retinol-palmitate and Laryngeal-Neoplasms

Laryngeal leukoplakia can be a premalignant precursor of squamous cell carcinoma, is often tobacco-related and can usually be readily monitored by indirect laryngoscopy. One of the main motivations for using retinyl palmitate in patients with persistent leukoplakia was to avoid general anesthesia for elderly patients, who are considered to be high-risk patients when direct larynoscopy is required for possible tissue biopsy. Our study was the first to investigate the effectiveness and toxicity of high-dose retinyl palmitate in the treatment of laryngeal leukoplakia. Treatment was divided into two phases. In the first phase, all patients underwent induction therapy with 300,000 IU/day of retinyl palmitate for the 1st week, which was then adjusted up to 1,500,000 IU/day in the 5th week in patients with resistant lesions. Patients whose lesions progressed during this period were withdrawn from the study. In the second phase, patients whose lesions responded to treatment or remained stable were assigned to a maintenance therapy of 150,000 IU/day. Complete remission was observed in 15 of 20 patients (75% of cases). Partial response was seen in the remaining 5 patients, with 3 of the patients relapsing. The median duration of treatment and follow-up was 18 months (range, 12-24 months). These results indicate that retinyl palmitate has substantial activity in laryngeal leukoplakias. Since only minor side effects were seen, the medication is an excellent candidate as a preventive agent for laryngeal cancer.

Topics: Aged; Aged, 80 and over; Alcohol Drinking; Anticarcinogenic Agents; Biopsy; Carcinoma in Situ; Carcinoma, Squamous Cell; Disease Progression; Diterpenes; Female; Follow-Up Studies; Humans; Hyperplasia; Laryngeal Neoplasms; Laryngoscopy; Leukoplakia; Male; Middle Aged; Neoplasm Recurrence, Local; Precancerous Conditions; Remission Induction; Retinyl Esters; Smoking; Vitamin A

Leukoplakia, a white patch in the oral cavity or in the larynx that cannot be scraped off is a premalignant precursor of squamous cell carcinoma. It is tobacco-related and easily monitored. The rate of transformation of leukoplakia into invasive cancer is directly related to the degree of histologic abnormality. In the largest and longest study in the United States (mean follow-up, 7.2 years), the long-term transformation rate for dysplastic lesions was 36%. Surgical removal is considered the best therapy. However many patients operated on for oral leukoplakia later develop local relapses, new leukoplakias, or squamous cell carcinoma. Although leukoplakia lesions can show spontaneous regression, the response rate observed under treatment of retinoids is much greater.. In our study, high-dose retinyl palmitate was used for the first time on leukoplakias of the larynx. The study was conducted in two phases. In the first phase, all patients underwent induction therapy with a high dose of Retinyl Palmitate (A-Mulsin Hochkonzentrat, Mucos Pharma, Geretsried, Germany) 300.000 IU daily for the first week up to 1,500,000 IU daily in the fifth week. Patients whose lesions progressed during this period were withdrawn from the study. In the second phase, patients whose lesions responded to treatment or remained stable were then assigned to a maintenance therapy. The median duration of treatment was 104 days (range 15-272).. We observed a complete remission rate of 65% (20 out of 31 patients), a partial remission in 8 patients (26%) and a relaps in three patients (9%) during the next 15 months follow-up. Relapses were mainly seen in patients with a history of a carcinoma in situ or squamous cell carcinoma.. One of the main reasons for using retinyl palmitate in patients with larynx leukoplakia was to avoid general anesthesia in elderly patients who were considered as high risk patients for undergoing surgery. These results indicate that retinyl palmitate has substantial activity in larynx premalignancy. Because of its minor toxicity, it is an excellent candidate for a preventive agent for larynx cancer.

Topics: Aged; Aged, 80 and over; Anticarcinogenic Agents; Cell Transformation, Neoplastic; Diterpenes; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Laryngeal Neoplasms; Larynx; Leukoplakia; Male; Middle Aged; Retinyl Esters; Vitamin A

FAR therapy is effective for cancers of the head and neck, in particular laryngeal cancer. This combined chemoradiotherapy consists of 5-FU, vitamin A and radiation. We found 10% stomal recurrences in reviewing 112 patients who had been treated with total laryngectomy. Stomal recurrences after total laryngectomy occur frequently in patients undergoing an emergency tracheotomy. We studied 33 such patients divided into 2 groups, on the basis of whether laryngectomy had been carried out after the emergency tracheotomy plus preoperative FAR therapy, or whether laryngectomy had been carried out without preoperative FAR therapy. The incidence of stomal recurrence was less among those given preoperative FAR therapy and was statistically significant. Such being the case, preoperative FAR therapy seems to e prophylactically effective against stomal recurrence after emergency tracheotomy.

Topics: Combined Modality Therapy; Diterpenes; Fluorouracil; Humans; Laryngeal Neoplasms; Laryngectomy; Neoplasm Recurrence, Local; Preoperative Care; Radiotherapy Dosage; Retinyl Esters; Tracheotomy; Vitamin A