Laryngeal Verrucous Carcinoma: A Systematic Review

Abstract

Objective Laryngeal verrucous carcinoma (LVC) is a rare, locally invasive neoplasm comprising 1% to 3.4% of laryngeal carcinomas. Management strategies are a topic of ongoing conversation, and no definitive treatment protocol based on T stage and presentation exists. This review examines characteristics, treatment modalities, and patient outcomes of LVC. Data Sources PubMed, MEDLINE, EMBASE, and Web of Science. Methods Databases were searched through October 29, 2015, for literature detailing individual patient cases of LVC. Variables analyzed included patient demographics, tumor characteristics, tumor size, treatment, and outcomes. Results Thirty-seven articles with 369 cases were included. LVC was found more commonly in males (13.8:1), at an average age of 58.7 years, and located in the glottis (74.0%). Most patients had local disease at presentation (94.9%). The most common presenting symptom was hoarseness (92.3%). The most common primary treatment was surgery alone (72.3%), with local excision as the most common technique (56.8%). In patients with data available on both surgical modality and T stage, most patients who presented as T1 and were managed surgically underwent local excision (79.2%). Surgical treatment alone led to high rates of disease-free survival at follow-up (86.8%). A large number of patients presenting with T1 disease were disease free at follow-up (88.6%). Overall survival was 80.3%. Conclusion LVC is most often managed surgically. The extent of surgical resection may be guided by T stage, with smaller tumors resected via local excision and larger tumors via partial or total laryngectomy. Regardless of T stage or therapy, LVC has a good posttreatment prognosis.

A population‐based analysis of verrucous carcinoma of the oral cavity

“…Earlier stage tumors are favorable from a management standpoint because localized disease often may be treated appropriately, with definitive surgical excision with adequate margins. In addition, VC commonly demonstrates cytohistopathologic features of epidermal hyperplasia, with “downward pushing borders” without invasion of the basement membrane, as well as the absence of nuclear atypia and mitotic figures . These features suggest superficial disease involvement and tend to be favorable findings for patient outcomes in that the chance of regional and distant spread is rare.…”

“…Koch et al demonstrated a 5‐year survival above 80% in patients with localized VC of the oral cavity . Dubal et al demonstrated via a population‐based cohort the superior prognosis of VC in the larynx compared with other malignancies . Similarly, Echanique et al observed improved outcomes with laryngeal VC compared to other neoplasms .…”

“…Dubal et al demonstrated via a population‐based cohort the superior prognosis of VC in the larynx compared with other malignancies . Similarly, Echanique et al observed improved outcomes with laryngeal VC compared to other neoplasms . To evaluate a larger cohort, we aimed to utilize a national database to identify epidemiological and clinicopathologic factors independently associated with survival outcomes in VC of the oral cavity.…”

Is primary radiotherapy an acceptable treatment modality for verrucous carcinoma of the larynx?

“…A number of other early studies identified similar results. Previous studies were recently summarized in a systematic review by Echanique et al in 2017 . In this review, 37 studies were included with 369 cases of laryngeal verrucous carcinoma.…”

“…There were no cases of anaplastic transformation. The study by Huang et al was not included in the systematic review performed by Echanique et al…”