Case Example Sequence of Response to External Beam Irradiation for T1 Glottic SCC

last modified on: Tue, 02/06/2018 - 14:05

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see also: Management Consideration Radiation Induced Malignancy in the Head and Neck

and: Laryngeal leukoplakia white plaques on vocal cords

Case Example Sequence of Response to External Beam Irradiation for T1 Glottic SCC                 CLICK ON IMAGES TO ENLARGE

Sep-2011 First Oto Clinic Visit with dysphonia for preceding 1 year. Moderate dysphonia (G2R2B1A0S2)

           self-rated negative impact of voice problem on life = "6" out of 6 (0 = no negative impact; 6 = profound negative impact)

           with elevated reflux symptom index.+ tobaccao use (greatest amount = 1 pack per week)

      Ddx: Chronic laryngitis. Possible laryngopharyngeal reflux, possible laryngeal candidiasis, possible vocal fold hemorrhage 

      Rx: Reflux precautions, reflux medications, trial of diflucan

Nov-2011 Followup clinic visit 6 weeks later  Moderate dysphonia persists. Imaging similar

      Ddx: Chronic laryngitis. Rule out papillomatosis vs cancer

Nov-2011 Microdirect laryngoscopy under general anesthesia

       Biopsy: left vocal cord = invasive moderately differentiated squamous cell cancer

               subsequently evaluated (paraffin embedded specimen) as positive for high risk HPV

           slightly irregular Z-line (G-E junction) biopsied: 'mild non-specific chronic inflammation'

Feb-2012 Followup clinic visit last day of XRT (63 gy)

         Dysphagia and dysphonia; modify omeprazole to liquid; maintaining weight

 

Mar-2012 Followup clinic visit 6 weeks after completion of radiation

         Vocal quality improved 'better than before irradiation'

Nov-2012  Followup     including voice clinic appt with dysphonia only mild (G1R1B0A0S0)

                       self-rated negative impact of voice problem on life = "1" out of 6 (0 = no negative impact; 6 = profound negative impact)

Diagnosis, Treatment Planning, and Response to Treatment

a Diagnosis made from bx at time of microdirect laryngoscopy
b. Treatment planning
c Larynx seen in clinic on last day of XRT and one year later
d Appearance of neck on last day of irradiation and one year later
e Larynx before irradiation and 15 months after