PREDICTORS OF ADVANCED LARYNGEAL SQUAMOUS CELL CARCINOMA INVASION ON THYROID GLAND TISSUE
Thyroid gland invasion in advanced laryngeal cancer
Keywords:
total laryngectomy, thyroidectomy, transglottic tumor, squamous cell carcinoma, hypothyroidism;
Abstract
Total laryngectomy presents the standard therapeutic protocol in the treatment of advanced laryngeal cancer. There is not enough research in this area to indicate the necessity of performing thyroidectomy in patients with advanced squamous cell carcinoma of the larynx, although some studies indicate that unilateral thyroidectomy is performed routinely in some centers. The National Comprehensive Cancer Network (NCCN) recommends ipsilateral hemithyroidectomy with laryngectomy for advanced squamous cell carcinoma of the larynx. However, in these cases, the risk of hypothyroidism and hypoparathyroidism is significantly higher, which requires postoperative monitoring of hormone status and thyroid replacement therapy. Invasion of the thyroid gland can occur due to direct or lymphovascular spread of advanced squamous cell carcinoma of the larynx, and the risk of locoregional recurrence and distant metastases in these cases increases significantly. The incidence of thyroid gland invasion in patients with advanced laryngeal squamous carcinoma is relatively low, and the most common predictors for infiltration are subglottic and transglottic extension of the laryngeal tumor, as well as direct invasion of the thyroid cartilage. Preservation of thyroid tissue during laryngectomy significantly reduces postoperative morbidity, however, thyroidectomy may be indicated if the presence of risk factors for thyroid invasion is assessed based on clinical, radiological and intraoperative findings. A careful assessment of risk factors is necessary to avoid the occurrence of locoregional recurrence, and thus a significantly worse prognosis.
References
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11. Vitamog MCF, Castañeda SS. Thyroid Gland Invasion in Laryngeal Carcinoma. Philippine Journal of Otolaryngology Head and Neck Surgery. 2017;32(02):22–24.
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13. Donnelly MJ, O’Meara N, O’Dwyer TP. Thyroid dysfunction following combined therapy for laryngeal carcinoma. Clin Otolaryngol Allied Sci 1995; 20(03):254–257.
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27. Dogan TN, Tuna EÜ, Acar A, Çay¨onü M, Boynue˘gri S, Gülten O, et al. Incidence of thyroid gland invasion in locally advanced laryngeal carcinoma, 2018; 58: 112–115.
28. Gorphe P, Ben Lakhdar A, Tao Y, et al. Evidence-based man- agement of the thyroid gland during a total laryngectomy. Laryngoscope. 2015;125(10):2317–2322.
29. Panda S, Kumar R, Konkimalla A, et al. Rationale behind thyroidectomy in total laryngectomy: analysis of endocrine insufficiency and oncological outcomes. Indian J Surg Oncol. 2019;10(4):608–613.
30. El-Sebai Ali M, Atef Ebada H, El-Shaheed MA, Musaad AbdElFattah A, Kamal ES. Routine thyroidectomy with total laryngectomy: Is it really indicated? A randomized controlled trial. Ann Med Surg (Lond). 2022; 74:103309.
31. Brennan AJ, Meyers AD, Jafek BW. The intraoperative management of the thyroid gland during laryngectomy. Laryngoscope. 1991; 101:929-34.
32. Iype EM, Jagad V, Nochikattil SK, Varghese BT, Sebastian P. Thyroid Gland Involvement in Carcinoma Larynx and Hypopharynx-Predictive Factors and Prognostic Significance. J Clin Diagn Res. 2016;10(2): XC05-XC07.
33. Gürbüz MK, Açıkalın M, Tasar S, H. Çaklı G. Yorulmaz M. Erdinç M, et al., Clinical effectiveness of thyroidectomy on the management of locally advanced laryngeal cancer, Auris Nasus Larynx. 2014; 41: 69–75.
34. Mourad M, Saman M, Sawhney R, Ducic Y, Management of the thyroid gland during total laryngectomy in patients with laryngeal squamous cell carcinoma, Laryngoscope 2015; 125: 1835–1838.
35. Agarwal V, IVBF. Branstetter, JT. Johnson, Indications for PET/CT in the head and neck, Otolaryngol, Clin. North Am. 2008; 41(1): 23–49.
36. Plaat RE, van Dijk BA, Muller Kobold AC, Steenbakkers RJ, Links TP, van der Laan BF, et al., Onset of Hypothyroidism after Total Laryngectomy: Effects of Thyroid Gland Surgery and Preoperative and Postoperative Radiotherapy, Head Neck, 2020; 42(4): 636–644.
37. Ho ACW, Ho WK, Lam PKY, Yuen APW, Wei WI, Thyroid dysfunction in laryngectomies 10 years after treatment, Head Neck. 2008; 30: 336–340.
38. Galbo AML, Kuik DJ, Lips P, Von Blomberg BME, Bloemena E, Leemans CR, et al. A prospective longitudinal study on endocrine dysfunction following treatment of laryngeal or hypopharyngeal carcinoma, Oral Oncol. 2013; 49: 950–955.
39. Muhammad T, Dhanani R, Mohtasham S, Hussain M, Faisal M, Malik KI, et al. Incidence of thyroid gland invasion in advanced laryngeal cancers and its impact on disease-specific survival; a retrospective review at a tertiary care center. Acta Otolaryngol. 2020; 140(10):882-885.
40. Vermund H, Krajci P, Eide TJ, Winther F. Laryngectomy whole organ serial sections–histological parameters correlated with recurrence rate. Acta Oncol 2004; 43(01):98–107
41. Nayak SP, Singh V, Dam A, et al. Mechanism of thyroid gland invasion in laryngeal cancer and indications for thyroidectomy. Indian J Otolaryngol Head Neck Surg. 2013; 65:69–73.
42. Li S, Polacco M, Gosselin B, Harrington L, Titus A, Paydarfar J, Management of the thyroid gland during laryngectomy, J. Laryngol. Otol. J. 2017; 131: 740–744.
43. McGuire JK, Viljoen G, Rocke J, Fitzpatrick S, Dalvie S, Fagan JJ, Does thyroid gland preserving total laryngectomy affect oncological control in laryngeal carcinoma? Laryngoscope. 2019; 1–5.
44. Isaacson SR, Snow JB. Etiologic factors in hypocalcemia secondary to operations for carcinoma of the pharynx and larynx. Laryngoscope. 1978; 88: 1290-1299.
45. Fagan J, Kaye P. Management of the thyroid gland with laryngectomy for cT3 glottic carcinomas. Clin Otolaryngol Allied Sci. 1997; 22(1):7–12.
46. Orloff LA, Wiseman SM, Bernet VJ, et al. American thyroid association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid. 2018; 28(7):830-841.
2. Gilbert RW, Cullen RJ, van Nostrand AW, Bryce DP, Harwood AR. Prognostic significance of thyroid gland involvement in laryngeal carcinoma. Arch Otolaryngol Head Neck Surg 1986;112(08): 856–859.
3. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93-99.
4. Elliott MS, Odell EW, Tysome JR, et al. Role of thyroidectomy in advanced laryngeal and pharyngolaryngeal carcinoma. Otolaryngol Head Neck Surg 2010;142(06):851–855
5. Dadas B, Uslu B, Cakir B, Ozdoğan HC, Caliş AB, Turgut S. Intraoperative management of the thyroid gland in laryngeal cancer surgery. J Otolaryngol 2001;30(03):179–183
6. Croce A, Moretti A, Bianchedi M. [Thyroid gland involvement in cancer of the larynx]. Acta Otorhinolaryngol Ital 1991;11(04): 429–435.
7. Al-Hakami HA, Al Garni MA, Al Subayea H, Al Otaibi Y, Neazy A, Jameel W, et al. The incidence of thyroid gland invasion in advanced laryngeal squamous cell carcinoma. Braz J Otorhinolaryngol. 2021;87(5):533-537.
8. Mawaddah A, See-Sze S, Marina M, Pua K, Abdullah-Sani M. The Incidence of Thyroid Gland Invasion in Patients with Carcinoma of the Larynx who Underwent Total Laryngectomy. Int Med J Malays. 2019;18(01): 13-20.
9. Arslanoğlu S, Eren E, Özkul Y, et al. Management of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2016;273(02): 511–515.
10. Holgado JWA, Grullo PER, Gloria JDLS, Pontejos AQY Jr. Thyroid Gland Involvement in Advanced Laryngeal Squamous Cell Carcinoma. Acta Med Philipp 2017; 51 (1): 11-13.
11. Vitamog MCF, Castañeda SS. Thyroid Gland Invasion in Laryngeal Carcinoma. Philippine Journal of Otolaryngology Head and Neck Surgery. 2017;32(02):22–24.
12. Pfister DG, Spencer S, Adelstein D, Adkins D, Anzai Y, Brizel DM, et al. Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2020;18(7):873-898.
13. Donnelly MJ, O’Meara N, O’Dwyer TP. Thyroid dysfunction following combined therapy for laryngeal carcinoma. Clin Otolaryngol Allied Sci 1995; 20(03):254–257.
14. Kim JW, Han GS, Byun SS, Lee DY, Cho BH, Kim Y-M. Management of thyroid gland invasion in laryngopharyngeal cancer. Auris Nasus Larynx 2008; 35(02):209–212.
15. Al-Khatib T, Mendelson AA, Kost K, et al. Routine thyroidectomy in total laryngectomy: is it really indicated? J Otolaryngol Head Neck Surg 2009; 38(05):564–567.
16. Jackson C, Babcock W. Laryngectomy for carcinoma of the larynx. Surg Clin North Am. 1931; 11:1207.
17. J.H. Ogura, Surgical pathology of cancer of the larynx, Laryngoscope. 1955; 65: 867–926.
18. Harrison D. Thyroid gland in the management of laryngophar- yngeal cancer. Arch Otolaryngol. 1973; 97(4):301–302.
19. Biel MA, Maisel RH. Indications for performing hemithyroidectomy for tumors requiring total laryngectomy. Am J Surg 1985; 150(04): 435–439.
20. Allen E, Fingeret A. Anatomy, Head and Neck, Thyroid. 2023 Jul 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–
21. Yeager VL, Archer CR. Anatomical routes for cancer invasion of laryngeal cartilages. Laryngoscope. 1982; 92:449-52.
22. Nakayama M. Clinical underestmation of laryngeal cancer. Arch Otolaryngol Head Neck Surg. 1993;119: 950-7.
23. Joshi P, Nair S, Chaturvedi P, Nair D, Shivakumar T, D'Cruz AK. Thyroid gland involvement in carcinoma of the hypopharynx. J Laryngol Otol. 2014;128(1):64-7.
24. Aghazadeh K, Dabiri Satri S, Sharifi A, Lotfi M, Maraghehpour B, Hashemiaghdam A. Predictors of Thyroid Gland Invasion in Laryngeal Squamous Cell Carcinoma. Iran J Otorhinolaryngol. 2018; 30(98):153-158.
25. Mendelson AA, Al-Khatib TA, Julien M, Payne RJ, Black MJ, Hier MP, Thyroid gland management in total laryngectomy: meta-analysis and surgical recommendations, Otolaryngol. Head Neck Surg. 2009; 140: 298–305.
26. Kumar R, Drinnan M, Robinson M, Meikle D, F. Stafford F, Welch AA, et al., Thyroid gland invasion in total laryngectomy and total laryngopharyngectomy: a systematic review and meta-analysis of the English literature, Clin. Otolaryngol. 38 (2013) 372–378.
27. Dogan TN, Tuna EÜ, Acar A, Çay¨onü M, Boynue˘gri S, Gülten O, et al. Incidence of thyroid gland invasion in locally advanced laryngeal carcinoma, 2018; 58: 112–115.
28. Gorphe P, Ben Lakhdar A, Tao Y, et al. Evidence-based man- agement of the thyroid gland during a total laryngectomy. Laryngoscope. 2015;125(10):2317–2322.
29. Panda S, Kumar R, Konkimalla A, et al. Rationale behind thyroidectomy in total laryngectomy: analysis of endocrine insufficiency and oncological outcomes. Indian J Surg Oncol. 2019;10(4):608–613.
30. El-Sebai Ali M, Atef Ebada H, El-Shaheed MA, Musaad AbdElFattah A, Kamal ES. Routine thyroidectomy with total laryngectomy: Is it really indicated? A randomized controlled trial. Ann Med Surg (Lond). 2022; 74:103309.
31. Brennan AJ, Meyers AD, Jafek BW. The intraoperative management of the thyroid gland during laryngectomy. Laryngoscope. 1991; 101:929-34.
32. Iype EM, Jagad V, Nochikattil SK, Varghese BT, Sebastian P. Thyroid Gland Involvement in Carcinoma Larynx and Hypopharynx-Predictive Factors and Prognostic Significance. J Clin Diagn Res. 2016;10(2): XC05-XC07.
33. Gürbüz MK, Açıkalın M, Tasar S, H. Çaklı G. Yorulmaz M. Erdinç M, et al., Clinical effectiveness of thyroidectomy on the management of locally advanced laryngeal cancer, Auris Nasus Larynx. 2014; 41: 69–75.
34. Mourad M, Saman M, Sawhney R, Ducic Y, Management of the thyroid gland during total laryngectomy in patients with laryngeal squamous cell carcinoma, Laryngoscope 2015; 125: 1835–1838.
35. Agarwal V, IVBF. Branstetter, JT. Johnson, Indications for PET/CT in the head and neck, Otolaryngol, Clin. North Am. 2008; 41(1): 23–49.
36. Plaat RE, van Dijk BA, Muller Kobold AC, Steenbakkers RJ, Links TP, van der Laan BF, et al., Onset of Hypothyroidism after Total Laryngectomy: Effects of Thyroid Gland Surgery and Preoperative and Postoperative Radiotherapy, Head Neck, 2020; 42(4): 636–644.
37. Ho ACW, Ho WK, Lam PKY, Yuen APW, Wei WI, Thyroid dysfunction in laryngectomies 10 years after treatment, Head Neck. 2008; 30: 336–340.
38. Galbo AML, Kuik DJ, Lips P, Von Blomberg BME, Bloemena E, Leemans CR, et al. A prospective longitudinal study on endocrine dysfunction following treatment of laryngeal or hypopharyngeal carcinoma, Oral Oncol. 2013; 49: 950–955.
39. Muhammad T, Dhanani R, Mohtasham S, Hussain M, Faisal M, Malik KI, et al. Incidence of thyroid gland invasion in advanced laryngeal cancers and its impact on disease-specific survival; a retrospective review at a tertiary care center. Acta Otolaryngol. 2020; 140(10):882-885.
40. Vermund H, Krajci P, Eide TJ, Winther F. Laryngectomy whole organ serial sections–histological parameters correlated with recurrence rate. Acta Oncol 2004; 43(01):98–107
41. Nayak SP, Singh V, Dam A, et al. Mechanism of thyroid gland invasion in laryngeal cancer and indications for thyroidectomy. Indian J Otolaryngol Head Neck Surg. 2013; 65:69–73.
42. Li S, Polacco M, Gosselin B, Harrington L, Titus A, Paydarfar J, Management of the thyroid gland during laryngectomy, J. Laryngol. Otol. J. 2017; 131: 740–744.
43. McGuire JK, Viljoen G, Rocke J, Fitzpatrick S, Dalvie S, Fagan JJ, Does thyroid gland preserving total laryngectomy affect oncological control in laryngeal carcinoma? Laryngoscope. 2019; 1–5.
44. Isaacson SR, Snow JB. Etiologic factors in hypocalcemia secondary to operations for carcinoma of the pharynx and larynx. Laryngoscope. 1978; 88: 1290-1299.
45. Fagan J, Kaye P. Management of the thyroid gland with laryngectomy for cT3 glottic carcinomas. Clin Otolaryngol Allied Sci. 1997; 22(1):7–12.
46. Orloff LA, Wiseman SM, Bernet VJ, et al. American thyroid association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid. 2018; 28(7):830-841.
Published
2025/10/30
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