Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A.
Department of Otolaryngology/Head and Neck Surgery, Weill-Cornell Medical College, New York City, New York, U.S.A.
Laryngoscope. 2021 Aug;131(8):1810-1815. doi: 10.1002/lary.29061. Epub 2020 Oct 3.
Laryngeal amyloidosis (LA) is a rare disease characterized by extracellular protein deposition within the larynx. Treatment is difficult due to the frequently submucosal and multifocal nature of disease. The mainstay of treatment is surgical resection; however, recurrence rates are high. Recently, use of radiotherapy (RT), either alone or postoperatively, for LA has been adapted from the management of extramedullary plasmacytoma and has been shown to provide local disease control. Here, we describe the experience with adjuvant RT for LA at our center.
Retrospective case series.
Retrospective study of patients with amyloidosis of the larynx, with or without other disease sites, seen at a tertiary academic center between 2011 and 2019. Outcomes included disease characteristics, recurrence rates, treatment modalities, and pre- and posttreatment voice handicap index (VHI)-10.
Ten patients met eligibility criteria. Mean follow-up time for all patients was 62.0 ± 41.0 months; mean follow-up time after last treatment was 51 ± 55 months. All but one patient underwent surgical resection of disease. Seven patients underwent subsequent RT. Of these seven, six underwent RT at our institution; five received a dose of 45 Gray (Gy); and one received a dose of 20 Gy. All seven completed RT without toxicity-related interruption. Patients undergoing RT underwent 2.1 ± 1.3 surgical procedures prior to RT; no patients required surgery after RT. Mean pretreatment VHI-10 was 22.9 ± 8.1; mean posttreatment VHI-10 was 12.9 ± 13.3.
RT after surgery for LA can provide good local control without unacceptable toxicity and may decrease the need for further surgery.
4 Laryngoscope, 131:1810-1815, 2021.
喉淀粉样变性（LA）是一种罕见疾病，其特征为喉部细胞外蛋白沉积。由于疾病常呈黏膜下和多灶性，治疗较为困难。治疗的主要方法是手术切除，但复发率较高。最近，放疗（RT）单独或术后用于 LA 的治疗方法已从治疗髓外浆细胞瘤中借鉴而来，并已显示出可提供局部疾病控制。在此，我们描述了我们中心使用辅助 RT 治疗 LA 的经验。
回顾性病例系列。
回顾性研究 2011 年至 2019 年间在三级学术中心就诊的有或无其他疾病部位的喉淀粉样变性患者。结果包括疾病特征、复发率、治疗方式以及治疗前后嗓音障碍指数（VHI）-10。
10 名患者符合入选标准。所有患者的中位随访时间为 62.0±41.0 个月；末次治疗后中位随访时间为 51±55 个月。除 1 例患者外，所有患者均接受了疾病的手术切除。7 例患者随后接受了 RT。其中 6 例在我院接受 RT，5 例接受 45Gy 剂量，1 例接受 20Gy 剂量。所有 7 例患者均顺利完成 RT，无因毒性相关中断治疗的情况。行 RT 的 7 例患者在 RT 前接受了 2.1±1.3 次手术；无患者在 RT 后需要手术。治疗前的平均 VHI-10 为 22.9±8.1，治疗后的平均 VHI-10 为 12.9±13.3。
LA 手术后行 RT 可提供良好的局部控制，且毒性可接受，可能减少对进一步手术的需求。
4 Laryngoscope, 131:1810-1815, 2021.
