To compare voice recovery trajectories between T1 and T2 glottic carcinoma patients over six months following radiotherapy.

A prospective cohort of 37 patients (27 T1 patients and 10 T2 patients) treated with intensity-modulated radiation therapy (60–70 Gy) was assessed at baseline, three and six months using the Arabic Voice Handicap Index-10, videostroboscopy and acoustic analysis.

The baseline handicap was comparable (p = 0.249). At 3 months, T2 patients lagged: total Arabic Voice Handicap Index-10 differed by 5.73 points (95 per cent confidence interval (CI) = −9.57 to −2.03; p = 0.012), approaching the minimal important difference, with concordant deficits in shimmer, jitter and harmonics-to-noise ratio. By 6 months the gap narrowed to 2.64 points (95 per cent CI = −4.92 to −0.29), below the minimal important difference, both groups reaching near-normative acoustic values.

Initial T stage influences the velocity rather than the extent of recovery. The T2 disadvantage is clinically meaningful at three months but falls below clinical relevance by six months.

Gross tumour volume has been proposed as a complementary prognostic marker in laryngeal squamous cell carcinoma. This systematic review and meta-analysis evaluates the prognostic value of pre-treatment gross tumour volume.

MEDLINE, Embase and Scopus were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting pre-treatment gross tumour volume and survival outcomes in laryngeal cancer were included. The primary outcome was overall survival, and the secondary outcome was disease-free survival. Hazard ratios were pooled using random-effects meta-analysis. Risk of bias was assessed using the Quality in Prognosis Studies tool, and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.

Eight retrospective studies including 1351 patients were included. Increasing gross tumour volume was significantly associated with worse overall survival (pooled hazard ratio per 1 cm3 increase: 1.03; 95 per cent confidence interval: 1.02–1.05), with a similar association observed for disease-free survival. Overall risk of bias was moderate.

Higher gross tumour volume is independently associated with poorer survival in laryngeal cancer and may provide prognostic information beyond tumour-node-metastasis staging.

Axillary lymph node metastases represent a rare and under-recognised pattern of disease progression in laryngeal squamous cell carcinoma, with limited data regarding their timing and clinical significance.

We retrospectively reviewed all patients treated for advanced-stage laryngeal squamous cell carcinoma at two tertiary medical centres between 2017–2022, identifying cases that subsequently developed axillary lymph node metastases.

Five patients (3.6 per cent) developed axillary lymph node metastases, all following total laryngectomy, four after salvage surgery for recurrent disease. Mean interval from surgery to axillary lymph node metastases diagnosis was 9.9 ± 4.2 months. All tumours were moderately to poorly differentiated, and axillary involvement was frequently associated with mediastinal nodal disease. All patients received systemic therapy, including chemotherapy and/or immunotherapy, and three died of disease during follow-up.

Axillary lymph node metastases occurred within a relatively narrow time window after total laryngectomy, suggesting a non-random metastatic pattern. Awareness of this pathway is important for post-laryngectomy surveillance and interpretation of follow-up imaging.

We evaluated airway volume in patients after total laryngectomy.

A total of 53 patients who underwent total laryngectomy were included in this study. Twelve of the patients had supraglottic Ca and 41 had transglottic Ca. Total lung volume, and intrapulmonary and tracheal airway volumes were measured.

After total laryngectomy, tracheal airway volume decreased more in transglottic Ca patients compared with supraglottic Ca patients (p < 0.05). Even though intrapulmonary airway volumes and total lung volumes were not different between transglottic Ca and supraglottic Ca patients (p > 0.05), these volumes decreased post-operatively in both groups (p < 0.05). In older patients, the post-operative decrease in the tracheal airway volume was higher than in younger patients (p < 0.05). Pre-operative radiotherapy was applied in 50.0 per cent of supraglottic Ca patients and 58.5 per cent of transglottic Ca patients (p > 0.05).

Because lower airway volume and total lung volume decrease after total laryngectomy, pulmonary rehabilitation should be administered post-operatively and appropriate follow up is essential to prevent tracheostomal narrowing.

This study examines changes in supportive care needs, quality of life and social support among laryngeal cancer patients following total laryngectomy.

Ninety-nine patients were assessed pre-operatively (T0), one (T1), three (T2) and six months (T3) post-total laryngectomy using SCNS-SF34, FACT-H&N and PSSS. Statistical analysis included repeated-measures analysis of variance and paired t-tests.

Unmet needs increased significantly over time in physical/daily (46.46 per cent →86.87 per cent), psychological (60.61 per cent →93.94 per cent), patient care (83.84 per cent →97.98 per cent) and health system domains (85.86 per cent →96.97 per cent), while sexual needs remained low. SCNS-SF34 scores rose (113.03→145.25; p < 0.001), FACT-H&N declined (97.17→75.19; p < 0.001) and PSSS decreased (55.48→41.99; p < 0.001), with family support most affected. All scales showed significant timepoint differences (p < 0.05). Notably, none of the patients underwent voice function restoration surgery during the study follow-up period, which may have amplified voice-related impacts on these outcomes.

Following total laryngectomy, laryngeal cancer patients experience escalating supportive care needs, alongside significant declines in quality of life and social support—with family support particularly affected by caregiving burdens.

The larynx is the second most prevalent subsite for head and neck cancer. Over half of head and neck cancer patients present with advanced disease. We report our regional practices for palliative intent laryngeal squamous cell cancer (SCC).

Retrospective analysis of patients with laryngeal SCC treated with palliative intent, discussed at the regional head and neck multidisciplinary team meeting from July 2010 to June 2016.

A total of 65 patients were included, of whom 45 per cent had potentially curable disease but were not fit for curative treatment. Nine patients (14 per cent) underwent tracheostomy, with mean survival and hospital stay of 278 and 48 days, respectively. Four patients (6 per cent) underwent debulking surgery with mean survival and hospital stay of 214 and 1 days, respectively.

All palliative treatment measures offered to patients can have an impact on survival and quality of life. Patients should be at the centre of the decision-making process and counselled on the potential impact of interventions.

Advanced laryngeal cancers are clinically complex; there is a paucity of modern decision-making models to guide tumour-specific management. This pilot study aims to identify computed tomography-based radiomic features that may predict survival and enhance prognostication.

Pre-biopsy, contrast-enhanced computed tomography scans were assembled from a retrospective cohort (n = 72) with advanced laryngeal cancers (T3 and T4). The LIFEx software was used for radiomic feature extraction. Two features: shape compacity (irregularity of tumour volume) and grey-level zone length matrix – grey-level non-uniformity (tumour heterogeneity) were selected via least absolute shrinkage and selection operator-based Cox regression and explored for prognostic potential.

A greater shape compacity (hazard ratio 2.89) and grey-level zone length matrix – grey-level non-uniformity (hazard ratio 1.64) were significantly associated with worse 5-year disease-specific survival (p < 0.05). Cox regression models yielded a superior C-index when incorporating radiomic features (0.759) versus clinicopathological variables alone (0.655).

Two radiomic features were identified as independent prognostic biomarkers. A multi-centre prospective study is necessary for further exploration. Integrated radiomic models may refine the treatment of advanced laryngeal cancers.

To evaluate the long-term functional outcomes in patients who received primary radiotherapy for tumour–node stage T2N0 glottic carcinoma, stratified for tumour extension.

A cross-sectional study was performed on patients who were treated with radiotherapy for T2N0 glottic carcinoma. Four questionnaires were used to measure different aspects of functional outcome. In addition, objective evaluation and perceptual analysis were performed.

Fourteen patients were included in this study. The median time between the start of radiotherapy and assessment was 42 months (range, 26–143 months). Patients reported high-level functioning, with low symptom scores and good swallowing function, and showed a median dysphonia grade of 1.5. The median Voice Handicap Index-30 score was 17.5.

Patients with T2N0 glottic carcinoma treated with radiotherapy had good long-term quality of life, with low symptom scores, good swallowing functioning and slightly elevated voice outcome parameters.

Heat from transoral laser microsurgery can cause tissue shrinkage, impacting the surgical margin. This study aimed to compare shrinkage between cold steel and carbon dioxide laser resections of laryngeal lesions.

A European Laryngological Society type II resection was performed on 10 mm ‘lesions’ marked on both the true and false folds of fresh-frozen human larynxes; specifically, laser resection was performed on the right side and cold steel resection on the left side.

Twenty-eight larynxes were included. Tissue shrinkage was significantly higher in laser resection (35–45 per cent) compared to cold steel resection (8–14 per cent) (p < 0.0001). In most cases, there was no significant difference in shrinkage between true and false fold sites.

This study demonstrates that specimen shrinkage is significantly higher in laser resections. This shrinkage will affect the size of the surgical margin; surgeons and pathologists should be aware of this when considering positive and close margins.

This paper reports a case of chondrosarcoma deriving from the left arytenoid cartilage that was resected via an anterior laryngofissure using the Tritube in situ, thus eliminating the need for a (temporary) tracheostomy.

A 49-year-old male with a chondrosarcoma deriving from the left arytenoid was treated with local resection of the tumour through an anterior laryngofissure. The intralaryngeal lumen was too small for a normal endotracheal tube. Using the Tritube (outer diameter, 4.4 mm), the patient could be intubated and ventilated adequately during the procedure. The Tritube did not obstruct the surgical view during the procedure.

The Tritube can be used for intubation and ventilation even in patients with a very narrow airway lumen, and does not obstruct the field of view during open laryngeal surgery, thereby avoiding the need for peri-operative tracheostomy.

Laryngeal dysplasia represents a complex pre-malignant condition characterised by a spectrum of mucosal changes, with a reported malignant transformation rate from dysplasia to invasive carcinoma of 14.0 per cent.

To identify whether increasing glottic dysplasia severity is associated with higher local malignant transformation rates or adverse clinical outcomes.

This retrospective cohort study identified 125 patients with any histopathological grade of glottic dysplasia over a 10-year period who were followed up for a standardised 10-year period.

The malignant transformation rate was 21.8 per cent over 10 years, demonstrating a statistically significant greater risk with increasing dysplasia severity. The mean time to transformation was 52 months, with time to transformation statistically associated with increasing dysplasia severity. Rapid progression to carcinoma within 12 months occurred in 40 per cent of cases, and 58 per cent of subsequently diagnosed laryngeal squamous cell carcinomas were tumour stage T1.

Laryngeal dysplasia carries a significant malignant potential, appearing greatest within 12 months of diagnosis and with increasing severity of dysplasia.

Enhanced recovery programmes have been widely adopted in other surgical disciplines but are not commonplace in head and neck surgery. The authors of this study created a pathway for post-operative laryngectomy patients.

A multidisciplinary working group reviewed the literature and agreed standards of care. A retrospective audit was conducted to measure current practice against our new pathway; after programme implementation our performance was reaudited in two prospective cycles, with an education programme and review after the first prospective cycle.

Statistically significant improvement in performance was realised in catheter and surgical drain removal, opiate analgesia use, mobilisation, and timeliness of swallow assessment. The rate of hospital acquired pneumonia reduced from 23.1 to 9.5 per cent and length of stay reduced by a median of 5.2 days to 14.8 days (non-significant).

The programme improved consistency of patient care across most areas that were measured. Improving patient stoma training needs to be prioritised.

This study aimed to evaluate the clinical significance of granulation tissue after endoscopic carbon dioxide laser surgery for glottic cancer.

This was a retrospective review of 36 patients who underwent endoscopic carbon dioxide laser surgery for T1 and T2 glottic cancer. Post-operative, endoscopic examinations were rated by three blinded otolaryngologists for time to heal and presence of granulation. Patient and surgical factors were compared with time to heal and granulation.

A total of 16 of 36 wounds (44 per cent) developed granulation tissue, and 24 wounds (67 per cent) healed without requiring surgical intervention. A total of 7 of 8 wounds biopsied more than 3.5 months after surgery had persistent cancer versus 1 of 4 wounds biopsied at equal to or less than 3.5 months (85.7 per cent vs 25 per cent; p = 0.03). Biopsy at more than 3.5 months was associated with 28-fold increased odds of cancer in biopsy compared with biopsy at equal to or less than 3.5 months (odds ratio, 28.0; 95 per cent confidence interval, 1.088–373.3).

After carbon dioxide laser surgery for glottic cancer, development of granulation tissue is common. Granulation that persists for more than 3.5 months necessitates biopsy because of increased risk of persistent cancer.

This study aimed to determine the incidence of laryngeal penetration and aspiration in elderly patients who underwent supracricoid laryngectomy with cricohyoidoepiglottopexy for laryngeal cancer.

A retrospective analysis of dynamic videofluoroscopic swallowing studies was performed in patients who had received supracricoid laryngectomy with cricohyoidoepiglottopexy as a treatment for laryngeal cancers. Digital analysis of videofluoroscopic swallowing studies included measurements of displacement and timing related to swallowing safety.

Videofluoroscopic swallowing studies from 52 patients were analysed. All participants were male and over 65 years old. Studies were performed five years after surgery. Among 52 videofluoroscopic swallowing studies, analysis showed that elevated pharyngeal constriction ratio (pharyngeal constriction ratio more than 0.0875, odds ratio = 5.2, p = 0.016), reduced pharyngoesophageal sphincter opening time (pharyngoesophageal sphincter open less than 0.6 seconds, odds ratio = 11.6, p = 0.00018) and reduced airway closure time (airway close less than 0.6 seconds, odds ratio = 10.6, p = 0.00057) were significantly associated with aspiration.

Deteriorated pharyngeal constriction, shortened airway closure and reduced pharyngoesophageal sphincter opening time are key factors for predicting laryngeal penetration or aspiration after supracricoid laryngectomy with cricohyoidoepiglottopexy.

Current evidence suggests there is no difference between endoscopic laser surgery and radiotherapy with regards to oncological outcomes of early laryngeal cancer. Patient management may therefore be directed towards voice and quality of life outcomes. This systematic review compares functional outcomes with respect to voice character, swallowing outcomes and quality of life for endoscopic laser surgery versus radiotherapy for T1 and T2 stage laryngeal carcinoma.

Search terminology was designed by both authors and used in Cochrane, PubMed and Web of Science databases. Studies of adult patients treated for primary T1 and T2 laryngeal squamous cell carcinoma utilising one objective (validated) measure of quality of life, swallowing or voice were included.

Initial searches identified 1767 studies. After inclusion and exclusion criteria were applied, 42 studies were identified for full-text review.

This review concluded that neither treatment is clearly advantageous. Future research should be composed of further prospective studies that use a standardised assessment regime to allow valid comparison.

The purpose of this study was to evaluate the outcome of salvage total laryngectomy and identify areas for further improvement.

A retrospective analysis of all patients who underwent salvage total laryngectomy between January 1999 and December 2018 was performed.

Thirty-one patients were identified. The most common primary tumour site was the glottis (83.8 per cent). Early stage (T1–T2) disease was identified in 83.9 per cent of cases. Overall survival at 2 and 5 years post-salvage total laryngectomy was 71 per cent and 45 per cent, respectively. Disease-free survival at 2 and 5 years post-salvage total laryngectomy was 65 per cent and 42 per cent, respectively. The rate of post-salvage total laryngectomy pharyngocutaneous fistula was 29 per cent.

More than half of patients will not survive beyond five years after salvage total laryngectomy. Regional recurrence was the most common form of failure and death. From this study, elective lateral and central neck dissection is advocated in patients with early laryngeal cancer who present with an advanced recurrence.

Transoral laser microsurgery for glottic squamous cell carcinoma is the standard of care at many institutions. Repeat transoral laser microsurgery for recurrence may avoid the need for radiotherapy and total laryngectomy. This study aimed to identify oncological and functional outcomes in a cohort of patients who had undergone repeat transoral laser microsurgery procedures.

A retrospective review of prospectively collected data of patients treated with transoral laser microsurgery for carcinoma in situ or tumour stages T1 or T2 glottic cancer, from 2003 to 2018.

Twenty patients were identified. Additional treatment was not needed in 45 per cent of patients. The five-year overall survival rate was 90 per cent. The disease-specific survival rate was 100 per cent. The laryngeal preservation rate was 85 per cent. There was improvement in mean Voice Handicap Index-10 scores following repeat transoral laser microsurgery treatment, when comparing the pre- and post-operative periods (mean scores = 15.5 vs 11.5, p = 0.373).

Repeat transoral laser microsurgery can be an oncologically safe alternative to other salvage therapies for glottic squamous cell carcinoma recurrence, without sacrificing functional outcomes.

Early laryngeal cancer treated with definitive radiotherapy or surgery has a high cure rate. This study evaluated the patterns of treatment failure and long-term results of early laryngeal cancers treated with definitive radiotherapy.

From January 2002 to December 2014, a total of 242 patients with early-stage laryngeal cancers were treated with radical radiotherapy.

All patients had squamous cell carcinoma of the larynx (92 per cent male and 8 per cent female). Median follow-up was 4.5 years. The majority of patients were smokers (57.4 per cent). Local failure was seen in 12.5 per cent of stage I patients and 22.8 per cent of stage II patients. The 5-year overall survival and disease specific survival were 84 per cent and 91 per cent, respectively.

In summary, radiotherapy is a suitable treatment modality for patients with early-stage laryngeal cancer, with an overall locoregional control rate of 84 per cent. Patients who fail radiotherapy may still undergo salvage laryngectomy.

To analyse the incidence of second primary lung cancer following treatment for laryngeal cancer and to identify risk factors for its development.

Retrospective case series.

The five-year actuarial incidence of second primary lung cancer was 8 per cent (1.6 per cent per year). This was associated with a very poor median survival of seven months following diagnosis. Supraglottic tumours were associated with an increased risk of second primary lung cancer compared to glottic tumours in both univariate (hazard ratio = 4.32, p = 0.005) and multivariate analyses (hazard ratio = 4.14, p = 0.03).

Second primary lung cancer occurs at a rate of 1.6 per cent per year following a diagnosis of laryngeal cancer, and this is associated in a statistically significant manner with supraglottic primary tumour. The recent National Lung Cancer Screening Trial suggests a survival advantage of 20 per cent at five years with annual screening using low-dose computed tomography scanning of the chest in a comparable cohort to ours. These findings have the potential to inform post-treatment surveillance protocols in the future.

Transoral laser microsurgery is an increasingly common treatment modality for glottic carcinoma. This study aimed to determine the effect of age, gender, stage and time on voice-related quality of life using the Voice Handicap Index-10.

Primary early glottic carcinoma patients treated with transoral laser microsurgery were included in the study. Self-reported Voice Handicap Index testing was completed pre-operatively, three months post-operatively, and yearly at follow-up appointments.

Voice Handicap Index improvement was found to be dependent on age and tumour stage, while no significant differences were found in Voice Handicap Index for gender. Voice Handicap Index score was significantly improved at 12 months and 24 months. Time versus Voice Handicap Index modelling revealed a preference for non-linear over linear regression.

Age and stage are important factors, as younger patients with more advanced tumours show greater voice improvement post-operatively. Patient's Voice Handicap Index is predicted to have 95 per cent of maximal improvement by 5.5 months post-operatively.