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Study of the Epidemiology and Management of Laryngeal Cancer in Kasr Al-Aini Hospital Hazem M

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Study of the Epidemiology and Management of Laryngeal Cancer in Kasr Al-Aini Hospital Hazem M 208 Original article Study of the epidemiology and management of laryngeal cancer in Kasr Al-Aini Hospital Hazem M. Abdel Tawaba, Mikhail W. AbdElMessiha, Nasser AA. AlNaggarb, Louay S El Sharkawyc aLecturer of Otorhinolaryngology, Faculty Objectives of Medicine, Cairo University, Cairo, Egypt Epidemiological study of laryngeal cancer and modalities of treatment according to TNM bFaculty of Medicine, Aden University, Aden, Yemen cProfessor of Otorhinolaryngology, classiſ cation. Faculty of Medicine, Cairo University, Cairo, Methods Egypt Retrospective study was conducted on 295 patients who were admitted at the Otolaryngology-Head Correspondence to Hazem Mohammed Abdel and Neck surgery department, Kasr-Al Aini hospital, Cairo University during the period from Jan 2009 Tawab, MD, Lecturer of Otorhinolaryngology, till Dec 2011. It was done on cases of laryngeal cancers and included study of the epidemiology Faculty of Medicine, Cairo University, Cairo, Egypt (age, gender, residence and smoking) and modalities of treatment according to TNM classiſ cation. Tel: +201110579379; Results E-Mail: [email protected] The mean age was (57.6 ± 10.5) ranging from (22 to 87) years old. Males were 93.9% Received 12 May 2014 while females were 6.1%, smokers were (254) 86.1% of 295 patient. In this study, the Accepted 25 May 2014 treatment modalities for primary tumor were: surgery alone, chemo-radiotherapy, surgery and The Egyptian Journal of Otolaryngology postoperative radiotherapy and radiotherapy alone as well as neck dissection for lymph node 2014, 30:208–214 control. The surgeries performed included 160 total laryngectomies, 47 partial (39 supracricoid, 4 supraglottic and 4 vertical) laryngectomies and 18 transoral endoscopic laser surgery selected according to the site and stage of the primary tumor. For lymph node control: 84 selective neck dissection, 8 radical or modiſ ed radical neck dissection and 13 combined. Conclusion Total laryngectomy was the most common modality of treatment for primary tumors as the majority of cases presented at late stages. For lymph node control, the selective neck dissection was the commonest treatment as most of the patients had N0 and N1 lymph node. Keywords: Epidemiology, laryngeal cancer, total laryngectomy, neck dissection, radiotherapy, chemo radiotherapy Egypt J Otolaryngol 30:208–214 © 2014 The Egyptian Oto - Rhino - Laryngological Society 1012-5574 Squamous cell carcinoma (SCC) represents more Introduction than 90% of laryngeal cancers. Th e remaining Laryngeal carcinoma is the second most common (<10%) malignant tumors include fi brosarcoma, malignancy of the head and neck [1]. In the USA, chondrosarcoma, chemodectoma, rhabdomyosarcoma, the typical patient is a man in his 50s or 60s with a malignant minor salivary gland tumors, adenocarcinoma, history of smoking and/or alcohol use. However, oat cell carcinoma, adenosquamous cell carcinoma, and the male predilection for this disease has recently giant cell and spindle cell carcinoma [5]. decreased from a male : female ratio of 15 : 1 to less than 5 : 1 currently. Th is change in demographics has Laryngeal cancers diff er in their propensity to spread been attributed to increased rates of smoking among on the basis of the site of the larynx where the tumor is women and their increasing presence in equally toxic located [6]. Th e incidence of occult metastasis in cancer work environments [2]. Signifi cant variation in the larynx is generally relatively low, about 13%, and most of distribution of carcinoma at the diff erent laryngeal these cases are advanced cases and supraglottic in origin [7]. subsites exists worldwide. Supraglottic and glottic tumors are the most prominent subsites whereas Generally, in head and neck SCC, when the primary subglottic carcinomas are uniformly rare. In the USA, locoregional control is achieved, this decreases the glottic carcinomas are the most common (glottic 59%, rate of distant metastases to 5% instead of 18% if the supraglottic 40%, and subglottic 1%) [3]. locoregional control failed [8]. Eighty-fi ve percent of laryngeal cancers can be attributed Th e 6th ed. (2002) of the International Union against to tobacco and alcohol use. Smoking is the predominant Cancer TNM classifi cation is identical to that of the risk factor for laryngeal carcinoma, with alcohol use American Joint Cancer Committee (6th ed., 2002), being an independent and synergistic eff ect [4]. which is the used most commonly [9]. 1012-5574 © 2014 The Egyptian Oto - Rhino - Laryngological Society DOI: 10.4103/1012-5574.138468 Epidemiology and management of laryngeal cancer Abdel Tawab et al. 209 Th e treatment of laryngeal carcinoma is usually Patients and methods planned to provide optimal survival free of disease, Th is retrospective study was carried out on 295 patients with maximum functional results. Th ere are many who were admitted at the Otolaryngology-Head and treatment modalities and they diff er from each other Neck Surgery Department, Kasr Al-Aini Hospital, in the outcome of voice, swallowing, and quality of life. Cairo University, during the period from January 2009 Th e decision is infl uenced by diff erent variations in the till December 2011. size and location of the tumor [10]. Th is study was carried out on patients with laryngeal Glottic laryngeal squamous carcinoma has an excellent carcinoma and included the study of epidemiology (age, prognosis in its early stages. Th e disease can be treated sex, residence, and smoking), diff erent presentations, eff ectively by external beam radiotherapy, conservative stages, diff erent modes of management, and follow-up open laryngeal surgery, or endoscopic excision using of patients if available. Any patient with suspected cold techniques or a CO laser [11]. 2 laryngeal cancer proved negative by pathology was excluded from the study. Advanced glottic carcinoma should be curable in most cases and treatment should include both the Regular follow-up of patients to detect recurrence larynx and the neck. Classically, the treatment plan is of the tumor or complete cure was performed only total laryngectomy with or without neck dissection, for 54 patients because of missed follow-up charts. followed by postoperative radiotherapy in many cases, At the time of their admission, all the patients were but recently, it became possible to preserve the larynx subjected to assessment of history, which included age, without an impairment in the survival rate in many sex, residence, special habits of medical importance, cases. Two main interventions are identifi ed by many and all the symptoms of laryngeal carcinoma as authors to allow this change in the treatment strategy: hoarseness of voice and stridor. General medical and the supracricoid partial laryngectomy ( SCPL) and the oncological history of the patient was also assessed chemoradiation organ preservation protocols [12]. to decide whether patients could tolerate surgery and postoperative rehabilitation. Physical examination of Early supraglottic carcinoma should also be treated by patients at the time of their admission was performed a unimodality treatment, with the conservation of the and included the search for any neck swelling such as laryngeal functions like the early glottic carcinoma [13]. the thyroid gland or lymph node for correct staging Th e elective neck management is recommended widely of the disease. An indirect laryngoscope and a fl exible in T2 lesions and bilateral treatment for the neck is fi beroptic laryngoscope were used in combination to preferred when the carcinoma originates from or near detect the site, extension of the lesion, adequacy of the midline [14]. In advanced supraglottic carcinoma, the airway, and the mobility of the vocal folds that the neck should be addressed in all cases: by an elective directly aff ect the staging of the tumor. CT scan neck treatment for all the N0 lesions and combining was performed routinely for all patients to detect neck dissection with postoperative chemoradiation the actual size of the tumor, its extension, cartilage in most of the N2–3 cases [15]. In the mean time, invasion, the possibility of extralaryngeal spread, the larynx should be treated on a conservation basis nonpalpable nodal metastasis, and invasion of the to prevent unnecessary total laryngectomy in most paraglottic and pre-epiglottic spaces. CT scan was advanced supraglottic lesions [16]. performed for all the patients before the biopsies were taken to avoid the false results caused by edema with Modalities of treatment of nodal metastasis include the biopsy procedure by direct laryngoscopy. MRI radiation therapy in the N0 neck as it reduces the was performed in the patients with a recurrent mass recurrence rate to a5%. Th e node-positive neck is after radiotherapy to exclude recurrence of the tumor treated more eff ectively by a combination of surgery from postradiation edema. Routine preoperative such as radical neck dissection (RND), modifi ed laboratory tests were performed for all patients or selective neck dissection ( SND), and radiation. whereas metastatic work-up was performed only for In patients with bulky nodal disease, a complete suspected cases on the basis of assessment of clinical response in the neck to sequential chemotherapy and history and examination. Pulmonary function tests radiotherapy or radiotherapy alone may indicate that were performed for all patients planned for partial neck surgery is not necessary for good locoregional laryngectomy. control and improved disease-free survival rates [17]. Th e review of the treatment modalities for the tumor Th e aim of this work is to study epidemiological aspects implemented in our department (Kasr Al-Aini of laryngeal cancer and its modalities of treatment Hospital) showed that they included the following: according to the TNM classifi cation. surgery alone, chemoradiotherapy, surgery, followed by 210 The Egyptian Journal of Otolaryngology radiotherapy or radiotherapy alone, and neck dissection In this study, 287 patients had SCC (96.6%). for lymph node control. Frequencies for T (Tis, T1, T2, T3, T4) and N (N0, N1, All collected cases were revised for completeness and N2a, N2c) are presented in Tables 1 and 2, respectively.
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