Arytenoid Fixation in Laryngeal Cancer: Radiological Pictures and Clinical Correlations with Respect to Conservative Treatments

Abstract

Background: The aim of this retrospective study was to identify different radiological features in intermediate–advanced laryngeal cancer (LC) associated with arytenoid fixation, in order to differentiate cases still safely amenable to conservative treatment by partial laryngectomy or chemoradiotherapy. Methods: 29 consecutive patients who underwent open partial horizontal laryngectomies (OPHLs), induction chemotherapy followed by radiotherapy in the case of >50% response (IC + RT) or total laryngectomy were classified as: pattern I (supraglottic LC fixing the arytenoid due to weight effect), pattern II (glottic LC involving the posterior paraglottic space and spreading toward the crico-arytenoid joint and infraglottic extension <10 mm), pattern III (glottic—infraglottic LC involving the crico-arytenoid joint and infraglottic extension >10 mm) and pattern IV (transglottic and infraglottic LC with massive crico-arytenoid unit involvement, reaching the hypopharyngeal submucosa). All glottic cancers treated with surgery were studied by a cross sectional approach. Results: A substantial agreement between the work-up and the pathology results has been obtained in each of the subcategories. Three-year disease-free survivals, local control and freedom from laryngectomy were significantly better in pattern II compared to pattern III–IV. Conclusions: LC showing fixed arytenoid due to weight effect or posterior paraglottic space involvement with infraglottic extension <10 mm assessed at the true vocal cord midline are still safely manageable by OPHL or IC + RT.

Transoral laser microsurgery in locally advanced laryngeal cancer: Prognostic impact of anterior versus posterior compartments

“…These three scenarios carry a different prognosis in terms of functional and oncologic outcomes. 28 Cricoarytenoid fixation is considered a limit for TOLMS and it could be corroborated in our series, where a lower local control was found in those patients with cricoarytenoid impairment. However, posterior radiologic PGS involvement may be present without arytenoid impairment.…”

The thyro-cricoarytenoid space (TCAS): clinical and prognostic implications in laryngeal cancer

“…We found that it significantly related to impaired vocal cord motility and radiological evidence of sclerosis of the arytenoid cartilage 4 . The recent literature confirmed the negative prognostic meaning of such posterior spread of glottic cancer to the cricoarytenoid joint and associated arytenoid fixation 6 . A change of TNM classification (from T3 to T3b) have already been suggested as a result 1 .…”

“…The recent literature in the sphere of laryngeal surgical oncology has increasingly focused on the anatomical space delineated by the thyroid, cricoid and arytenoid cartilages [1][2][3][4][5][6][7] , which we refer to as the "thyro-cricoarytenoid space" (TCAS). The inferior paraglottic space (PGS) is a submucosal compartment bound laterally by the laryngeal cartilaginous framework and medially by the vocal muscle 8 .…”

Chemoradiotherapy but Not Radiotherapy Alone for Larynx Preservation in T3. Considerations from a German Observational Cohort Study

“…As a decision aid, Succo et al differentiated four patterns of vocal cord fixation: patients with fixation of the arytenoid by weight effect (pattern I) or involvement of the posterior paraglottic space, spreading towards the crico-arytenoid joint, and with infraglottic extension ≤ 10 mm (pattern II) were safely manageable by pCRT. Patients with involvement of the crico-arytenoid joint and infraglottic extension >10 mm (pattern III) and massive crico-arytenoid unit involvement reaching the hypopharyngeal mucosa (pattern IV) should undergo upfront TL [ 41 ].…”