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Objectives: In this retrospective study, we evaluated the effectiveness of the tumor volume, grade invasion depth in the prediction of cervical lymph node metastasis. Identification of diagnostic parameters reliably predicting cervical lymph node involvement can be useful in improving the management of laryngeal cancer. Methods: One hundred and seven patients with squamous cell carcinoma of larynx and who underwent surgery were assessed retrospectively. Age, sex, Tumor-Node-Metastasis (TNM) stage, grade, invasion depth and computerised tomography (CT) volume of the tumors were analysed. The association between these parameters and cervical lymph node metastasis was determined. Results: Thirty two patients (29.91%) had positive cervical lymph nodes. Lymph node metastasis is detected in 13 (46.43%) poorly differentiated tumors, and in 19 (24.05%) moderate-well differentiated tumors. Mean volume was 2.15±0.14 cc in lymph node negative patients and 2.97±1.05 cc in lymph node positive patients. Mean invasion depth was 10.1±0.87 mm in lymph node negative patients and in 11.3±1.05 mm lymph node positive patients. The tumor grade and volume predicted successfully lymph node metastasis in patients with squamous cell carcinoma of the larynx, however invasion depth was not associated with nodal metastasis (p=0.047, p=0.0022, p=0.916, respectively). Conclusion: The tumor grade and volume could predict cervical lymph node metastasis in patients with squamous cell carcinoma of the larynx, whereas the depth of invasion did not. Calculation of the tumor volume radiologically can help predict lymph node metastasis by minimizing the variability in measurements such as the depth of invasion. [ABSTRACT FROM AUTHOR]

Objective: Through integrated bioinformatics analysis, the goal of this work was to find new, characterised N7-methylguanosine modification-related long non-coding RNAs (m7G-lncRNAs) that might be used to predict the prognosis of laryngeal squamous cell carcinoma (LSCC). Methods: The clinical data and LSCC gene expression data for the current investigation were initially retrieved from the TCGA database & sanitised. Then, using co-expression analysis of m7G-associated mRNAs & lncRNAs & differential expression analysis (DEA) among LSCC & normal sample categories, we discovered lncRNAs that were connected to m7G. The prognosis prediction model was built for the training category using univariate & multivariate COX regression & LASSO regression analyses, & the model's efficacy was checked against the test category data. In addition, we conducted DEA of prognostic m7G-lncRNAs among LSCC & normal sample categories & compiled a list of co-expression networks & the structure of prognosis m7G-lncRNAs. To compare the prognoses for individuals with LSCC in the high- & low-risk categories in the prognosis prediction model, survival and risk assessments were also carried out. Finally, we created a nomogram to accurately forecast the outcomes of LSCC patients & created receiver operating characteristic (ROC) curves to assess the prognosis prediction model's predictive capability. Results: Using co-expression network analysis & differential expression analysis, we discovered 774 m7G-lncRNAs and 551 DEm7G-lncRNAs, respectively. We then constructed a prognosis prediction model for six m7G-lncRNAs (FLG-AS1, RHOA-IT1, AC020913.3, AC027307.2, AC010973.2 and AC010789.1), identified 32 DEPm7G-lncRNAs, analyzed the correlation between 32 DEPm7G-lncRNAs and 13 DEPm7G-mRNAs, and performed survival analyses and risk analyses of the prognosis prediction model to assess the prognostic performance of LSCC patients. By displaying ROC curves and a nomogram, we finally checked the prognosis prediction model's accuracy. Conclusion: By creating novel predictive lncRNA signatures for clinical diagnosis & therapy, our findings will contribute to understanding the pathogenetic process of LSCC. [ABSTRACT FROM AUTHOR]

Aims and background: Laryngeal carcinomas comprise one-third of all head and neck carcinomas. Early detection of these lesions is pertinent for curative and functional preservation. Narrow band imaging (NBI) is a novel biological endoscopic tool enabling in vivo differentiation of nonmalignant from malignant laryngeal lesions. Ni et al. proposed a classification of laryngeal lesions based on intraepithelial papillary capillary loops (IPCL) patterns from type I to V. The European Laryngological Society (ELS) introduced a simpler classification in 2015, categorizing vascular changes as either longitudinal or perpendicular. The present study is aimed at identifying the angiogenetic pattern of different laryngeal lesions and validating the two different grading systems. Materials and methods: Preoperative flexible laryngoscopy coupled NBI evaluation was done for 30 consecutive patients with laryngeal lesions posted for excision biopsy and graded according to both Ni's and ELS grading. The biopsy results of the lesions were correlated with preoperative NBI gradings. Results: Of the 30 patients, 23 (76.7%) were males, and seven (23.3%) were females. The maximum number of patients, 13 (43.3%) belonged to Ni's grade V, whereas 15 patients (50%) each showed longitudinal and perpendicular pattern blood vessels, respectively in ELS grading. A total of 14 patients (46.7%), five patients (16.7%), and 11 patients (36.7%) were revealed to be benign, dysplastic, and malignant, respectively on biopsy. Both Ni's and ELS grading had a statistically significant association with the benign or malignant nature of the lesion. The sensitivity and specificity of Ni's grading were 84.2 and 90.9%, and of ELS grading were 78.9 and 100%, respectively. Both these gradings had similar measures of agreement with histopathological examination (HPE) (measured by Cohen's ?). Conclusion: The NBI is a useful diagnostic tool in evaluating laryngeal pathologies. Clinical significance: The ELS grading system which is convenient and easy to use than Ni's grading can be reliably used for classifying laryngeal lesions. [ABSTRACT FROM AUTHOR]

Objectives: Laryngeal squamous cell carcinomas (LSCC) is one of the most common aggressive neoplasms of the head and neck region. There is a significant need for identification of successful and accurate prognostic markers to better estimate the clinical outcomes for LSCC patients. In this study, we aimed at analyzing the differential expressions of inhibitor growth (ING) family members and to evaluate the prognostic values of deregulated ING genes in LSCC. Methods: We investigated the relative expressions of ING genes in laryngeal tumor-normal tissue pairs at mRNA level using quantitative real-time polymerase chain reaction and relative expression of ING3 in the protein level using Western Blot analysis. Results: The rate of genetic alterations of ING3 was relatively higher in head and neck cancers including LSCC. ING3 expression was significantly upregulated in LSCC tissue samples at both mRNA and protein level. Higher expression of ING3 was also correlated with poor disease-free survival of patients with head and neck cancer. Conclusions: Our findings assigned an oncogenic feature for ING3 in laryngeal cancer with a significant upregulation detected in advanced cases and suggested a vital prognostic potential for ING3. [ABSTRACT FROM AUTHOR]

Background: Carcinoma larynx is one of the most common cancers in the head neck region. Mortality and morbidity in this disease is still high in spite of modern treatment modalities. Smoking and Alcohol is recognized as common predisposing factor for carcinoma larynx. Neck node metastasis increases the mortality twice than the primary alone. Most of the Laryngeal carcinoma patient with neck node metastasis are smoker in our country. Stopping the consumption of tobacco may reduce both mortality and morbidity of carcinoma larynx. Metastasis is more common in supraglottic carcinoma of larynx. This study is carried to observe the association of tobacco with lymph node metastasis in supra-glottic carcinoma of larynx. Materials and Methods: This cross sectional study was conducted in Otolaryngology and head Neck surgery department of Dhaka Medical College and Mitford Hospital of Dhaka, Bangladesh from June 2013 to June 2015. 212 cases of supraglottic carcinoma age ranging from 35 year to 90 years (mean age 63.6 ±11.65) was included in this study. Results: Sixty two percent patients were diagnosed with cervical lymph node metastasis. 83.28% patients with nodal metastasis were above 60 years of age and 75.67% patients were manual worker.100% node positive patients were smoker. Smoking for longer period (>30yrs) and higher in number (>30 sticks/day) were found in advanced stage. Significant association was found between site, size, macroscopic features, cellular differentiation and demographic factors of patient with neck node metastasis in supraglottic carcinoma larynx. Conclusion: As neck node metastasis significantly reduces prognosis so we must be more attentive towards factors that increase the chance of nodal metastasis to avoid the advancement of the disease. [ABSTRACT FROM AUTHOR]

There are lots of diseases causing pediatric upper airway obstruction and stridor. They can be both congenital or acquired. While congenital causes are laryngomalacia, vocal cord palsy, congenital subglottic stenosis, acquired ones range from infections to foreign bodies or neoplasms. Laryngeal neoplasms develop almost epithelial in origin. Non-epithelial tumors consist 1% of laryngeal neoplasms. Although lipoma is the most common soft tissue tumor, laryngeal involvement is very rare and seen in the ages between 40-60 years. A 13-month-old child who had laryngeal lipoma and upper airway obstruction was aimed to present in this paper. [ABSTRACT FROM AUTHOR]

Renal clear cell metastatic carcinoma of the larynx is an extremely rare diagnosis with poor survival. The objective of this short review is to provide insight into current state of literature on this rare neoplasm. Additionally we include the case of a patient with metastatic process of the thyroid cartilage that was treated with novel targeted therapies which enabled prolonged survival and good quality of life. These findings support their inclusion in treatment protocols of patients with metastatic renal clear cell carcinoma of the larynx, especially in those refusing surgery which is the main treatment option in literature so far. [ABSTRACT FROM AUTHOR]

Recently, the incidence rate of head and neck cancer (HNC) has been increasing significantly. It is estimated that there are over 550,000 new cases per year, of which over 130,000 are laryngeal cancers. It is assumed that in more than 60% of patients the disease is diagnosed late, at stages III–IV, which is associated with unfavorable prognoses: the average survival ranges from 15% to 45%. The mainstay of successful tumor therapy is the early detection of neoplastic tissue. The laryngological examination with the use of traditional instruments should be expanded with an endoscopic examination of the larynx using optics in the outpatient clinics. This procedure is sufficient to select patients who need a direct laryngoscopy with a surgical biopsy, usually under general anesthesia in operating room conditions. However, it may bear potential complications. In 1941, Papanicolaou and Traut showed that brush cytology could be useful in detecting precancerous conditions and cervical cancers. For decades, research on the usefulness of brush cytology in diagnosing precancerous conditions and laryngeal cancers has been conducted. This paper aims to enable the reader to understand the issues related to laryngeal cancer and present the results of the previous use of brush cytology in the diagnostic process. [ABSTRACT FROM AUTHOR]

Background/Aim: Comparison of the expression of Ki-67, MCM3, 5, 7 and MTI/II proteins using immunohistochemistry (IHC) on whole section (WS) and tissue microarray (TMA) of laryngeal squamous cell carcinoma (LSCC) samples. Materials and Methods: A total of 51 archival paraffin blocks of LSCC were used. TMAs were prepared from 1.5 mm core punches. IHC reactions were performed using antibodies against Ki-67, minichromosome maintenance proteins (MCM3, 5, 7) and metallothionein (MTI/II). Results: Spearman rank correlation test revealed moderate positive correlation in the case of Ki-67: WS vs. TMA (r=0.38, p=0.07) and strong positive correlation in regard to the rest of tested markers: MCM3, WS vs. TMA (r=0.49, p=0.0004); MCM5, WS vs. TMA (r=0.61, p<0.0001); MCM7, WS vs. TMA (r=0.59, p<0.0001); MTI/II, WS vs. TMA (r=0.66, p<0.0001). Mann Whitney U-test showed no significant differences in the case of Ki-67 and MCM5. Moreover, Bland-Altman test showed a low level of bias in regard to Ki-67, WS vs. TMA and MCM5, WS vs. TMA. Conclusion: TMA may be an effective and reliable method of assessment of Ki-67 and MCM5 expression in LSCC. [ABSTRACT FROM AUTHOR]

Narrow-band imaging (NBI) laryngoscopy is an optical-biopsy technique used for screening and diagnosing cancer of the laryngeal tract, reducing the biopsy risks but at the cost of some drawbacks, such as large amount of data to review to make the diagnosis. The purpose of this paper is to develop a deep-learning-based strategy for the automatic selection of informative laryngoscopic-video frames, reducing the amount of data to process for diagnosis. The strategy leans on the transfer learning process that is implemented to perform learned-features extraction using six different convolutional neural networks (CNNs) pre-trained on natural images. To test the proposed strategy, the learned features were extracted from the NBI-InfFrames dataset. Support vector machines (SVMs) and CNN-based approach were then used to classify frames as informative (I) and uninformative ones such as blurred (B), with saliva or specular reflections (S), and underexposed (U). The best-performing learned-feature set was achieved with VGG 16 resulting in a recall of I of 0.97 when classifying frames with SVMs and 0.98 with the CNN-based classification. This work presents a valuable novel approach towards the selection of informative frames in laryngoscopic videos and a demonstration of the potential of transfer learning in medical image analysis. Flowchart of the proposed approach to automatic informative-frame selection in laryngoscopic videos. The approach leans on the transfer learning process, which is implemented to perform learned-features extraction using different convolutional neural networks (CNNs) pre-trained on natural images. Frame classification is performed exploiting two different classifiers: support vector machines and fine-tuned CNNs. [ABSTRACT FROM AUTHOR]

TNF-α has been confirmed to promote tumor growth in LSCC. PGE2 expression in LSCC tissues was significantly higher than in tumor-adjacent tissues. In the present work, we aimed to discover the combined role of TNF-α and PGE2 in LSCC progression and its potential mechanisms. TNF-α and PGE2 were quantified by ELISA. TRAF2, MMP-9 and GRK2 expressions were detected by immunohistochemistry and western blot. UM-SCC-11A cell proliferation was tested by CCK-8, and cell migration and invasion were determined by transwell assay. GRK2/TRAF2 interaction was tested by Co-IP. The results showed that TNF-α, PGE2, TRAF2, MMP-9 and GRK2 expressions were significantly higher in tumor tissues than in tumor-adjacent tissues. Higher expressions of TRAF2, MMP-9 and GRK2 were associated with poorer prognosis of LSCC. Combined TNF-α with PGE2 promoted UM-SCC-11A cell proliferation, migration and invasion. The interactions of TRAF2 and GRK2, as well as MMP-9 expression, were upregulated in response to TNF-α and PGE2 co-stimulation. In conclusion, we found crosstalk between PGE2 and TNF-α signaling pathways, and the interaction between GRK2 and TRAF2 led to the activation of TNF-α-TRAF2-MMP-9 signaling and resulted in the progression of LSCC. [ABSTRACT FROM AUTHOR]

Graphical abstract Abstract The incidence of laryngeal cancer (LYC) is second only to lung cancer, which is also the second most common cancer in head and neck cancer. Risk assessment metabolomics biomarkers to diagnose LYC have not been found by now. To profile the metabolites in healthy controls (HCs) and LYC patients (LYCs), urine metabonomics study was performed based on reversed phase liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (RPLC-QTOF/MS). Six urine differentially expressed metabolites (Variable Importance in Projection >1, p < 0.05) were identified by searching reference library or comparing with standard based on OPLS-DA (orthogonal partial least squares-discriminant analysis) model. d -pantothenic acid, palmitic acid, myristic acid, oleamide, sphinganine and phytosphingosine were identified as differential metabolites associated with the LYC and they might play roles in sphingolipid metabolism, fatty acid biosynthesis, fatty acid elongation in mitochondria, pantothenate and coenzyme A (CoA) biosynthesis, beta-Alanine metabolism and fatty acid metabolism. These six differential metabolites were combined to test the potentiality of diagnosis of LYC. Results revealed that the area under the curve (AUC) value, sensitivity and specificity of receiving operator characteristic (ROC) curve were 0.97, 95% and 97%, respectively, indicating that this diagnosis method could be used to distinguish LYCs from HCs with good sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Human laryngeal squamous cell carcinoma (LSCC) is a malignant cancer type. Epithelial‑mesenchymal transition marker Snail family transcriptional repressor 1 (SNAI1) is associated with the occurrence, development, invasion and metastasis of numerous tumor types, such as lung, liver and ovarian cancer. Previous studies have indicated that microRNA‑153 (miR‑153) may serve as a novel tumor suppressor, which is involved in tumor metastasis; however, the role and clinical significance of miR‑153 in LSCC are not fully understood. The aim of the present study was to determine the role of miR‑153 in the growth and aggressiveness of LSCC cells. Bioinformatics prediction method, western blot analysis, Matrigel invasion assay and immunofluorescence were used to analyze whether SNAI1 can be regulated and controlled by miR‑153 in LSCC cells. An inverse association between miR‑153 and SNAI1 was observed in LSCC tissues. It was demonstrated that SNAI1 is a direct target of miR‑153 in LSCC. In addition, the results indicated that miR‑153 knockdown inhibited PCI‑13 cell migration and invasion by targeting SNAI1, which may be a potential marker that can reflect the degree of malignancy in patients with LSCC. Furthermore, miR‑153 knockdown decreased Twist family BHLH transcription factor 1 and metastasis‑associated 1 family member 3 expression in LSCC cells. In conclusion, these data indicated that miR‑153 regulates LSCC migration via the targeting of SNAI1 gene, which may be a potential predictor for patients with LSCC. [ABSTRACT FROM AUTHOR]

Early detection and follow up of the laryngeal malignancies is usually done using the fiber optic exam. The tumors below 1 mm are difficult to be identified using normal white light. Narrow Band Imaging (NBI) is a new technology that uses an optical filter in order to obtain a light with fixed wave length of 415 nm and 540 nm. The special NBI allows the surgeon to visualize the vascular network at the site of the tumor. The mucosal capillaries are displayed in brown and the veins from the submucosa are displayed in cyan. Observing the abnormal vessel patterns will guide the surgeon in performing targeted biopsies that will be used in early detection and follow up of patients with laryngeal malignancies. [ABSTRACT FROM AUTHOR]

Abstract: Background: This is a comparative analysis of the diagnostic accuracy of narrow band imaging (NBI) and laryngovideostroboscopy (LVS) in the assessment of premalignant and malignant vocal fold lesions. Methods: A prospective analysis was performed on 105 consecutive patients with vocal fold lesions. The NBI and LVS were obtained before the microsurgery. Results: The NBI and LVS showed no significant differences in identifying premalignant and malignant pathologies. However, in analysis restricted to identification of only malignant lesions, the specificity (88.9% vs 20.6%), accuracy (90.5% vs 51.4%), and positive predictive value (PPV; 84.8% vs 45.1%) were significantly higher for NBI (P value < .001; .015; and .045, respectively). A comparison of LVS scored results relative to each NBI type revealed statistically significant differences (P < .001). A moderate positive correlation between NBI and LVS was demonstrated (P = .54). Conclusion: The NBI and LVS are useful, complementary tools in evaluating early potential vocal fold malignancies. The NBI was superior to LVS on several statistical analyses. [ABSTRACT FROM AUTHOR]

Introduction: Almost one-fourth of head and neck cancers in India are laryngeal cancers. Both conservative and surgical therapeutic approaches are available. According to present tumor-node-metastasis staging protocol, thyroid cartilage invasion is a crucial criterion for diagnosing advanced stages of the disease. A major cartilage invasion depicts T4A stage of disease for which surgical treatment is required. Aims: The present study aims to evaluate the accuracy of multidetector computed tomography (MDCT) in evaluation thyroid cartilage invasion in T3 and T4 stage of laryngeal cancers. Materials and Methods: It is a retrospective analysis done in the Department of Radiology, Pramukhswami Medical College, Anand, Gujarat, on 22 patients of T3 and T4 stage of laryngeal cancer who presented for pretherapeutic MDCT neck evaluation. The MDCT results were retrospectively reviewed and compared with postoperative histopathological results. Statistical analysis was done for each parameter as positive predictive value (PPV) (main statistical parameter), negative predictive value, sensitivity, and specificity. Results: MDCT showed a PPV of 60.00% in detecting any type of thyroid cartilage invasion, 66.66% for major and 33.33% for minor cartilage invasion. Extralaryngeal spread of disease was the most specific marker for cartilage involvement. In total, 31.8% of cases were downgraded in staging by pathology. Conclusion: Overestimation of thyroid cartilage invasion by MDCT is a reality which should be in mind before making final therapeutic decisions. Although crucial, it should not be the sole criteria preventing while making a surgical versus conservative therapeutic call. [ABSTRACT FROM AUTHOR]

Objective: In this study, we retrospectively analyzed 40 patients who underwent laryngectomy to treat laryngeal carcinomas at our clinic in terms of cancer epidemiology, preoperative indications, treatments, complications, histopathology, prognosis, and survival and we compared our data with those in the literature. Material and Methods: Between 2000 and 2005, 40 patients with laryngeal carcinoma were included in our study. Results: All 40 cases were males (100%) and their average age was 55.85 years. The mean duration of disease at the time of the first visit to our clinic was 5.05 months. The most common symptom was dysphonia (95%). The tumor was supraglottic in 20 cases (50%), glottic in 7 cases (17.5%), and transglottic in 13 cases (32.5%). The most common surgical treatment was total laryngectomy with neck dissection (72.5% of patients), the most common early complication was a salivary fistula (5 patients; 12.5%), and the most common late complication stomal stenosis (3 patients, 7.5%). On postoperative histopathological evaluation, squamous cell carcinoma was detected in 39 cases and verrucous carcinoma was detected in 1 case. Also, a postoperative histopathological evaluation showed that 3 of the cases were of stage 1, 9 of the cases (22.5%) were of stage 2, 13 of the cases (32.5%) were of stage 3, and 15 of the cases (37.5%) were of stage 4. The postoperative histopathological grades were grade 1 in 13 patients (32.5%), grade 2 in 24 patients (60%), and grade 3 in 2 patients (5%). Metastatic lymph nodes were histopathologically evident in 8 of the 20 supraglottic cases (40%), in 4 of the 13 transglottic cases (30.8%), and in 2 of the 7 glottic cases (28.6%). Metastatic lymph nodes were found in 4 of 30 clinically staged N0 patients (13.33%). The 1-year, 3-year, and 5-year survival rates of all cases were 97.5%, 92.3%, and 70.5%, respectively. Conclusion: In our country, total laryngectomy remains the principal surgical choice because many patients are of low socioeconomic status and visit doctors only late in disease progression. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the photothermal effects of gold nanorods (GNRs) modified with antiepidermal growth factor receptor (EGFR) monoclonal antibody (mAb) on laryngeal cancer cells. EGFR protein expressions in HEP-2 cells, and normal laryngeal epithelial and laryngeal cancer tissues were detected by western blot. The cytotoxicity against HEP-2 and BEAS-2B cells was tested by MTT assay, and the photothermal effects were assessed by near-infrared (NIR) irradiation. The apoptosis of HEP-2 cells was detected by flow cytometry. EGFR expression in laryngeal cancer tissues was significantly higher than that in normal tissues (P < 0.05). The inhibitory effects of GNRs and anti-EGFR mAb/GNRs on the apoptosis of HEP-2 and BEAS-2B cells were enhanced with increasing dose. Anti- EGFR mAb/GNRs were more cytotoxic to HEP-2 cells and less cytotoxic to BEAS-2B cells than GNRs. NIR irradiation inhibited cell proliferation, which was enhanced with rising power, accompanied by continuously dropping survival rate. The apoptosis rate of the anti-EGFR mAb/GNRs group was significantly higher than that of the GNRs group, and the apoptosis rate of the irradiation + anti- EGFR mAb/GNRs group also significantly exceeded that of the irradiation + GNRs group (P < 0.05). Anti-EGFR mAb/GNRs promoted HEP-2 cell apoptosis more evidently than GNRs did. Functional modification of GNRs augmented the targeted specificity to cancer cells, biocompatibility, and stability. Anti-EGFR mAb/GNRs have great potential in biomedical fields. [ABSTRACT FROM AUTHOR]

BACKGROUND: Laryngeal cancer is one of the most common malignancies in the head and neck. Activated platelets play a critical role in cancer development and progression. Altered mean platelet volume (MPV) and platelet distribution width (PDW) have been found in various types of cancer. The purpose of the current study was to investigate the association of platelet indices with laryngeal cancer. STUDY DESIGN: The study included 216 patients with laryngeal cancer, 189 subjects with benign laryngeal disease, and 213 control subjects between January 2015 and December 2015. All participants' clinical and laboratory characteristics at initial diagnosis were collected. RESULT: MPV was significantly lower and PDW was markedly higher in laryngeal cancer patients compared with control subjects and patients with benign laryngeal disease. A significant correlation between MPV and lymph node metastasis was found. The prevalence of laryngeal cancer increased as MPV quartiles decreased and PDW quartiles increased. Furthermore, MPV and PDW were independent risk factors for distinguishing laryngeal cancer from benign laryngeal disease. CONCLUSIONS: The patients with laryngeal cancer have reduced MPV and increased PDW compared to the subjects without laryngeal cancer. In addition, MPV and PDW play different roles in laryngeal cancer from benign laryngeal disease. [ABSTRACT FROM AUTHOR]

Purpose: Preventive detection of premalignant lesions of vocal fold can play an important role for earlier detection of larynx cancer. In this paper, an automatic detection of premalignant lesions based on human voice production theory is designed. More specifically, premalignant lesions such as leukoplakia, Erythroplakia, Keratosis, etc are directly related to the vocal fold, features extracted from glottal fold waveform can be pertinent and critical. The proposed method performs as non-intrusive technique based on the extraction of vocal fold waveform from the recorded utterances. Method: The basic idea is to extract pertinent features from the source signal (glottal waveform). However, such signal is not directly accessible. Hence, we perform a first treatment of recorded speech using Iterative Adaptive Inverse Filtering (IAIF) to extract the glottal waveform. IAIF is applied on two databases: Massachusetts Eye and Ear Inrmary (MEEI) database and Saarbrucken Voice Database (SVD) with sustained vowel samples. From the glottal flow impulses, pertinent instances are used to build pertinent features. A deep exploration of extracted features, using statistical tools such as boxplot and Principal Component Analysis (PCA), leads to select the most critical and pertinent features. By using Support Vector Machine Technique as classification technique, a discrimination between normal and premalignant tumor is achieved. Results: Preliminary results show that some features are not discriminant. Those features are discarded and only pertinent ones are used in learning and testing processing using SVM. The performances are assessed using four criteria, sensitivity, specificity, precision and accuracy. When selected features are combined according to PCA analysis, an accuracy of about 92% is accomplished. Conclusion: It is shown in this study that is possible to detect the premalignant lesions with acceptable and fairly sensitivity, specificity, precision and accuracy. Such algorithm can help detect at earlier stage laryngeal cancer. [ABSTRACT FROM AUTHOR]

The following article is part of a series in an initiative by the American Head and Neck Society's Education Committee and will review clinical practice guidelines for head and neck oncology. The primary goal is to increase awareness of current best practices pertaining to head and neck surgery and oncology. This manuscript is a review of current knowledge in laryngeal cancer with a focus on anatomy, epidemiology, diagnosis, evaluation, and treatment. [ABSTRACT FROM AUTHOR]

Due to the lack of a definite diagnosis, a frequent recurrence rate and resistance to chemotherapy or radiotherapy, the clinical outcome for patients with advanced laryngeal cancer has not improved over the last decade. Annexin A2 is associated with the invasion and metastasis of cancer cells. In the present study, it was demonstrated using differential proteomics analysis that Annexin A2 is highly expressed in laryngeal carcinoma tissues and this was confirmed using immunohistochemistry, which demonstrated that the expression of Annexin A2 in laryngeal carcinoma tissues was significantly higher than in healthy adjacent tissue. In addition, its potential predictive value in the prognosis of patients with laryngeal carcinoma was evaluated. The results demonstrated that Annexin A2 expression was significantly associated with tumor size, lymph node metastasis, distant metastasis and clinical stage. In addition, higher Annexin A2 expression was associated with a poor prognosis of patients with laryngeal cancer. Thus, the results of the present study indicate that Annexin A2 expression is an independent prognostic biomarker for evaluating the malignant progression of laryngeal cancer. [ABSTRACT FROM AUTHOR]

Background: Lymphoepithelial carcinoma is a tumor mostly diagnosed in the nasopharynx, but it has also been described in a variety of nonnasopharyngeal sites. It is extremely rare in the larynx and should be distinguished from squamous cell carcinoma. Therefore, it must be known by clinicians, pathologists and oncologists. In this case report, we discuss its etiopathogeny, its epidemiological, clinical, pathological and therapeutic aspects, and its outcome. Case presentation: An 81-year-old Morrocan man, smoker for 40 years, presented with a 1 year history of dysphonia, dyspnea and dysphagia. Laryngoscopy showed a mass occupying supraglottic, glottic and subglottic levels of the larynx. Cervico-thoracic computed tomography scan showed a laryngeal wall thickening with cervical lymphadenopathy. Laryngeal biopsy was performed. Microscopic analysis and immunohistochemistry confirmed the diagnosis of laryngeal lymphoepithelial carcinoma. Immunostaining for LMP1 was negative. Conclusion: Laryngeal lymphoepithelial carcinoma is an extremely rare and an aggressive tumor. It is rarely associated with the EBV. It must be regarded as a distinct entity. Radiotherapy is advisable as the unique therapy for local tumor. A correct diagnosis and a close collaboration between the pathologist and clinicians is mandatory for an optimal treatment strategy. [ABSTRACT FROM AUTHOR]

Background: Laryngeal cancer is the second most common cancer of the head and neck after cancer of the oral cavity. The primary causes of death in cases of laryngeal cancer are the recurrence of locoregional disease and distant metastasis. Anatomic and tissue alterations resulting from surgery and/or radiotherapy of primary laryngeal tumors can make it difficult to determine a locoregional recurrence or residual disease by physical examination or computed tomography (CT)/magnetic resonance imaging (MRI). The majority of studies have shown a high accuracy in the detection of local and regional recurrence of head and neck cancer after different treatment modalities, using fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT. Aim: To determine the diagnostic accuracy of PET/CT in patients with suspicion of locoregional recurrence from laryngeal carcinoma after surgery with or without adjuvant radiotherapy. Materials and methods: This was a retrospective study. Forty-five patients who previously underwent surgical treatment with or without adjuvant radiotherapy for primary laryngeal squamous cell carcinoma and who underwent examination using FDG-PET/CT imaging after clinical and instrumental (CT/MRI) suspicion of locoregional recurrence (T or N) were recruited. Results: Overall specificity, sensitivity, and accuracy of PET/CT were found to be 88%, 100%, and 93.3%, respectively. With respect to the suspected cases of recurrence in the primary site, sensitivity, specificity, and accuracy of PET/CT were found to be 100%, 87.5%, and 91.6%, respectively. In patients with suspected metastatic neck disease, PET/CT revealed a sensitivity, specificity, and accuracy of 100%, 90%, and 95.4%, respectively. Conclusion: According to the results of this study, PET/CT imaging in laryngeal tumors is a useful tool in case of suspected locoregional recurrence where conventional imaging (CT and MRI) is unable to resolve the diagnostic doubt. [ABSTRACT FROM AUTHOR]

Interleukin-35 (IL-35) has been proposed as a novel immune-suppressing cytokine. However, the function of IL-35 in malignant diseases is yet to be elucidated. The present study investigated IL-35 expression levels in laryngeal squamous cell carcinoma (LSCC) tissues and the peripheral blood of patients to explore the potential involvement of IL-35 in LSCC progression. In the present study, IL-35 expression levels in tissues and peripheral blood were analyzed by reverse transcription-quantitative polymerase chain reaction and an enzyme-linked immunosorbent assay. The association between IL-35 expression levels and clinical characteristics was also evaluated. The present results demonstrated that IL-35 expression in tumor tissues was significantly higher than in adjacent normal tissues, and a significant association between IL-35 expression levels in tissues and the tumor site was detected. Furthermore, the expression of IL-35 in the peripheral blood of patients was significantly decreased subsequent to tumor resection. No correlation between peripheral blood IL-35 expression and clinical characteristics was detected. In conclusion, the present study demonstrated that IL-35 is highly expressed in LSCC tissues and in the peripheral blood of patients with LSCC. There was a notable, significant reduction of peripheral blood IL-35 expression following surgical resection of tumors. These results may be useful for diagnostic or therapeutic purposes in patients with LSCC. [ABSTRACT FROM AUTHOR]

Aim Patients with larynx cancer usually use alcohol besides tobacco. It has been reported earlier that nearly half of the patients who have undergone laryngectomy after larynx cancer diagnosis still continue to consume alcohol after the operation. The aim of this study was to compare the mood and character features of patients who do or do not consume alcohol during the postoperative period and thus to be able to predict the patients who will continue their alcohol use at the postoperative period. Materials and methods The patients who have undergone partial or total laryngectomy operation were included in this study. To avoid early period treatment stress, it was required that the patients have completed their 6 months of postoperative period. The interviews made with the patients included filling out of the sociodemographic data form, TCI (temperament and character inventory), BDI (Beck depression inventory), BAI (Beck anxiety inventory), AUDIT (alcohol use disorders identification test) and CAGE (cut-down, annoyed, guilty, eye-opener) inquiry forms. Results 80 patients who admitted alcohol consumption at the time of larynx cancer diagnosis were divided in to two groups and, 40% ( n = 32) of this patients continued alcohol consumption after laryngectomy (Group 1) and 60% ( n = 48) cut down on their alcohol use (Group 2). A statistically significant difference was observed between Group 1 and Group 2 at AUDIT and CAGE score averages ( P < 0.001, P < 0.001, respectively). When TCI data were compared between Group 1 and Group 2, patients who continued their alcohol use at the postoperative period had significantly higher novelty seeking scores compared to others ( P = 0.03). Conclusion Our data suggest that it may be possible in the preoperative period to predict the patients who will continue their alcohol use in the postoperative period and take precautions. [ABSTRACT FROM AUTHOR]

Objectives To analyse the specificity and sensibility of narrow band imaging illumination technology in the early detection of laryngeal cancer in the patients' population without previous diagnosis of laryngeal cancer in a screening setting. Design Unicentre, prospective study. Setting One tertiary medical centre. Participants A total of 158 patients completed all protocol steps. Main outcome measures Sensitivity, specificity, positive and negative predictive values of narrow band imaging (NBI) in detecting precancerous lesions and early laryngeal cancer. Results The blind assessment of NBI patterns concurred in 90% of patients. In identifying laryngeal cancer and its precursor lesions, in-office NBI showed a high sensitivity of 97% (CI, 84.2%-99.9%), specificity of 92.5% (CI, 79.6%-98.4%), PPV of 91.4% (CI, 76.9%-98.2%), NPV of 97.4% (CI, 86.2%-99.9%) and accuracy of 94.5% but intra-operative NBI demonstrated a sensitivity of 97% (CI, 84.2%-99.9%), a slightly higher specificity of 95% (CI, 83.1%-99.4%), PPV of 94.1% (CI, 80.3%-993%), NPV of 97.4% (CI, 86.5%-99.9%) and accuracy of 95.9%. The comparative receiver operating characteristic curves confirmed a slightly higher performance for the intra-operative NBI evaluation without any statistical significance ( P = 0.41). Conclusions Our results confirm the high values of sensitivity and specificity of NBI system in detecting pre-neoplastic laryngeal lesions or early laryngeal cancer in a patients' population selected only by means of risk factors exposure and confirmed the potential role of NBI evaluation as in-office screening tool. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the relationship between metabolic 18Fluoro-Deoxyglucose-Positron Emission Tomography (18FDG/PET) and morpho-functional parameters derived by Magnetic Resonance Imaging (MRI) in patients with histologically proven laryngeal cancer. To assess the clinical impact of PET/MRI examination on patient's staging and treatment planning.Methods: 16 patients with histologically proven laryngeal cancer were enrolled and underwent whole body PET/CT followed by a dedicated PET/MRI of the head/neck region. Data were separately evaluated by two blinded groups: metabolic (SUV and MTV), diffusion (ADC) and perfusion (Ktrans, Ve, kep and iAUC) maps were obtained by positioning regions of interest (ROIs). Tumoral local extension assessed on PET/MRI was compared to endoscopic findings.Results: A good inter-observer agreement was found in anatomical location and local extension of PET/MRI lesions (Cohen's kappa 0.9). PET/CT SUV measures highly correlate with ones derived by PET/MRI (e.g., p=0.96 for measures on VOI). Significant correlations among metabolic, diffusion and perfusion parameters have been detected. PET/MRI had a relevant clinical impact, confirming endoscopic findings (6 cases), helping treatment planning (9 cases), and modifying endoscopic primary staging (1 case).Conclusions: PET/MRI is useful for primary staging of laryngeal cancer, allowing simultaneous collection of metabolic and functional data and conditioning the therapeutic strategies. [ABSTRACT FROM AUTHOR]

A novel and effective pharynx and larynx cancer segmentation framework (PLCSF) is presented for automatic base of tongue and larynx cancer segmentation from gadolinium-enhanced T1-weighted magnetic resonance images (MRI). The aim of the proposed PLCSF is to assist clinicians in radiotherapy treatment planning. The initial processing of MRI data in PLCSF includes cropping of region of interest; reduction of artefacts and detection of the throat region for the location prior. Further, modified fuzzy c-means clustering is developed to robustly separate candidate cancer pixels from other tissue types. In addition, region-based level set method is evolved to ensure spatial smoothness for the final segmentation boundary after noise removal using non-linear and morphological filtering. Validation study of PLCSF on 102 axial MRI slices demonstrate mean dice similarity coefficient of 0.79 and mean modified Hausdorff distance of 2.2 mm when compared with manual segmentations. Comparison of PLCSF with other algorithms validates the robustness of the PLCSF. Inter- and intra-variability calculations from manual segmentations suggest that PLCSF can help to reduce the human subjectivity. [ABSTRACT FROM AUTHOR]

Background: Although laryngectomy is the treatment of choice for patients with T4 larynx cancer, many patients are unable or unwilling to undergo laryngectomy and instead pursue larynx-preservation strategies combining radiotherapy (RT) and chemotherapy. Herein, the authors analyzed the National Cancer Data Base to evaluate overall survival (OS) between patients treated with surgical and organ-preserving modalities.Methods: The National Cancer Data Base was queried for patients diagnosed from 2004 through 2012 with T4M0 laryngeal cancer who underwent either laryngectomy (surgery) with adjuvant RT (SRT), chemotherapy starting concurrently within 7 days of RT (CCRT), or multiagent induction chemotherapy starting 43 to 98 days before RT (ICRT). Multivariate analysis and propensity score matching were used to explore the association between the intervention and OS. Recursive partitioning analysis was performed to identify groups benefiting from particular modalities.Results: A total of 1559 patients who underwent SRT, 1597 patients who underwent CCRT, and 386 patients who underwent ICRT were included. Adjusting for covariates, CCRT was found to be associated with inferior OS compared with SRT (hazard ratio [HR], 1.55; 95% confidence interval [95% CI], 1.41-1.70 [P<.01]) and with ICRT (HR, 1.25; 95% CI, 1.07-1.45 [P<.01]). OS among the patients treated with SRT did not appear to differ significantly from that of the ICRT cohort (HR, 0.87; 95% CI, 0.73-1.03 [P =  0.10]), a finding confirmed with propensity score matching. Recursive partitioning analysis identified no subset of patients that derived an OS benefit from either approach over the other.Conclusions: OS among patients undergoing SRT was found to be superior to that of patients treated with CCRT but did not significantly differ from that of those undergoing ICRT. Because these intriguing findings require validation, SRT should remain the standard of care for patients with this disease. However, organ preservation with ICRT may be a reasonable alternative in certain patients. Cancer 2017;123:600-608. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

Objective To estimate the clinical significance of target biopsy for clinical diagnosis and determine accurate laryngeal lesion pathologic specimen acquisition via narrow-band imaging ( NBI) endoscopy. Methods A total of 138 samples from patients with laryngeal lesions (carcinoma, 118; hyperplasia, 3; mild dysplasia, 2; moderate dysplasia, 5; severe dysplasia, 5; vocal cord polyp, 1; and inflammatory lesion, 4) were collected from the Department of Otolaryngology Head and Neck Surgery of Tianjin Union Medical Center from 1 January 2013 to 1 February 2015. All patients were divided into the regular biopsy and NBI target biopsy groups; the imaging data were recorded and patient samples were biopsied. Pathologic diagnoses were used to evaluate the accuracies of regular and target biopsy. Results Based on the pathologic diagnosis, NBI target pathology yielded an accurate laryngeal lesion pathologic specimen acquisition rate of 95.6% (65/68), significantly higher than that yielded by regular biopsy (75.7%, 53/70; χ2 = 10.99, P = 0.001). In the NBI target pathology group, the correct accurate pathologic specimen acquisition rates at laryngeal cancer diagnostic stages 0 (Tis), I and II were 100%, 100% and 85.71%, respectively, which were higher than the corresponding rates in the regular biopsy group (0%, χ2 = 10.000, P = 0.002; 25%, χ2 = 5.625, P = 0.018; and 38.46%, χ2 = 6.454, P = 0.011, respectively). Conclusions In cases of laryngeal carcinoma, NBI endoscopy plays an important role in clinical diagnosis and accurate pathologic specimen acquisition and could be a regular clinical method for laryngeal lesion detection. [ABSTRACT FROM AUTHOR]

The present study aimed specifically investigate the expression and correlation of kelch-like ECH-associated protein-1 (KEAP1), nuclear factor (erythroid-derived 2)-like 2 (NRF2), quinone oxidoreductase-1 (NQO-1) and heme oxygenase-1 (HO-1) in laryngeal cancer and their association with clinicopathological features. A total of 33 paired human fresh advanced laryngeal cancer and adjacent normal specimens were collected following total laryngectomy. Immunohistochemical and immunoblotting analysis were performed to evaluate the expression of KEAP1, NRF2, NQO-1 and HO-1. All of the patients clinicopathologic features were collected. Immunohistochemistry indicated that NRF2-positive staining was as high as 79% (26/33) in the cancer samples and predominantly located in the nuclei, whereas positive expression of KEAP1, NQO-1 and HO-1 was detected in 70% (23/33), 76% (25/33) and 82% (27/33) of cancer tissues, respectively, and primarily expressed in the cytoplasm. The corresponding adjacent normal samples produced almost no or weak expression of the proteins. There were significant differences in protein expression between the two groups (P<0.01). Immunoblotting analysis also demonstrated that their expression levels were higher in cancer tissue compared with adjacent normal tissue. Notably, KEAP1, NQO-1 and HO-1 expression was positively correlated with nuclear NRF2 in cancer tissues, whereas they had no correlation with age, tumor stage (clinical stage III and IV), tumor size and lymph node metastasis. In conclusion, increased expression of NRF2, KEAP1, NQO-1 and HO-1 were common in advanced laryngeal cancer. Evaluation of these factors may have important clinical significance for the diagnosis and treatment of this disease. [ABSTRACT FROM AUTHOR]

A cohort study was undertaken to analyze the risk of recurrence among 1616 patients with primary squamous cell carcinoma of the larynx from 1983 to 2010 at a single, tertiary academic center in Oslo, Norway. The cohort was followed from the date of diagnosis to September 2011. Competing risk regression analysis assessed the association between various risk factors and the risk of recurrence, where death was considered a competing event. Recurrence was observed in 368 patients (23%) during the study period. The majority (71%) of recurrences involved the location of the primary tumor. The overall risk of recurrence during the first three years after initiating treatment was 20.5%. Increased risk of recurrence was observed in patients with supraglottic cancer, younger patients, those with T2–T3 tumors and in patients treated in the earlier part of the study period. Significant factors for recurrence in glottic carcinomas were age, treatment in the earlier part of the study and T-status, whereas age was a significant factor in supraglottic cancer. N-status appeared less significant. In conclusion, follow-up of laryngeal squamous cell carcinoma should place particular emphasis on the site of the primary tumor, younger patients, cases of supraglottic cancer and T2-T4 primary tumors, especially during the first three years after treatment. More studies are needed to assess the impact of surgical versus non-surgical treatment, and eventually the significance of recurrence, for disease-specific and overall survival in cases of advanced laryngeal squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

Laryngeal cancer has poorer outcomes if diagnosed at a later stage. Improving awareness could encourage earlier presentation and improve outcomes. This study aimed to evaluate a public engagement campaign targeted at raising awareness of laryngeal cancer. An epidemiological study identified high-risk populations in the region. A target population as well as a matched control population was selected. A cancer awareness survey combined with focus groups guided the design of a 3-month multimedia campaign. The survey was repeated post-campaign to evaluate the campaign effectiveness. The study identified populations with the highest rates of laryngeal cancer and late stage disease at presentation. The surveys performed revealed a limited effect of the multimedia campaign in raising awareness of the signs and symptoms of laryngeal cancer. Recall of the campaign also faded rapidly. This is the first public awareness campaign aimed at laryngeal cancer carried out in the UK. The results suggest that short-term campaigns have a limited effect and a more prolonged approach should be considered. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although the development of novel diagnostic and treatment strategies concerning laryngeal cancer is highly intensive, the survival rate remains virtually unchanged. Small non-coding RNAs appear to be very promising biomarkers - and so remain the focus of extensive investigation in laryngeal cancer. OBJECTIVE: We examined the expression of five miRNA and five genes related to cancer whether they could be potential laryngeal cancer biomarkers. METHODS:We performed an analysis in 47 patients diagnosed with laryngeal cancer. The qPCR technique was used to investigate the expression profile. RESULTS: While miR-21-3p and miR-525-5p were found to be significantly up-regulated, miR-139-3p and miR-885-5p expression is lower in laryngeal cancer. Moreover, PIK3R1 and HACE1 were found to be also down-regulated. CONCLUSIONS: The change in miRNA expression is frequent than the expression of other tested genes. The expression of passenger strands such as miR-21-3p and miR-139-3p, which are rarely investigated, is also significantly affected in laryngeal cancer. While PIK3R1, HACE1, miR-139-3p, and miR-885-5p may act as tumor suppressor genes in the studied tumour type, miR-21-3p and miR-525-5p seem to have oncogenic properties. Our findings suggest that miR-885-5p and PIK3R1 are the best indicators for the classification of laryngeal cancer tissue and normal mucosa. [ABSTRACT FROM AUTHOR]

Relapse and metastasis are the main causes of unfavorable outcome in head and neck cancers. Whereas, understanding of the molecular background of these processes is far from being complete. Therefore, in this study we aimed to identify potential biomarker candidates of relapse and metastasis in laryngeal squamous cell carcinoma (LSCC) by combining the 2D electrophoresis based protein screen and immunohistochemical analysis of candidate proteins. We screened three groups of LSCC cell lines derived from primary tumors, recurrent tumors and metastases and identified seven proteins that differed significantly in relative abundance between the analyzed groups. Among the identified proteins were the heat shock proteins HSP60 and HSP70 that were significantly downregulated both in recurrences- and metastases-derived cell lines but not in primary tumor-derived cell lines. Moreover, we identified significant upregulation of the annexin V, calreticulin and the inorganic pyrophosphatase (PPA1) exclusively in the metastases-derived cell lines. As these upregulated proteins could potentially become novel biomarkers of metastasis, we have compared their abundance in primary tumor LSCC N(0) cases, primary tumor LSCC N(+) cases as well as in LSCC metastases N(+). Our results show an intense increase of cytoplasmic PPA1 abundance in the N(+) ( p = 0.000042) compared to the N(0) group. In summary, we show a group of proteins deregulated in recurrences and metastases of LSCC. Moreover, we suggest the PPA1 protein as a potential new biomarker for metastasis in this cancer. [ABSTRACT FROM AUTHOR]

We report the utilization of dendrimer-entrapped gold nanoparticles (Au DENPs) modified by polyethylene glycol (PEG) with good biocompatibility for enhanced computed tomography (CT) imaging of human laryngeal squamous carcinoma and indirect CT lymphography imaging in New Zealand rabbits. In this work, PEG-modified amine-terminated poly(amidoamine) dendrimers of generation 5 (G5·NH 2 ) were used as templates to synthesize Au DENPs, followed by acetylation of the remaining dendrimer terminal amines to generate PEGylated Au DENPs. The formed PEGylated Au DENPs was used for both enhanced CT imaging of human laryngeal squamous carcinoma cells (Hep-2 cells) and the xenograft tumor mode, and indirect CT lymphography imaging in New Zealand rabbits. In vitro cytotoxicity assay, flow cytometry analysis, and cell morphology observation revealed that the formed PEGylated Au DENPs were non-cytotoxic at a Au concentration up to 400 μM for 24 h and indicated their good biocompatibility. Transmission electron microscopy data confirmed that the PEGylated Au DENPs was uptaken dominantly by the lysosomes of the cells. The PEGylated Au DENPs enabled not only enhance CT imaging of a xenograft tumor model in nude mice after intravenous injection of the particles, but also effective indirect CT lymphography imaging in rabbits. These findings suggest that the designed PEGylated Au DENPs can be used as a potentially effective contrast agent for CT imaging of various biological systems and different kinds of carcinoma, especially lymphatic mapping and human laryngeal squamous carcinoma. [ABSTRACT FROM AUTHOR]

Introduction: Both induction chemotherapy (ICT) followed by irradiation and concurrent chemotherapy and radiotherapy have been reported as valuable alternatives to total laryngectomy in patients with advanced larynx/hypopharynx cancer.Materials and Methods: Of the 60 enrolled patients, randomly assigned into two groups (30 in each group) previously untreated patients with stages III to IV larynx/hypopharynx squamous cell carcinoma were assigned to received two cycles of ICT with interval of 3 weeks (a) Group A paclitaxel 175 mg/m 2 on day 1 and carboplatin 450 mg on day 2 (PC), (b) Group B docetaxel and cisplatin 75 mg/m 2 each on day 1 and ifosfamide 2 g/m 2 on day 1-3 along with mesna (docetaxel-ifosfamide-cisplatin). Both groups were followed by conventional radiotherapy (60-70 Gy/5#/week). Primary end point was a response after ICT. Secondary endpoints included acute toxicities and overall response.Results: Baseline patient and tumor characteristics were well balanced between both groups, the response after ICT seen was 80% in Group A complete response (CR) 36.6% and partial response (PR) 43.3% and in Group B 79% response, CR 33% and PR 46%; whereas toxicities in Group B grade 3/4 neutropenia and grade 2/3 vomiting more severe than Group A. Radiation therapy was well tolerable to both groups with mild side effects.Conclusions: Definite role of neoadjuvant chemotherapy in locally advanced larynx/laryngopharyngeal cancer as organ preservation therapy. The efficacy found was quite similar and improved response in both groups except toxicity profile of Group B more severe, requiring the use of colony stimulating factors and supportive care along with. [ABSTRACT FROM AUTHOR]

Background In this trial, the ability of confocal laser endomicroscopy (CLE), a new imaging modality with a cellular resolution, to further differentiate primary flat lesions of the larynx was evaluated. Methods First, an optical coherence tomography was used to filter out normal tissue and carcinoma. All other lesions (30 lesions in 19 patients) were investigated with CLE. The suspected diagnosis was compared to histopathology. Results Optical coherence tomography identified all noninvasive lesions. CLE provided further information with cellular resolution. In 2 of 30 cases, low image quality prevented classification. In laryngeal lesions (27 of 30), moderate to high-grade dysplasia was correctly suspected in 10 of 10 cases (100%). Hyperplasia was overrated as dysplasia in 7 of 15 cases (46.7%). Sensitivity was 100% and specificity was 40%. Conclusion When used in conjunction with optical coherence tomography, CLE seems helpful for discrimination of noninvasive lesions, although it tends to overrate the severity of the changes. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1695-E1704, 2016 [ABSTRACT FROM AUTHOR]

Paraneoplastic syndromes are associated with a variety of malignant neoplasms and are systemic and non-metastatic manifestations that develop in a minority of cancer patients. This review examines all published cases of paraneoplastic syndromes associated with neuroendocrine carcinomas of the larynx. There are a total of ten patients reported with paraneoplastic syndromes associated with laryngeal neuroendocrine carcinomas in the literature. Of these, nine died and the tenth is alive with liver metastases. There were five cases of small-cell neuroendocrine carcinoma, four cases of moderately differentiated neuroendocrine carcinoma, and one case of well-differentiated neuroendocrine carcinoma associated with paraneoplastic syndromes. As these syndromes have significant clinical relevance, physicians should be aware of the possible presence of paraneoplastic syndromes in the diagnostic process of patients with neuroendocrine carcinoma of the larynx. [ABSTRACT FROM AUTHOR]

A definitive relationship between Helicobacter pylori (HP) and upper respiratory tract disorders has not been established. In this case-control study, we investigated the relationship between HP and laryngeal carcinoma by real-time PCR method in Turkey. 74 subjects were enrolled from patients who were admitted to the Otolaryngology Department. Formalin-fixed-paraffin-embedded tissue samples with laryngeal cancer were used and all samples were evaluated by real-time PCR method. Our study population included 72 males and 2 females with a mean age range of 62.7 years. Helicobacter Pylori was detected in only one case. The positive case was also investigated with histopathologic evaluation and HP immunohistochemistry. However, we could not detect HP in this case with both methods. This study revealed that HP might not contribute to the pathogenesis of laryngeal carcinoma. A definitive relationship between HP and upper respiratory tract disorders has not been established. [ABSTRACT FROM AUTHOR]

Aim To investigate whether neoadjuvant intra-arterial chemotherapy down-stages the tumors and predicts ultimate outcome in patients with advanced laryngeal and hypopharyngeal cancer. Methods Fifteen patients with stage III and IV cancers received two cycles of intra-arterial cisplatin (40 mg/m2) at days 1 and 15, infused super-selectively into superior thyroid artery. Interim evaluation using RECIST 1.1 and volumetry was done in all patients at day 25. Subsequently, the patients received concurrent chemoradiotherapy or surgery with radiotherapy. Final evaluation was done in 10 patients. Results At interim evaluation, five patients qualified as responders. Partial response, stable disease and progressive disease rates were 40, 33 and 27%, respectively. At final evaluation, complete response was noted in all patients. Conclusions At interim evaluation, the response rates were lower compared to intravenous neoadjuvant chemotherapy and response to intra-arterial chemotherapy did not predict the ultimate outcome. Thus neoadjuvant intra-arterial chemotherapy offers no advantage over concurrent chemoradiotherapy. [ABSTRACT FROM AUTHOR]

Laryngeal squamous cell carcinoma (LSCC) is a common malignant tumor of the otolaryngeal region and accounts for 1–2% of all malignancies diagnosed worldwide. miR-340 down-regulation and EZH2 up-regulation have been frequently identified in multiple cancers, but the role of miR-340 and EZH2 in LSCC has not been explored. In this study, we investigated the regulative role of miR-340 in EZH2 expression and LSCC progression. The results showed that EZH2 was up-regulated and miR-340 was down-regulated in both Hep-2 cells and LSCC tissues. Molecularly, our results confirmed that miR-340 directly targeted EZH2 gene and inhibited EZH2 expression. MTT assay and BrdU assay showed that miR-340 transfection reduced the cell proliferation ability of Hep-2 cells. The transwell assay indicated that the invasion and migration ability of Hep-2 cells was dramatically inhibited by miR-340 transfection. In addition, miR-340 transfection induced cell apoptosis with concomitant enhancement of Bax, increase of Caspase-3 expression and activity, and reduction of Bcl-2 expression in Hep-2 cells. Both miR-340 transfection and EZH2 knockdown induced p27 expression and suppressed PI3K/Akt activation in Hep-2 cells. Strikingly, EZH2 knockdown reduced cell proliferation, and EZH2 overexpression significantly rescued the miR-340-mediated suppressive effect on cell proliferation. Moreover, miR-340 could obviously induce the inhibition of Hep-2 cell-derived tumor growth and EZH2/p27 expression ratio in vivo . Taken together, these data suggest that miR-340 impedes LSCC progression by targeting EZH2 with the possible mechanism to enhance the expression of anti-oncogene p27 and suppress PI3K/Akt activation, providing a novel target and a potential therapeutic pathway against LSCC. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study is to evaluate the efficacy of 18 F-FDG-PET as first-line diagnostic investigation, prior to performing a direct laryngoscopy with biopsy under general anesthesia, in patients suspected of recurrent laryngeal carcinoma after radiotherapy. Patients and methods 150 patients suspected of recurrent T2–4 laryngeal carcinoma at least two months after prior (chemo)radiotherapy with curative intent for resectable disease were randomized to direct laryngoscopy (CWU: conventional workup strategy) or to 18 F-FDG-PET only followed by direct laryngoscopy if PET was assessed ‘positive’ or ‘equivocal’ (PWU: PET based workup strategy), to compare the effectiveness of these strategies. Primary endpoint was the number of indications for direct laryngoscopies classified as unnecessary based on absence of recurrence, both on direct laryngoscopy and on six month follow up. Safety endpoints comprised resectability of recurrent lesions and completeness of surgical margins following salvage laryngectomy. Results Intention-to-treat analyses were performed on all randomized patients (CWU: n = 74, PWU: n = 76). Tumor recurrence was similar in both groups: 45 patients (30%; 21 CWU, 24 PWU) within six months. In 53 patients in the CWU arm (72%, 95% CI: 60–81) unnecessary direct laryngoscopies were performed compared to 22 in the PWU arm (29%, 95% CI: 19–40) ( p < 0·0001). The percentage of salvage laryngectomies (resectability) and positive surgical margins were similar between CWU and PWU (81%, 63% respectively, p = 0·17, and 29%, 7%, respectively, p = 0.20). The prevalence of the combination of local unresectability and positive margins is in the CWU group 24% and in the PWU group 8%. No difference ( p = 0.32) in disease specific survival between both groups was found. Conclusion In patients with suspected laryngeal carcinoma after radiotherapy, PET as the first diagnostic procedure can reduce the need for direct laryngoscopy by more than 50% without jeopardizing quality of treatment. [ABSTRACT FROM AUTHOR]

Background We evaluated the use of fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT for the identification of extracapsular spread (ECS) with supporting histologic correlations in laryngeal cancer. Methods We reviewed the medical records of 89 patients with laryngeal cancer who underwent FDG PET/CT before surgery. Results ECS was present in 38.2% (18 of 47) of dissected necks and in 32.2% (20 of 62) of dissected cervical levels. There was a significant difference in the standardized uptake value maximum (SUVmax) between cervical lymph nodes with and without ECS (6.39 ± 4.53 vs 1.21 ± 1.70; p < .001); the cutoff value for differentiating nodes with ECS from those without ECS was 2.8, with a sensitivity of 85.7% and specificity of 85.6%. Conclusion A median SUVmax cutoff value >2.8 was associated with an increased risk of cervical lymph node metastasis and ECS in patients with laryngeal cancer. © 2014 Wiley Periodicals, Inc. Head Neck 38: 290-293, 2016 [ABSTRACT FROM AUTHOR]

Laryngeal lipoma is a rare cause of upper airway obstruction in the pediatric population. We present a case of a 6-year-old boy with a laryngeal lipoma. Diagnosis was subject to doctors-delay, but open neck surgical resection was successful. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic performance of Ultrasound-guided Transcutaneous Tru-Cut biopsy (USGTCB) of laryngo-hypopharyngeal masses suspicious for malignancy. Furthermore we investigated whether USGTCB is accurate for both untreated masses and suspected recurrences.Materials and Methods: From August 2004 to July 2014 we prospectively enrolled 66 patients for a total of 68 USGTCBs: 38 USGTCB were performed for a suspicious untreated mass and in 30 for a suspected recurrence. We calculated the sensitivity, specificity, positive predictive value and negative predictive value for all procedures and separately for untreated masses and suspected recurrences.Results: USGTCB diagnosed 57 malignancies (51 squamous cell carcinomas, 6 other tumors) and 11 benign lesions. There were no false positives reported, whereas five false negatives were observed: two in patients with an untreated mass, three in patients with a suspected recurrence. Overall, the sensitivity of the technique was 91.9% (95% confidence interval [CI]: 82.2-97.3%); the specificity was 100% (95% CI: 54.1-100%); positive and negative predictive values were 100% (95% CI: 93.7-100%) and 54.5% (95% CI: 23.5-83.1%) respectively, with similar performances in untreated masses and suspected recurrences of SCC.Conclusion: USGTCB is an effective procedure for the histological diagnosis of laryngo-hypopharyngeal masses suspicious for malignancy in patients showing contraindications to biopsy via microlaryngoscopy under general, with similar performances for untreated masses and suspected recurrences. [ABSTRACT FROM AUTHOR]

Background. Narrow band imaging (NBI) is a new imaging technique for the depiction of tumor-specific neoangiogenesis. The purpose of the present study was to assess the value of NBI in the early diagnosis of laryngeal cancer. Methods. This prospective study includes 205 consecutive patients with a laryngeal lesion scheduled for microlaryngoscopy. NBI was immediately performed after white light endoscopy (WLE), whereas excisional biopsy was carried out for histologic verification of diagnosis. Results. In identifying laryngeal cancer and its precursor lesions, NBI with WLE showed a significantly higher sensitivity (97% vs 79%) and accuracy (97% vs 90%) than WLE alone, but the specificity (96% vs 95%) was essentially equal in both methods. Conclusion. NBI qualifies for rapid detection and delineation of suspicious lesions. Additionally, this noninvasive method is also beneficial in a variety of benign lesions. [ABSTRACT FROM AUTHOR]

Laryngeal spindle cell carcinoma (SpCC) is an uncommon subtype of squamous cell carcinoma which represents 0.5% of all laryngeal squamous cell carcinomas. It is a biphasic tumor consisting of the combination of a malignant mesenchymal spindle cell component and a squamous cell component that includes dysplasia, carcinoma in situ, or invasive carcinoma. Although it has aggressive biological features, the probability of making a diagnosis in the early stages is high as it often leads to obstructive symptoms in the early period. Due to its low incidence, there is no clear consensus on prognostic factors and optimal treatment strategies yet. In this paper, a 60-year-old laryngeal SpCC case that was effectively treated with wide local excision followed by adjuvant radiotherapy was presented with the literature. [ABSTRACT FROM AUTHOR]

Multiple paragangliomas of the head and neck are rare conditions. Carotid paragangliomas are most common multiple paragangliomas. Laryngeal paragangliomas are very rare neuroendocrine tumors and usually are seen as symptomatic solitary lesions. We present multimodality imaging findings of incidentally detected laryngeal paraganglioma in a woman with synchronous carotid body paraganglioma and positive family history. To the best of our knowledge, this is the first case of laryngeal and carotid body paragangliomas in a patient with positive family history. Radiologists should keep in mind that paragangliomas may occur in various locations as multiple tumors. [ABSTRACT FROM AUTHOR]