The management of glottic and supraglottic cancers of the larynx in relation to neck metastasis

Yıl 2003, Cilt: 11 Sayı: 5, 129 - 133, 13.10.2003

Ali Vefa Yücetürk Onur Çelik Görkem Eskiizmir

Öz

Objectives: We evaluated the management of glottic and supraglottic laryngeal cancers in relation to neck metastasis.Patients and Methods: Fifty-two patients 51 males, 1 female; mean age 59.2 years; range 27 to 82 years under- went surgery for primary laryngeal cancers. Preoperative and postoperative TNM classification and staging were made according to the AJCC 1997 criteria. The mean follow- up period was 39.4 months range 6 to 74 months .Results: The tumors were glottic in 31 patients and supra­ glottic in 21 patients. Laryngectomies were partial in 34 patients and total in 18 patients. Ali the patients with supra­ glottic tumors and those with glottic T2.4 tumors unden/vent neckdissection, aswell. Radiotherapyvvasadministeredto 22 patients with established N2 or N3 tumors. Clinical assess- ment was in agreement with the pathological result in 63.5%; 13.5% and 23.1% of cases were underdiagnosed and over- diagnosed, respectively. The rates of neck metastasis were 0% in T-ı, 25% in T2 , 75% in T3, and 66.7% in T4 supraglottic tumors. The corresponding rates for glottic cancers were 0%, 16.7%, 28.6%, and 60%, respectively. The overall rate of N+ tumors was 28.9%. Four patients 7.7% developed local, two patients 3.9% developed regional recurrences. Mortality occurred in eight patients 15.4% due to follovving causes: laryngeal recurrence T4 N2, T4 N2, TgN^, regional recurrence T4N2 , asecond primary malignancy in one patient, and other causes in three patients. Five- and two-year disease-specific survival rates Kaplan-Meier analysis were 90.7%, and over­ all survival rates were 73.7% and 87.3%, respectively.Conclusion: Neck metastasis and advanced stage of the tumor were the most effective prognostic factors.

Anahtar Kelimeler

Carcinoma, squamous cell/surgery, laryngeal neoplasms/diagnosis/surgery, lymph nodes/pathology, lymphatic metas­tasis, neck, neckdissection, neoplasm staging, survival rate

Glottik ve supraglottik larenks kanserlerinde tedavinin boyun metastazı açısından değerlendirilmesi

Öz

Amaç: Glottik ve supraglottik larenks kanserlerinde tedavinin boyun metastazı ile ilgili boyutları değerlendirildi.Hastalar ve Yöntemler: Çalıflmaya primer larenks kanseri nedeniyle cerrahi tedavi uygulanan 52 hasta alındı. Ameliyat öncesi ve sonrası TNM sınıflandırması ve evreleme AJCC1997 ölçütlerine göre yapıldı. Ortalama izlem süresi 39.4ay dağılım 6-74 ay idi.Bulgu l a r : Otuz bir hastada glottik, 21 hastada supraglottik kanser saptandı. Otuz dört hastada parsiyel, 18 hastada total larenjektomi uygulandı. Supraglottik ve T2 - 4glottik kanserlerin hepsine aynı seansta boyun diseksiyonu da uygulandı. Patolojik incelemede N2veya pN3b u l unan 22 hastaya ameliyat sonrasında radyoterapi uygulandı. Klinik değerlendirmenin patolojik sonuçla uyumu%63.5 bulundu; olguların %13.5’inde ve %23.1’inde değerlendirme eksik veya fazla yapılmıfltı. Boyun metastazı oranı supraglottik kanserlerde T1’de %0, T2’de %25,T3’te %75, T4’te %66.7 bulundu. Glottik kanserlerde buoranlar sırasıyla %0, %16.7, %28.6 ve T4’te %60 olarakbelirlendi. N+tümörlerin genel oranı %28.9 idi. Dört hastada %7.7 lokal, iki hastada %3.9 rejyonel nüks görüldü. İzlem süresi içinde sekiz hasta flu nedenlerle yaflamını yitirdi: Larenjeal nüks T4N2, T4N2, T3N1 , rejyonelnüks T4N2 , ikinci primer tümör 1 hasta , kanser dıflınedenler 3 hasta . Befl ve iki yıllık hastalığa özgü sağkalım oranı %90.7; toplam sağkalım sırasıyla %73.7 ve%87.3 bulundu Kaplan-Meier analizi .Sonuç: Boyun metastazı ve ileri tümör evresi larenks kanserinde en etkin prognostik faktörlerdir

Anahtar Kelimeler

Karsinom, yassı epitel hücreli/cerrahi, larenjeal neoplaziler/tanı/cerrahi, lenf nodu/patoloji, lenfatik metastaz, boyun, boyun diseksiyonu, neoplazi evrelemesi, sağkalım oranı

Kaynakça

• Bryce DP. The management of laryngeal cancer. J Otolaryngol 1979;8:105-26.
• Mikaszewski B, Stankiewicz C, Kowalska B, Brzoznowski W. Effectiveness of elective neck dissec- tion in patients with laryngeal carcinoma. Otolaryngol Pol 2000;54 Suppl 31:145-7. [Abstract]
• Sasaki CT, Carlson RD. Malignant neoplasms of the larynx. In: Cummings CW, Fredrickson JM, Harker LA, Krause CJ, Schuller DE, editors. Otolaryngology- head and neck surgery. Vol. 3, 2nd ed. St. Louis: Mosby Year Book; 1993. p. 1925-54.
• American Joint Committee on Cancer. AJCC Cancer Staging Manual. 5th ed. Philadelphia: Lippincott- Raven; 1997.
• Bron L, Brossard E, Monnier P, Pasche P. Supracricoid partial laryngectomy with cricohyoidoepiglottopexy and cricohyoidopexy for glottic and supraglottic carci- nomas. Laryngoscope 2000;110:627-34.
• Unal M, Karatay MC, Katircioglu OS, Suoglu Y, Erdamar B, Sirin M, et al. Local and regional recur- rence in early glottic carcinomas [Article in Turkish]. Kulak Burun Boğaz Ihtis Derg 2000;10:205-9.
• Martinez Berganza y Asensio R, Fraile Rodrigo JJ, de Miguel Garcia F, Gil Paraiso P, Naya Galvez MJ, Damborenea Tajada J. Surgery of cancer of the larynx. Analysis of the results of our cases. An Otorrinolaringol Ibero Am 2000;27:445-55. [Abstract]
• Nguyen-Tan PF, Le QT, Quivey JM, Singer M, Terris DJ, Goffinet DR, et al. Treatment results and prognos- tic factors of advanced T3-4laryngeal carcinoma: the University of California, San Francisco (UCSF) and Stanford University Hospital (SUH) experience. Int J Radiat Oncol Biol Phys 2001;50:1172-80.
• Buckley JG, MacLennan K. Cervical node metastases in laryngeal and hypopharyngeal cancer: a prospec- tive analysis of prevalence and distribution. Head Neck 2000;22:380-5.
• De Stefani A, Magnano M, Cavalot A, Usai A, Lerda W, Mola P, et al. Adjuvant radiotherapy influences the survival of patients with squamous carcinoma of the head and neck who have poor prognoses. Otolaryngol Head Neck Surg 2000;123:630-6.
• Esposito ED, Motta S, Cassiano B, Motta G. Occult lymph node metastases in supraglottic cancers of the larynx. Otolaryngol Head Neck Surg 2001;124:253-7.
• Guney E, Yigitbasi OG. Management of N0neck in T1- T2 unilateral supraglottic cancer. Ann Otol Rhinol Laryngol 1 9 9 9 ; 1 0 8 : 9 9 8 - 1 0 0 3 .
• Kligerman J, Olivatto LO, Lima RA, Freitas EQ, Soares JR, Dias FL, et al. Elective neck dissection in the treat- ment of T3/T4N0squamous cell carcinoma of the lar- ynx. Am J Surg 1995;170:436-9.
• Pitman KT. Rationale for elective neck dissection. Am J Otolaryngol 2000;21:31-7.
• Yuceturk AV, Ta rhan S, Goktan C, Egrilmez M. Assessment of cervical lymph nodes using high-re s o l u- tion ultrasonography in patients with head-neck cancer [Article in Turkish]. Kulak Burun Boğaz Ihtis Derg 1 9 9 9 ; 6 : 1 9 0 - 1 9 3 .
• Sencer S, Iflık Z, Minareci Ö, Kelefl N, Değer K, Öztürk A. Larenks kanserlerinin preoperatif değerlendirilme- sinde BT, MRG ve histopatoloji bulgularının karflılafl- tırılması. Türk ORL Arflivi 2000;38:153-8.
• Kau RJ, Alexiou C, Stimmer H, Arnold W. Diagnostic procedures for detection of lymph node metastases in cancer of the larynx. ORL J Otorhinolaryngol Relat Spec 2000;62:199-203.
• Gallo O, Fini-Storchi I, Napolitano L. Treatment of the contralateral negative neck in supraglottic cancer patients with unilateral node metastases (N1-3). Head Neck 2000;22:386-92.