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Supraglottis T1 Tumor is limited to one subsite of the supraglottis, with normal vocal cord mobility.. mobility T2
Tumor invades mucosa of more than one adjacent subsite of the supraglottis or glottis or region outside the supraglottis (e.g., mucosa of base of tongue, vallecula, medial wall of pyriform sinus), without fixation of the larynx. larynx.
T3 Tumor is limited to the larynx with vocal cord fixation and/or invades any of the
following: postcricoid area, pre-epiglottic tissues, paraglottic space, and/or minor area, pretissues, space thyroid cartilage erosion (e.g., inner cortex).
Tumor invades through the thyroid cartilage and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of neck, including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus).
Tumor invades prevertebral space, encases the carotid artery, or invades space, artery mediastinal structures. structures
thyroid. T2 T3 T4a T4b Tumor invades prevertebral space. or esophagus).g. Tumor is limited to the larynx with vocal cord fixation and/or invades paraglottic cortex space. T1a Tumor is limited to one vocal cord. or invades mediastinal structures. strap muscles. structures .. T1b Tumor involves both vocal cords.g. mobility.Glottis T1 Tumor is limited to the vocal cords(s) (may involve anterior or posterior commissure). inner cortex). with normal mobility. encases the carotid artery. trachea. space and or minor thyroid cartilage erosion (e. including deep extrinsic muscle of the tongue. Tumor extends to the supraglottis and/or subglottis and/or with impaired vocal cord subglottis.. soft tissues of the neck. Tumor invades through the thyroid cartilage and/or invades tissues beyond the larynx (e. mobility.
including deep extrinsic muscles of the tongue. structures.. T2 Tumor extends to the vocal cord(s).g. or space artery invades mediastinal structures. with vocal cord fixation. mobility T3 Tumor is limited to the larynx. soft tissues of neck. subglottis. strap muscles. larynx T4a Tumor invades cricoid or thyroid cartilage and/or invades tissues beyond the larynx (e. trachea. with normal or impaired cord(s mobility.thyroid. encases the carotid artery. . T4b Tumor invades prevertebral space.Subglottis T1 Tumor is limited to the subglottis. or esophagus).
2. 3. 80% specific) Advantages: Advantages: 1. Office based. Biopsy (Gold standard) Vital dyes: toludine blue. 52% specific) 5 Aminolevulenic Acid (5-ALA) nebulizer + short wave visible light (95% sensitive. No specimen. No disturbance of the anatomy. 4. Optical coherence tomography: uses near infrared light waves to tomography: produce cross-sectional images in vivo. 2. inflammation (false +ve). Demanding technique. In experienced hands can detect the smallest lesions. 3. with resolution like that of histology to detect epithelial and subepithelial lesions . and hyperkeratosis (false ±ve) Disadvantage: Disadvantage: 1. Limited subsuface detection 150-200 only. methylene blue + contact endoscopy (91% sensitive. Not reliable in scarring.
any T.N+) (T3/4- .Severe Dysplasia/Carcinoma In Situ (CIS) Early Glottic and Cancer (T1/2.N0) Early Supraglottic Cancer (T1/2) Advanced Laryngeal Cancer (T3/4.
Observation? Laser excision via endoscope Stripping of VC??? Radiotherapy Office based treatment Chemoprevention of Laryngeal Cancer .Treatment vs.
Endoscopic Laser excision Radiotherapy Vertical partial laryngectomy Supracricoid laryngectomy .
Supra glottic laryngectomy Laser Supra cricoid laryngectomy . Radiation.
Total laryngectomy +/.RT Neck dissection if indicated Chemoradiation Laser .
Disadvantages: Disadvantages 1. Laryngeal edema. 3. unfit pt. Radionecrosis. Multiple sessions over weeks Used once and recurrence is salvaged by Total Laryngectomy Complications (Mucositis. Hypothyroidism) Dose of radiation: Radiation doses ranges from 60 to 70 Gy radiation: administered in 2-Gy fractions over 54 days . Stricture and fibrosis. T1-T2/N0) Some centers recommend in early supraglottic lesions (T1 and small exophytic T2. Superior in voice preservation ??? Now recommended for more diffuse early lesions like T1b. Odynophagia. 2. Not preferred in T2 glottic lesions with impaired VC mobility. Xerostomia.) Same rate of local control as surgery.Used in early glottic lesions (Tis.
bet. it showed better locoregional control and less toxicity Continuous hyperfractionated accelerated RT (CHART): (CHART): multiple fractions/day over 12 days showed even better local control rates as it prevents tumor repopulation but with higher toxicity .Gy.New RT regimens now lean towards Altered fractionation schedules: schedules: Hyperfractionation and hyperfractionation + Acceleration Hyperfractionation: Hyperfractionation: allows lower fraction dose (1. 74-80 Gy.2 Gy) with multiple daily doses of a total dose range bet.1-1. 74.
Combination of chemotherapy (CT) and RT has the following effects: Additive effect: CT eradicates micrometastasis. Synergistic effect: CT agent interfere with DNA repair after sublethal dose (cisplatin) Reduce repopulation of tumor cells by enhancing cytotoxic effect. 1. Reduce hypoxia making cells more radiosensitive via reducing interstitial pressure or vice versa. as hypoxia may activate the agent (mitomycin) Agent kills radioresistant cells in S phase (hydroxyurea) and synchronize cells to G2/mitosis phase (paclitaxil) . Spatial cooperation: independent activity of each ttt modality (RT in the field and CT in and out the field). 2.
Neoadjuvant or ´Inductionµ CRT Concurrent CRT (Chemorad) (Chemorad) Induction Chemotherapy Followed by Chemorad (under randomized trials) .
making it more difficult to obtain local control with curative modalities such as RT or surgery. . Multiple agents may be used over multiple cycles as compared to concurrent CRT. better compliance. (lesser complications) Higher doses of CT drugs can be given. administration of CT followed by RT (or surgery) alone. Cite the potential for tumors to progress during CT. with fewer unplanned delays and dose reductions.
2-year survival (68%) between the nonsurgical and surgical arms. this trial randomized patients with stage III or IV larynx cancer to either: (a) three cycles of neoadjuvant CT with cisplatin and 5-FU followed by definitive RT (b) laryngectomy followed by postoperative RT. Published in 1991. equivalent B. trial did not appropriately test the role of neoadjuvant CT. This trial showed: A. . as the study did not include an RT alone arm.
2 cycles of CT: Cisplatin: Cisplatin 100 mg/m²/3wks 5FU: 5FU 600 mg/m²/3wks +/Docitaxil: Docitaxil 15 mg/m²/wk Respone ( 50%) No response 3rd cycle CT then RT Salvage total + post op RT .
Cisplatin-based CT regimens have been used in all concurrent CRT protocols. Superior to induction CRT in locoregional control rates. Trails are based one fractionation of both RT and CT cycles to achieve the best results with least toxcity. compared to other agents. Higher rate of toxcity. Can be delivered as a single agent in full dose with RT it adds relatively little to stomatitis and radiation mucositis. .
Concurrent cisplatin and RT had superior locoregional control (69%) compared to neoadjuvant CRT followed by RT (55%) or RT alone (51%).Three-arm trial randomized patients with advanced laryngeal cancer to either: 1. Both concurrent cisplatin/RT and induction CT followed by RT had superior laryngectomy-free survival (47% and 45%. Results: Results: An update of this trial was presented in 2006 At 5 years: 1. RT alone Neoadjuvant cisplatin and 5-FU followed by RT Concurrent cisplatin and RT. 3. . 2. 3. Overall survival at 5 years was statistically similar between all three arms at approximately 55%. 2. respectively) compared to RT alone (34%).
The energy from these lasers is preferentially absorbed by oxyhemoglobin. Effect: causing photoangiolysis of the sublesional blood vessels. the pulsed dye laser (PDL) and the pulsed KTP laser. Preferential destruction of intraepithelial desmosome junctions and separation of the treated epithelial cells from the basement membrane. with the absorption of energy from the pulsed KTP being superior to that of PDL. .g. 1) FiberFiber-based laser systems: systems: The 585nm PDL and 532nm pulsed KTP lasers are the two most widely used lasers for the in-office treatment.This includes the treatment of premalignant lesions using photodynamic therapy (PDT) and fiber-based laser systems e.
PDL 585 nm wavelength Angiolytic Preferentially absorbed by hemoglobin Microvascular Microvascular specific property Relative tissue tissue-sparing. It can be used with local 5-ALA in PDT Pulsed KTP 532 nm wavelength Angiolytic and hemostatic Preferentially absorbed by oxyhemoglobin Greater affinity than PDL .
. Disadvantages: 1. Avoidance of general anesthesia Lower cost Improved efficiency Minimal scarring Treatment of bil. 5. 2. 3. commissure with minimal risk of web formation.based laser cont. Poor lesion exposure. 4. No specimen. 2. lesions and ant. 3. Poor patient tolerance.FiberFiber. Advantages: 1.
These photoreactive chemicals are activated by light of a specific freq. The light activation of tissues at the target site in the presence of oxygen results in cell death that is confined to the cells that have selectively accumulated the chemical. Photofrin Hematoporphyrin derivative Foscan (temoporfin) Used in ttt of benign laryngeal lesions like multiple papillomatosis.Photodynamic therapy: therapy: Uses nontoxic chemicals that are taken up preferentially by dysplastic or malignant cells. Range unique to the compound used. Photosensitizing agents: agents: 5-ALA. .
cont. repeatable. Disadvantage: Disadvantage: Careful light-avoiding precautions are required up to 4 wks. 4. The effects on voice quality are minimal. 3. scarring of the vocal folds has not been observed.PDT cont. Office based 2. Advantages: Advantages: 1. No pathologic specimen .
In numerous studies a low -fat diet and an increase in the consumption of fruits. 13-cis-retinoic acid (13-cRA) has been studied extensively in oral leukoplakia. and protease inhibitors. or prevent carcinogenesis before invasive cancer develops A number of agents show potential as chemopreventive agents for head and neck cancers including green tea polyphenols.was conducted in laryngeal lesions. A multiagent trial using 13-cRA. suppress. . curcumin. alpha tocopherol. vegetables.Chemoprevention is the use of specific chemical agents to reverse. COX II inhibitors. sulindac. and fiber were associated with a protective effect against a number of cancers. and interferon. A complete remission was observed in 50% (7/14) of laryngeal lesions at 12 months.
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