Partial laryngectomy for glottic cancer after high-dose radiotherapy

Article Abstract:

Patients with early stage cancer of the glottic area of the larynx may be treated by surgery or radiotherapy. Tumor recurrence or persistence following radiotherapy may require subsequent surgery. This occurs in about 10 percent of patients with T1 tumors (small tumor involving at least the basement layer of tissue); and 30 percent of those with T2 tumors (larger tumors, with deeper tissue involvement than T1 tumors). The usual surgery performed is total laryngectomy (excision of the entire larynx, including vocal cords); this surgery provides a 70 percent chance of achieving cancer control. The possible alternative of performing vertical partial laryngectomy is often overlooked. This procedure involves removal of true and false cords, a portion of thyroid cartilage, and subglottic tissue, but only on one side. When performed after radiation therapy, it is believed to provide in sufficient tumor-free margins and patient recovery is characterized by poor wound healing and poor postoperative laryngeal function. A report is presented of the results achieved using this procedure over a 20-year period. There were 25 patients who underwent this procedure to salvage the larynx after radiotherapy for cancer of the vocal cords. Minimum follow-up was two years, and half the patients were followed for 4.4 years. During this time, 96 percent of patients remained free of cancer. The five-year actuarial survival rate was 80 percent. One patient required a permanent tracheostomy (opening into the windpipe) due to recurrent pneumonia; otherwise, all patients had satisfactory swallowing and vocal function. It is concluded that vertical partial laryngectomy is as effective following radiotherapy as it is when used as the primary treatment for glottic cancer, and should be considered more often as an alternative to total laryngectomy following tumor recurrence. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Laryngeal cancer

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Results of radical radiotherapy for inflammatory breast cancer

Article Abstract:

Inflammatory carcinoma of the breast is an aggressive type of cancer, having a high risk of rapid spread and an extremely poor prognosis. This cancer usually has an acute onset with symptoms of redness, edema, and local heat of the breast. Treatment by mastectomy (breast removal) is almost always followed by local or regional cancer spread. Treatment with radiotherapy has been advocated to improve survival, but there are conflicting reports on the results. In nonrandomized studies, combination chemotherapy has been reported to improve survival. To reevaluate the effectiveness of this treatment, a retrospective review was undertaken of 65 women, with inflammatory breast cancer without metastasis (cancer spread), who were treated by radical radiotherapy. There were 18 women who received only radiotherapy (treated prior to 1974); 47 women (72 percent) received both radiotherapy and systemic chemotherapy. Radiotherapy was delivered to the breast, chest wall, and sometimes the breast lymph nodes; average total radiation dose was 6,984 units. At five years, the disease-free survival rate was 17 percent, and overall survival was 28 percent. There were 30 women who had local recurrence. The only factor predictive of local recurrence was initial response to chemotherapy. None of the three patients who had complete response to initial chemotherapy had local recurrence. Of the 17 women with partial response, five had local recurrence; and of the 17 women with less than partial response, 12 had local recurrence. It is concluded that even at high doses, radical radiotherapy alone does not control local tumor growth in patients with inflammatory breast cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Usage, Evaluation, Breast cancer, Radiotherapy, Chemotherapy, Drug therapy, Combination, Combination drug therapy

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