GLOTTIC CANCER ON THE RISE

Glottic carcinoma rates in children and young adults have increased over the past three decades, according to a retrospective review.

The findings may meant that doctors need to reconsider the way they manage papillary laryngeal lesions in young patients, the review's senior author told Reuters Health.

"I had never encountered a vocal-cord-cancer patient 30 years old (or younger) in the first half of my career," Dr. Steven M. Zeitels from Massachusetts General Hospital and Harvard Medical School, in Boston, said in an email.

That would change, as described in a report online February 7 in the Annals of Otology, Rhinology and Laryngology. Dr. Zeitels's team drew on data from glottic-carcinoma patients evaluated by the researcher from mid-1990 through mid-2018.

Between mid-1990 and mid-2004, 112 patients were diagnosed with glottic carcinoma, none of them younger than 31.

Between mid-2004 and mid-2018, however, of the 241 patients diagnosed with glottic carcinoma, three were 10 to 19 years old, three were 20 to 25, and five were 26 to 30.

Three of the 11 young patients had a history of smoking (all of them less than three pack-years), but all 10 patients tested were positive for high-risk human papillomavirus (HPV) types.

None of the 11 younger patients had been previously treated for benign recurrent respiratory papillomatosis (RRP), although it was initially suspected prior to biopsy because of the morphology of the lesions and the patients' young age.

One of the younger glottic-cancer patients had been treated by the initial surgeon with microlaryngoscopic removal of her papillary squamous-cell carcinoma. When it recurred about two years later, the same laryngologist, deciding that the recurrent disease had converted to benign RRP, retreated it with five intralesional injections of cidofovir, a known carcinogen.

This resulted in transformation of the slow-growing superficial and confined T1 glottic disease into an aggressive and deeply invasive neoplasm that ultimately required an extended partial laryngectomy and radiotherapy.

"Today, there should be a reappraisal of injecting the antiviral agent cidofovir into papillary laryngeal lesions, which has been done frequently for the past 20 years for benign RRP," Dr. Zeitels said.

"Given that benign RRP of the vocal cords has been a well-known HPV disease in children for over a century, it is very remarkable that there is now an HPV malignancy (papillary carcinoma) that looks similar, creating diagnostic and therapeutic confusion," he said.

"Listen to voices of all of your patients who come in for visits and examinations," Dr. Zeitels said. "The overwhelming majority of patients who have vocal-cord lesions have easily discernable hoarseness. In children and young adults who have persistent hoarseness >3 weeks, there should be a much lower threshold to perform office laryngoscopy, and if there is any suspicion about the office exam, intraoperative microlaryngoscopy with biopsy should be done."

He added, "Vocal-cord papillary cancers are frequently amenable to voice-preserving transoral minimally invasive microlaryngoscopic treatment with angiolytic lasers, which avoids the unavoidable complications of administering ionizing radiation to young patients. Moreover, individuals who develop HPV papillary cancers are predisposed to developing synchronous and metachronous neoplasms, so it is important to preserve ionizing radiation for large lesions since it is a single-use treatment."

SOURCE: https://bit.ly/2StPhBS

Ann Otol Rhinol Laryngol 2019.