Should patients with laryngeal small cell neuroendocrine carcinoma receive prophylactic cranial irradiation?

Eur Arch Otorhinolaryngol. 2016 Oct;273(10):2925-30. doi: 10.1007/s00405-015-3799-y. Epub 2015 Nov 3.


While small cell neuroendocrine carcinomas (SCNCs) most often arise in the lung, extrapulmonary SCNCs arise in a variety of locations-including the head and neck region. In particular, laryngeal SCNCs-while rare tumors-are nevertheless recognized as distinct lesions. The rarity of laryngeal SCNC gives rise to two distinct difficulties: first (particularly with small biopsy specimens), laryngeal SCNC can be difficult to diagnose by routine light microscopy; second, limited experience with these tumors can make the crafting of a treatment plan for individual patients difficult. As regards the first problem, pathologic diagnosis is greatly enhanced by the application of immunohistochemistry. The second problem-crafting a successful treatment strategy-presents a much larger difficulty. It is tempting to extrapolate from experience with the (more common) pulmonary SCNC in search of a strategy applicable to laryngeal SCNC; such an extrapolation, however, may not be uniformly successful. In particular, while a combination of radiation therapy and chemotherapy appears to be as valuable in the treatment of extrapulmonary as it is in the treatment of pulmonary SCNC, prophylactic cranial irradiation (PCI)-which has enjoyed some success in the treatment of some patients with pulmonary SCNC-does not appear to have similar utility in patients with laryngeal SCNC. Accordingly, the use of PCI does not appear to have a role to play at this point in time in the treatment of patients with laryngeal SCNC.

Keywords: Brain metastases; Extrapulmonary small cell neuroendocrine carcinoma; Larynx; Neuroendocrine neoplasms; Prophylactic cranial irradiation.

Publication types

  • Review

MeSH terms

  • Brain Neoplasms / prevention & control*
  • Brain Neoplasms / secondary
  • Carcinoma, Neuroendocrine / pathology
  • Carcinoma, Neuroendocrine / prevention & control*
  • Carcinoma, Neuroendocrine / secondary
  • Carcinoma, Small Cell / pathology
  • Carcinoma, Small Cell / prevention & control*
  • Carcinoma, Small Cell / secondary
  • Cranial Irradiation*
  • Humans
  • Immunohistochemistry
  • Laryngeal Neoplasms / pathology*
  • Male
  • Middle Aged