Verrucous Carcinoma of the Larynx

Abstract

Verrucous carcinoma is a well-differentiated squamous cell carcinoma with minimal cytologic atypia. Characteristically, the surface shows papillary fronds with prominent hyperkeratosis. Its benign appearance makes diagnosis difficult and often delays treatment. This is a review of 52 histologically confirmed cases of verrucous carcinoma of the larynx treated at the Mayo Clinic between 1960 and 1987. The follow-up ranged from 2 to 304 months. The most common primary treatment modality was surgery. Two patients died of laryngeal cancer. In both cases, the recurrence was a high-grade carcinoma histologically distinct from the original verrucous carcinoma. The T stage, clinical stage, and type of surgical excision failed to predict survival. The presence of extensive leukoplakia surrounding the exophytic tumor approached statistical significance (p = .08) in predicting recurrence. Four patients were treated with radiotherapy--in each, to control residual disease. One of these patients developed a local recurrence. None of the irradiated tumors in this series showed anaplastic dedifferentiation, and none of the irradiated patients died of uncontrolled local or regional disease. We conclude that verrucous carcinoma of the larynx should be treated by conservative surgical resection when possible. Radiotherapy can be effectively used for disease that cannot be resected with preservation of laryngeal function. Total laryngectomy should be reserved for recurrent disease or the rare case of anaplastic transformation.

Radiochemotherapy with Vinblastine, Methotrexate, and Bleomycin in the treatment of verrucous carcinoma of the head and neck

“…Local tumor control with no local recurrences was achieved in 11 of 12 of our patients and the toxicity of combined treatment was acceptable. This result compares favorably with the results of surgical series and even more with those of radiotherapy series, in which local recurrence rates in the range of 0%-29% [4][5][6][7][8] and 38%-46% [5,[9][10][11], respectively, were reported. However, in the case of rare clinical entities like VC, one should be aware that comparison of effectiveness of different treatment modalities is problematic, primarily because, in pertinent studies, broad time intervals are usually covered, including a bias because of substantial improvements in equipment and treatment techniques.…”

“…According to the presented results, the combined approach appears to compete favorably with surgery as a preferred treatment modality in this disease, which resulted in local failure rates of up to 29% [4][5][6][7][8]. The administration of chemotherapy during the course of irradiation seems to compensate successfully suboptimal effectiveness of irradiation in VC.…”

“…Radiotherapy is an alternative option, usually resulting in poorer local control compared to surgery [3]. Local recurrence rate ranges between 0% and 29% in surgically treated patients [4][5][6][7][8] and between 38% and 46% in primarily irradiated patients [5,[9][10][11]. The literature on the role of chemotherapy in the treatment of VC is limited to case reports or small series, reflecting clinicians' poor experience with this treatment modality [12][13][14][15][16][17][18][19][20][21][22][23].…”

Temporal Bone Verrucous Carcinoma: Outcomes and Treatment Controversy

“…A recent report suggests that dedifferentiation can occur not only after radiation, but also before treatment and after surgery alone [39]. In 1998, the Mayo Clinic reviewed 52 cases of laryngeal verrucous carcinoma and concluded that radiotherapy can be used effectively as an adjunct to surgical resection to preserve laryngeal function [40]. Only one of four patients in this series treated with radiotherapy to control residual disease developed a recurrence, and none showed dedifferentiation or distant metastasis after radiation treatment.…”

Radioterapia y el carcinoma verrucoso de laringe

“…En una serie de 52 casos de carcinoma verrucoso de laringe, dos pacientes tuvieron recurrencia local de su enfermedad y en el estudio histológico se demostró una desdiferenciación 9 . Para la adecuada evaluación de estos pacientes resulta imprescindible un buen diagnóstico histológico.…”