Combined posterior and supraglottic stenosis (CS) often presents as debilitating dysphonia or dyspnea, secondary to blunt trauma or traumatic intubation. However, CS has proven to be a late complication of chemoradiat...Combined posterior and supraglottic stenosis (CS) often presents as debilitating dysphonia or dyspnea, secondary to blunt trauma or traumatic intubation. However, CS has proven to be a late complication of chemoradiation therapy. Traditional treatment of combined posterior and supraglottic stenosis (CS) secondary to chemoradiation has been frequently complicated by poor tissue healing. This case study illustrates a novel endoscopic surgical technique employing a large laterally-based flap as a posterior glottic keel by rotating it anteroinferiorly and suturing it in place. As a result of the procedure, the bilateral vocal folds, which were midline and immobile preoperatively, regained normal motion. The supraglottic airway was also restored. Successful endoscopic treatment of CS with bilateral vocal fold immobility is possible using a large laterally-based flap, even in the face of tissue changes secondary to chemoradiation.展开更多
Background: The current treatment options of early glottic carcinoma are radiotherapy;trans laser microsurgery, and open surgery. However, the best treatment is still controversial due to lack of randomized controlled...Background: The current treatment options of early glottic carcinoma are radiotherapy;trans laser microsurgery, and open surgery. However, the best treatment is still controversial due to lack of randomized controlled trials. We aimed to evaluate the treatment results and the prognostic factors of local control of early glottic squamous cell carcinoma patients (GSCC) T1-2N0M0 treated at our institution. Material and Methods: We retrospectively studied the charts of 52 patients with early GSCC T1-T2N0M0 from 2010-2015 at the Clinical Oncology Department, Ain-Shams University. 24 patients had T1 and 28 had T2 early glottic carcinoma. The overall survival OS, local control rate, and laryngeal preservation rate were evaluated. Kaplan-Meier method, Cox proportional hazards model were used to analyze the data. Results: Median duration of follow-up was 13 months. Thirty-eight patients received radiation treatment alone (73.1%), 7.7% of the patients underwent surgery alone, and 19.2% of the patients had surgery combined with radiotherapy. Local recurrence after radiation failure developed in 6/52 patients, all had T2 disease and were salvaged by total laryngectomy. The ultimate local control rate was 88.5%, and the ultimate laryngeal preservation rate was 77.2% (40/52 patients). The median OS of the 52 patients was 13 months (range 2 - 46 months). Univariate analysis of factors associated with poor local control showed that age > 60 years was the only significant factor (P = 0.048). Conclusion: Radiotherapy achieves high local control and laryngeal preservation rates for patients with early glottic carcinoma, and is associated with a low rate of severe complications compared to surgery. Salvage surgery is feasible after radiotherapy failure.展开更多
Purpose: To compare concurrent chemoradiotherapy with radiotherapy in T2N0 glottic cancer. Materials and Methods: Thirty nine patients were treated with radiotherapy alone. In detail, 30 patients treated between 1985 ...Purpose: To compare concurrent chemoradiotherapy with radiotherapy in T2N0 glottic cancer. Materials and Methods: Thirty nine patients were treated with radiotherapy alone. In detail, 30 patients treated between 1985 and 1995, and 9 patients treated between 1995 and 2010 were included in the radiotherapy alone group. Between 1995 and 2010, 22 patients were treated with concurrent chemoradiotherapy. Conventional fractionation was applied in 19 patients in the radiotherapy group and in 1 patient in the chemoradiotherapy group. Hyperfractionation was applied to 20 patients in the radiotherapy group and to 21 patients in the chemoradiotherapy group. Total dose ranged from 64 Gy to 76.8 Gy in the radiotherapy group and from 66 Gy to 76.8 Gy in the chemoradiotherapy group. Cisplatin or carboplatin was administered in the chemoradiotherapy group. Results: There were no differences in the 5-year preservation rate of vocal function (82.8% vs 87.4%, p = 0.652), local control rate (77.2% vs 92.9%, p = 0.163), and 5-year overall survival rate (86.4% vs 90.2%, p = 0.497) between the radiotherapy and chemoradiotherapy groups. Conclusion: In T2N0 glottic cancer, no difference was observed between radiotherapy alone and concurrent chemoradiotherapy groups.展开更多
Background: This is a retrospective study on a group of patients with early glottic carcinoma, treated with curative radiotherapy. The aim of the study is to assess voice quality after treatment. We also evaluated loc...Background: This is a retrospective study on a group of patients with early glottic carcinoma, treated with curative radiotherapy. The aim of the study is to assess voice quality after treatment. We also evaluated local recurrence, overall survival, disease free survival and toxicity. Material and Methods: We examined a total of 36 patients, out of which 27 were smokers: 10 females/5 smokers;26 males/22 smokers. The sample was observed from January 2007 to July 2012 (average follow-up period: 33.5 months, range 12 - 76). Diagnosis of early glottic carcinoma was eight during the two-year period 2007/2008, nine during 2009/2010, eleven during year 2011 and eight during year 2012. All patients suffering from early glottic carcinoma, histopathologically confirmed, were classified as follows: 24 patients T1a, 3 patients T1b, 6 patients T2 and 3 patients had a carcinoma in situ. They were treated only with conventional radiotherapy. After the treatment (total dose 70 Gy), patients were asked to fill out the Voice Handicap Index (VHI) questionnaire, composed of 30 questions that covered physical, emotional and functional areas. Results: The global VHI was evidenced with good voice quality (62% of patients: VHI < 30;34% of patients: VHI 31 - 60). Vocal disability was mild in over 70% of patients within the physical area and over 80% within the emotional area. We observed two local recurrences, one occurred five years after the end of radiation therapy and one six months after. In terms of toxicity, we observed that acute reactions, such as dysphonia, dysphagia and erythema, were relatively limited. Conclusions: The VHI index suggests that radiotherapy produces acceptable functional results, with limited repercussion on life quality. In line with literature, our data confirmed good cure rates and larynx preservation (94.4%).展开更多
The aims of this study were to evaluate the results of CO2 laser surgery alone and CO2 laser surgery combined with radiotherapy in patients with T2N0M0 glottic carcinoma. A retrospective analysis was conducted of 35 c...The aims of this study were to evaluate the results of CO2 laser surgery alone and CO2 laser surgery combined with radiotherapy in patients with T2N0M0 glottic carcinoma. A retrospective analysis was conducted of 35 cases of T2N0M0 glottic carcinoma. Fourteen patients with normal vocal cord mobility were treated with endoscopic CO2 laser surgery alone. The remaining 21 patients were treated with CO2 laser surgery followed by radiotherapy (44 - 70 Gy, including low-dose carboplatin chemoradiotherapy). Main outcome measures were local control, organ preservation, recurrence, 5-year survival, and successful salvage in cases of recurrence. We evaluated the patient’s voice with the psychoacoustics GRBAS scale, maximum phonation time (MPT), and airflow rate (AFR) obtained by aerodynamic tests. Mean follow-up period was 5 years. Among the 35 T2N0M0 patients, 5-year survival and 5-year voice preservation rates were 97% and 89%, respectively. Local recurrence occurred in 7 of these patients (20%);4 of 7 local recurrences were successfully re-treated by laser surgery. Total laryngectomy was necessary for salvage treatment in the remaining 3 patients. The post-treatment voice qualities were judged to be the same or improved over pretreatment qualities. There was little change in MPT and AFR after treatment in non-recurrence patients. CO2 laser microsurgery is an excellent tool for treating selected cases of T2N0M0展开更多
Injection laryngoplasty with biomaterials is an effective technique to treat glottic insufficiency.However,the inadequate durability,deficient pro-secretion of extracellular matrix(ECM)and poor functional preservation...Injection laryngoplasty with biomaterials is an effective technique to treat glottic insufficiency.However,the inadequate durability,deficient pro-secretion of extracellular matrix(ECM)and poor functional preservation of current biomaterials have yielded an unsatisfactory therapeutic effect.Herein,a self-fusing bioactive hydrogel comprising modified carboxymethyl chitosan and sodium alginate is developed through a dual-crosslinking mechanism(photo-triggered and dynamic covalent bonds).Owing to its characteristic networks,the synergistic effect of the hydrogel for vocal folds(VFs)vibration and phonation is adequately demonstrated.Notably,owing to its inherent bioactivity of polysaccharides,the hydrogel could significantly enhance the secretion of major components(type I/III collagen and elastin)in the lamina propria of the VFs both in vivo and in vitro.In a rabbit model for glottic insufficiency,the optimized hydrogel(C1A1)has demonstrated a durability far superior to that of the commercially made hyaluronic acid(HA)Gel.More importantly,owing to the ECM-inducing bioactivity,the physiological functions of the VFs treated with the C1A1 hydrogel also outperformed that of the HA Gel,and were similar to those of the normal VFs.Taken together,through a simple-yet-effective strategy,the novel hydrogel has demonstrated outstanding durability,ECM-inducing bioactivity and physiological function preservation,therefore has an appealing clinical value for treating glottic insufficiency.展开更多
目的比较等离子射频消融术与CO_(2)激光治疗早期声门型喉癌(EGC)的效果。方法根据治疗方法的不同将80例EGC患者分为对照组(n=40,CO_(2)激光)与研究组(n=40,等离子射频消融术),比较两组患者的围手术期指标[手术时间、术中出血量、术后住...目的比较等离子射频消融术与CO_(2)激光治疗早期声门型喉癌(EGC)的效果。方法根据治疗方法的不同将80例EGC患者分为对照组(n=40,CO_(2)激光)与研究组(n=40,等离子射频消融术),比较两组患者的围手术期指标[手术时间、术中出血量、术后住院时间、术后24 h视觉模拟评分法(VAS)评分]、嗓音功能[振幅微扰、谐噪比(HNR)、基频微扰]、生活质量[嗓音障碍指数(VHI)]、吞咽功能[电视透视吞咽功能检查(VFSS)]、局部复发情况及并发症发生情况。结果研究组患者手术时间、术后住院时间均明显短于对照组,术中出血量明显少于对照组,术后24 h VAS评分明显低于照组,差异均有统计学意义(P﹤0.01)。术后4周,两组患者HNR均高于本组术前,基频微扰、振幅微扰均低于本组术前,研究组患者HNR高于对照组,基频微扰、振幅微扰均低于对照组,差异均有统计学意义(P﹤0.05)。术后6个月,两组患者VHI评分均低于本组术前,VFSS评分均高于本组术前,研究组患者VHI评分低于对照组,VFSS评分高于对照组,差异均有统计学意义(P﹤0.05)。研究患者的局部复发率和并发症总发生率均低于对照组,但差异均无统计学意义(P﹥0.05)。结论与CO_(2)激光相比,等离子射频消融术治疗EGC的效果更好,可以缩短手术时间,减少术中出血量,减轻术后疼痛感,同时对患者嗓音、吞咽功能的影响较小,可以促进患者术后快速康复,并且提高生活质量。展开更多
目的探讨显微支撑喉镜低温等离子射频消融治疗早期声门型喉癌的效果。方法选取74例早期声门型喉癌患者,随机分为显微镜组和切除术组,各37例。切除术组采用单纯喉部分切除术治疗,显微镜组采用显微支撑喉镜低温等离子射频消融治疗。对比2...目的探讨显微支撑喉镜低温等离子射频消融治疗早期声门型喉癌的效果。方法选取74例早期声门型喉癌患者,随机分为显微镜组和切除术组,各37例。切除术组采用单纯喉部分切除术治疗,显微镜组采用显微支撑喉镜低温等离子射频消融治疗。对比2组围术期情况、黏膜恢复评分、疼痛视觉模拟(VAS)评分、嗓音声学功能、炎性因子及并发症。结果和切除术组对比,显微镜组术中出血量较少,手术时间、住院时间均较短;术后4周黏膜恢复评分较高,术后1 d VAS评分较低;术后6个月显微镜组基频微扰、标准化噪声能力、振幅微扰均较低;术后1 d显微镜组C反应蛋白(CRP)、白介素-6(IL-6)水平均较低,白介素-2(IL-2)水平较高(P<0.05)。显微镜组并发症总发生率为2.70%(1/37),较切除术组24.32%(9/37)低(P<0.05)。结论对早期声门型喉癌患者采用显微支撑喉镜低温等离子射频消融治疗,可减少术中出血量,减轻炎性应激,加快患者术后恢复,并可改善嗓音声学功能,且安全性更高。展开更多
文摘Combined posterior and supraglottic stenosis (CS) often presents as debilitating dysphonia or dyspnea, secondary to blunt trauma or traumatic intubation. However, CS has proven to be a late complication of chemoradiation therapy. Traditional treatment of combined posterior and supraglottic stenosis (CS) secondary to chemoradiation has been frequently complicated by poor tissue healing. This case study illustrates a novel endoscopic surgical technique employing a large laterally-based flap as a posterior glottic keel by rotating it anteroinferiorly and suturing it in place. As a result of the procedure, the bilateral vocal folds, which were midline and immobile preoperatively, regained normal motion. The supraglottic airway was also restored. Successful endoscopic treatment of CS with bilateral vocal fold immobility is possible using a large laterally-based flap, even in the face of tissue changes secondary to chemoradiation.
文摘Background: The current treatment options of early glottic carcinoma are radiotherapy;trans laser microsurgery, and open surgery. However, the best treatment is still controversial due to lack of randomized controlled trials. We aimed to evaluate the treatment results and the prognostic factors of local control of early glottic squamous cell carcinoma patients (GSCC) T1-2N0M0 treated at our institution. Material and Methods: We retrospectively studied the charts of 52 patients with early GSCC T1-T2N0M0 from 2010-2015 at the Clinical Oncology Department, Ain-Shams University. 24 patients had T1 and 28 had T2 early glottic carcinoma. The overall survival OS, local control rate, and laryngeal preservation rate were evaluated. Kaplan-Meier method, Cox proportional hazards model were used to analyze the data. Results: Median duration of follow-up was 13 months. Thirty-eight patients received radiation treatment alone (73.1%), 7.7% of the patients underwent surgery alone, and 19.2% of the patients had surgery combined with radiotherapy. Local recurrence after radiation failure developed in 6/52 patients, all had T2 disease and were salvaged by total laryngectomy. The ultimate local control rate was 88.5%, and the ultimate laryngeal preservation rate was 77.2% (40/52 patients). The median OS of the 52 patients was 13 months (range 2 - 46 months). Univariate analysis of factors associated with poor local control showed that age > 60 years was the only significant factor (P = 0.048). Conclusion: Radiotherapy achieves high local control and laryngeal preservation rates for patients with early glottic carcinoma, and is associated with a low rate of severe complications compared to surgery. Salvage surgery is feasible after radiotherapy failure.
文摘Purpose: To compare concurrent chemoradiotherapy with radiotherapy in T2N0 glottic cancer. Materials and Methods: Thirty nine patients were treated with radiotherapy alone. In detail, 30 patients treated between 1985 and 1995, and 9 patients treated between 1995 and 2010 were included in the radiotherapy alone group. Between 1995 and 2010, 22 patients were treated with concurrent chemoradiotherapy. Conventional fractionation was applied in 19 patients in the radiotherapy group and in 1 patient in the chemoradiotherapy group. Hyperfractionation was applied to 20 patients in the radiotherapy group and to 21 patients in the chemoradiotherapy group. Total dose ranged from 64 Gy to 76.8 Gy in the radiotherapy group and from 66 Gy to 76.8 Gy in the chemoradiotherapy group. Cisplatin or carboplatin was administered in the chemoradiotherapy group. Results: There were no differences in the 5-year preservation rate of vocal function (82.8% vs 87.4%, p = 0.652), local control rate (77.2% vs 92.9%, p = 0.163), and 5-year overall survival rate (86.4% vs 90.2%, p = 0.497) between the radiotherapy and chemoradiotherapy groups. Conclusion: In T2N0 glottic cancer, no difference was observed between radiotherapy alone and concurrent chemoradiotherapy groups.
文摘Background: This is a retrospective study on a group of patients with early glottic carcinoma, treated with curative radiotherapy. The aim of the study is to assess voice quality after treatment. We also evaluated local recurrence, overall survival, disease free survival and toxicity. Material and Methods: We examined a total of 36 patients, out of which 27 were smokers: 10 females/5 smokers;26 males/22 smokers. The sample was observed from January 2007 to July 2012 (average follow-up period: 33.5 months, range 12 - 76). Diagnosis of early glottic carcinoma was eight during the two-year period 2007/2008, nine during 2009/2010, eleven during year 2011 and eight during year 2012. All patients suffering from early glottic carcinoma, histopathologically confirmed, were classified as follows: 24 patients T1a, 3 patients T1b, 6 patients T2 and 3 patients had a carcinoma in situ. They were treated only with conventional radiotherapy. After the treatment (total dose 70 Gy), patients were asked to fill out the Voice Handicap Index (VHI) questionnaire, composed of 30 questions that covered physical, emotional and functional areas. Results: The global VHI was evidenced with good voice quality (62% of patients: VHI < 30;34% of patients: VHI 31 - 60). Vocal disability was mild in over 70% of patients within the physical area and over 80% within the emotional area. We observed two local recurrences, one occurred five years after the end of radiation therapy and one six months after. In terms of toxicity, we observed that acute reactions, such as dysphonia, dysphagia and erythema, were relatively limited. Conclusions: The VHI index suggests that radiotherapy produces acceptable functional results, with limited repercussion on life quality. In line with literature, our data confirmed good cure rates and larynx preservation (94.4%).
文摘The aims of this study were to evaluate the results of CO2 laser surgery alone and CO2 laser surgery combined with radiotherapy in patients with T2N0M0 glottic carcinoma. A retrospective analysis was conducted of 35 cases of T2N0M0 glottic carcinoma. Fourteen patients with normal vocal cord mobility were treated with endoscopic CO2 laser surgery alone. The remaining 21 patients were treated with CO2 laser surgery followed by radiotherapy (44 - 70 Gy, including low-dose carboplatin chemoradiotherapy). Main outcome measures were local control, organ preservation, recurrence, 5-year survival, and successful salvage in cases of recurrence. We evaluated the patient’s voice with the psychoacoustics GRBAS scale, maximum phonation time (MPT), and airflow rate (AFR) obtained by aerodynamic tests. Mean follow-up period was 5 years. Among the 35 T2N0M0 patients, 5-year survival and 5-year voice preservation rates were 97% and 89%, respectively. Local recurrence occurred in 7 of these patients (20%);4 of 7 local recurrences were successfully re-treated by laser surgery. Total laryngectomy was necessary for salvage treatment in the remaining 3 patients. The post-treatment voice qualities were judged to be the same or improved over pretreatment qualities. There was little change in MPT and AFR after treatment in non-recurrence patients. CO2 laser microsurgery is an excellent tool for treating selected cases of T2N0M0
基金sponsored by the National Natural Science Foundation of China(Grant No.32171351 and 82000969)the“1.3.5”Project for Disciplines of Excellence,West China Hospital,Sichuan University(Grant No.ZYJC18002)+1 种基金Post-Doctor Research Project,West China Hospital,Sichuan University(Grant No.2021HXBH005)Key Research and Development Program of Sichuan Province(Grant No.2021YFS0216)。
文摘Injection laryngoplasty with biomaterials is an effective technique to treat glottic insufficiency.However,the inadequate durability,deficient pro-secretion of extracellular matrix(ECM)and poor functional preservation of current biomaterials have yielded an unsatisfactory therapeutic effect.Herein,a self-fusing bioactive hydrogel comprising modified carboxymethyl chitosan and sodium alginate is developed through a dual-crosslinking mechanism(photo-triggered and dynamic covalent bonds).Owing to its characteristic networks,the synergistic effect of the hydrogel for vocal folds(VFs)vibration and phonation is adequately demonstrated.Notably,owing to its inherent bioactivity of polysaccharides,the hydrogel could significantly enhance the secretion of major components(type I/III collagen and elastin)in the lamina propria of the VFs both in vivo and in vitro.In a rabbit model for glottic insufficiency,the optimized hydrogel(C1A1)has demonstrated a durability far superior to that of the commercially made hyaluronic acid(HA)Gel.More importantly,owing to the ECM-inducing bioactivity,the physiological functions of the VFs treated with the C1A1 hydrogel also outperformed that of the HA Gel,and were similar to those of the normal VFs.Taken together,through a simple-yet-effective strategy,the novel hydrogel has demonstrated outstanding durability,ECM-inducing bioactivity and physiological function preservation,therefore has an appealing clinical value for treating glottic insufficiency.
文摘目的比较等离子射频消融术与CO_(2)激光治疗早期声门型喉癌(EGC)的效果。方法根据治疗方法的不同将80例EGC患者分为对照组(n=40,CO_(2)激光)与研究组(n=40,等离子射频消融术),比较两组患者的围手术期指标[手术时间、术中出血量、术后住院时间、术后24 h视觉模拟评分法(VAS)评分]、嗓音功能[振幅微扰、谐噪比(HNR)、基频微扰]、生活质量[嗓音障碍指数(VHI)]、吞咽功能[电视透视吞咽功能检查(VFSS)]、局部复发情况及并发症发生情况。结果研究组患者手术时间、术后住院时间均明显短于对照组,术中出血量明显少于对照组,术后24 h VAS评分明显低于照组,差异均有统计学意义(P﹤0.01)。术后4周,两组患者HNR均高于本组术前,基频微扰、振幅微扰均低于本组术前,研究组患者HNR高于对照组,基频微扰、振幅微扰均低于对照组,差异均有统计学意义(P﹤0.05)。术后6个月,两组患者VHI评分均低于本组术前,VFSS评分均高于本组术前,研究组患者VHI评分低于对照组,VFSS评分高于对照组,差异均有统计学意义(P﹤0.05)。研究患者的局部复发率和并发症总发生率均低于对照组,但差异均无统计学意义(P﹥0.05)。结论与CO_(2)激光相比,等离子射频消融术治疗EGC的效果更好,可以缩短手术时间,减少术中出血量,减轻术后疼痛感,同时对患者嗓音、吞咽功能的影响较小,可以促进患者术后快速康复,并且提高生活质量。
文摘目的探讨显微支撑喉镜低温等离子射频消融治疗早期声门型喉癌的效果。方法选取74例早期声门型喉癌患者,随机分为显微镜组和切除术组,各37例。切除术组采用单纯喉部分切除术治疗,显微镜组采用显微支撑喉镜低温等离子射频消融治疗。对比2组围术期情况、黏膜恢复评分、疼痛视觉模拟(VAS)评分、嗓音声学功能、炎性因子及并发症。结果和切除术组对比,显微镜组术中出血量较少,手术时间、住院时间均较短;术后4周黏膜恢复评分较高,术后1 d VAS评分较低;术后6个月显微镜组基频微扰、标准化噪声能力、振幅微扰均较低;术后1 d显微镜组C反应蛋白(CRP)、白介素-6(IL-6)水平均较低,白介素-2(IL-2)水平较高(P<0.05)。显微镜组并发症总发生率为2.70%(1/37),较切除术组24.32%(9/37)低(P<0.05)。结论对早期声门型喉癌患者采用显微支撑喉镜低温等离子射频消融治疗,可减少术中出血量,减轻炎性应激,加快患者术后恢复,并可改善嗓音声学功能,且安全性更高。
