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Sequence of Response to External Beam Irradiation for T1 Glottic SCC - Clinical case example

last modified on: Mon, 10/23/2023 - 08:30

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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

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

Diagnosis made from bx at time of microdirect laryngoscopy

Treatment planning

Larynx seen in clinic on last day of XRT and one year later

Appearance of neck on last day of irradiation and one year later

Larynx before irradiation and 15 months after