Cancer of the Larynx
CancerIndex Home - Guide to Internet Resources for Cancer Home > Cancer Types > Head and Neck > Cancer of the Larynx

Laryngeal cancer is a malignancy arising in the tissues of the larynx (voicebox). People who smoke have a higher risk of developing the disaese. Most laryngeal cancers are of squamous cell histology, these can be categorised as either keratinizing or non-keratinizing. There are a variety of other non-squamous cell laryngeal cancers.

Menu: Cancer of the Larynx

Information for Patients and the Public
Information for Health Professionals / Researchers
Latest Research Publications

Information Patients and the Public (10 links)


Information for Health Professionals / Researchers (8 links)

Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Ghatak S, Dutta M, Kundu I, Ganguly RP
Primary solitary extramedullary plasmacytoma involving the true vocal cords in a pregnant woman.
Tumori. 2013 Jan-Feb; 99(1):e14-8 [PubMed]
Primary solitary extramedullary plasmacytoma of the larynx involving the true vocal cords is an extremely rare entity. Extramedullary plasmacytoma has the potential to transform into multiple myeloma and mandates strict vigilance and routine follow-up. We describe such a case in a 29-year-old pregnant woman who presented with progressive hoarseness, dysphagia and intermittent respiratory difficulty. Fiberoptic laryngoscopy revealed a fleshy mass involving the posterior third of the true vocal cords, encroaching on the ventricle and false cords. Histopathology and immunohistochemistry revealed extramedullary plasmacytoma of a monoclonal nature. In spite of Bence Jones proteinuria and a rising serum β 2-microglobulin level, a thorough search for metastasis and subsequent treatment with radiotherapy were delayed due to the patient's pregnancy. She is the youngest adult ever reported with primary solitary extramedullary plasmacytoma involving the true cords. Described for the first time in pregnancy, the relevant issues in management are highlighted.


Hong JC, Kim SW, Lee HS, et al.
Salvage transoral laser supraglottic laryngectomy after radiation failure: a report of seven cases.
Ann Otol Rhinol Laryngol. 2013; 122(2):85-90 [PubMed]
OBJECTIVES: We evaluated the oncological and functional outcomes of salvage transoral laser supraglottic laryngectomy after radiation failure. In addition, we demonstrated the usefulness of laser surgery in patients with recurrent supraglottic cancer.
METHODS: Between December 1999 and May 2011,7 patients (6 men and 1 woman) underwent transoral laser supraglottic laryngectomy after radiation failure. We conducted 4 different types of endoscopic supraglottic laryngectomy. In the cases with lymph node metastasis, we performed neck dissection at the time of laser surgery.
RESULTS: All patients had recurrent squamous cell carcinoma confirmed on the surgical specimen. Two patients were classified as having T1 disease, 2 as having T2 disease, and 3 as having T3 disease with preepiglottic space involvement. The 2- and 5-year overall survival rates were 85.7% and 68.6%, respectively. There was a recurrence at 8 months of followup after laser surgery in 1 patient; he underwent successful salvage total laryngectomy. The ultimate local control rate was 100%, and the laryngeal preservation rate was 85.7%. The hospitalization times ranged from 2 to 32 days (mean, 15.6 days). The mean decannulation time was 10.7 days (range, 5 to 30 days). All patients started oral feeding within 1 to 3 days after surgery.
CONCLUSIONS: Salvage transoral laser supraglottic laryngectomy following radiation failure seems a feasible and oncologically safe procedure in recurrent supraglottic cancers ranging from T1 to selected T3 with minimal preepiglottic space involvement. It can be an option for minimally invasive organ preservation surgery with lesser morbidity for recurrent supraglottic cancer.


Vassileiou A, Vlastarakos PV, Kandiloros D, et al.
Laryngeal cancer: smoking is not the only risk factor.
B-ENT. 2012; 8(4):273-8 [PubMed]
AIM: To investigate the role of smoking, alcohol, coffee consumption, demographic factors, toxic agents, and occupation in laryngeal carcinogenesis.
MATERIALS/METHODS: A case-control study included 70 patients with histologically confirmed laryngeal cancer and 70 controls with non-neoplastic conditions unrelated to diet/smoking/alcohol. Relative risk, odds ratio (OR), and 95% confidence intervals were estimated using multiple logistic regression.
RESULTS: Current smokers had 19.46 OR of laryngeal cancer compared to non-smokers (p = 0.006). The respective OR for alcohol consumption was 3.94 (p = 0.006). While the risk increased in heavy drinkers, there was no difference in duration of alcohol consumption. There was a strong and consistent relation between laryngeal cancer and the consumption of Greek/Turkish coffee cups/day (p = 0.002, OR = 1.77). Diesel exhaust fumes also seemed to increase the risk of laryngeal cancer, although the association was found to be no longer significant after analysis with logistic regression.
CONCLUSION: The present study confirmed the relation of smoking and alcohol with laryngeal cancer. However, other factors such as coffee and diesel exhaust fumes may play an important role in laryngeal carcinogenesis.


Dionysopoulos D, Pavlakis K, Kotoula V, et al.
Cyclin D1, EGFR, and Akt/mTOR pathway. Potential prognostic markers in localized laryngeal squamous cell carcinoma.
Strahlenther Onkol. 2013; 189(3):202-14 [PubMed]
INTRODUCTION: EGFR (epidermal growth factor receptor), cyclin D1 and Akt/mTOR pathways are active in head and neck cancer. The aim of this study was to explore biomarker expression, their correlations with clinicopathological parameters and their prognostic utility in a cohort of patients with localized squamous laryngeal carcinoma.
PATIENTS AND METHODS: We assessed relative messenger RNA expression of EGFR, Akt1, 2, and 3, mTOR and CCND1, copy number variants of the EGFR and CCND1 genes and immunohistochemical protein expression of EGFR, p-Akt308, p-Akt473, pmTOR, PTEN, p53 and cyclin D1 in paraffin-embedded tissue samples of localized laryngeal carcinomas.
RESULTS: In 289 patients with T3-4 (77.8%), node-negative (84.1%) tumors of the larynx, high EGFR and CCND1 mRNA correlated with no or ex-smoking, (p = 0.003 and p = 0.029, respectively), while low Akt3 mRNA correlated with alcohol abuse, N0 stage, total laryngectomy, and absence of neck dissection. At a median follow-up of 74.5 months, high mTOR mRNA expression was marginally associated with shorter disease-free survival (hazard ratio [HR] = 1.54; p = 0.093) and high Akt3 mRNA with shorter overall survival (HR = 1.49; p = 0.0786), in univariate analysis. In multivariate analysis, node-positive status, subglottic-transglottic location, surgery other than total laryngectomy and mTOR/CCND1 mRNA interaction with a hazard ratio of 2.16 (p value for interaction:  0.0010) were independent predictors of relapse, while node-positive status and subglottic-transglottic location were associated with higher risk for death.
CONCLUSION: In localized laryngeal cancer, clinicopathological parameters and an interaction of high mTOR and CCND1 mRNA expression were found to be associated with poor patient outcome.


Dequanter D, Lothaire P, Zouaoui K, Brohée D
Epidemiology and clinical characteristics of larynx and hypopharynx carcinoma: a comparative study in the Hainaut and review of the literature.
Acta Chir Belg. 2012 Nov-Dec; 112(6):423-5 [PubMed]
INTRODUCTION: The epidemiology and clinical picture of laryngeal and hypopharyngeal carcinomas have changed significantly in the past 50 years. The aim of this study was to analyze selected epidemiological and clinical characteristics of laryngeal and hypopharyngeal carcinoma.
METHODS: A complete chart review of all patients records was conducted. All the patients who were diagnosed as having laryngeal or hypopharyngeal cancer from January 1, 2004 through December 31, 2009 were included in the study. The demographics of the patient population, the disease profile were analyzed.
RESULTS: 138 patients with laryngeal or hypopharyngeal disease were treated. 76 patients presented a laryngeal cancer. Disease characteristics indicated that most cases of supraglottic cancer were in a locally advanced stage (84.4%), whereas most patients with glottis cancer were diagnosed with early stage (63.3%). A hypopharyngeal cancer was diagnosed in 62 cases. A significant increasing trend in hypopharyngeal cancer has been seen in males. The majority of the patients was alcohol consumers and had a histology showing squamous cell carcinoma. There were 33 females and 105 males whose ages ranged at presentation from 47 to 86 years. Of the 138 patients treated, 24 and 47 patients were respectively T3 and T4 and 37 patients were N1, 37 patients N2 and 10 patients N3 (Table I). Most patients had stage IV disease (65/138). Majority of cases presented with local advanced stage. Of the 138 patients treated, 24 and 47 patients were respectively T3 and T4. The highest rate of local advanced stage was observed in patients with pyriform sinus carcinomas (81%); the lowest rate was observed for glottis tumors (41.8%). Regional lymph node metastases were diagnosed in 61% of the analyzed cases. 37 patients were N1, 37 patients N2 and 10 patients N3. The highest rate (82.2%) of regional lymph node metastases were observed in cases of pyriform sinus carcinomas, and the lowest (31.7%) in glottis carcinomas. Most patients had stage IV disease (65/138). 49 patients received radiotherapy; 48 patients were treated by surgery followed by (chemo)radiotherapy. 41 patients were treated initially by concomitant chemoradiotherapy.
CONCLUSION: A tendency for increasingly younger patients to develop larynx and hypopharynx carcinomas was observed. Most patients had stage IV disease but no trend for a percentage increase in locally advanced tumors was observed. A significant increasing trend in hypopharyngeal cancer has been seen in males.


Rakusić Z, Bisof V
Larynx preservation: advantages and limitations.
Coll Antropol. 2012; 36 Suppl 2:231-3 [PubMed]
For a long time standard treatment approach for resectable squamous cell carcinoma of larynx was surgery with or without subsequent radiotherapy. Surgery, particulary total laryngectomy, has been associated with serious impairment of quallity of life. Between nonsurgical approaches, concurrent cisplatin based chemoradiotherapy has become a very promising treatment modality for larynx preservation. However, concurrent chemotherapy has been associated with serious toxicity. The most recent treatment approach in larynx preservation is related to taxan based induction chemotherapy.


Mikić A, Zvrko E, Trivić A, et al.
Small cell neuroendocrine tumor of the larynx--a small case series.
Coll Antropol. 2012; 36 Suppl 2:201-4 [PubMed]
Neuroendocrine tumors are the most common nonsquamous types of laryngeal neoplasms. They are classified as typical carcinoids, atypical carcinoids, small-cell neuroendocrine carcinomas, and paragangliomas. The aim of the paper is to present four patients with small-cell neuroendocrine tumor arising in larynx. There were one woman and three men whose ages were 47-77 years; all of them had metastases when first seen. The clinical presentation and management of such type of tumor are discussed. Small-cell neuroendocrine carcinomas are very aggressive neoplasms. Patients could benefit from surgery, but radiotherapy and chemotherapy remain the treatment of choice. Examination of a large series is required to define the most useful diagnostic methods and the most successful treatment modalities.


Carić T, Bilić M, Bilić LK, et al.
Neuroendocrine tumors of larynx--two case reports and literature review.
Coll Antropol. 2012; 36 Suppl 2:173-8 [PubMed]
Neuroendocrine tumors (NET) of the larynx are rare and heterogenous group, with much confusion about nature and classification of these neoplasms in the past. Diagnosis is based primarily on light microscopy and confirmed by immunohistochemistry and electron microscopy. A classification in 4 different types; paraganglioma, typical carcinoid, atypical carcinoid and small cell neuroendocrine carcinoma (SCNC) is a current consensus. Thorough diagnostic and a proper classification of neuroendocrine neoplasms are of paramount importance--prognosis and treatment differ significantly. We present two cases: 63-year old patient with SCNC of the larynx and a 53-year old patient with atypical carcinoid of the larynx. OctreoScan is useful tools for diagnostics and follow up of the patients and it is predictive for effectiveness of octreotide therapy.


Zvrko E, Mikić A, Jancić S
Relationship of E-cadherin with cervical lymph node metastasis in laryngeal cancer.
Coll Antropol. 2012; 36 Suppl 2:119-24 [PubMed]
E-cadherin, a 120 kDa transmembrane protein, plays an important role in malignant progression and tumour differentiation. The loss or reduction in E-cadherin expression has been found in several tumours including laryngeal squamous cell carcinoma. The present study aimed to investigate the prognostic implications of changes in expression of the E-cadherin in laryngeal carcinoma. E-cadherin expression was determined by immunohistochemistry in paraffin- embedded tissue specimens from 80 patients. A staining score was given based on the percentage of cells stained (0-100%). E-cadherin expression varied greatly among tissue samples from 2 to 72 (median 25). Using the median expression of E-cadherin as a cut- off 41 (51.3%) tumours were classified in the "low E-cadherin" group and the rest, 39 (48.7%) tumours, consisted the "high E-cadherin" group. We found significant differences in the staining scores of E-cadherin between those tumours with and without nodal metastases (p = 0.025) and advanced clinical stage (TNM stage III and IV) (p = 0.014). The results of a stepwise logistic regression analysis showed that E-cadherin staining score and the location of primary tumour were independent predictors of nodal metastases. The immunohistochemical determination of E-cadherin expression may be useful instrument to characterise the metastatic potential of carcinomas. Larger studies are needed to confirm the role of E-cadherin expression in predicting the behavior of laryngeal squamous cell carcinomas.


Rosso M, Kraljik N, Mihaljević I, et al.
Epidemiology of laryngeal cancer in Osijek-Baranja County (eastern Croatia).
Coll Antropol. 2012; 36 Suppl 2:107-10 [PubMed]
The aim of this retrospective study was to provide the incidence and mortality rate for all patients with laryngeal carcinoma diagnosed in Osijek-Baranja County, during the period of 1999-2008. In this period, there were 329 registered patients, from which 301 (91.5%) males, and 28 (8.5%) females. Age-standardized rate (ASR World) laryngeal cancer incidence was 6.4/100,000 (13.4/100,000 for males and 0.9/100,000 for females). In the same period, 238 people, including 224 (94.1%) men and 14 (5.9%) women died of laryngeal carcinoma. Age-standardized rate (ASR World) laryngeal cancer mortality was 4.4/100,000 (9.8/100,000 for males and 0.5/100 000 for females). There is a significant decline in mortality in males and increased mortality in females. Laryngeal carcinoma is a significant public health problem in the Osijek-Baranja county. Although the study period shows a tendency to decrease in the number of new cases and deaths, in the times ahead it is important to focus the emphasis on prevention and early detection with the goal of reducing incidence and mortality.


Stanković M, Milisavljević D, Stojanov D, et al.
Influential factors, complications and survival rate of primary and salvage total laryngectomy for advanced laryngeal cancer.
Coll Antropol. 2012; 36 Suppl 2:7-12 [PubMed]
This is a retrospective review of patients with advanced malignant neoplasms of the larynx treated with total laryngectomy. 387 total laryngectomies for advanced squamous cell carcinoma of larynx performed in the period between 1995 and 2007 were analyzed. Primary total laryngectomy (PRT) was performed in 316 patients, while initial radiotherapy radiotherapy (60-70 Gy) and concomitant chemotherapy (cisplatin-5 fluorouracil) with radiotherapy were applied in totally 71 patients who later received salvage total laryngectomy (STL). All the laryngectomies were performed by four surgeons, using the same routine surgical technique. Postoperative clinical examination was made every three months during five years. We documented the occurrence of: local and general complications, survival rate, residual and recurrent disease, lymph node metastasis, and other changes. Salvage total laryngectomy after previous radiotherapy (STL-pRT) and after chemoradiotherapy (STL-pCTRT) caused more frequent local complications than primary total laryngectomy (PTL). TNM stage and localization of primary laryngeal tumor had significant influence on five year survival rate. It amounted: 61.4% for PTL, 52.6% for STL-pCTRT, and 48.5% for STL-pRT. Incomplete response to initial treatment produced low survival rate. Salvage total laryngectomy caused more frequent local complications, especially after chemoradiotherapy when compared to primary laryngectomy. Survival rate was increased when chemotherapy is added to radiotherapy. Five year survival rate depended on TNM stage and localization of primary tumor.


Prgomet D
New modalities to treat laryngeal cancer.
Coll Antropol. 2012; 36 Suppl 2:3-6 [PubMed]
Early laryngeal cancer comprises T1 and T2 stages of the disease. Open functional operations achieve local control of the disease in 90-95% of T1 patients and in 70-90% of T2 patients. Primary RT achieves local control in 85-94% of T1 tumors and in 70-80% of patients with T2 tumors. Introduction of endoscopic laser surgery resulted in further popularization of preservation laryngeal surgery, whereby equally successful treatment results are achieved with minimal invasiveness. Quality of voice is also better after RT and laser resection. In the last century a golden standard of treatment of advanced laryngeal cancer (T3/T4 stage) was total laryngectomy (TL) with neck dissection followed by adjuvant RT. Overall 5 year survival was around 50%. Due to impact of TL on quality of life, "Larynx preservation strategy" (LPS) was developed in the early '90 for advanced stages of the disease. Novel approach is an introduction of targeted therapy, such as anti-EGFR monoclonal antibody, cetuximab. Concomitant cetuximab with RT achieves higher survival, and better locoregional disease control in comparison to administration of single RT modality. Therefore non-surgical methods of treatment of advanced laryngeal carcinoma are constantly changing and improving as new chemotherapeutics are being introduced into protocols. Uncritical enthusiasm with non-surgical methods of treatment resulted in higher incidence of treatment toxicities, higher rates of "salvage surgery" with more frequent adverse effects. That resulted in a consensus attempt around "LPS" project with reevaluation of clinical studies and uniform recommendations for future studies. When choosing appropriate therapy for oncological patient, quality of life (QOL) is a special category to be taken into account besides complications, pain, duration of treatment and overall benefit for the patient.


Lefebvre JL, Pointreau Y, Rolland F, et al.
Induction chemotherapy followed by either chemoradiotherapy or bioradiotherapy for larynx preservation: the TREMPLIN randomized phase II study.
J Clin Oncol. 2013; 31(7):853-9 [PubMed]
PURPOSE: To compare the efficacy and safety of induction chemotherapy (ICT) followed by chemoradiotherapy (CRT) or bioradiotherapy (BRT) for larynx preservation (LP).
PATIENTS AND METHODS: Previously untreated patients with stage III to IV larynx/hypopharynx squamous cell carcinoma received three cycles of ICT-docetaxel and cisplatin 75 mg/m(2) each on day 1 and fluorouracil 750 mg/m(2) per day on days 1 through 5. Poor responders (< 50% response) underwent salvage surgery. Responders (≥ 50% response) were randomly assigned to conventional radiotherapy (RT; 70 Gy) with concurrent cisplatin 100 mg/m(2) per day on days 1, 22, and 43 of RT (arm A) or concurrent cetuximab 400 mg/m(2) loading dose and 250 mg/m(2) per week during RT (arm B). Primary end point was LP at 3 months. Secondary end points were larynx function preservation (LFP) and overall survival (OS) at 18 months.
RESULTS: Of the 153 enrolled patients, 116 were randomly assigned after ICT (60, arm A; 56, arm B). Overall toxicity of both CRT and BRT was substantial following ICT. However, treatment compliance was higher in the BRT arm. In an intent-to-treat analysis, there was no significant difference in LP at 3 months between arms A and B (95% and 93%, respectively), LFP (87% and 82%, respectively), and OS at 18 months (92% and 89%, respectively). There were fewer local treatment failures in arm A than in arm B; salvage surgery was feasible in arm B only.
CONCLUSION: There is no evidence that one treatment was superior to the other or could improve the outcome reported with ICT followed by RT alone (French Groupe Oncologie Radiothérapie Tête et Cou [GORTEC] 2000-01 trial [Induction CT by Cisplatin, 5FU With or Without Docetaxel in Patients With T3 and T4 Larynx and Hypopharynx Carcinoma]). The protocol that can best compare with RT alone after ICT is still to be determined.


Corry J, Peters L, Kleid S, Rischin D
Larynx preservation for patients with locally advanced laryngeal cancer.
J Clin Oncol. 2013; 31(7):840-4 [PubMed]
A 53-year-old man presented with a 6-month history of mild hoarseness, with no associated pain, dysphagia, or stridor. At nasoendoscopy, a lesion was detected involving the whole length of the left vocal cord, with abnormal mucosa also seen in the right ventricle (Fig 1). The left vocal cord movement was impaired. There were no palpable neck nodes. Biopsy under anesthesia revealed moderately differentiated squamous cell carcinoma. He was a current smoker of 30 cigarettes per day (45 pack-year smoking history), and he consumed four standard drinks of alcohol per day. His Eastern Cooperative Oncology Group performance status was 1, and he had no significant comorbidities. Radiologic review of his outside computed tomography scan noted that it was of poor quality, and a magnetic resonance imaging scan was recommended, which showed low-volume T4a disease based on focal thyroid cartilage penetration (Fig 2). A positron emission tomography (PET) scan revealed no evidence of nodal or distant metastasis.


Petrakos I, Kontzoglou K, Nikolopoulos TP, et al.
Glottic and supraglottic laryngeal cancer: epidemiology, treatment patterns and survival in 164 patients.
J BUON. 2012 Oct-Dec; 17(4):700-5 [PubMed]
PURPOSE: To evaluate the effectiveness of different therapeutic managements in relation to clinical disease stage, the location of the lesion and to register the rate of disease recurrence of patients with glottic and supraglottic laryngeal cancer, and to also study some specific epidemiologic characteristics.
METHODS: A series of 164 patients with laryngeal glottic and supraglottic squamous cell cancer (SCC) treated surgically, with radiation therapy (RT), chemotherapy or combination of these was analysed. After treatment, all patients were followed up for an average of 58 months. All data concerning the primary lesion, therapeutic management, recurrence, staging, 5-year overall survival and epidemiological characteristics such as smoking and alcohol abuse were recorded and analysed in combination with the follow up data.
RESULTS: The therapeutic approach most commonly used was RT for stage I tumors and surgery for stages II, III and IV. Stage I and II patients treated with RT had high recurrence rate (60%). Patients with recurrence had 45.3% 5-year overall survival rate and average survival time 80 months, whereas patients with no recurrence had 77.4% 5-year overall survival rate and average survival time 173 months (p=0.0001). There was significant difference in survival between stage I and III (p=0.035), stage I and IV (p=0.0038) and stage II and IV (0.0156). The average overall survival time for non smokers was 195 months (median 1707rpar;, while for smokers it was 99 months (median 100; p=0.0047). The average overall survival time for alcohol abusers was 79 months (median 54), while for those who did not use alcohol it was 153 months (median 150; p=0.016).
CONCLUSION: The 5-year overall survival rate was 61.3%. RT alone in stages I and II proved inferior in decreasing re-currences compared with surgery. Smokers had significantly shorter overall survival.


Mizrak A, Sanli M, Bozgeyik S, et al.
Dexmedetomidine use in direct laryngoscopic biopsy under TIVA.
Middle East J Anesthesiol. 2012; 21(4):605-12 [PubMed]
BACKGROUND: The purpose of this study is to investigate the suitability of dexmedetomidine as a helpful sedative agent in direct laryngoscopic biopsy (DLB), under total intravenous anesthesia (TIVA).
METHODS: In this double blind randomised study, patients were allocated to receive dexmedetomidine 0.5 microg/kg (group D, n = 20) or saline placebo (group P, n = 20) intravenously. Forty ASA I-III patients were infused propofol and administered rocuronium bromur. They were intubated and performed biopsy. Aldrete scores, intraoperative propofol and postoperative analgesic requirements, satisfaction scores, recovery time, Ramsay sedation scale (RSS), haemodynamic changes and side effects were recorded.
RESULTS: Postoperative analgesic requirement in group D was significantly lower and satisfaction scores and RSS were significantly higher than in group P. Additionally, MAP (mean arterial blood pressure) significantly decreased at post-extubation time in group D.
CONCLUSION: The premedication with a single dose of dexmedetomidine decreases intraoperative propofol and postoperative analgesic requirements, increases the postoperative satisfaction and RSS considerably in patients undergoing DLB under TIVA.


Buda I, Hod R, Feinmesser R, Shvero J
Chondrosarcoma of the larynx.
Isr Med Assoc J. 2012; 14(11):681-4 [PubMed]
BACKGROUND: Chondrosarcoma of the larynx is a rare tumor. The most common symptom is hoarseness. Treatment is controversial.
OBJECTIVES: To describe six patients with laryngeal chondrosarcoma from a single center.
METHODS: The medical records of a major tertiary hospital were reviewed for all patients with laryngeal chondrosarcoma diagnosed and treated from 1959 to 2010. Data on background, clinical treatment and outcome were collected.
RESULTS: Six patients, all males with a mean age of 53.3 years, were identified. Partial laryngectomy was performed in three patients, and total laryngectomy, local excision, and partial cricoidectomy in one patient each. Four patients had a permanent tracheostomy after surgery. One patient required postoperative chemotherapy and one radiotherapy. Follow-up time was 12-216 months (mean 102 months). Recurrence developed in two patients 2 and 8 years after initial treatment and was treated by salvage surgery in both patients. One patient died during the follow-up from an unrelated cause. The others are currently alive.
CONCLUSIONS: This study supports earlier reports recommending initial treatment with partial or total laryngectomy for laryngeal chondrosarcoma. Long-term follow-up for recurrence is advised. We recommend preserving the larynx, if possible, even if a permanent tracheostomy is necessary.


Carico E, Radici M, Losito NS, et al.
Expression of E-cadherin and α-catenin in T1 N0 laryngeal cancer.
Anticancer Res. 2012; 32(12):5245-9 [PubMed]
AIM: To determine whether modulation of expression of cell adhesion molecules occurs in neoplastic transformation of laryngeal epithelium and to investigate their possible role in clinical outcome.
MATERIALS AND METHODS: Fifty-five T1 N0 laryngeal biopsies were tested by immunohistochemistry for the E-cadherin/α-catenin adhesion complex.
RESULTS: High immunohistochemical expression of E-cadherin and α-catenin was found in 18% and 53% cases, respectively. Expression of both adhesion molecules decreased according to histological grading; a significant relationship was particularly found between high E-cadherin expression and G1 cases (p=0.013). High E-cad-herin expression was statistically associated with in situ carcinoma (p=0.006). Non-statistical significance was evidenced between these adhesion molecules and tobacco use or site of occurence. Regarding clinical outcome, recurrence was associated with low expression of both adhesion molecules.
CONCLUSION: E-cadherin and α-catenin down-regulation might be associated with neoplastic transformation in laryngeal tissues and might be regarded as a risk factor for clinical recurrence.


Monteiro R, Gonçalves I, Parente B, Moura e Sá J
Tracheal bronchus with metachronous tumor.
J Bronchology Interv Pulmonol. 2012; 19(4):343-4 [PubMed]
Tracheal bronchus, a bronchus arising from the lateral wall of the trachea, is a rare congenital anomaly. It is usually asymptomatic but symptoms could occur with relatively poor local drainage. There are a few cases of lung cancer within the tracheal bronchus reported in the literature; however, none of them were reported to be metachronous. A metachronous tumor is a second primary malignancy diagnosed >6 months after the diagnosis of the index tumor. We present a case of a squamous cell carcinoma originating in a tracheal bronchus of a 53-year-old patient previously diagnosed with a supraglottic malignancy.


Kocjan BJ, Gale N, Hočevar Boltežar I, et al.
Identical human papillomavirus (HPV) genomic variants persist in recurrent respiratory papillomatosis for up to 22 years.
J Infect Dis. 2013; 207(4):583-7 [PubMed]
Seventy initial and 125 follow-up tissue specimens of laryngeal papillomas, obtained from 70 patients who had had recurrent respiratory papillomatosis for from 1-22 years, were investigated for the presence of human papillomavirus (HPV) DNA and HPV E5a, LCR and/or full-length genomic variants. HPV-6 was found in 130/195, HPV-11 in 63/195, and HPV-6/HPV-11 in 2/195 samples. Within 67/70 (95.7%) patients, all follow-up HPV isolates genetically matched completely initial HPV isolate over the highly variable parts of the genome or over the entire genome. Frequent recurrence of laryngeal papillomas is a consequence of long-term persistence of the identical initial HPV genomic variant.


Baugnon KL, Beitler JJ
Pitfalls in the staging of cancer of the laryngeal squamous cell carcinoma.
Neuroimaging Clin N Am. 2013; 23(1):81-105 [PubMed]
Laryngeal carcinoma is a devastating malignancy that severely affects patients' quality of life, with compromise of ability to talk, breathe, and swallow. Accurate tumor staging is imperative, because treatment plans focus on laryngeal conservation therapy whenever possible. Although the mucosal extent of tumor and vocal cord mobility is best assessed with endoscopic evaluation, cross-sectional imaging is essential for accurate T-staging, because only cross-sectional imaging can assess the submucosal extent of the tumor, cartilage invasion, and extralaryngeal spread. This article reviews topics crucial for interpreting imaging studies of patients with laryngeal squamous cell carcinoma.


Boonyaphiphat P, Pruegsanusak K, Thongsuksai P
The prognostic value of p53, Bcl-2 and Bax expression in laryngeal cancer.
J Med Assoc Thai. 2012; 95(10):1317-20 [PubMed]
OBJECTIVE: Determine the prognostic value of p53, Bcl-2 and Bax expression in cancer of the larynx.
MATERIAL AND METHOD: Ninety-four patients diagnosed with laryngeal squamous cell carcinoma were analyzed for 5-year overall survival in relation to immunohistochemical expression of p53, Bcl-2, and Bax proteins.
RESULTS: The present study included 86 males and eight females with a mean age of 65.1 years. Half of the patients (51%) were in stages III and IV. Radiation (44.7%) and radiation plus surgery (40.4%) were the main treatments. The frequency of p53, Bcl-2, and Bax expression was 58.1%, 18.5%, and 87.2%, respectively. The 5-year overall survival rate was 49.7%. Univariate analysis revealed that T-stage, N-stage and treatment were significantly associated with 5-year overall survival. In the multivariate Cox regression, T-stage, treatment, and Bcl-2 expression were significantly associated with survival. Positive Bcl-2 expression was associated with better survival (Hazard ratio 0.23, 95% CI 0.06-0.81).
CONCLUSION: The positive Bcl-2 expression is an independent prognostic marker in laryngeal squamous cell carcinoma.


Forastiere AA, Zhang Q, Weber RS, et al.
Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer.
J Clin Oncol. 2013; 31(7):845-52 [PubMed] Article available free on PMC after 01/03/2014
PURPOSE: To report the long-term results of the Intergroup Radiation Therapy Oncology Group 91-11 study evaluating the contribution of chemotherapy added to radiation therapy (RT) for larynx preservation.
PATIENTS AND METHODS: Patients with stage III or IV glottic or supraglottic squamous cell cancer were randomly assigned to induction cisplatin/fluorouracil (PF) followed by RT (control arm), concomitant cisplatin/RT, or RT alone. The composite end point of laryngectomy-free survival (LFS) was the primary end point.
RESULTS: Five hundred twenty patients were analyzed. Median follow-up for surviving patients is 10.8 years. Both chemotherapy regimens significantly improved LFS compared with RT alone (induction chemotherapy v RT alone: hazard ratio [HR], 0.75; 95% CI, 0.59 to 0.95; P = .02; concomitant chemotherapy v RT alone: HR, 0.78; 95% CI, 0.78 to 0.98; P = .03). Overall survival did not differ significantly, although there was a possibility of worse outcome with concomitant relative to induction chemotherapy (HR, 1.25; 95% CI, 0.98 to 1.61; P = .08). Concomitant cisplatin/RT significantly improved the larynx preservation rate over induction PF followed by RT (HR, 0.58; 95% CI, 0.37 to 0.89; P = .0050) and over RT alone (P < .001), whereas induction PF followed by RT was not better than treatment with RT alone (HR, 1.26; 95% CI, 0.88 to 1.82; P = .35). No difference in late effects was detected, but deaths not attributed to larynx cancer or treatment were higher with concomitant chemotherapy (30.8% v 20.8% with induction chemotherapy and 16.9% with RT alone).
CONCLUSION: These 10-year results show that induction PF followed by RT and concomitant cisplatin/RT show similar efficacy for the composite end point of LFS. Locoregional control and larynx preservation were significantly improved with concomitant cisplatin/RT compared with the induction arm or RT alone. New strategies that improve organ preservation and function with less morbidity are needed.


Ye J, Liu H, Hu Y, et al.
Tumoral indoleamine 2,3-dioxygenase expression predicts poor outcome in laryngeal squamous cell carcinoma.
Virchows Arch. 2013; 462(1):73-81 [PubMed]
The development of laryngeal squamous cell carcinomas (LSCC) is strongly influenced by the host immune system. Indoleamine 2,3-dioxygenase (IDO) can promote and maintain an immunosuppressive microenvironment which can impede the efficacy of anticancer responses. The purpose of the current study is to investigate the prognostic value of intratumoral IDO expression in LSCC. The expression of IDO protein was retrospectively assessed by immunohistochemistry in 187 LSCC patients. The potential association of tumor IDO expression with clinical parameters and tumor-infiltrating lymphocytes (TILs) was analyzed separately. Survival curves were estimated by the Kaplan-Meier method, and differences between groups were determined by log-rank test. Multivariate logistic regression analysis was performed to determine the independent factors associated with survival. Based on the evaluation score, 90 carcinomas (48.1 %) were identified with high IDO expression and 97 carcinomas (51.9 %) showed low expression. Tumor IDO expression was not associated with clinical stage, presence of metastases, and other clinicopathological parameters. Also, high IDO expression was not correlated with tumor-infiltrating CD3(+) and CD8(+) TILs. Instead it was positively related with the density of FOXP3(+) Tregs. Furthermore, multivariate analysis identified a significant association of overall survival and disease-free survival with tumor IDO status. IDO high expression represents a significant negative prognostic factor in patients with LSCC. Current results provide further support for using IDO as an immunotherapeutic target in LSCC. The precise role of tumoral IDO in human LSCC remains to be elucidated in the future.


Li X, Gao L, Li H, et al.
Human papillomavirus infection and laryngeal cancer risk: a systematic review and meta-analysis.
J Infect Dis. 2013; 207(3):479-88 [PubMed]
BACKGROUND: A number of molecular epidemiological studies have been conducted to explore the association of human papillomavirus (HPV) infection with laryngeal cancer. However, the findings are heterogeneous.
METHODS: We systematically reviewed studies on HPV infection and laryngeal cancer published up to 15 May 2012 and quantitatively summarized the prevalence of HPV infection and its association with the risk of laryngeal cancer by means of meta-analysis.
RESULTS: In total, 55 eligible studies were included. The overall HPV prevalence in laryngeal cancer tissues was 28.0% (95% confidence interval [CI], 23.5%-32.9%). A total of 26.6% laryngeal cancer patients were infected with high-risk HPV types only, and HPV-16 was most frequently observed type, with a prevalence of 19.8% (95% CI, 15.7%-24.6%). The meta-analysis based on 12 eligible case-control studies suggests a strong association between HPV infection and laryngeal squamous cell carcinoma, with a summary odds ratio (OR) of 5.39 (95% CI, 3.25-8.94). Different magnitudes of association were observed for HPV-16 (OR, 6.07; 95% CI, 3.44-10.70) and HPV-18 (OR = 4.16; 95% CI, .87-20.04; P < .01). Stratified analyses were performed with respect to HPV genotypes and characteristics of the study population.
CONCLUSIONS: HPV infection, especially infection due to the high-risk type HPV-16, was found to be significantly associated with the risk of laryngeal squamous cell carcinoma.


Hata M, Taguchi T, Koike I, et al.
Efficacy and toxicity of (chemo)radiotherapy for primary subglottic cancer.
Strahlenther Onkol. 2013; 189(1):26-32 [PubMed]
BACKGROUND AND PURPOSE: Primary subglottic cancer is a rare malignancy. We investigated the efficacy and toxicity of radiotherapy for subglottic cancer.
PATIENTS AND METHODS: Nineteen patients with primary squamous cell carcinoma of the subglottis received radiotherapy, 14 of whom also underwent chemotherapy. Of the 19 patients, 15 received definitive radiotherapy to the gross tumors with total doses of 70-70.2 Gy in 35-39 fractions, and 4 underwent preoperative radiotherapy with total doses of 37.8-55.8 Gy in 21-31 fractions, followed by total laryngectomy.
RESULTS: Of the 19 patients, 5 developed local progression and 2 developed distant metastasis at the median follow-up period of 5 years. The 5-year local control and disease-free rates were 74 and 63%, respectively. Three patients died of tumor progression, and the 5-year overall and disease-free survival rates were 80 and 63%, respectively. Regarding acute toxicities, transient mucositis and dermatitis of grade 3 or lower were observed in all patients, but there were no late toxicities of grade 3 or higher.
CONCLUSION: Radiotherapy is a safe and effective treatment for patients with primary squamous cell carcinoma of the subglottis. The use of chemotherapy together with radiotherapy may enhance treatment efficacy and contribute to larynx preservation through good local control.


Allegra E, Franco T, Trapasso S, et al.
Modified supracricoid laryngectomy: oncological and functional outcomes in the elderly.
Clin Interv Aging. 2012; 7:475-80 [PubMed] Article available free on PMC after 01/03/2014
BACKGROUND: Supracricoid laryngectomy is an organ preservation surgical technique for early-stage glottic tumors. Modified supracricoid laryngectomy using sternohyoid muscles for neoglottis reconstruction is a new surgical technique. This report evaluates oncological and functional outcomes of this new technique and its feasibility in elderly patients.
METHODS: Clinical records from 21 consecutive patients affected by glottic cancer and treated by modified SCL between 2004 and 2009 were retrospectively reviewed. Postoperative parameters and quality of voice after modified SCL were retrospectively reviewed. Actuarial overall survival, disease-specific survival rates, and recurrence-free survival rates were assessed. The functional and oncological outcomes of patients over 65 years were compared with those of patients younger than 65 years of age.
RESULTS: There were no postoperative complications and all of the patients had complete swallowing rehabilitation. Twenty of the 21 patients had decannulation. Two patients received total laryngectomy for locoregional relapse. Overall survival and disease-specific survival rates were 100%. Recurrence-free survival rates were 90.1% and 90% in patients younger and older than 65 years of age, respectively. The larynx preservation index was lower in patients who were older than 65 years of age. The postoperative courses with regard to functional outcome and voice quality in elderly patients were similar to those of patients younger than 65 years of age.
CONCLUSION: Modified SCL is a new open organ preservation surgical technique that is oncologically safe. The positive functional and oncological outcomes of this surgical procedure allow it to be performed in elderly patients.


Lu B, Di W, Wang H, et al.
Tumor suppressor TSLC1 is implicated in cell proliferation, invasion and apoptosis in laryngeal squamous cell carcinoma by regulating Akt signaling pathway.
Tumour Biol. 2012; 33(6):2007-17 [PubMed]
Overwhelming evidence has demonstrated that TSLC1 (tumor suppressor in lung cancer 1), a novel tumor suppressor, is crucially implicated in various biological processes including progression, proliferation and apoptosis during tumorigenesis. However, the exact functions and molecular details of TSLC1 in laryngeal cancer remain ill-defined. Here, the expression of TSLC1 in laryngeal squamous cell carcinoma (LSCC) tissues and cells was detected, and the biological roles of TSLC1 in LSCC cells were investigated. The results showed that expressions of TSLC1 mRNA and protein were significantly reduced in LSCC tissues with low expression in 18 of 85 (21.18 %) and 16 of 85 (18.82 %), respectively. Additionally, statistical analysis revealed a significant correlation of TSLC1 expression with TNM staging and lymph node metastases (P < 0.05), but not related to age, gender and tumor differentiation (P > 0.05). Elevation of TSLC1 level inhibited cell proliferation, reduced cell invasion in vitro and induced cell apoptosis in Hep-2 cells, most importantly, TSLC1 upregulation decreased the level of pAkt, but not changed the level of total Akt in Hep-2 cells. Stepwise investigations demonstrated that overexpression of TSLC1 in Hep-2 cells increased caspase-3 activity and expressions of bax and p21 proteins but decreased the levels of bcl-2, MMP-2 and MMP-9 proteins. These data suggest that TSLC1 may exert essential roles in the progression and development of LSCC, and thus TSLC1 may be a potential molecular target for LSCC treatment.


Caicedo-Granados E, Beswick DM, Christopoulos A, et al.
Oncologic and functional outcomes of partial laryngeal surgery for intermediate-stage laryngeal cancer.
Otolaryngol Head Neck Surg. 2013; 148(2):235-42 [PubMed]
OBJECTIVE: To evaluate the oncologic and functional outcomes of partial laryngeal surgery (PLS) using transoral laser microsurgery (TLM) and supracricoid laryngectomy (SCL) in patients with intermediate-stage laryngeal squamous cell carcinoma (LSCC).
STUDY DESIGN: Historical cohort study.
SETTING: Single tertiary care center.
SUBJECTS AND METHODS: Retrospective review of oncologic and functional outcomes in intermediate-stage (T2-3/N0-1, stage II and III) LSCC patients who underwent TLM or SCL from 1998 to 2010.
RESULTS: Sixty patients were included, of whom 28 (47%) underwent TLM and 32 (53%) underwent SCL. For the entire cohort, 2- and 5-year probabilities were 86.2% (95% confidence interval [CI], 73.0%-93.2%) and 72.9% (95% CI, 52.4%-85.6%), respectively, for overall survival (OS) and 79.3% (95% CI, 65.6%-88.0%) and 62.4% (95% CI, 41.9%-77.4%), respectively, for recurrence-free survival (RFS). There was no difference between the TLM and SCL cohorts in OS (P = .542) or RFS (P = .483). More than 75% of patients avoided adjuvant therapy. Communication Scale and Functional Outcome Swallowing Scale scores at median follow-up of 33 months were 2 or better in 97% and 91% of patients, respectively, reflecting functional voice and swallowing postoperatively. Eighty-eight percent of patients retained a functional larynx.
CONCLUSION: PLS provides excellent oncologic and functional outcomes for intermediate-stage LSCC and should be considered an alternative to chemoradiation or total laryngectomy in selected patients.


Maughan E, Pankhania M, Shah K, Gurr P
Managing chondrosarcoma of the epiglottis: a case report.
Ann R Coll Surg Engl. 2012; 94(8):e240-2 [PubMed]
Laryngeal chondrosarcomas are a very rare malignancy with less than 150 cases reported in the literature. Of these, the epiglottis is the most unusual primary neoplastic subsite. Uncertainties arise owing to the extremely rare nature of the condition with regard to treatment and investigation for metastases in overtly low grade cases. We present the case of a 62-year-old woman with a low grade chondrosarcoma, arising from the tip of the epiglottis, presenting with dysphagia but no other symptoms.


This page last updated: 22nd May 2013
Displaying links verified within last 2 weeks at time of update.

CancerIndex Logo

Home
Site Map
Cancer Types
Treatments
Locations
Glossary
Search

Patients/Public
Health Professionals
Researchers

About

Disclaimer
© 1996-2013