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Ecancermedicalscience 2022Radiotherapy is a standard treatment option for early glottic carcinoma (stage I and II) with a fraction size of 2-2.2 Gy over 5-7 weeks. This study evaluates the...
BACKGROUND
Radiotherapy is a standard treatment option for early glottic carcinoma (stage I and II) with a fraction size of 2-2.2 Gy over 5-7 weeks. This study evaluates the outcome and prognostic factors of a 3-week hypofractionated treatment in early glottic malignancy.
MATERIALS AND METHODS
The case records of 329 eligible patients with stage I and II glottic carcinoma recorded at the institution from 2003 to 2008 were retrospectively analysed. All patients were treated in a Cobalt-60 machine to a dose of 52.5 Gy in 15 fractions (3.5 Gy/fraction) over 3 weeks.
RESULTS
Eighty-three percent had stage I disease. The local control rate at 5 years was 91.9%. On univariate analysis, stage I and II patients without subglottic extension had better local control. Disease extension to the subglottis fared poorly on multivariate analysis. After salvage treatment, the 5-year disease-free survival rate was 96.1% and the functional larynx preservation rate was 94.9% for stage I and 83.9% for stage II. The rate of severe complications was 2.1%.
CONCLUSION
Comparable results with low morbidity are achievable with a 3-week hypofractionation in early glottic cancers and it offers better patient convenience.
HIGHLIGHTS
In early glottic cancer, hypofractionated radiation provides excellent local control.Subglottic extension is a poor prognostic factor.5-year disease-free survival rate of 96.1%.5-year functional larynx preservation rate of 94.9%.Severe complication rate of 2.1%.
PubMed: 35919227
DOI: 10.3332/ecancer.2022.1381 -
Indian Journal of Otolaryngology and... Oct 2019Injury to the aerodigestive tract following external laryngeal trauma is rare. Reports of acquired laryngopharyngeal fistula are very few. We report a very rare...
Injury to the aerodigestive tract following external laryngeal trauma is rare. Reports of acquired laryngopharyngeal fistula are very few. We report a very rare presentation of penetrating neck trauma presenting with fracture of the cricoid cartilage, subglottic stenosis and pharyngosubglottic fistula. The term 'pharyngosubglottic fistula' is used here for the first time to describe a communication tract between hypopharynx and subglottis. The successful surgical management of this case is discussed.
PubMed: 31742017
DOI: 10.1007/s12070-018-1390-8 -
Cancer Imaging : the Official... Oct 2023Accuracy of head and neck MRI (HN-MRI) in predicting tumor invasion of laryngeal site/subsites in patients with laryngeal cancer prior to laryngectomy is poorly...
BACKGROUND
Accuracy of head and neck MRI (HN-MRI) in predicting tumor invasion of laryngeal site/subsites in patients with laryngeal cancer prior to laryngectomy is poorly evaluated in the literature. Therefore, we aim to evaluate the diagnostic value of HN-MRI in accurate pre-operative estimation of tumor invasion to laryngeal subsites in patients with laryngeal cancer.
METHODS
Patients with laryngeal cancer who underwent HN-MRI for cancer staging and underwent total laryngectomy between 2008 and 2021 were included. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of HN-MRI in predicting tumor invasion of laryngeal subsites were calculated based on concordance between the HN-MRI and histopathological results.
RESULTS
One hundred and thirty-seven patients underwent total laryngectomy [primary: 82/137(60%), salvage 55/137(40%)]. The utilization of HN-MRI resulted in the downstaging of 16/137 (11.6%) patients and the upstaging of 8/137 (5.8%) patients. For the whole cohort, there was a significant discordance between HN-MRI and histopathology for T-category; out of 116 cT4a disease, 102(87.9%) were confirmed to have pT4a disease, and out of 17 cT3 disease, 9(52.9%) were confirmed to have pT3 disease, p < 0.001. The MRI overall diagnostic accuracy of predicting tumor invasion was 91%, 92%, 82%, 87%, 72%, 76%, 65% and 68% for base of tongue, arytenoid, vocal cord, posterior commissure, pre-epiglottic space, cricoid cartilage, inner thyroid cortex, and subglottis, respectively.
CONCLUSIONS
In patients with laryngeal cancer undergoing total laryngectomy, HN-MRI demonstrates promising accuracy in predicting tumor invasion of specific laryngeal subsites (e.g., base of tongue). Our findings showed the potential of HN-MRI as a valuable tool for pre-operative planning and treatment decision-making in this patient population.
Topics: Humans; Laryngeal Neoplasms; Neoplasm Invasiveness; Magnetic Resonance Imaging; Neoplasm Staging; Laryngectomy; Retrospective Studies
PubMed: 37858162
DOI: 10.1186/s40644-023-00618-y -
Journal of Biomedical Optics Sep 2019Subglottic stenosis (SGS) is a challenging disease to diagnose in neonates. Long-range optical coherence tomography (OCT) is an optical imaging modality that has been...
Dynamic programming and automated segmentation of optical coherence tomography images of the neonatal subglottis: enabling efficient diagnostics to manage subglottic stenosis.
Subglottic stenosis (SGS) is a challenging disease to diagnose in neonates. Long-range optical coherence tomography (OCT) is an optical imaging modality that has been described to image the subglottis in intubated neonates. A major challenge associated with OCT imaging is the lack of an automated method for image analysis and micrometry of large volumes of data that are acquired with each airway scan (1 to 2 Gb). We developed a tissue segmentation algorithm that identifies, measures, and conducts image analysis on tissue layers within the mucosa and submucosa and compared these automated tissue measurements with manual tracings. We noted small but statistically significant differences in thickness measurements of the mucosa and submucosa layers in the larynx (p < 0.001), subglottis (p = 0.015), and trachea (p = 0.012). The automated algorithm was also shown to be over 8 times faster than the manual approach. Moderate Pearson correlations were found between different tissue texture parameters and the patient’s gestational age at birth, age in days, duration of intubation, and differences with age (mean age 17 days). Automated OCT data analysis is necessary in the diagnosis and monitoring of SGS, as it can provide vital information about the airway in real time and aid clinicians in making management decisions for intubated neonates.
Topics: Algorithms; Humans; Image Interpretation, Computer-Assisted; Infant, Newborn; Laryngostenosis; Larynx; Tomography, Optical Coherence
PubMed: 31493317
DOI: 10.1117/1.JBO.24.9.096001 -
Journal of Medical Case Reports Feb 2016Epithelial-myoepithelial carcinoma is an extremely rare disease that usually occurs in the parotid gland but can occur in a variety of sites such as the nasal cavity,... (Review)
Review
BACKGROUND
Epithelial-myoepithelial carcinoma is an extremely rare disease that usually occurs in the parotid gland but can occur in a variety of sites such as the nasal cavity, paranasal sinus, and base of the tongue.
CASE PRESENTATION
We report a rare case of epithelial-myoepithelial carcinoma, which developed in the subglottic region. A 78-year-old Korean woman visited our hospital complaining of hoarseness, which had developed 1 month previously. Flexible laryngoscopy showed a round mass that blocked approximately 80 % of the tracheal diameter. Complete excision of the mass was carried out under general anesthesia, using a transoral approach. Epithelial-myoepithelial carcinoma was diagnosed following immunohistochemical analysis.
CONCLUSIONS
We report a rare case of epithelial-myoepithelial carcinoma that occurred in the subglottic region. To the best of our knowledge, only one other case has been reported since this disease was first identified approximately 40 years ago.
Topics: Aged; Carcinoma; Female; Humans; Laryngeal Neoplasms; Myoepithelioma
PubMed: 26922486
DOI: 10.1186/s13256-016-0824-8 -
Ear, Nose, & Throat Journal Mar 2022
PubMed: 35324324
DOI: 10.1177/01455613221086528 -
Ear, Nose, & Throat Journal Jun 2022The hemangioma is the most common vascular tumor, involving the head and neck in 60% of cases. It is rare in the larynx. In children, hemangiomas are more frequent on... (Review)
Review
INTRODUCTION
The hemangioma is the most common vascular tumor, involving the head and neck in 60% of cases. It is rare in the larynx. In children, hemangiomas are more frequent on the subglottis, whereas in adults the most common site is the supraglottis. Laryngeal hemangioma with cavernous features isolated to the free edge of the vocal fold is a very rare clinical finding. We present 2 cases of glottic hemangioma. Both patients reported severe hoarseness.
CASES
In the first patient, an extensive blue-purple mass was seen on the right vocal cord. The patient was posted for microlaryngeal surgery with carbon dioxide (CO) laser. Second patient had a large, smooth, flesh-colored polypoid mass emanating from the left vocal cord. The patient was posted for microlaryngeal surgery. After 2 months, both patients showed a considerable voice improvement.
DISCUSSION
Vocal cord hemangiomas are very rare, and they usually cause problem in the voice of the patient. A vascular lesion that may mimic a hemangioma may sometimes result from an organizing hematoma following a hemorrhage on the vocal cords due to voice abuse. Laryngeal hemangiomas also need to be distinguished pathologically from polypoidal vascular granulation tissue that may be produced by laryngeal biopsy, intubation, or trauma. Indirect endoscopy is enough to diagnosis. No active treatment is advised for adult laryngeal hemangiomas unless the lesions are symptomatic or show a tendency to involve other parts. There is no uniformly accepted treatment of head and neck hemangiomas. Surgical excision with laser CO microlaryngoscopic techniques gives satisfactory results.
Topics: Adult; Carbon Dioxide; Child; Hemangioma; Humans; Laryngeal Neoplasms; Lasers, Gas; Vocal Cords
PubMed: 32921178
DOI: 10.1177/0145561320952191 -
The Laryngoscope Jan 2017Current imaging modalities lack the necessary resolution to diagnose subglottic stenosis. The aim of this study was to use optical coherence tomography (OCT) to evaluate...
OBJECTIVES/HYPOTHESIS
Current imaging modalities lack the necessary resolution to diagnose subglottic stenosis. The aim of this study was to use optical coherence tomography (OCT) to evaluate nascent subglottic mucosal injury and characterize mucosal thickness and structural changes using texture analysis in a simulated intubation rabbit model.
STUDY DESIGN
Prospective animal study in rabbits.
METHODS
Three-centimeter-long sections of endotracheal tubes (ETT) were endoscopically placed in the subglottis and proximal trachea of New Zealand White rabbits (n = 10) and secured via suture. OCT imaging and conventional endoscopic video was performed just prior to ETT segment placement (day 0), immediately after tube removal (day 7), and 1 week later (day 14). OCT images were analyzed for airway wall thickness and textural properties.
RESULTS
Endoscopy and histology of intubated rabbits showed a range of normal to edematous tissue, which correlated with OCT images. The mean airway mucosal wall thickness measured using OCT was 336.4 μm (day 0), 391.3 μm (day 7), and 420.4 μm (day 14), with significant differences between day 0 and day 14 (P = .002). Significance was found for correlation and homogeneity texture features across all time points (P < .05).
CONCLUSIONS
OCT is a minimally invasive endoscopic imaging modality capable of monitoring progression of subglottic mucosal injury. This study is the first to evaluate mucosal injury during simulated intubation using serial OCT imaging and texture analysis. OCT and texture analysis have the potential for early detection of subglottic mucosal injury, which could lead to better management of the neonatal airway and limit the progression to stenosis.
LEVEL OF EVIDENCE
NA Laryngoscope, 127:64-69, 2017.
Topics: Animals; Disease Models, Animal; Image Interpretation, Computer-Assisted; Intubation, Intratracheal; Laryngoscopy; Laryngostenosis; Prospective Studies; Rabbits; Tomography, Optical Coherence
PubMed: 27559721
DOI: 10.1002/lary.26241 -
Otolaryngology--head and Neck Surgery :... Jan 2019To characterize the phenotype and function of fibroblasts derived from airway scar in idiopathic subglottic stenosis (iSGS) and to explore scar fibroblast response to... (Comparative Study)
Comparative Study
OBJECTIVE
To characterize the phenotype and function of fibroblasts derived from airway scar in idiopathic subglottic stenosis (iSGS) and to explore scar fibroblast response to interleukin 17A (IL-17A).
STUDY DESIGN
Basic science.
SETTING
Laboratory.
SUBJECTS AND METHODS
Primary fibroblast cell lines from iSGS subjects, idiopathic pulmonary fibrosis subjects, and normal control airways were utilized for analysis. Protein, molecular, and flow cytometric techniques were applied in vitro to assess the phenotype and functional response of disease fibroblasts to IL-17A.
RESULTS
Mechanistically, IL-17A drives iSGS scar fibroblast proliferation ( P < .01), synergizes with transforming growth factor ß1 to promote extracellular matrix production (collagen and fibronectin; P = .04), and directly stimulates scar fibroblasts to produce chemokines (chemokine ligand 2) and cytokines (IL-6 and granulocyte-macrophage colony-stimulating factor) critical to the recruitment and differentiation of myeloid cells ( P < .01). Glucocorticoids abrogated IL-17A-dependent iSGS scar fibroblast production of granulocyte-macrophage colony-stimulating factor ( P = .02).
CONCLUSION
IL-17A directly drives iSGS scar fibroblast proliferation, synergizes with transforming growth factor ß1 to promote extracellular matrix production, and amplifies local inflammatory signaling. Glucocorticoids appear to partially abrogate fibroblast-dependent inflammatory signaling. These results offer mechanistic support for future translational study of clinical reagents for manipulation of the IL-17A pathway in iSGS patients.
Topics: Biopsy, Needle; Case-Control Studies; Cell Proliferation; Cells, Cultured; Cicatrix; Cytokines; Enzyme-Linked Immunosorbent Assay; Female; Fibroblasts; Fibrosis; Flow Cytometry; Humans; Immunohistochemistry; Interleukin-17; Laryngostenosis; Male; Polymerase Chain Reaction; Reference Values; Sensitivity and Specificity; Signal Transduction
PubMed: 30322354
DOI: 10.1177/0194599818803584 -
Cureus Nov 2019Objectives This study aimed to compare the results of a software calculation method (SCM) and the mathematical calculation method (MCM) in measuring the cross-sectional...
Objectives This study aimed to compare the results of a software calculation method (SCM) and the mathematical calculation method (MCM) in measuring the cross-sectional area (CSA) at four different upper airway segments. Methods The data from the retrospective chart reviews of patients older than 18 years who had undergone computed tomography (CT) of the neck at our tertiary care center between September 2014 and September 2018 were reviewed. Data of patients who were intubated, tracheostomized, had nasogastric tubes, tumors, craniofacial anomalies, trauma, or any pathology that may affect the normal airway anatomy were excluded. We measured the anteroposterior (APD) and transverse diameter (TD) utilizing the CT software. CSA was calculated using both the mathematical formula (MCM) and software (SCM) at the glottis, proximal subglottis, distal subglottis, and tracheal levels. A paired sample t-test was used to determine the significant difference between SCM and MCM at each level. Results The data of 100 patients (59% female) were reviewed. There was a significant difference between the SCM and MCM at all four levels. The mean differences between the SCM and MCM were -33.63 mm, -24.20 mm, 6.04 mm (p < 0.001) at the glottis, proximal subglottis, and trachea, respectively. The mean difference at the distal subglottis was -4.08 mm (p = 0.01). Conclusion Our study found a significant difference between the SCM and MCM in measuring the CSA of the four airway segments. Theoretically, the SCM is more accurate and precise than MCM in measuring CSA; however, we could not prove the superiority of either method.
PubMed: 31886046
DOI: 10.7759/cureus.6106