In this study we determined the frequency of association of human papillomavirus (HPV) and laryngeal carcinomas and investigated the possibility that HPV may be associated with larger or more aggressive tumors. Laryngeal squamous cell carcinomas from 40 patients who did not have preexisting papillomas by clinical history were retrieved from formalin-fixed, paraffin-embedded blocks and analyzed for HPV. Twenty-two cases were tumors of the true vocal folds, and 18 were supraglottic. Clinical follow-up was available for 25 patients. We used the polymerase chain reaction (PCR) with the “hot start” modification and consensus primers that can detect over 30 distinct HPV types. Three of the 40 patients (8%) had detectable HPV DNA. These 3 patients did not have unusual age demographics and were smokers. All but 1 of the 22 HPV-negative patients who were questioned were also smokers. We compared the outcomes for large (4 cm or greater) HPV-positive and -negative tumors. Six of the 40 tumors were 4 cm or greater and involved contiguous structures. Two of these 6 were HPV-positive, and these patients died of disease after 3 and 16 months, respectively. Of the 4 HPV-negative patients with tumors greater than 4 cm, 3 are disease-free at 41, 42, and 3 months, respectively, and 1 was lost to follow-up. The third HPV-positive patient had a tumor less than 1 cm, and is disease-free after 38 months. While the number of HPV-positive cases is too small for definitive conclusions, it is possible that for large tumors the presence of HPV DNA may portend a worse prognosis. However, in the population of patients with laryngeal carcinoma whom we have studied, we conclude that the L1 region of HPV DNA is rarely seen to be present in the tumors by “hot start” PCR, and hence HPV is probably not a common cancer promoter for laryngeal carcinoma.
A patient with a moderately advanced squamous cell carcinoma of the larynx (T2, glottic) is presented. The consultants discuss their preferred diagnostic and treatment options. All consultants agree that the chances for cure (5-yr survival) are 80-85%, but they differ as to the preferred treatment approach to preserve phonation. Drs. Biller and Pearson predict that 80-90% of patients would be alive and have usable voice, with surgical treatment, whereas Dr. Bryce believes the chances of voice preservation are 65% after radiotherapy only. In his opinion an additional 10% would be helped by conservation partial laryngeal surgery.
Systematic ECG-analyses and determinations of serum creatin-kinase were performed in 32 patients with mammary carcinoma of the left, prior to and immediately after postoperative radiation therapy. Treatment was done with a gammatron, during this, the average load to the anterior cardiac wall amounted to 3600 rd. Eleven cases exhibited coronary-negative T-waves in at least two chest leads after treatment, seven other cases had flat negative or isoelectric T-waves. Two patients additionally revealed prolongation of the relative QT-period by more than 115%. These changes are interpreted as a sign of radiation-induced myopericarditis. Pericardial effusions did not appear during the follow-up period, furthermore no modifications of creatin-kinase activity. Clinical injury to the patients developed in no case.
