Mucoepidermoid Carcinomas of the Larynx

2022 ◽  
pp. 000348942110694
Author(s):  
Holden W. Richards ◽  
Caitlin Bertelsen ◽  
Bronwyn Hamilton ◽  
David Sauer ◽  
Joshua Schindler
Keyword(s):  
Radiation Therapy ◽  
Radical Neck Dissection ◽  
Case Series ◽  
Tumor Grade ◽  
Tertiary Hospital ◽  
Additional Treatment ◽  
Partial Laryngectomy ◽  
High Grade ◽  
Intermediate Grade ◽  
Postoperative Radiation Therapy

Objectives: Discussions regarding the specific management and outcomes for laryngeal MEC are limited to very small, single-institution case series. To look further into the diagnosis and management of these uncommon non-squamous cell carcinomas of the larynx, we present 3 recent cases of laryngeal MEC treated at our institution. Methods: Patients at a tertiary hospital treated for MEC between October 2019 and December 2020 were retrospectively identified. Chart review, imaging analysis, and histologic slide creation were completed for all patients. Results: We identified and treated 2 patients with high-grade supraglottic and 1 patient with intermediate-grade glottic MEC. These patients presented to our clinic with a primary complaint of either gradual, worsening dysphonia, dysphagia, or both. All patients underwent laryngovideostroboscopy as well as panendoscopy with directed submucosal biopsy, which was consistent with MEC. MRI was performed in 2 of the cases further elucidating the extent of submucosal spread. PET-CT was performed in all 3 cases, and none demonstrated evidence of regional or distal metastases. Surgically, high-grade MEC lesions were treated with a total laryngectomy. The intermediate MEC lesion was managed with a supracricoid partial laryngectomy (SCPL). Surgical margins were free of tumor in all cases with no nodal metastases by modified radical neck dissection. Radiation therapy was offered to both high-grade MEC patients and declined by one. Radiation was not recommended to the patient with intermediate-grade MEC as we believed that the risk of additional treatment outweighed the benefit. Conclusion: We believe that MEC of the larynx should be considered in patients with atypical submucosal laryngeal masses. Laryngovideostroboscopy, MRI, and PET imaging may be valuable in determining the extent of the lesions and planning appropriate surgery. Postoperative radiation therapy should be considered a per tumor grade in other more studied sites, as there is no data on efficacy in laryngeal MEC.

Functional and psychosocial effects of multimodality limb-sparing therapy in patients with soft tissue sarcomas.

1989 ◽  
Vol 7 (9) ◽  
pp. 1217-1228 ◽  
Author(s):  
A E Chang ◽  
S M Steinberg ◽  
M Culnane ◽  
M H Lampert ◽  
A J Reggia ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Sexual Activity ◽  
Standardized Test ◽  
Soft Tissue Sarcomas ◽  
High Grade ◽  
Postoperative Radiation ◽  
Limb Function ◽  
Postoperative Radiation Therapy ◽  
Global Quality Of Life

We have documented functional and psychosocial changes in patients with extremity soft tissue sarcomas who have undergone multimodality limb-sparing treatments. In 88 patients, parameters related to economic status, sexual activity, pain, limb function, and global quality of life (QOL) were recorded prior to surgery and every 6 months postoperatively. Changes from the preoperative assessment for every parameter were analyzed in each patient. Six months after surgery, there was a decrease in employment status, sexual activity, and in limb function in a significant number of patients. At 12 months, these decreases were still evident. Despite these changes, global QOL measured by a standardized test showed at least some improvement in a significant proportion of patients at 12 months. These findings highlight the difficulty in defining QOL. It could not be ascertained if radiation therapy and/or chemotherapy were causative factors in specific changes because of the small numbers of patients in each subgroup. However, among 60 patients with high-grade sarcomas, significant wound problems developed in 10 of 33 who received postoperative radiation therapy in combination with adjuvant doxorubicin and cyclophosphamide chemotherapy compared with one of 27 patients who received adjuvant chemotherapy alone (P = .016). Also, among high-grade sarcoma patients with 12-month follow-up, six of 19 patients who received radiation therapy and chemotherapy developed joint contractures compared with zero of 15 patients who received chemotherapy alone (P less than .04). The combination of postoperative radiation therapy and chemotherapy appeared to be associated with significantly more tissue-related injury in patients with high-grade sarcomas compared with chemotherapy alone.

Ewing’s Sarcoma of the Hand

2008 ◽  
Vol 34 (1) ◽  
pp. 35-39 ◽  
Author(s):  
O. A. ANAKWENZE ◽  
W. L. PARKER ◽  
L. E. WOLD ◽  
K. K AMRAMI ◽  
P. C. AMADIO
Keyword(s):  
Radiation Therapy ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Case Series ◽  
Surgical Excision ◽  
Case Review ◽  
Retrospective Case ◽  
Postoperative Radiation Therapy ◽  
Definitive Surgery

A retrospective case review was carried out to report the outcomes in a contemporary case series of Ewing’s sarcoma originating in the hand. We identified five patients treated since 1995. All five had wide surgical excision, one by ray amputation. All were treated with chemotherapy. Four patients also received radiation therapy, two to treat metastases and two as an adjunct to local excision. There were no local recurrences. Two patients developed metastases. Both died of their disease. Neither of these two patients had received local postoperative radiation therapy; one did not receive chemotherapy before definitive surgery. The other three patients were alive and free of disease at last follow-up, 4 to 12 years after initial presentation.

Vocal Rehabilitation in the Laryngectomized Patient with a Tracheoesophageal Shunt

1974 ◽  
Vol 83 (4) ◽  
pp. 445-451 ◽  
Author(s):  
Robert M. Komorn
Keyword(s):  
Radiation Therapy ◽  
Radical Neck Dissection ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Vocal Rehabilitation ◽  
Alaryngeal Speech ◽  
Intelligence Failure ◽  
Low Incidence ◽  
Laryngectomized Patient ◽  
Tracheoesophageal Shunt

A tracheoesophageal shunt was used for vocal rehabilitation in 29 laryngectomized patients. Twenty-three patients had the shunt constructed at the time of laryngectomy. Radiation therapy or radical neck dissection did not limit the usefulness of the shunt. Twenty of the 29 patients acquired useful speech (69%). T-E shunt speech equals or exceeds other forms of alaryngeal speech when measured against the parameters of rate, duration, and intelligence. Failure to acquire useful speech occurred in nine patients because of either stenosis of the shunt (10%), aspiration (7%), or wound probems (14%). Stenosis of the shunt was primarily a problem in patients who received postoperative radiation therapy without a stent in the shunt. Wound problems were related to either our previous use of a lateral based flap or diabetes mellitus. Since January 1973 there has only been one failure in fourteen shunts constructed. The technique as now used is simple, applicable in a wide variety of clinical situations and associated with a low incidence of complications.

Radiotherapy of Intracranial Astrocytomas

Neurosurgery ◽  
1979 ◽  
Vol 5 (3) ◽  
pp. 301-308 ◽  
Author(s):  
Paul W. Scanlon ◽  
William F. Taylor
Keyword(s):  
Radiation Therapy ◽  
Postoperative Radiotherapy ◽  
Tumor Grade ◽  
Low Grade ◽  
Unexpected Finding ◽  
High Grade ◽  
Death Rates ◽  
Brain Irradiation ◽  
Total Brain ◽  
Better Than

Abstract In a review of 417 intracranial astrocytomas treated radiotherapeutically at the Mayo Clinic from 1960 through 1969, the well-known correlation of tumor grade with survival was verified. Totally unexpected was the finding that age was fully as important a discriminant as tumor grade. Another unexpected finding was that patients treated with biopsy only followed by radiation therapy did as well as or slightly better than those subjected to resection followed by postoperative radiotherapy. We could not verify the importance to survival of either large dose or large volume radiotherapy, which has been emphasized by some. Patients receiving less than 1400 rets did just as well as or slightly better than those receiving more than 1400 rets. With low grade astrocytomas, survival beyond 4 years was significantly worse (higher death rates) in the group receiving more than 1400 rets. This suggested the possibility of radiation damage with delayed manifestations. We also could not verify an increased effectiveness for the generally accepted use of total brain irradiation for high grade gliomas.

Postoperative radiation therapy for small, low-/intermediate-grade parotid tumors with close and/or positive surgical margins

Head & Neck ◽  
2011 ◽  
Vol 34 (7) ◽  
pp. 953-955 ◽  
Author(s):  
Samuel M. Richter ◽  
Patricia Friedmann ◽  
Waleed F. Mourad ◽  
Kenneth S. Hu ◽  
Mark S. Persky ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Surgical Margins ◽  
Postoperative Radiation ◽  
Intermediate Grade ◽  
Postoperative Radiation Therapy ◽  
Positive Surgical Margins ◽  
Parotid Tumors

Adjuvant Therapy for Soft Tissue Sarcoma

2005 ◽  
Vol 3 (2) ◽  
pp. 207-213 ◽  
Author(s):  
Scott M. Schuetze ◽  
Michael E. Ray
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
High Risk ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Survival Rates ◽  
Wide Resection ◽  
High Grade ◽  
Postoperative Radiation Therapy ◽  
Increased Risk

Wide surgical excision is the backbone of therapy for localized soft tissue sarcoma and often produces excellent results. Patients with a marginal resection of disease and high-grade or large tumors are at an increased risk of recurrence. Radiation therapy (external beam or brachytherapy) has been shown to reduce the risk of local recurrence of disease and should be offered to patients with large (>5 cm) or high-grade sarcomas, especially if a wide resection cannot be performed. Use of preoperative versus postoperative radiation therapy should be planned, in consultation with a radiation oncologist and a surgical oncologist, before resection of the sarcoma if possible. Chemotherapy using an anthracycline- and ifosfamide-based regimen may improve disease-free and overall survival rates. Chemotherapy appears to be most beneficial for patients with very large (≥10 cm), high-grade sarcomas of the extremity who are at a high risk of experiencing distant recurrence of disease. The effect of adjuvant chemotherapy on overall survival remains controversial. Research is greatly needed to identify the patients who are most likely to benefit from conventional chemotherapy, improve the treatment of retroperitoneal sarcomas, and identify novel agents that may impact the natural history of high-risk soft tissue sarcoma.

Correlation of pathologic tumor grade with survival in oral cavity squamous cell carcinoma.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18557-e18557
Author(s):  
Eric Anderson ◽  
Michael Luu ◽  
Diana J. Lu ◽  
Anthony Tuan Nguyen ◽  
Jon Mallen-St. Clair ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Oral Cavity ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Multivariable Analysis ◽  
Tumor Grade ◽  
Low Grade ◽  
High Grade ◽  
Intermediate Grade

e18557 Background: Pathologic tumor grade is a well-established prognostic risk factor that impacts staging and standard-of-care treatment decisions across multiple cancer types. However, the significance of tumor grade in cancers of the head and neck is less certain. Even in oral cavity squamous cell carcinoma (OCSCC), the head and neck cancer subsite with largest body of literature regarding the predictive value of tumor grade is, the prognostic significance of tumor grade remains controversial. Thus, we sought to better elucidate the prognostic importance of tumor grade in OCSCC. Methods: Patients with OCSCC diagnosed from 2004-2015 and undergoing primary surgery with or without adjuvant treatment in the National Cancer Data Base (NCDB) were identified. Overall survival (OS) was estimated using the Kaplan-Meier method with and without propensity score matching (PSM). Univariate and multivariable survival analyses were performed using Cox regression. Analyses were adjusted for multiple clinicopathologic factors, including age, sex, comorbidity status, year of diagnosis, pathologic staging, margin status, number of lymph nodes (LN) examined/positive, extranodal extension (ENE), lymphovascular invasion (LVI), adjuvant radiation, and concomitant chemotherapy. Results: Median follow-up was 40.7 months. Of 13,941 patients with OCSCC, 2,883 had low-grade tumors, 8,716 had intermediate-grade tumors, and 2,342 had high-grade tumors. Higher tumor grade was strongly associated with decreased survival. Specifically, five year OS was 62.7%, 52.8%, and 42.5% in low-grade (LG), intermediate-grade (IG), and high-grade (HG) OCSCC, respectively (p-value < 0.001). In PSM cohorts, OCSCC patients with high-grade had significantly worse 5 year OS (47.7% vs. 57.7%, p < 0.001) in comparison to those with LG OCSCC. Similarly, patients with IG tumors has worse 5-year OS (55.6% vs. 60.3%, p = 0.001) than patients with LG tumors in PSM cohorts. In multivariable analysis, both HG (HR 1.38, 95% CI 1.25-1.52, p < 0.001) and IG (HR 1.17, 95% CI 1.08-1.26, p < 0.001) OCSCC was associated with worse survival than what was observed in LG tumors. The magnitude of the independent effect of tumor grade in multivariable analysis was greater than or equal to what was observed with other well-established prognostic factors like margin positivity (HR 1.34), ENE (HR 1.35), and LVI (HR 1.18). Conclusions: Pathologic tumor grade is a strong predictor of survival among patients with OCSCC. Tumor grade should be considered when making therapeutic recommendations for OCSCC.

scholarly journals Efficacy and Morbidity of Partial Laryngectomy and Postoperative Radiation Therapy

1990 ◽  
Vol 100 (11) ◽  
pp. 1146???1151 ◽  
Author(s):  
Marilene B. Wang ◽  
Robert S. Lavey ◽  
Thomas C. Calcaterra
Keyword(s):  
Radiation Therapy ◽  
Partial Laryngectomy ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy

Clinical features and treatment of World Health Organization Grade II and III meningiomas in childhood: report of 23 cases

2012 ◽  
Vol 10 (5) ◽  
pp. 423-433 ◽  
Author(s):  
Xiao-Qiang Wang ◽  
Cheng-Chuan Jiang ◽  
Lin Zhao ◽  
Ye Gong ◽  
Jie Hu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Progesterone Receptor ◽  
Clinical Features ◽  
Labeling Index ◽  
High Grade ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Mib 1

Object High-grade meningiomas in childhood are rare, and their clinical features are unknown. The objective of this study was to determine the clinical characteristics and prognosis of childhood high-grade meningiomas. Methods Twenty-three patients with childhood high-grade meningiomas were treated at the Huashan Hospital. Clinical data were collected, tumor samples were reexamined, and prognoses were attained through follow-up visits and telephone interviews. Survival probability was calculated using the Kaplan-Meier method. A 2-sided probability level of 0.05 was chosen for statistical significance. Results The series included 18 males and 5 females (mean age 12.1 years). The most common symptoms were headache and vomiting (43%). Three patients had accompanying neurofibromatosis Type II (NF2). The high-grade meningioma cases with NF2 had larger tumor diameters than those without NF2 (p = 0.010). The skull base was the most common tumor site (39%). Complete resections were achieved in 11 patients after their initial operations. Adjuvant radiation therapy was performed in 9 cases. Follow-up evaluations were performed for 20 patients (mean follow-up 70 months). Ten patients experienced recurrences, 2 patients had lung metastases, and 7 patients died of the recurrence. The extent of surgery was significantly related to progression-free survival (PFS; p = 0.038). A negative progesterone receptor combined with strongly positive Bcl-2 immunoreactivity was significantly related to PFS (p = 0.001) and overall survival (p = 0.002). The MIB-1 labeling index was significantly related to overall survival (p = 0.018), whereas postoperative radiation therapy was not significantly related to PFS (p = 0.087) and overall survival (p = 0.40). Conclusions Childhood high-grade meningioma is a rare tumor type. Childhood high-grade meningioma has a male predominance and the basilar region is the most common tumor location. Patients with these tumors have high recurrence and mortality rates. The extent of resection is an important prognosis factor. A negative progesterone receptor combined with a strongly positive Bcl-2 immunoreaction might predict cancer recurrence. The MIB-1 labeling index correlates with the prognosis, and an MIB-1 labeling index > 3% increases the risk of recurrence in childhood high-grade meningioma. More cases should be collected, and longer follow-up periods should be obtained, to evaluate the effects of postoperative radiation therapy in childhood high-grade meningioma.

scholarly journals Genomic Heterogeneity of Breast Tumor Pathogenesis

2009 ◽  
Vol 3 ◽  
pp. CMO.S2946
Author(s):  
Rachel E. Ellsworth ◽  
Jeffrey A. Hooke ◽  
Craig D. Shriver ◽  
Darrell L. Ellsworth
Keyword(s):  
Current System ◽  
Treatment Options ◽  
Expression Patterns ◽  
Tumor Grade ◽  
Molecular Data ◽  
Clinical Test ◽  
Low Grade ◽  
High Grade ◽  
Breast Cancer Patients ◽  
Intermediate Grade

Pathological grade is a useful prognostic factor for stratifying breast cancer patients into favorable (low-grade, well-differentiated tumors) and less favorable (high-grade, poorly-differentiated tumors) outcome groups. Under the current system of tumor grading, however, a large proportion of tumors are characterized as intermediate-grade, making determination of optimal treatments difficult. In an effort to increase objectivity in the pathological assessment of tumor grade, differences in chromosomal alterations and gene expression patterns have been characterized in low-grade, intermediate-grade, and high-grade disease. In this review, we outline molecular data supporting a linear model of progression from low-grade to high-grade carcinomas, as well as contradicting genetic data suggesting that low-grade and high-grade tumors develop independently. While debate regarding specific pathways of development continues, molecular data suggest that intermediate-grade tumors do not comprise an independent disease subtype, but represent clinical and molecular hybrids between low-grade and high-grade tumors. Finally, we discuss the clinical implications associated with different pathways of development, including a new clinical test to assign grade and guide treatment options.

Sign in / Sign up

Export Citation Format

Share Document