Treatment

Verrucous carcinoma may be treated by excision (by laser or surgery), and by radiotherapy. It appears that surgery is a more effective treatment for VC [236, 274]. Hagen et al. reported a 92.4% cure rate for primary surgery in patients with laryngeal VC [145]. In contrast, Ferlito and Recher reported a 29% cure rate for radiotherapy in laryngeal VC [107]. Other studies have shown a 46-57% rate of failure for primary radiation therapy in VCs [224, 243, 353].

Furthermore, early reports suggested anaplastic transformation following radiotherapy [95, 107, 145,

Fig. 1.16. Papillary squamous cell carcinoma. a Tumour consists of papillae with a central fibrovascular core, covered by neo-plastic squamous epithelium. b The covering epithelium is composed of pleomorphic cells resembling carcinoma in situ

Fig. 1.16. Papillary squamous cell carcinoma. a Tumour consists of papillae with a central fibrovascular core, covered by neo-plastic squamous epithelium. b The covering epithelium is composed of pleomorphic cells resembling carcinoma in situ

278, 287, 309]. However, recent studies do not support this notion. It appears that some of the reported cases of transformation of VC to SCC after radiotherapy were of mixed (hybrid) tumours. Moreover, similar transformation can also occur after surgical treatment of VC [237, 240, 275, 353]. Radiotherapy is now believed to be an appropriate mode of treatment for oral VC [177] and laryngeal VC [275].

In his original report, Ackerman noted metastasis in the regional lymph node in only one of the 31 patients, and no distant spread was observed in his series [5]. Further studies confirmed his observation that pure VCs do not metastasise [107, 274]; cases of VC with metastases were really a hybrid carcinoma that had not been detected at initial biopsy.

Verrucous carcinomas therefore have a good prognosis; the overall 5-year survival rate is 77% [196]. It is important to recognise hybrid tumours, as foci of a conventional SCC in a VC indicate the potential for metastasis. Orvidas et al. reported that a patient with a hybrid carcinoma of the larynx died of the disease [274]. Patients with hybrid carcinomas must be treated aggressively as if they had a conventional SCC [274].

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