Lee Yi-Chan, Fang Tuan-Jen, Lin Cheng-Tao
1 Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital , Taipei, Taiwan .
J Palliat Med. 2014 Jul;17(7):867-9. doi: 10.1089/jpm.2014.0077.
The aim was to achieve endoscopic debulking surgery with regional low-dose radiotherapy as an alternative to tracheostomy for the management of metastatic endoluminal laryngeal tumor.
Endometrial adenocarcinoma rarely metastasizes to the head and neck region. Laryngeal metastases from endometrial adenocarcinoma are even rarer and usually indicate widespread disease. We present the case of a 55-year-old Asian woman with endometrial adenocarcinoma. She received radical surgical treatment and postoperative radiotherapy in April 2009. Fifteen months later, a solitary pulmonary lingual lobe metastasis was found and lobectomy was performed. The patient had hemoptysis another 15 months later, and a laryngeal endoluminal tumor was found by bronchoscopic examination. To prevent upper airway compromise, we performed transoral endoscopic debulking surgery with postoperative regional low-dose radiotherapy, instead of traditional tracheostomy. The patient underwent palliative chemotherapy after the surgery. After the intervention, the patient lived 19 months without upper airway obstruction.
According to the literature reviewed, this is the first case of endometrial adenocarcinoma with metastasis to the larynx. We here present this unique case and provide a less invasive treatment for upper airway obstruction. Without a tracheostoma, the patient's quality of life was greatly improved. Moreover, there was a reduced risk of lower airway infection.
We suggest endoscopic debulking surgery with regional low-dose radiotherapy as an alternative to tracheostomy for the management of metastatic endoluminal laryngeal tumors.
旨在实现内镜下减瘤手术联合局部低剂量放疗，以此作为气管切开术的替代方案，用于治疗转移性喉腔内肿瘤。
子宫内膜腺癌很少转移至头颈部区域。子宫内膜腺癌的喉转移更为罕见，通常提示疾病广泛播散。我们报告一例55岁的亚洲女性子宫内膜腺癌患者。她于2009年4月接受了根治性手术治疗及术后放疗。15个月后，发现孤立性肺舌叶转移并进行了肺叶切除术。又过了15个月，患者出现咯血，经支气管镜检查发现喉腔内肿瘤。为防止上呼吸道梗阻，我们实施了经口内镜下减瘤手术并术后进行局部低剂量放疗，而非传统的气管切开术。术后患者接受了姑息化疗。干预后，患者存活19个月，未出现上呼吸道梗阻。
根据所查阅的文献，这是首例子宫内膜腺癌转移至喉部的病例。我们在此展示这一独特病例，并为上呼吸道梗阻提供了一种侵入性较小的治疗方法。患者未行气管造口，生活质量得到极大改善。此外，下呼吸道感染风险降低。
我们建议内镜下减瘤手术联合局部低剂量放疗可作为气管切开术的替代方案，用于治疗转移性喉腔内肿瘤。
