Cílem této prospektivní studie je pomocí analýzy videostroboskopických záznamů porovnat pacienty s benigními a maligními lézemi hlasivek zařazené do skupin A (7 pacientů) s dlaždicobuněčným karcinomem, B (10 pacientů) s dysplázií I.-III. stupně, C (11 pacientů) s edémy hlasivek, D (15 pacientů) s cystou na hlasivce, E (26 pacientů) s polypem hlasivky a do kontrolní skupiny F (11 pacientů). Celkem se studie zúčastnilo 80 pacientů, 31 mužů a 49 žen. Pro vyhodnocení záznamů byla vybrána maximální šíře štěrbiny v oblasti zadní komisury na amplituda slizniční vlny. Průměrná maximální šíře štěrbiny byla zvětšená nejméně u skupiny B a dále v pořadí skupina A, C, E a D. U kontrolní skupiny nabývala maximální šíře štěrbiny nejnižší průměrné hodnoty. Slizniční vlna byla nejméně postižena u skupiny pacientů s cystou na hlasivce. Největší postižení slizniční vlny bylo ve vzestupném pořadí u skupiny pacientů s edémem nebo polypem hlasivek.
The objective of this prospective study is to use videostroboscopic recordings for comparing probands with benign and malignant lesions of vocal cords with a control group of patients. According to null hypothesis there is no difference between videostroboscopic recordings of the groups A, B, C, D, E and F. A total of 80 patients were included in the study, 31 men and 49 women. The probands were accordingly divided into 5 groups: Group A included 7 patients with squamous cell carcinoma of vocal cord at the T1 or T2 stage, group B included 10 patients with dysplasia of I-III degree, group C encompassed 11 patients with vocal cord oedema, group D included 15 patients with a cyst on vocal fold and group E contained 26 patients with a benign polyp on one of the folds. The control group F embraced 11 patients with negative laryngological anamnesis and a normal voice. In order to evaluated videostroboscopic recordings and their quantification for statistical evaluation, two parameters were selected: maximum width of the opening (rima glottis) in the region of comissura posterior during phonation and amplitude of mucous wave during phonation. The width was evaluated as none, 1 mm, 2-3 mm, or more than 3 mm. The amplitude of mucous wave was evaluated as increased, normal, decreased or completely absent. It is possible to say that the mean maximum width of the opening in the area of comissura posterior was enlarged especially in group B (dysplasia) and further in the order of group A (carcinomas), group C (oedemas), groups E (polyps) and group D (cysts). In the control group F the maximum width of opening in the comissura posterior region reached the lowest mean value. The mucous wave was the least affected one in control group F without any disease of larynx and in group D of patients with vocal folds affected by cysts, where it was normal in 100%. The mucous wave was increasingly affected in the order of group E with polyps, in group A with oedemas, in group B with dysplasia and in group A of patients with carcinoma of vocal folds.
Endoskopické chordektomie s použitím Alaseru klasifikované podle Remacla a Ruderta (chordektomie I.-V. typu) zahrnují velký rozsah postupů od jednoduchého obnažení hlasivek, neboli submukózní chordektomii (typ I) přes rozsáhlejší chirurgické výkony (subligamentózní chordektomii (typ II), transmuskulární chordektomii (typ III) ke kompletní (typ IV) nebo rozšířené chordektomii (typ V). Laserový endoskopický chirurgický výkon je indikován u pacientů s časným stadiem karcinomu hrtanu v oblasti glotis (T1a,b, T2) nebo u prekanceróz (laryngeální intraepiteliální neoplázie – LIN I-III). Za ekvivalentní léčbu časných stadií karcinomu hrtanu je považována i radioterapie. Obě dvě léčebné metody mohou vést ke zhoršení hlasu. Vzhledem k tomu, že procento přežití a úspěšnosti léčby je pro obě léčebné modality velmi podobné, dostává se do popředí sledování kvality života pacienta (QoL) a kvality hlasu. Je třeba vzít v úvahu i potenciální možnost zachování radioterapie jako následné léčebné modality pro případnou recidivu či duplicitní nádor v blízké lokalitě. Na Klinice ORL a chirurgie hlavy a krku 1. lékařské fakulty Univerzity Karlovy bylo sledováno 128 pacientů s diagnózou časného karcinomu hrtanu nebo dysplázie I-III. Pacienti byli rozděleni do dvou skupin podle typu léčby. Byly sledovány a vzájemně srovnány: stroboskopické parametry (symetrie, amplituda, periodicita slizniční vlny, rozšíření nevibrujícího segmentu, doba a úplnost uzavření glotis), celkový čas fonace, vokální rozsah podle profilu rozsahu hlasu (VRP – fonetogram), subjektivní analýza kvality hlasu a objektivní analýza hlasu (s použitím softwaru MDVP). Shodné parametry byly i porovnávány ve skupinách po jednotlivých typech chordektomií. Pro zhodnocení kvality života a hlasu byly zvoleny dotazníky QoL30 a VHI (Voice handicap index). Nebyly nalezeny žádné statisticky významné rozdíly u výše zmíněných parametrů při srovnání pacientů léčených chordektomií typu I-III a radioterapií. Velká většina hodnocených parametrů u podskupin laserové chordektomie IV a V byla signifikantně horší ve srovnání s podskupinami radioterapie či laserové chordektomie I.-III. typu. Laserovou chordektomii I.-III. typu můžeme považovat za vysoce účinnou léčbu pro časná stadia karcinomu hrtanu při současném zachování shodné funkce jako při radioterapii. Volba chirurgické léčby umožňuje ponechání radioterapie pro případnou léčbu recidivy.
Endoscopic laser-assisted cordectomies classified by Remacle and Rudert (type I-V cordectomies) comprise a vast range of procedures from simple vocal cord stripping or submucosal cordectomy (type I) through more extensive surgery (subligamentous cordectomy- type II, transmuscular cordectomy- type III) to complete (type IV) or extended cordectomies (type V) used when tumour involves the anterior commisure, arytenoid region, subglottic region etc. Endoscopic laser-assisted surgery of the larynx is usually indicated in early stages of infiltrative malignant disease of the glottic region (T1a-b, T2) or in preneoplastic conditions (laryngeal intraepithelial neoplasia - LIN I, II or III). Radiotherapy is also believed to be an equivalent type of oncological therapy for these diseases. Both surgery and radiotherapy can worse one of the main functions of the human larynx- the human voice. Because the overall survival rates and local control rates are quite similar in both types of therapy, one should always have in mind something that is beyond the main goal of achieving radical removal of the tumour- patient’s quality of life (QoL) and quality of voice. It is very interesting to compare QoL and voice quality in different types of treatment. The possibility to conserve the radiotherapy for the possible recurrence of the disease should be also considered. 128 patients diagnosed with an early glottic cancer or severe dysplastic lesion of the glottis and treated by means of surgical removal of the disease or radiotherapy have been included into a retrospective study conducted by the Department of Otorinolaryngology and Head and Neck Surgery of the 1st Faculty of Medicine of the Charles University in collaboration with the Department of Phoniatrics of the 1st Faculty of Medicine of the Charles University. Patients were divided into 2 groups according to the selected treatment modality. Stroboscopic findings (symmetry, amplitude, periodicity of the mucosal wave, extension of non-vibrating mucosal segment, time of and completeness of the glottic closure), total fonation time, vocal range according to the voice range profile (VRP- phonetograph), subjective voice quality analysis and objective voice analysis (using MDVP software) were compared between patients in both groups. Moreover we compared similar parameters in the groups of patients treated by different types of cordectomy. QoL 30 questionnaire and Voice Handicap Index tool were chosen for the quality of life evaluation. There were no statistically significant differences in the above mentioned parameters when comparing patients treated by cordectomy type I-III and by radiotherapy. In contrast patients treated by cordectomy type IV and V showed significantly worse results compared to both of the above mentioned groups. Surgical therapy (type I-III cordectomies) in early stages of disease can be considered highly efficient treatment modality according to these results and could be considered the method of choice in this indication taking into account the possibility of radiotherapy as an invaluable treatment option for the recurrent disease. There were no statistically significant differences in results between patients treated by endoscopic laser-assisted coredectomy type I-III or by radiotherapy. Vast majority of evaluated parametres in laser cordectomy IV and V subgroups were found significantly worse when comapared with radiotherapy or cordectomy I-III subgroups.
OBJECTIVE: To compare post treatment quality of life (QoL) of patients treated by radiotherapy or endoscopic transoral endolaryngeal surgery using two quality of life scoring tools. METHODS: From May 1998 to July 2005, 48 patients (11 women and 37 men) with early glottic cancer were treated with curative radiotherapy (18 patients) or laser cordectomy (30 patients), and retrospectively evaluated using QoL questionnaires; European Organization for Research and Treatment of Cancer (EORTC) - EORTC-QoL Core Questionnaire (QLQ-C30 version 2.0) and organ specific EORTC - QLQ, Head and Neck Module (QLQ-H&N35) at the University Hospital Motol, Czech Republic. RESULTS: Mean follow-up was 24 months. Only patients in complete remission were enrolled in the study. The overall score calculated separately for both questionnaires was not statistically different between both groups. Statistically significant differences were found only in specific group of questions focusing on saliva production (p=0.034) and sexuality performance (p=0.002). The majority of cases treated with cordectomy were Tis lesions. In the radiotherapy group, T1 lesions predominated (p=0.0001). Patients treated with radiotherapy were significantly older than those treated with cordectomy (p=0.027), which could explain the worsened score in sexuality questions. There were no significant differences found between genders allocated either to cordectomy or radiotherapy group. CONCLUSION: The overall QoL did not differ between patients treated with cordectomy or radiotherapy, despite the fact that patients treated with radiotherapy had more advanced disease and were older. There was significantly worse saliva and sexuality question score in the radiotherapy group.
- MeSH
- dospělí MeSH
- endoskopie MeSH
- glottis chirurgie MeSH
- kvalita života MeSH
- laserová terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory hrtanu chirurgie radioterapie MeSH
- následné studie MeSH
- průzkumy a dotazníky MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- spinocelulární karcinom chirurgie radioterapie MeSH
- ukazatele zdravotního stavu MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Geografické názvy
- Česká republika MeSH
A 62-year-old woman presented with symptoms of dyspnea. Ultrasonography and computed tomography examinations revealed mass extending from the cricoid cartilage to the left lobe of thyroid gland and thyroid cartilage. Cytology revealed possibility of cartilaginous origin, which was proven to be chondrosarcoma Grade 1 from the biopsy specimen obtained during panendoscopy. She underwent one stage radical resection and immediate reconstruction of laryngeal skeleton defect by mucocartilaginous graft from the nasal septum. Her postoperative course was optimal with preservation of all the laryngeal functions. Twenty-eight months postoperatively, she had to undergo total laryngectomy as a salvage procedure for the advanced local recurrence. We report on the relatively easy technique for functional reconstruction of the large laryngeal defect with the employment of cartilage graft from the nasal septum.
- MeSH
- biopsie MeSH
- cartilago cricoidea * MeSH
- časové faktory MeSH
- chondrosarkom * chirurgie MeSH
- chrupavka * transplantace MeSH
- laryngektomie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- nádory hrtanu * chirurgie MeSH
- nosní přepážka * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
The aim of the study was to assess the impact of factors that could predict the probability of local failure in early laryngeal squamous cell carcinoma treated with curative radiotherapy. Sixty seven patients (12 women and 55 men) with laryngeal cancer stage I (47 patients) and stage II (20 patients) were treated from 1998 to 2003 with curative radiotherapy and retrospectively evaluated. Median follow-up was 36 months (3-80). Local relapse occurred in 10 patients (15%), regional lymphnodes relapse affected 2 patients. The median time between start of radiotherapy to recurrence was 13 months (3-48). Death due to cancer occurred in 4 patients (2 died from locoregional progression of the recurrence and 2 from distant metastases), whereas 7 patients died from non-cancer related causes. The 2-year overall survival rate was 90% and 5-year OS was 79%. The 2-year local control rate was 82% and 5-year local control was 79%. In the univariate analysis there was a statistically significant decrease in local control influenced by grading (p < 0.0001). High risk group of relapse encompassed patients with at least two negative factors: supraglottic tumor, women, radiotherapy prolongation by 3 or more days and high grade tumor and has 3 times worse local control than low risk group (p=0.0125). The highest risk of local recurrence was in the first three years after radiotherapy than later (p=0.0057). On multivariate analysis unfavourable prognostic factors for local control were gender (p=0.022), presence of 2 or more negative risk factors (p=0.018) and lengths of follow up (p=0.005). Radiation dose, stage, age, hemoglobin level and anterior commissure involvement were not significant factors for local control. Overall survival was affected both in the univariate and multivariate analysis by presence of local relapse (p < 0.005) and follow up duration (p < 0.02). Anemia had borderline significance for overall survival in univariate analysis (p=0.064), but in the multivariate analysis was significant unfavourable factor (p=0.008). Other studied factors (radiation dose, anterior commissure involvement and age) were not reaching level of statistical significant value for overall survival. Close follow up strategy is recommended for high risk group of patients with two or more risk factors especially in the first three years after radiation therapy.
- MeSH
- financování organizované MeSH
- glottis patologie účinky záření MeSH
- invazivní růst nádoru patologie MeSH
- kombinovaná terapie MeSH
- laryngektomie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory hrtanu chirurgie patologie radioterapie MeSH
- přežití bez známek nemoci MeSH
- progrese nemoci MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- spinocelulární karcinom chirurgie patologie radioterapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
Druhou nejčastější skupinou nádorů dýchacích cest jsou nádory hrtanu. Největší pokrok lze zejména pozorovat v diagnostice a léčbě jejich časných stadií. Na základě rozdělení podle rozsahu provedené resekce byla nově vytvořena nová klasifikace chordektomií. Autoři se omezili na popis a vymezení hranice jednotlivých typů chordektomií a stanovení jejich základních indikačních kritérií tak jak byla přijata Evropskou laryngologickou společností.
Tumors of larynx represent the second most frequent group of tumors in respiratory pathways. The greatest progress concerns the diagnostics and therapy of early stages of the disease. Based on classification according to extent of performed resection a new classification of cordectomy was created. The authors limit their outline to description and delineation of the borders among different types of cordectomy and setting their basic indication criteria in a way adopted by the European laryngological society.
