Verrucous carcinoma of the larynx: role of human papillomavirus, radiation, and surgery.
There is confusion regarding verrucous carcinoma of the larynx, an enigmatic, well-differentiated variant of squamous cell carcinoma known for local recurrence and anaplastic transformation following irradiation. This report adds 12 new cases and reviews the literature concerning radiation results versus surgical results. Treatment of 37 patients with primary radiotherapy resulted in a 49% cure rate and a 51% failure rate; the death rate from anaplastic transformation was 11%. Primary surgery on 144 patients resulted in a 92.4% cure rate, a 7.6% initial failure rate, and a 3.5% rate of deaths attributed to neoplasm. Isolation of human papillomavirus type 16 (HPV-16) DNA sequences indicates that the lesion is genetically abnormal. Radiation-induced DNA breaks may activate these sequences. These findings support a surgical approach. Treatment recommendation for T1 lesions is carbon dioxide laser excision to minimize tissue trauma and local recurrence. For T2 to T4 lesions, the recommendation is sound oncologic extirpation. Neck dissection is not indicated.
Department of Otorhinolaryngology, Louisiana State University Medical Center, New Orleans 70112-2234.
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Hagen
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Lyons
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Haindel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000708:Anaplasia; D002291:Carcinoma, Papillary / Q000382:microbiology / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003037:Cobalt Radioisotopes / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000382:microbiology / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D007825:Laryngectomy; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D027383:Papillomaviridae; D012074:Remission Induction; D015996:Survival Rate; D014412:Tumor Virus Infections
D003037:Cobalt Radioisotopes