Kizim Y. Clinical and morphological substantiation of Anti-Reflux therapy in patients with squamous cell carcinoma of the larynx stage I-II T1-2N0M0 in association with laryngopharyngeal reflux

Laryngopharyngeal reflux (LPR) is a pathological condition during which backflow of stomach contents into the laryngopharynx on esophageal structures. It is also hypothesized that LPR is one of the causal risk factors for laryngeal cancer. Squamous cell carcinomas of the head and neck, including laryngeal cancer, are the 6th most common according to world statistics in developed countries. Despite the improvement of local control and survival with the use of combined chemotherapy, local recurrences are registered in ≈30-40% of patients, and in 20-30% of cases metastasis occurs. In the modern medical literature there is limited information on the assessment of the relationship between LPR and laryngeal cancer. The dissertation is devoted to the problem of increasing the efficiency of diagnosis and treatment of patients with stage I-II laryngeal cancer of the larynx in association with LPR. Aim: to increase the effectiveness of diagnosis and treatment of patients with squamous cell carcinoma of the larynx stage I-II in association with LPR. The first time the frequency of LPR in patients with stage I-II laryngeal cancer was studied using daily pH-monitoring and questionnaires based on modified visual-analog scales The Reflux Symptom Index (RSI) and The Reflux Finding Score (RFS). The RSI is a highly reliable method of screening for LPR in patients with laryngeal cancer. Features of the pathomorphological picture of squamous cell carcinoma of the larynx of stage I-II in association with LPR were determined. Based on pathomorphological studies, it was found that LPR is associated with the development of a chronic inflammatory process in the laryngeal mucosa and the stimulation of hyperplasia of the integumentary epithelium. The infiltration of the mucosa by M2 macrophages in the presence of a significant number of T-regulatory cells registered under conditions of LPR indicates the influence of LPR on the polarization of the immune response, which may create preconditions for the development of squamous cell carcinoma of the larynx. Based on the obtained data, a program of differentiated treatment of patients with stage I-II laryngeal cancer in association with LPR was developed. The application of the developed therapeutic and diagnostic algorithm for patients with squamous cell carcinoma of the larynx stage I-II in association with LPR can increase the effectiveness of diagnosis and treatment by reducing the number of relapses. Clinical approbation of the obtained results showed practical significance in improving the effectiveness of diagnosis and treatment of patients with squamous cell carcinoma of the larynx stage I-II in association with LPR.