• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.7 no.1
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• pp.32-38
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• 1996

The preservation of the voice-producing mechanism is an important feature in the management of laryngeal cancer by radiotherapy. But, radiation therapy has certain side effects such as mucositis, tissue edema, necrosis and fibrosis which could effect on normal voice production. Several subjective studies that used questionnaires and auditory perceptual judgements of voice have been interpreted to mean that radiation results in a normal or near-normal voice. Objective evidence of the status of vocal function after radiation treatment, however, is still lacking. We analyzed the changes that occur in voice parameters in a group of patients undergoing radiation therapy, in order to determine the effect of radiation on voice quality. In this study acoustic, aerodynamic measures of vocal function were used to determine the characteristics of voice production. We found that voice parameters in early glottic cancer changed meaningfully comparing to normal larynx with or without radiation and radiation therapy has an little effect on normal larynx.

• Korean Journal of Head & Neck Oncology
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• v.20 no.2
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• pp.172-176
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• 2004

Background and Objectives: Standard treatment of locally advanced laryngeal, hypopharyngeal, and some oropharyngeal cancers includes total laryngectomy. In an attempt to preserve the larynx through induction chemotherapy, we designed induction chemotherapy followed by definitive radiation in patients with potentially respectable head and neck cancer to determine whether organ preservation is feasible without apparent compromise of survival. Materials and Methods: The twenty-six patients diagnosed advanced head and neck squamous cell carcinoma, Stage III or IV (AJCC 2002) and performed organ preservation protocols in Ajou university hospital from 1994 to 2001 were included in this study. Results: Neoadjuvant chemotherapy showed an overall response rate of 84.6% and a complete remission (CR) rate was 59.1% following neoadjuvant chemotherapy and radiation. Seven of thirteen patients were able to preserve their larynges for more than two years by chemotherapy and radiation. There were no treatment related mortality after 2 cycles of induction chemotherapy. Conclusion: Although Organ preservation protocol through neoadjuvant chemotherapy and radiation need more controlled randomized study, it was considered alternative treatment modality in advanced head and neck cancer.

• Korean Journal of Head & Neck Oncology
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• v.19 no.1
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• pp.16-20
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• 2003

Objectives: Radiotherapy is an effective treatment in the initial management of T1 glottic carcinoma, but local recurrent or residual tumor growth is found in approximately 10% of the patients. Even in recurrence or residual tumor, in highly selected cases, conservation surgery with preservation of a portion of the larynx is feasible. So we investigated the efficacy of salvage vertical partial laryngectomy for recurrent glottic carcinoma after irradiation. Material and Methods: Retrospectively we reviewed a consecutive series of 10 patients treated by conservative vertical partial laryngectomy of the larynx for radiation-failure, recurrent T1 glottic squamous cell carcinoma treated at Severance Hospital from 1994 to 2002. Results: Local recurrence developed in 4 patients (40%). Two patient was salvaged by further totallaryngectomy. Successful salvage was achieved finally in 8 (80%) of the 10 patients. There was no operative mortality. Postoperative perichondritis was developed in two patients. One was resolved by conservative treatment, but the other has underwent the total laryngectomy. Conclusion: A vertical partial laryngectomy in case of recurrent glottic carcinoma after a course of irridation should be the therapy of choice when stringent criteria are observed.

• Korean Journal of Bronchoesophagology
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• v.6 no.2
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• pp.172-176
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• 2000

Background and Objectives： The treatment of laryngeal carcinoma is not settled to date and surgeons have used lasers for a variety of benign and malignant lesions in the larynx with good success. The aim of this study is to evaluate the potential role of laser surgery for laryngeal carcinoma. Materials and Methods : Medical records from patients who had undergone laser surgery for laryngeal carcinoma at Seoul National University Hospital between January 1988 3nd December 1998 were reviewed retrospectively. Results : A total of 47 patients were seen during that period and their mean follow-up length was 29 months. Their local control rate was 91％ (94% for glottic T1, 60% for glottic T2, 50% for supraglottic T1 and 100％ for supraglottic T2). The cure rate after laser surgery with or without postoperative radiotherapy was 87％ and 6 of 47 patients showed local or regional recurrences. For those 6 patients, neck dissection, partial or total laryngectomy with or without postoperative RT were conducted and they were all followed up without evidence of disease. All 47 patients who had undergone laser surgery for laryngeal squamous cell carcinoma were followed up with NED and their larynx preservation rate was 96%. Conclusion： This study demonstrates the oncologic validity of laser surgery to the treatment of unadvanced laryngeal carcinoma. However, strict case selection is needed to avoid locoregional recurrences and consequent salvage operations.

• Korean Journal of Head & Neck Oncology
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• v.19 no.1
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• pp.34-40
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• 2003

Objective: To analyze the treatment-related parameters after the radiotherapy of T1N0 squamous cell carcinoma of the glottic larynx. Materials and Methods: Between October 1989 and August 2000, 54 patients with histologically proven T1N0 squamous cell carcinoma of the glottic larynx who received definitive radiation therapy in Department of Radiation Oncology, Asan Medical Center were analyzed. They were all males with age ranged from 31 to 80 years (median 61 years). 1997 AJCC stages were 31 T1a, 23 T1b. Patients were treated with 4-MV X-rays with a parallel-opposed two-field technique. Ten patients received 66.0-68.4Gy at 1.2Gy per fraction twice daily, 21 patients received 64.8-66.6Gy at 1.8Gy per fraction once daily, and 23 patients received 66.0Gy at 2.0Gy per fraction once daily. Follow-up period was 16-119 months (median 56 months). Results: 5-year overall survival and local control rates for patients with T1 lesions were 87.0% and 88.5%, respectively. 5-year local control with larynx preservation rate was 90.5%. Host and tumor-related prognostic factors including age, stage, anterior commissure involvement and tumor bulk proved not to be significant. Only shorter overall treatment time among treatment-related factors had correlation with imporved local control. Conclusion: Comparable high local control rate with organ preservation was achieved with primary radiation therapy and salvage surgery. Shortening of overall treatment time is related to improved local control rate. To determine the optimal fractionation scheme, randomized trial is mandatory.

• Korean Journal of Bronchoesophagology
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• v.9 no.1
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• pp.30-38
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• 2003

Cancers of the cervical esophagus occur uncommonly, but treatment is remaining a challenging problem and surgery demands special knowledge of abdominal, thoracic, and neck surgery. The primary risk factor is chronic heartburn, leading to a sequence of esophagitis, Barrett's esophagus, reflux esophagitis and etc. Among the various treatment modalities, Surgery is still a mainstay of treatment. The main aim of surgery is not only oncologically adequate resection but also preservation or restoration of physiologic functions, such as deglutition and phonation. Surgical treatment of cervical esophageal cancer is influenced by special problems arising from tumor factors, patient factors and surgeon factors. Complete clearance of loco-regional disease and prevention of postoperative complications are of particular importance for the improvement of long-term survival in patients with these cancers. So the cervical and thoracic extension of these tumors usually required an extensive lymphadenectomy with primary resection. Radical resection of the primary site almostly include sacrifice of the larynx, but the voice could be rehabilitated with various methods, such as tracheoesophageal prosthesis or tracheoesophageal shunts, etc. Restoration of the esophageal conduit can be performed using gastric or colon interposition, radial forearm free flap or jejunum free flap, etc. Recently, the advances of radiation therapy and chemotherapy will enable less extended resections with greater rates of laryngeal preservation. At initial presentation, up to 50％ to 70％ of patients will have advanced locoregional or distant disease with virtually no chance for cure. Patients with advanced but potentially resectable esophageal cancer are generally treated by surgery with some form of neoadjuvant chemotherapy, radiotherapy, or both, with 5-year survivals in the 20％ to 30％ range. So the significant adverse factors affecting survival should be taken into account to select the candidates for surgery.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.21 no.2
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• pp.112-120
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• 2010

Transoral $CO_2$ laser microsurgery has been widely used for various laryngeal diseases. Laser cordectomy for the management of early laryngeal carcinoma has advantages with regards to oncologic results, preservation of laryngeal functions, morbidity and cost in comparison to those of open surgery or radiation therapy. $CO_2$ laser is also applicable to benign vocal fold lesions such as nodules, polyps, cysts, reinke's edema, granulomas, papillomas, hemangiomas and glottis webs. $CO_2$ laser is suitable for microsurgery because it has small focus size and hemostatic effect. We should also recognize the risks of $CO_2$ laser for safe use.

• Korean Journal of Head & Neck Oncology
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• v.24 no.1
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• pp.26-32
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• 2008

Purpose：Hypopharyngeal carcinoma is usually diagnosed as an advanced disease after an asymptomatic beginning, and it is related to a high frequency of lymph node metastases. An eventual negative outcome may occur not only because of possible locoregional failures but also for frequent distant metastases. Thus, the efficacy of induction chemotherapy followed by radiation therapy, with regards to the response, survival rate and complications for locally advanced hypopharyngeal carcinoma patients, was examined. Methods and Materials：Since July 1998 to February 2001, 18 patients having locally advanced hypopharyngeal carcinoma were treated with induction chemotherapy followed by radiation therapy, and the results were retrospectively analyzed. The regimen of the induction chemotherapy was the 5-flurouracil(5-FU, 1,000mg/$m^2$ daily for 5 consecutive days) and cisplatin(100mg/$m^2$ on day 1) combination at 3-week intervals for 2 cycles. The total radiation dose for the primary tumor and metastatic lymph nodes was 68.4-72.0Gy(median：70.2Gy) Results：The 3-year overall survival rate and disease free survival rate were 31.3% and 22.2%, respectively. In 6 patients(33.3%), preservation of the larynx for over 3 years was possible. After the induction chemotherapy and radiotherapy, a complete response was noted in 14 patients(77.8%), and a partial response in 4 patients (22.2%), with an overall response rate of 100%. Conclusion：Induction chemotherapy followed by radiation therapy is an effective treatment and larynx preservation rate was 33% in patients with locally advanced hypopharyngeal carcinoma in our report.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.19 no.1
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• pp.7-10
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• 2008

The early glottic cancers are traditionally treated by radiotherapy or endoscopic surgery. The excellent effectiveness of both treatment modalities for local control, larynx preservation, and disease specific death is similar. Therefore, functional voice outcome after treatment is one of the most important factors in the choice of treatment for early glottic cancer. To assess the functional outcomes and compare the voice quality in patients with early glottic cancer treated with curative intent with radiotherapy or laser cordectomy, we performed literature review. Most studies showed that the voice quality after radiation therapy is slightly better than that after laser cordectomy. Subanalysis according to types of laser cordectomy, however, indicates that voice quality depends on type of laser cordectomy. Especially, type I or type II laser cordectomy might be superior to other types of laser cordectomy and radiation therapy. We conclude that the laser cordectomy is a good surgical alternative for properly selected early glottic cancer including professional voice users.

• Radiation Oncology Journal
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• v.11 no.2
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• pp.277-283
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• 1993

Background: We peformed a retroslective study in patients with previously untreated advanced (Stage III or IV) laryngeal and hypopharyngeal cancer to compare the results of induction chemotherapy followed by definitive radiation therapy (CT+ RT) with those of conventional laryngectomy and postoperative radiation therapy (OP + RT). Method: Between 1985 and 1990, twenty-four patients were treated with two or three courses of chemotherapy and radiation therapy (66-75 Gy). Twenty-five patients were received laryngectomy and radical neck dissection (except 3 patients) and postoperative radiation therapy (55~64 Gy). Result: After a median fellow-up of 20 months, the actusrial 5-year overall survival rate was $24\%$ (chemotherapy group) and $36\%,$ (op group). (P>0.1). The local control rate was the $65\%,$ (13/20) and $68.2\%,$ (15/22). (p>0.1). The rate of laryngeal preservation was $65\%$ (13/20) in chemotherapy group. Conclusion: Induction chemotherapy and definitive radiation therapy can be effective in preserving the larynx in a high percentage of patients with advanced laryngeal and hypopharyngeal cancer.