Douglas P. Bryce

Second primary respiratory tract malignancies in glottic carcinoma

Of 740 cases of glottic cancer, a second respiratory tract tumor developed in 48. Only 14 cases would have been expected in a sample of the same age and sex distribution drawn from the general population of Ontario. Of 25 patients with second tumors in the lung, 23 are dead. Of these 23, 17 had been cured of Stage T1 glottic cancer. An actuarial method for calculating the risk of developing a second respiratory tract tumor amongst the survivors of glottic cancer is described. Of the survivors, 12% will have a second respiratory tract tumor within ten years following initial diagnosis of glottic cancer. Of patients with Stage T1 glottic cancer, 7% will die of a second respiratory tract tumor within ten years. This rate is slightly more than that for those who die of laryngeal cancer in this stage grouping. Late recurrences and/or second primary tumors in the larynx following radiotherapy are rare. Methods for reducing the risk of death from a second respiratory tract tumor are discussed.

The management of subglottic laryngeal stenosis by resection and direct anastomosis

The causes and relative incidence of stenosis in the trachea and subglottis are described. The special difficulties encountered in the subglottic region are discussed and references made to various treatments described in the past.

Management of advanced glottic cancer a 10 year review of the Toronto experience

Abstract This paper presents a detailed retrospective analysis of all patients with glottic cancer (with the exception of early vocal cord cancer) who were seen at the Princess Margaret Hospital from 1965 through 1974. 358 patients with this diagnosis were seen during this time period; Stage T2N0M0 comprised 46% of the total group, T3N0M0 :25%; 13% had nodal disease and 1.5% had distant disease at presentation. 293 patients were treated with radical radiotherapy; surgery was reserved for salvage of persistent or recurrent disease. The local control rate with radical radiotherapy was 66% for Stage T2N0M0 , 45% for Stage T3N0M0 and 56% for Stage T4N0M0 . 60% of the radiation failures were salvaged by surgery; surgical morbidity was low. The overall tumor control rates for the major stage groupings were 80% for Stage T2N0M0 , 69% for Stage T3N0M0 and 63% for Stage T4N0M0 . Of the survivors 82.5% of Stage T2N0M0 , 65% of Stage T3N0M0 and 90% of Stage T4N0M0 had an intact larynx and natural voice. Essential features of our management policy include moderate (but effective) dose radiotherapy combined with meticulous radiotherapy planning and careful follow-up to identify radiation failures. Our philosophy of treatment and its rationale emphasize preservation of the larynx and natural voice where possible, but without sacrificing survival.

Verrucous Carcinoma of the Larynx Management by Radiotherapy and Surgery

Verrucous carcinoma is an unusual and distinct variant of well differentiated squamous cell carcinoma, and accounts for approximately 1 to 2% of all primary squamous cell carcinomas of the larynx. There has been considerable controversy regarding the role of radiotherapy in the management of these tumors, as they are said to be radioresistant, and in a number of instances “anaplastic transformation” has apparently occurred following such therapy. We have reviewed 18 patients with verrucous carcinoma of the larynx in which eight received surgical therapy alone, eight received radiotherapy alone, and two received combined therapy. We conclude that radiotherapy and surgery are equally effective in eradicating the disease. “Anaplastic transformation” of these tumors represents a small but nevertheless real risk following radiotherapy. Accordingly, our current therapeutic policy is to treat by surgical excision those smaller tumors which can be removed by conservation laryngectomy procedures, reserving radiotherapy for those large tumors which would require total laryngectomy if treated surgically.

Management of Patients with Long-Term Tracheotomies and Aspiration

The purpose of this study was to develop a management protocol for patients with long-term tracheotomies and aspiration, in order to develop clinical criteria for extubation and reduction of aspiration-related complications. We studied 39 patients with tracheotomies in place for over 3 months, 28 of whom completed management. Patients were classified according to degree of impairment and managed with the aims of avoiding aspiration and performing extubation whenever feasible. Criteria for choosing various management strategies are presented.