Canadian journal of otolaryngology最新文献

A clinicopathologic correlation of 39 cases of a histologically biphasic malignant neoplasm of the larynx is presented. The histologic pattern of this entity was mainly that of a malignant spindle cell process, but a definite squamous cell carcinoma component was evident. Grossly the tumors were usually prominently polypoid. A morphologic transition of the squamous cell carcinomatous element into the spindle cell component was strongly suggested, supporting the contention that this entity is pathogenetically a pleomorphic or spindle cell squamous cell carcinoma. Follow-up information on 20 cases indicated a two-year mortality of 40 per cent, refuting the contention that this entity is of low-grade malignancy. Complete surgical removal of the neoplasm, with or without irradiation, offered the best therapeutic approach. Irradiation alone was unsuccessful.

Two types of vertical hemilaryngectomy are discussed. The frontolateral operation is indicated for infiltrating lesions of the cord, anterior to the vocal process, which approach or involve the anterior commissure. It should not be used for carcinomas which extend posteriorly beyond the tip of the vocal process, into the ventricle or below the inferior surface of the cord. The "extended" frontolateral operation is useful for infiltrative cordal lesions showing (1) posterior extension to or beyond the tip of the vocal process, but not into the posterior commissure, (2) beginning impairment of motility without actual fixation of the cord, (3) limited and superficial extension to the ventricle or margin of the ventricular band, or (4) subglottic extension amounting to no more than a few millimeters. The lesions are removed en bloc, along with a large portion of the thyroid cartilage and usually the entire arytenoid. Accurate delineation of the gross extent of the lesion is essential if these techniques are to be successfully applied. Failures are likely if attempts are made to over-extend the indications.

This paper presents an overview of studies of therapy of head and neck squamous cell carcinoma in which chemotherapy was combined with other modalities. The rationale for using chemotherapy with surgery is discussed, but ststematic studies of this combination of modalities have not been reported. Systemic chemotherapy plus radiation therapy has been studied using hydrozyurea, t-fluorouracil (5-FU), and methotrexate (MTX). Uncontrolled studies with hydroxyurea report favorable results, but a well-controlled study gave negative results. Controlled studies with 5-FU have given favorable results in certain tumor stages and sites of origin. MTX plus radiation in a small series produced slightly better survival than radiation alone. Intra-arterial chemotherapy plus radiation therapy has been the subject of exploratory studies but no firm conclusions can be drawn from these studies. Chemotherapy plus immunotherapy has been explored and merits further study. Based on the studies reported to date one can suggest the need for large-scale randomized control studies of long-term chemotherapy combined with other modalities.

The microvasculature of both the human and monkey larynx is described. The recognized patterns of growth and spread of laryngeal carcinoma are discussed in relation to the microvasculature. The direction of enlargement of these tumors may be influenced by the lines of least resistance created in the tissues by the microvasculature.

The subject of combined therapy for carcinoma of the head and neck is as perplexing now as it was in its beginning. Low vs high dose pre-operative radiation for carcinoma of the larynx remains a valid question. A total of 92 patients with advanced laryngeal carcinoma were studied at the University of Illinois. The results of treatment for 2 patients receiving planned low dose pre-operative radiation and 30 patients receiving planned high dose pre-operative radiation have been studied, using the actuarial method to calculate survival. Improved survival and decreased complications are evident in the low dose pre-operative group as compared to the high dose pre-operative group.