title: Should patients with laryngeal small cell neuroendocrine carcinoma receive prophylactic cranial irradiation?
abstract: While small cell neuroendocrine carcinomas (SCNCs) most often arise in the lung, extrapulmonary SCNCs arise in a variety of locations-including the head and neck region. In particular, laryngeal SCNCs-while rare tumors-are nevertheless recognized as distinct lesions. The rarity of laryngeal SCNC gives rise to two distinct difficulties: first (particularly with small biopsy specimens), laryngeal SCNC can be difficult to diagnose by routine light microscopy; second, limited experience with these tumors can make the crafting of a treatment plan for individual patients difficult. As regards the first problem, pathologic diagnosis is greatly enhanced by the application of immunohistochemistry. The second problem-crafting a successful treatment strategy-presents a much larger difficulty. It is tempting to extrapolate from experience with the (more common) pulmonary SCNC in search of a strategy applicable to laryngeal SCNC; such an extrapolation, however, may not be uniformly successful. In particular, while a combination of radiation therapy and chemotherapy appears to be as valuable in the treatment of extrapulmonary as it is in the treatment of pulmonary SCNC, prophylactic cranial irradiation (PCI)-which has enjoyed some success in the treatment of some patients with pulmonary SCNC-does not appear to have similar utility in patients with laryngeal SCNC. Accordingly, the use of PCI does not appear to have a role to play at this point in time in the treatment of patients with laryngeal SCNC.
authors.affiliation: Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Coca-Pelaz
authors.affiliation: Department of Pathology, Allegiance Health, Jackson, MI, USA.
authors.forename: Kenneth O
authors.initials: KO
authors.lastname: Devaney
authors.affiliation: Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.|Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Rodrigo
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Gyorgy B
authors.initials: GB
authors.lastname: Halmos
authors.affiliation: Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
authors.forename: Primož
authors.initials: P
authors.lastname: Strojan
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, FL, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Avraham
authors.initials: A
authors.lastname: Eisbruch
authors.affiliation: Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Smee
authors.affiliation: Pathology Division, Shizuoka Cancer Center Hospital and Research Institute, Shizuoka, Japan.
authors.forename: Kimihide
authors.initials: K
authors.lastname: Kusafuka
authors.affiliation: University of Udine School of Medicine, Udine, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rinaldo
authors.affiliation: Coordinator of the International Head and Neck Scientific Group, Padua, Italy. a.ferlito@uniud.it.
authors.forename: Alfio
authors.initials: A
authors.lastname: Ferlito
mesh_terms: D001932:Brain Neoplasms / Q000517:prevention & control* / Q000556:secondary; D018278:Carcinoma, Neuroendocrine / Q000473:pathology / Q000517:prevention & control* / Q000556:secondary; D018288:Carcinoma, Small Cell / Q000473:pathology / Q000517:prevention & control* / Q000556:secondary; D016371:Cranial Irradiation; D006801:Humans; D007150:Immunohistochemistry; D007822:Laryngeal Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged
keywords: Brain metastases; Extrapulmonary small cell neuroendocrine carcinoma; Larynx; Neuroendocrine neoplasms; Prophylactic cranial irradiation