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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The TNM-classification of laryngeal carcinomas of the UICC contains a number of weaknesses which diminish their prognostic relevance. Based on clinical observations and microscopic investigations of surgical specimens, several changes are proposed to improve the existing TN-classification. The larynx is subdivided by the UICC into the supraglottic, the glottic and the subglottic main area and their tumours. There are embryological, anatomical, functional and oncological reasons to divide the larynx into two main areas only--the supraglottis and the glottis (vocal folds) without any further subsites and to abandon a separate group of subglottic tumours. The T size of a tumour should not be assessed according to the extent of an ill-defined anatomical region, but measured in millimetres of greatest surface extent only. The T2 category of vocal fold tumours should not contain those which lead to an inhibited mobility of the fold. All tumours with reduced vocal fold mobility or fixation should be classified as T3 or T4 according to the dimension of invasion. Post-operative pathological examinations (pT/pN) allow an assessment of the true extent of a tumour in three dimensions. A validation study using a 'metric' TpT-classification shows very distinct groups of tumours with a significantly different prognosis from Tis 1 to T4. Studies of lymph node metastases in the neck have shown that, number, size, site of metastasis and the presence of extracapsular tumour spread have a significant influence on the prognosis. An improved N/pN-classification taking these factors in consideration is proposed.
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PMID:Revision of classification of laryngeal cancer, is it long overdue? (Proposals for an improved TN-classification). 156 74

The clinical and histopathological characteristics of seven cases of Moderately Differentiated Neuroendocrine Carcinomas (MDNEC) and two cases of Poorly Differentiated Neuroendocrine Carcinomas (PDNEC) have been reviewed. The tumours arose in the supraglottis of predominantly elderly men. Two cases had raised levels of urinary 5-hydroxy-indole-acetic acid at presentation but no case developed the carcinoid syndrome. PDNEC were histologically identical to the oat cell type carcinoma of the bronchus and were associated with an extremely aggressive clinical course with both patients dying of widespread metastases within one month of registration. MDNEC also metastasized frequently with four of seven cases dying with widespread disease. The tumours have previously been reported as not being radiosensitive; however three cases remain free of disease following biopsy and radiotherapy alone. The place of radiotherapy in the management of these tumours is discussed.
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PMID:Neuroendocrine carcinomas of the larynx. 166 46

Between January 1980 and December 1988, 141 patients were treated with radical radiotherapy for carcinoma of the larynx. One hundred and ten (78%) tumours arose on the vocal cords, twenty nine (21%) from the supraglottis and two (1%) from the subglottis. All 63 stage T1 cases, and all except three of 62 T2 cases seen in the time period, were treated by radiotherapy. In addition 14 selected T3 and 5 T4 cases were irradiated. Only 7% had clinical evidence of regional lymph node metastases at presentation. Median follow up is 47.5 months and 2+ year actuarial local control rates are T1-87%, T2-63%, T3-79% and T4-53%. The rates for vocal cord primaries are T1-86%, T2-58%, and T3-75%. Median time to local failure was 8 months with none occurring beyond 21 months. Two of 130 N0 cases (1.5%) relapsed in cervical lymph nodes with a policy of selective prophylactic irradiation of the regional lymphatic areas. Thirty three/thirty seven patients with locoregional failure underwent salvage surgery with 27/32 (84%) evaluable patients achieving ultimate locoregional control with median follow up of 18.5 months from salvage. Four patients (3%) developed distant metastases and 21 (15%) developed a second primary malignancy (including 13 lung cancers) with an actuarial rate of second primary tumours of 23% at five years. Three year actuarial survival for the whole group is 77% but 66% of deaths were due to causes other than larynx cancer. Tumour specific mortality by stage is T1-1.6%, T2-12%, T3,4-21%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Radical radiotherapy for carcinoma of the larynx--Westmead Hospital experience. 176 87

Patients in whom the diagnosis of early carcinoma of the larynx is made and treated as outlined below have a good to excellent outlook (from 85 to 95% survival for glottic lesions). Metastases from lesions of the free edge of the vocal cord usually do not occur because of the paucity of lymphatics, whereas lesions of the supraglottis are more apt to metastasize to regional lymph nodes and local spread. The subglottic area on the other hand by in large has a more ominous prognosis. Carcinoma in situ is treated mainly by endoscopic surgery, whereas T1 lesions of the glottis can either be treated by surgery or radiation with comparable results. This author prefers conservation surgery for the majority of T1 lesions. Radiotherapy is utilized for selected patients with T1 glottic lesions.
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PMID:Controversies in the diagnosis and treatment of early carcinoma of the larynx. 200 83

Radiotherapy was administered to 478 consecutively treated patients with laryngeal T1 squamous cell carcinoma between 1963-1985. One hundred and seventeen had a supraglottic, 358 a glottic, and 3 a subglottic tumor. Supraglottis: 71% males; 49% T1a; 14 patients with nodes. Glottis: 90% males; 82% T1a; 1 patient with node. The 10-year value for local control in the supraglottic group was 55% and in the glottic group 81%. No difference was observed between T1a and T1b. Regional nodes and distant metastases were seldom seen in the glottic, but frequently observed in the supraglottic group. The treatment results appeared to be most favorable in women. The 10-year corrected survival for supraglottic and glottic tumors demonstrated a highly significant difference, 67% compared to 94%. There was a significantly increasing incidence of events with lower tumor differentiation. Split-course and conventional radiotherapy gave equal treatment results, but late complications were significantly more common with the former. A major problem was new primary cancers, which within 20 years occurred in 34% of patients surviving a supraglottic tumor and in 23% of the glottic patients. The predominant new site was the lung (23% and 13%, respectively). Thus, in the glottic group more patients died from the new cancer than from the glottic carcinoma.
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PMID:Primary radiotherapy of T1 squamous cell carcinoma of the larynx: analysis of 478 patients treated from 1963 to 1985. 237 Jan 81

Three hundred and thirty-three patients with carcinoma of the pyriform sinus or supraglottis were reviewed with regard to lymph node involvement and prognosis. All patients were treated with curative intent and had a minimum follow-up of 3 years. Every patient was restaged according to the AJCC, 1983 recommendations. In addition, nodal fixation to cervical fascia or muscle was evaluated with regard to prognosis. Seventy-five percent (89/119) of the pyriform sinus cancer and 47% (101/214) of the supraglottic cancer patients presented with clinically palpable cervical nodes. The distribution of patients according to N stage was 143 (43%), 84 (25%), 58 (17%), 48 (14%) for N0, N1, N2, N3 respectively. In patients where information on nodal fixation was available, 29% had fixed nodes. No difference in prognosis was noted between N0 and N1 or N2 and N3 stages, and these groups were therefore combined. The 3-year survival was 85% for T1 (N0/N1), 77% for T2 (N0/N1), 63% for T3 (N0/N1), and 65% for T4 (N0/N1) cases compared to 19% for T1 (N2/N3), 34% for T2 (N2/N3), 33% for T3 (N2/N3), and 32% for T4 (N2/N3) cases demonstrating that N stage predominates over T stage with respect to survival. Both the local recurrences and distant metastases increased as N stage advanced. A noteworthy difference between patients with fixed nodes and mobile nodes was found with regard to neck recurrence (35% versus 17%), distant metastases (33% versus 19%) and survival (27% versus 58%). In conclusion, nodal stage is a highly significant determinant of survival independent of T stage in cancers of the pyriform sinus and supraglottis. N0, N1 status and mobility were predictive of a favorable prognosis as opposed to N2, N3 status and fixation. These findings were consistent when the pyriform sinus cancers and supraglottic cancers were analyzed separately.
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PMID:The prognostic significance of lymph node involvement in pyriform sinus and supraglottic cancers. 361 Jul 2

The survival, pattern of failure and complications in 47 patients with Stage III and IV cancers of the glottis, supraglottis and hypopharynx treated with surgery and postoperative radiotherapy using a new treatment technique referred to as "mini-mantle" were analyzed. The absolute survival probability of the entire group was 53 and 31% at 3 and 5 years. The local control probability at 3 and 5 years was 63 and 58%, and was higher for the supraglottic/hypopharyngeal than for glottic carcinomas. Advanced lesions, lymph node metastases and positive resection margins were significantly related to a worse local control. Five patients developed complications requiring surgical correction, but none experienced mortality. Moderate complications were treated conservatively without lasting sequelae. This technique is a reasonably safe and efficient procedure and can be effectively employed for the management of advanced laryngeal and hypopharyngeal carcinomas after definitive surgery.
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PMID:Combined surgery and postoperative radiation therapy for advanced laryngeal and hypopharyngeal carcinomas. 397 62

Eleven cases of metastases to the intrinsic larynx are reported. This number constitutes the largest collection from a single institution in the literature and brings the total recorded cases to 83. Cutaneous melanomas are the preponderant primaries, followed by renal cell carcinomas, and carcinomas of the breast and lung, respectively. The supraglottis is the favored site for the metastatic deposit; the glottis, the least frequently involved area.
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PMID:Metastases to the larynx. 404 64

The incidence of palpable and occult cancer and the absence of cancer in lymph nodes were determined for individual sites in the larynx and pharynx of 540 patients who underwent neck dissection. The incidence of palpable cancer in lymph nodes was lowest for cancers of the central supraglottis and transglottis (32-41%), intermediate for cancers of the marginal supraglottis and glossoepiglottis (48-57%), and highest for cancers of the pyriform sinus (69%). The incidence of occult cancer in lymph nodes for individual sites in the larynx and pharynx was determined by pathologic study of neck dissection specimens from 253 patients without palpable lymph nodes (NO neck). The incidence of occult lymphatic metastases in the NO neck and the need for elective neck irradiation were least for cancers of the transglottis and central supraglottis (14-16%), intermediate for cancers of the glossoepiglottis and the marginal supraglottis (20-38%), and greatest for cancers of the pyriform sinus (47%). The risk of nodal recurrence increased from 8% for those without cancer in lymph nodes to 38% for those with occult or palpable cancer in lymph nodes. A policy of observing the NO neck in patients with a low incidence of occult lymphatic metastases and a low risk of neck recurrence to avoid the unnecessary irradiation of many to benefit a few is discussed.
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PMID:The need for elective irradiation of occult lymphatic metastases from cancers of the larynx and pyriform sinus. 406 65

Three hundred fifteen patients with squamous cell carcinomas involving the aryepiglottic (A-E) folds were treated between January 1964 and December 1991. The age ranged from 39 to 87 years (mean, 62.4 years; median, 61.3 years) and the male-to-female ratio was 5:1 (54 women and 261 men). Symptom duration prior to diagnosis was 4.8 months. Eighty percent of patients had T3 and T4 lesions and 56.3% had neck metastases at presentation. Six patients (1.8%) had distant metastases and were excluded from this study. Clinically the tumors presented as either exophytic infiltrating lesions which were confined to the A-E fold (n = 57) or mucosally spreading tumors which extended to the lateral supraglottis or pyriform sinus (n = 258). Prior to 1978 preoperative radiation (3000 to 5000 cGy) was used. Higher doses of postoperative radiation (5000 to 6000+ cGy) were used thereafter. After 1982 the use of myocutaneous flaps for closure of partial laryngopharyngectomy defects was routine. Almost all N0 neck disease was treated by radiation or surgery. Combined therapy was used in N1-N3 disease. One quarter of the patients had single-modality therapy (25.7%; 81 patients) with a cumulative 5-year disease-free survival of 53%. The remainder of the patients (n = 234) had combined therapy with a cumulative 5-year survival of 67.2%. The latter group had 163 conservation surgeries and 121 total laryngectomy resections. The 5-year disease-free survival for preoperative radiation with surgery (68%) and postoperative radiation with surgery (64%) was similar. Those treated by radiation alone had a 34% 5-year disease-free survival and those treated with surgery alone had a 61% 5-year disease-free survival. The cumulative locoregional control rate was 77%. The cumulative disease-free survival at 5, 10, 15, and 20 years is 66%, 57%, 55%, and 55%, respectively. Infiltrating tumors had a better disease-free survival (by more than 10%) than spreading tumors. The 5-year survival rates were separated well by clinical stages of tumors. In patients with T1 tumors the 5-year survival was 87%; in those with T2 tumors, 80%; in those with T3 tumors, 78%; and in those with T4 tumors, 41%. The survival rate was greater in those with N0 tumors than in those with N+ tumors by 25% and greater in those with N1 tumors than in those with N2 + N3 tumors by an additional 18%. The overall complication rate was 26% and in 7.7% these were fatal.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Squamous cell carcinomas of the aryepiglottic fold: therapeutic results and long-term follow-up. 760 79


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