Jan Wedman

Voice results in patients with T1a glottic cancer treated by radiotherapy or endoscopic measures

Abstract. Early squamous cell carcinomas of the glottis can be treated effectively by means of surgery or external beam radiotherapy. The curability rate is about the same for both treatment modalities, but differing results have been reported regarding functional results. We selected 24 patients from a larger group of patients who had been treated for T1a glottic laryngeal cancer without the involvement of the anterior commissure. Fifteen patients were treated endoscopically and nine by radiotherapy. During a routine control videolaryngostroboscopy at an outpatient clinic, an objective and a subjective voice analysis were performed. The objective and subjective voice analyses showed no differences between the two treatment modalities. Videolaryngostroboscopy showed a significantly more pronounced glottic wave at the side that was originally affected by the tumour in the radiotherapy group. This difference disappeared when we looked at both vocal cords. Significant differences between the two treatment modalities were not found in any of the other parameters. Thus, this study shows no difference in the voice quality of patients treated by irradiation or by endoscopy. Therefore, the post-treatment voice quality is not a reason to favour radiotherapy for small T1a glottic squamous cell cancers without involvement of the anterior commissure.

The impact of comorbidity on treatment-related side effects in older patients with laryngeal cancer

The standard treatment of elderly head and neck patients is controversial. The goal of this study was to evaluate the relationship between co-morbidity and complications in elderly laryngeal cancer patients treated with different modalities. Retrospective analysis of patients 75 years old and older with laryngeal cancer (n=139) and patients 65 years old and younger as a reference control group (n=289) diagnosed in our department between 1997 and 2007 has been performed. Pretreatment co-morbidity (ACE-27), treatment-related complications and one- and six-month death rates have been analyzed. Co-morbidity rate was more pronounced in the elderly group, but did not result in more complications. Correlation has been found between co-morbidity and complication in the whole patients group, but not in the elderly group. By multivariate analysis, in all age groups radiation therapy (vs. total laryngectomy) and tumor stage were predictors of complications but co-morbidity and age were not. According to our study there is no reason to treat elderly laryngeal cancer patients differently. The weaker relation between co-morbidity and complications emphasizes the importance of careful pre-treatment evaluation in elderly.

Treatment of simple snoring using radio waves for ablation of uvula and soft palate: a day-case surgery procedure.

Objective Uvulopalatoplasty, performed with high‐frequency radio waves, was evaluated as a treatment for social snoring.

Co-morbidity and treatment outcomes of elderly pharyngeal cancer patients: A matched control study

Treatment choice in elderly pharyngeal cancer patient is disputed. This study was aimed to asses association of co-morbidity, complications and survival in different treatment modalities of pharyngeal cancer patients. Retrospective analysis of pharyngeal cancer patients, diagnosed between 1997 and 2007 in a tertiary referral hospital was performed. Patients 75years and older (n=42), were matched with two control patients 64years and younger (n=84). Co-morbidity (ACE-27), treatment related complications and survival data were assessed and analyzed. Frequency of co-morbidity was similar in both age groups, although discarding alcohol abuse resulted in higher incidence of co-morbidity in the elderly group. Complication rate was not significantly different. In a multivariate analysis only stage found to be a significant predictor of complications. Survival estimates adjusted to sex, age and birth cohort revealed co-morbidity to be a significant predictor for survival in elderly and young patients. No evidence has been found to treat elderly pharyngeal cancer patients differently than younger ones. Treatment related complications are not predicted by co-morbidities in young and elderly patients; however survival is predicted by comorbidity. Therefore thorough pre-treatment evaluation and care necessary in the elderly population.

Narrow Band Imaging Improves Observer Reliability in Evaluation of Upper Aerodigestive Tract Lesions

Visualization by endoscopy is essential in the diagnosis of upper aerodigestive tract lesions. Recent studies showed that narrow band imaging (NBI) increases the diagnostic potential of conventional white light imaging (WLI) by highlighting the superficial vessels. The objective of this study was to evaluate whether the use of NBI would influence inter‐ and intraobserver agreement while making diagnostic decisions using rigid endoscopy of the upper aerodigestive tract.

Predictive value of the Groningen Frailty Indicator for treatment outcomes in elderly patients after head and neck, or skin cancer surgery in a retrospective cohort

Careful selection of patients eligible for extensive head and neck cancer surgery is extremely important. A reliable predictor for postoperative outcomes in the vulnerable elderly population is not yet available. The concept of frailty describes a clinical state of increased vulnerability and can be assessed using frailty tests, such as the Groningen Frailty Indicator. In the current study, the influence of Groningen Frailty Indicator‐measured frailty on clinical outcome was investigated in elderly patients surgically treated for head and neck cancer.

Neuroendocrine carcinoma of the larynx - an extraordinary malignancy with high recurrence rates and long survival : Our experience in 11 patients

Dear Editor, Laryngeal neuroendocrine carcinoma are rare tumours that are believed to originate from pluripotential stem cells located in the submucosa of the larynx. Constituting <1% of all tumours originating from the larynx, they still form the second most common group of neoplasms at this location, after laryngeal squamous cell carcinoma. The World Health Organization classification divides laryngeal neuroendocrine carcinomas into four groups; typical carcinoid, atypical carcinoid, small cell neuroendocrine carcinoma and paragangliomas. Recently an aggressive subtype of the atypical carcinoid group was identified as a separate entity, the large cell neuroendocrine carcinoma. Identification of the right tumour type is of importance as tumour behaviour and response to therapy are closely related to the histological diagnosis. There are several pitfalls in the diagnostic and staging process of laryngeal neuroendocrine carcinoma. The different subtypes show considerable overlap in histological and immunohistochemical features, and neuroendocrine tumours can be a part of composite tumours, consisting of both a neuroendocrine neoplasm and a squamous cell carcinoma, impeding or delaying appropriate treatment. Owing to the rarity of these tumours, only small series have been published. Therefore, it remains important that institutions report on their experience with these neoplasms. The aim of this study was to increase the understanding of the clinicopathological behaviour by reviewing the medical files of patients diagnosed with a laryngeal neuroendocrine carcinoma at our institution. Materials and methods

Chronic recurrent multifocal osteomyelitis.

We report what is, to our best knowledge, the first case of chronic recurrent multifocal osteomyelitis (CRMO) in which the frontal and sphenoid bones were involved. Characterized by a prolonged and fluctuating course of osteomyelitis at different sites, CRMO is self-limited, although sequelae can occur. The diagnosis is one of exclusion. It is important to publish cases like this, because the recognition of CRMO can prevent aggressive surgical and medical treatment.

Predictors of postoperative complications and survival in patients with major salivary glands malignancies : A study highlighting the influence of age

The purpose of this study was to reveal prognostic factors for surgical complications and survival in young and elderly patients with malignant salivary gland tumors.

Narrow-band imaging in transoral laser surgery for early glottic cancer in relation to clinical outcome

The purpose of this study was to validate the prognostic value of adding narrow‐band imaging (NBI) during transoral laser surgery (TLS) for early glottic cancer.