCC before an operation [5]. For these patients, systemic postoperative treatment is essential. However, no postoperative treatment strategy for composite SmCC in the head and neck region has been established. Here, we present a case of laryngeal composite SmCC and discuss the optimal postoperative treatment. 2. Case Presentation A 59-year-old male patient was referred to our outpatient clinic for further examination and treatment of a laryngeal tumor. The patient had no remarkable medical or family history, was a heavy smoker (60 pack-years), and was a social drinker. The tumor was detected at the left arytenoid, and the left vocal cord was fixed (Figure 1). A computed tomography (CT) scan showed that the thyroid cartilage was intact. Several cervical lymph node metastases were detected on the left side of the neck; however, distant metastasis was not detected. Cervical ultrasonography also revealed multiple metastatic