1
|
Raad RA, Holland K, Ritz EM, Tajudeen BA, Al-Khudari S, Stenson K, Teitcher J, Fidler MJ, Jelinek M, Joshi N, Bhayani MK. A nationwide analysis of salvage surgery for laryngeal cancer in the elderly. Head Neck 2023; 45:2915-2924. [PMID: 37738087 DOI: 10.1002/hed.27525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/13/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND We aim to describe outcomes of elderly patients undergoing salvage surgery for laryngeal cancer and to characterize the interplay of age with various other factors in this growing population. METHODS Using the National Cancer Database, we identified cases of salvage laryngectomy in patients who failed chemoradiation. An age cutoff of 70 years was used to separate subjects into two groups. Various factors were compared. RESULTS Of the 825 patients included, 166 (20.1%) were elderly. Elderly patients had worse overall survival (p = 0.001), higher 30-day and 90-day mortality (p = 0.006, p < 0.001), and a longer length of stay (LOS) (p = 0.015). LOS over 1 week was associated with worse survival (p = 0.032). CONCLUSION Elderly patients had worse overall perioperative survival than their younger counterparts. LOS and 30-day readmissions were associated with higher risk of mortality in this group. We provide a contemporary set of relevant information for head and neck cancer providers to consider in this growing population.
Collapse
Affiliation(s)
- Richard A Raad
- Department of Otorhinolaryngology-Head & Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Katie Holland
- Department of Otorhinolaryngology-Head & Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ethan M Ritz
- Rush University Bioinformatics and Biostatistics Core, Rush University, Chicago, Illinois, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head & Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Samer Al-Khudari
- Department of Otorhinolaryngology-Head & Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kerstin Stenson
- Department of Otorhinolaryngology-Head & Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua Teitcher
- Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, Illinois, USA
| | - Mary Jo Fidler
- Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Jelinek
- Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil Joshi
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Mihir K Bhayani
- Department of Otorhinolaryngology-Head & Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
2
|
Hartl DM, Guerlain J, Gorphe P, Kapre M, Kapre Gupta N, Saba NF, Robbins KT, Ronen O, Rodrigo JP, Strojan P, Mäkitie AA, Kowalski LP, Shah JP, Ferlito A. Review of Outcomes after Salvage Surgery for Recurrent Squamous Cell Carcinoma of the Head and Neck. Cancers (Basel) 2023; 15:4692. [PMID: 37835386 PMCID: PMC10571840 DOI: 10.3390/cancers15194692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Surgery with adjuvant chemoradiotherapy or chemoradiotherapy is the mainstay in treatment for advanced stage head and neck squamous cell carcinoma; however, locoregional recurrences are frequent. Salvage surgery could be proposed in selected patients to improve local control, disease-free, and overall survival. Factors for improved disease-free and overall survival in patients treated with salvage surgery include age, tumor location, the initial T stage, HPV status, resection margins, and the time elapsing from the initial treatment. Clinical trials with adjuvant therapies have shown promise after salvage surgery in terms of tolerance and response, but clinical guidelines for using these adjuvant treatments are currently lacking. The aim of this review is to present current knowledge concerning the incidence and management of recurrent head and neck squamous cell carcinoma and current data concerning survival and morbidity after salvage surgery.
Collapse
Affiliation(s)
- Dana M. Hartl
- Department of Anesthesia, Surgery, and Interventional Radiology, Head and Neck Oncology Service, 94805 Villejuif, France
| | - Joanne Guerlain
- Department of Anesthesia, Surgery, and Interventional Radiology, Head and Neck Oncology Service, 94805 Villejuif, France
| | - Philippe Gorphe
- Department of Anesthesia, Surgery, and Interventional Radiology, Head and Neck Oncology Service, 94805 Villejuif, France
| | - Madan Kapre
- Department of ENT and Head Neck Surgery, Neeti Clinics Nagpur, Nagpur 440010, India
| | - Neeti Kapre Gupta
- Department of ENT and Head Neck Surgery, Neeti Clinics Nagpur, Nagpur 440010, India
| | - Nabil F. Saba
- The Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - K. Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University Medical School, Springfield, IL 62703, USA
| | - Ohad Ronen
- Department of Otolaryngology—Head and Neck Surgery, Galilee Medical Center Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed 5290002, Israel
| | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, IUOPA, ISPA, CIBERONC, 33204 Oviedo, Spain
| | - Primož Strojan
- Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology—Head and Neck Surgery, Research Program in Systems Oncology, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland
| | - Luiz P. Kowalski
- Head and Neck Surgery Department, University of São Paulo Medical School, Sao Paulo 05403-000, Brazil
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, Sao Paulo 01509-001, Brazil
| | - Jatin P. Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy
| |
Collapse
|
3
|
Şener GY, Sütcüoğlu O, Öğüt B, Güven DC, Kavuncuoğlu A, Özdemir N, Özet A, Aksoy S, Tezel YGG, Akyürek N, Yazıcı O. Comparison of PD-L1 and VISTA expression status in primary and recurrent/refractory tissue after (chemo)radiotherapy in head and neck cancer. Strahlenther Onkol 2023; 199:761-772. [PMID: 36862156 DOI: 10.1007/s00066-023-02053-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/29/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND PD-L1 and VISTA are thought to play a role in escape from the immune system, tumor progression, and treatment response in tumoral tissue. The current study aimed to evaluate the effects of radiotherapy (RT) and chemoradiotherapy (CRT) on PD-L1 and VISTA expression in head and neck cancers. METHODS PD-L1 and VISTA expression were compared between the primary biopsy taken at the time of diagnosis and refractory tissue biopsies of patients who received definitive CRT or recurrent tissue biopsies of patients who had surgery followed by adjuvant RT or CRT. RESULTS In total, 47 patients were included. Radiotherapy had no effect on the expression levels of PD-L1 and VISTA in patients with head and neck cancer (p = 0.542 and p = 0.425, respectively). A positive correlation was found between PD-L1 and VISTA expression (p < 0.001; r = 0.560). PD-L1 and VISTA expression in the first biopsy were found to be significantly higher in clinical lymph node-positive patients compared to node-negative patients (PD-L1 p = 0.038; VISTA p = 0.018). The median overall survival of patients with ≥ 1% VISTA expression in the initial biopsy was significantly shorter than that of patients with < 1% VISTA expression (52.4 vs. 110.1 months, respectively; p = 0.048). CONCLUSION It was found that PD-L1 and VISTA expression did not change with RT or CRT. Further studies are needed to evaluate the relationship of PD-L1 and VISTA expression with RT and CRT.
Collapse
Affiliation(s)
| | - Osman Sütcüoğlu
- Department of Medical Oncology, School of Medicine, Gazi University, Besevler/Ankara, Turkey.
| | - Betül Öğüt
- Department of Pathology, Gazi University, Ankara, Turkey
| | - Deniz Can Güven
- Department of Medical Oncology, Hacettepe University, Ankara, Turkey
| | | | - Nuriye Özdemir
- Department of Medical Oncology, School of Medicine, Gazi University, Besevler/Ankara, Turkey
| | - Ahmet Özet
- Department of Medical Oncology, School of Medicine, Gazi University, Besevler/Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University, Ankara, Turkey
| | | | - Nalan Akyürek
- Department of Pathology, Hacettepe University, Ankara, Turkey
| | - Ozan Yazıcı
- Department of Medical Oncology, School of Medicine, Gazi University, Besevler/Ankara, Turkey
| |
Collapse
|
4
|
El-Sebai Ali M, Atef Ebada H, El-Shaheed MA, Musaad AbdElFattah A, Kamal ELS. Routine thyroidectomy with total laryngectomy: Is it really indicated? A randomized controlled trial. Ann Med Surg (Lond) 2022; 74:103309. [PMID: 35145675 PMCID: PMC8818527 DOI: 10.1016/j.amsu.2022.103309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/08/2022] [Accepted: 01/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background We investigated the incidence of thyroid gland invasion in patients with advanced laryngeal carcinoma who were treated with total laryngectomy, also the impact of different preoperative and intraoperative predictors on thyroid gland invasion. Moreover, the impact of thyroid gland preservation on the locoregional tumor control and the recurrence rates after surgery were investigated. Materials and methods This study was conducted over 5 years on 100 patients with advanced laryngeal carcinoma who underwent total laryngectomy. The adopted protocol in our hospital is to perform an ipsilateral thyroid lobectomy if there is subglottic extension, thyroid or cricoid cartilage invasion or true invasion of the thyroid gland. The patients of the study were divided into thyroid sparing and thyroid sacrificing groups. The two groups were compared in terms of demographic data, tumor characteristics, incidence of postoperative hypothyroidism and tumor recurrence. Results There was no significant difference between groups regarding the tumor profile. Regarding local tumor spread, the only two subsites that showed significant difference is anterior commissure and thyroid cartilage invasion. In the thyroid sacrificing group, invasion of the thyroid gland was proved histopathologically in only one patient. Postoperatively, the incidence of hypothyroidism was significantly higher in the thyroid sacrificing group. However, there was no statistically significant difference between the two groups regarding the incidence of tumor recurrence. Conclusion The incidence of thyroid gland invasion by an advanced laryngeal carcinoma is low. Preservation of the thyroid gland during laryngectomy to reduce the risk of thyroid dysfunction does not affect the oncological control. Thyroid gland invasion incidence in advanced laryngeal carcinoma is low. Thyroid gland Preservation during laryngectomy does not affect the oncological control. There was no statistically significant difference between the thyroid sparing and thyroid sacrificing group regarding the incidence of recurrence. Due toding author”. Due toding author".
Collapse
|
5
|
Miśkiewicz-Orczyk K, Ścierski W, Lisowska G, Zięba N, Misiołek M. Factors Associated with Outcomes Following Salvage Surgery for Recurrent Laryngeal Cancer: A Retrospective Study of 50 Cases from a Single Center in Poland. Med Sci Monit 2021; 27:e932004. [PMID: 34535622 PMCID: PMC8456775 DOI: 10.12659/msm.932004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This retrospective study from a single center in Poland aimed to identify factors associated with outcomes following salvage surgery in 50 patients with recurrent laryngeal cancer. MATERIAL AND METHODS The study group consisted of 50 patients with recurrent laryngeal cancer after primary organ preservation treatment (12 patients after partial surgery, 30 patients after radiation therapy, and 8 patients after prior treatment using both methods). None of the patients received chemotherapy before salvage surgery. All patients with recurrence of laryngeal cancer underwent total laryngectomy with elective bilateral nodal surgery. Local and/or nodal recurrence was considered the failure of primary organ preservation treatment. Efficacy of treatment was assessed in relation to overall survival (OS), disease-free survival (DFS), local control (LC), and locoregional control (LRC). RESULTS Treatment results showed a poor prognosis in patients with local and/or nodal recurrence of laryngeal cancer. In the study group, the updated 5-year rates were as follows: OS rate of 26%; DFS rate of 25%; LC rate of 44%; and LRC rate of 39%. Univariate analysis showed that the stage before primary treatment was a predictive factor of OS (P=0.012). CONCLUSIONS The findings from this retrospective study of 50 patients with recurrent laryngeal carcinoma showed that salvage surgery following organ preservation treatment resulted in a 5-year OS rate of 26%.
Collapse
Affiliation(s)
- Katarzyna Miśkiewicz-Orczyk
- Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Wojciech Ścierski
- Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Grażyna Lisowska
- Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Natalia Zięba
- Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Maciej Misiołek
- Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| |
Collapse
|
6
|
León X, Montoro V, García J, López M, Farré N, Majercakova K, Gallego Ó, López-Pousa A, Quer M. Organ Preservation in Patients With Advanced Laryngeal Tumours. Results of Induction Chemotherapy Versus Chemoradiotherapy in Actual Clinical Practice. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otoeng.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
7
|
León X, Montoro V, García J, López M, Farré N, Majercakova K, Gallego Ó, López-Pousa A, Quer M. Organ preservation in patients with advanced laryngeal tumours. Results of induction chemotherapy versus chemoradiotherapy in actual clinical practice. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:143-151. [PMID: 32475610 DOI: 10.1016/j.otorri.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/19/2020] [Accepted: 02/04/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES A high percentage of patients with locally advanced larynx carcinomas are candidates for inclusion in organ preservation protocols. The objective of this study is to compare the results of two schemes of preservation, induction chemotherapy versus chemoradiotherapy, in patients with locally advanced larynx carcinomas in the context of actual clinical practice. METHODS Our retrospective study included 157 patients with locally advanced tumours of the larynx (T3-T4) treated with induction chemotherapy (n = 121) or chemoradiotherapy (n = 36). RESULTS From 121 patients who began treatment with induction chemotherapy, 6 died due to toxicity, 37 were treated with surgery, and 78 completed the preservation scheme; 36 patients received treatment with chemoradiotherapy. There were no significant differences in 5-year disease-specific survival between both treatments: 68.9% in induction chemotherapy versus 75.7% in chemoradiotherapy (p = 0.259). In 45.9% of patients the laryngeal function was preserved. Patients treated with chemoradiotherapy had a tendency to have better 5-year laryngeal dysfunction-free survival than patients treated with induction chemotherapy (55.6% versus 44.8%, p = 0.079). CONCLUSION Patients included in a protocol of organ preservation achieved a 5-year laryngeal dysfunction-free survival of 45.9%. There were no significant differences in disease-specific survival among patients treated with induction chemotherapy or chemoradiotherapy.
Collapse
Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España.
| | - Victoria Montoro
- Servicio de Otorrinolaringología, Hospital de Mollet, Mollet del Vallés, Barcelona, España
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Nuria Farré
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Katarina Majercakova
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Óscar Gallego
- Servicio de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Antonio López-Pousa
- Servicio de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España
| |
Collapse
|
8
|
Plaat RE, van Dijk BAC, Muller Kobold AC, Steenbakkers RJHM, Links TP, van der Laan BFAM, Plaat BEC. Onset of hypothyroidism after total laryngectomy: Effects of thyroid gland surgery and preoperative and postoperative radiotherapy. Head Neck 2019; 42:636-644. [PMID: 31833166 PMCID: PMC7154538 DOI: 10.1002/hed.26048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 11/03/2019] [Accepted: 12/03/2019] [Indexed: 12/22/2022] Open
Abstract
Background To determine time of onset and risk of hypothyroidism after total laryngectomy (TL) with and without (hemi)thyroidectomy in relation to treatment regimen, that is, preoperative radiotherapy (RT‐TL), postoperative radiotherapy (TL‐RT), and postoperative re‐irradiation (RT‐TL‐RT). Methods Retrospective review of 128 patients treated by RT‐TL (51 patients), TL‐RT (55 patients), and RT‐TL‐RT (22 patients). Risk of hypothyroidism was determined by multivariable Cox regression analysis and euthyroid survival was calculated using Kaplan‐Meier method. Results Hypothyroidism developed in 69 (54%) patients. The median onset of hypothyroidism was later (P < .01) and the risk of hypothyroidism was lower (hazard ratio 0.49; P = .014) in the TL‐RT group compared to both other treatment regimens. Euthyroid survival did not differ between the treatment regimens. Two years euthyroid survival was 24% with and 61% without (hemi)thyroidectomy (P < .001). Conclusions Patients treated with TL‐RT have later onset of hypothyroidism. Higher risk for hypothyroidism is associated with salvage TL after radiotherapy and (hemi)thyroidectomy.
Collapse
Affiliation(s)
- Robert E Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Boukje A C van Dijk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiotherapy, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thera P Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
9
|
Aydil U, Akmansu M, Gümüşay Ö, Eravcı FC, Bakkal FK, Yazıcı Ö, Kızıl Y, Zorlu ME, Yıldız R, Köybaşıoğlu A. Failure of Concurrent Chemoradiotherapy for Organ Preservation in Laryngeal Cancer: Survival Outcomes and Recurrence Patterns. EAR, NOSE & THROAT JOURNAL 2019; 98:E92-E96. [PMID: 30983390 DOI: 10.1177/0145561319839788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although definitive chemoradiation (CRT) has been used for locally advanced laryngeal cancer for more than 2 decades, studies focusing on CRT failures in advanced laryngeal cancer are scarce. In this study, we aimed to determine the failure patterns and the survival outcomes in the patients who had recurrence after concurrent CRT for laryngeal cancer. Clinical records of the patients who had definitive concurrent CRT for laryngeal cancer between 2001 and 2014 at a tertiary referral center were reviewed. The end points of the study were 1-, 2-, and 3-year overall survival (OS) and disease-specific survival (DSS).In our results, there were 48 failures and the mean time period from the first diagnosis of disease to the diagnosis of recurrence was 18.0 months (range 2-72; standard deviation: 15.6). The most common recurrence pattern was local recurrence in 21 (47.9%) patients followed by regional recurrence in 11 (22.9%) patients. The 1 and 3 years OS rates were 41.7%, and 19.2% for the entire cohort, and 64.5%, and 29.7% for the patients who had not systemic recurrence at presentation of recurrence, respectively. The 1 and 3 years DSS rates were 43.5%, and 20.0% for the entire cohort, and 69.0%, and 31.8% for the patients who had not systemic recurrence at presentation of recurrence, respectively. All patients who had systemic recurrence initially (n = 13) died within 9 months (median = 4 months, range: 1-9 months). This study reveals that survival outcomes are unfavorable in the CRT failures and careful patient selection is critical to minimize failures. In the presence of systemic recurrence, disease course is aggressive.
Collapse
Affiliation(s)
- Utku Aydil
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Müge Akmansu
- 2 Department of Radiation Oncology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Özge Gümüşay
- 3 Department of Medical Oncology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Fakih Cihat Eravcı
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Faruk Kadri Bakkal
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Ömer Yazıcı
- 2 Department of Radiation Oncology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Yusuf Kızıl
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Mehmet Ekrem Zorlu
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Ramazan Yıldız
- 3 Department of Medical Oncology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Ahmet Köybaşıoğlu
- 4 Department of Otorhinolaryngology, Head & Neck Surgery, Lösev Ankara Hospital, Ankara, Turkey
| |
Collapse
|
10
|
Silverman DA, Puram SV, Rocco JW, Old MO, Kang SY. Salvage laryngectomy following organ-preservation therapy – An evidence-based review. Oral Oncol 2019; 88:137-144. [DOI: 10.1016/j.oraloncology.2018.11.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 01/07/2023]
|
11
|
Modified Design of Anterolateral Thigh Flap for Total Pharyngolaryngectomy Reconstruction: A Single-Center Experience. Ann Plast Surg 2018; 81:62-67. [PMID: 29762451 DOI: 10.1097/sap.0000000000001480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Defects after total pharyngolaryngectomy for hypopharyngeal cancer often require reconstruction via free tissue transfer. Recently, anterolateral thigh (ALT) flap has become the gold standard in many centers because of its advantages with respect to versatility, minimal donor-site morbidity, good speech quality, and relatively low fistula and anastomotic leakage rates. Moreover, ALT allows 2 surgical teams to work simultaneously. However, the height of the parallelogram in the ALT design for neoesophagus reconstruction is usually set at a minimum of 9.4 cm (circumference, 2πr) for smooth food passage. Because this height exceeds 8 cm, the donor site may not be closed primarily, which highly depends on the patient's body habitus and the skin tone or quality and requires other methods, such as local flap or skin graft for wound closure, which subsequently increase operating time and donor-site complication rate. OBJECTIVES Thus, we aimed to construct a simple and modified ALT design that will not only include the advantages described earlier but also provide adequate donor-site primary closure without jeopardizing complication rates. METHODS Ten patients with hypopharyngeal cancer underwent reconstructive surgery using our modified ALT design after total pharyngolaryngectomy between 2010 and 2017. Our modified ALT design converts this "classical" shape into a parallelogram so that the height of the modified design is always less than 8 cm, thus allowing for easy primary closure of the wound. RESULTS The donor-site defects of all 10 patients were closed primarily. No donor-site complications and partial or total flap loss were observed. One patient experienced persistent wound infection with dehiscence, for which debridement was performed. The stricture and fistula rates were 10% (n = 1) and 20% (n = 2), respectively. The mean follow-up time is approximately 1 year. CONCLUSIONS Minimizing donor-site morbidity is an important goal in reconstructive surgery. Our modified ALT flap design is simple, enabling easy primary closure of the donor-site defect, with improved results for the patient and operators. Furthermore, this design is also suitable for ALT flaps with widths larger than 8 cm.
Collapse
|
12
|
Abstract
Today, most head and neck cancer subsites, such as the larynx, hypopharynx, nasopharynx, and oropharynx, are treated with radiation therapy with or without chemotherapy as a primary treatment modality. Surgery is reserved for the salvage of recurrent tumors that occur within the head and neck in the absence of distant (ie, lung, liver) metastasis. However, unlike all other head and neck subsites, oral cancer should ideally be managed with primary surgery with the possibility of adjuvant radiation therapy with or without chemotherapy depending on the presence of certain high-risk pathologic features.
Collapse
Affiliation(s)
- Rabie M Shanti
- Department of Oral and Maxillofacial Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine, 240 S 40th Street #122, Philadelphia, PA 19104, USA; Department of Otorhinolaryngology/Head and Neck Surgery, Perelman School of Medicine University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Bert W O'Malley
- Department of Otorhinolaryngology/Head and Neck Surgery, Perelman School of Medicine University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| |
Collapse
|
13
|
Systematic review and meta-analysis of the complications of salvage total laryngectomy. Eur J Surg Oncol 2017; 43:42-51. [DOI: 10.1016/j.ejso.2016.05.017] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/14/2016] [Indexed: 11/22/2022] Open
|
14
|
Chen MF, Chang JTC, Tsang NM, Liao CT, Chen WC. Radiotherapy of Early-Stage Glottic Cancer: Analysis of Factors Affecting Prognosis. Ann Otol Rhinol Laryngol 2016; 112:904-11. [PMID: 14587984 DOI: 10.1177/000348940311201014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study is a retrospective analysis of 134 patients treated with radiotherapy at our hospital. The sample included 88 stage T1 and 46 stage T2 patients. Sixty-two patients had anterior commissure involvement, 37 patients had impaired vocal cord mobility, and 24 patients had supraglottic or subglottic extension. Irradiation was given, with the dose ranging from 60 to 72 Gy. Laryngectomy was the main salvage treatment for local recurrence. The 5-year initial and final local control rates were 71% and 83%, and the 10-year initial and final local control rates were 69% and 80%, comparable to the results of other series. The 5-year rate of overall survival with final larynx preservation was 77%. Multivariate analysis revealed that anterior commissure involvement is prognostic of a poor outcome in patients with T1 glottic cancer. Further subgroup analysis revealed that a fraction size of >200 cGy could overcome the negative impact of anterior commissure involvement and significantly improve the 5-year local control rate in T1 patients (100% at >200 cGy versus 45% at ≤200 cGy; p = .04). Subglottic extension of the glottic cancer predicted poor outcome in T2 patients. The 5-year local control rates of patients with and without subglottic extension were 9% and 77%, respectively (p < .001). According to our results, radiotherapy with a fraction size of >200 cGy is recommended for T1 disease with anterior commissure involvement. For patients with T2 disease and subglottic extension, radiotherapy alone produces poor results. Further improvement of outcomes by other treatment strategies needs to be investigated.
Collapse
Affiliation(s)
- Miao-Fen Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Putz City, Chia-Yi, Taiwan
| | | | | | | | | |
Collapse
|
15
|
Richey LM, Shores CG, George J, Lee S, Couch MJ, Sutton DK, Weissler MC. The effectiveness of salvage surgery after the failure of primary concomitant chemoradiation in head and neck cancer. Otolaryngol Head Neck Surg 2016; 136:98-103. [PMID: 17210342 DOI: 10.1016/j.otohns.2006.06.1267] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Accepted: 06/30/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE: To determine survival outcomes and locoregional control rates in patients with locoregional head and neck squamous cell cancer (HNSCC) who failed primary concomitant chemoradiation (CRT) intended for cure and underwent attempted surgical salvage. STUDY DESIGN AND SETTING: Design was a nonrandomized retrospective cohort study. Of 204 patients with HNSCC who received primary concomitant chemoradiation intended for cure between 1995 and 2004, 38 recurred and underwent attempted salvage surgery at a tertiary care academic center. RESULTS: Among the 38 patients undergoing surgical salvage, 12- and 24-month overall survival rates were 60 percent and 27 percent. Locoregional control at 24 months was 42 percent. Lower survival was seen with initial N3 disease ( P = 0.0115). Overall surgical morbidity was 24 percent. CONCLUSION/SIGNIFICANCE: The results of salvage surgery after failed chemoradiation for HNSCC are poor. Those with N3 disease fare least well. Patients should be well informed about the realistic chances of cure and potential morbidity of surgery. © 2007 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved.
Collapse
Affiliation(s)
- Luke M Richey
- General Clinical Research Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599-7070, USA
| | | | | | | | | | | | | |
Collapse
|
16
|
Tripathi RM, Shrivastav A, Shrivastav BR. Biogenic gold nanoparticles: As a potential candidate for brain tumor directed drug delivery. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2014; 43:311-7. [DOI: 10.3109/21691401.2014.885445] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
17
|
Sayles M, Grant DG. Preventing pharyngo-cutaneous fistula in total laryngectomy: A systematic review and meta-analysis. Laryngoscope 2013; 124:1150-63. [DOI: 10.1002/lary.24448] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 09/02/2013] [Accepted: 09/23/2013] [Indexed: 12/29/2022]
Affiliation(s)
- Mark Sayles
- Department of Otolaryngology-Head and Neck Surgery; Queen's Medical Centre; Nottingham University Hospitals' NHS Trust; Nottingham United Kingdom
| | - David G. Grant
- Department of Otolaryngology-Head and Neck Surgery; Queen's Medical Centre; Nottingham University Hospitals' NHS Trust; Nottingham United Kingdom
| |
Collapse
|
18
|
Organ preservation in T4a laryngeal cancer: is transoral laser microsurgery an option? Eur Arch Otorhinolaryngol 2013; 270:2719-27. [PMID: 23408021 PMCID: PMC3758515 DOI: 10.1007/s00405-013-2382-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 01/24/2013] [Indexed: 01/17/2023]
Abstract
The main objective of this study is to assess the feasibility of transoral laser microsurgery (TLM) in the treatment of T4a laryngeal cancer and to report the oncological and functional outcomes. This is a retrospective case-series study, held in a single-institute, academic tertiary referral center. Seventy-nine patients with previously untreated T4a glottic (n = 31, 39 %) or supraglottic laryngeal carcinoma (n = 48, 61 %) were included in this study. Five patients (6 %) were treated exclusively by TLM, 16 (20 %) had TLM and unilateral neck dissection, 27 (35 %) had TLM and bilateral neck dissection. Adjuvant (chemo)radiotherapy was additionally administered in 26 (33 %) cases following TLM and neck dissection, and in 5 (6 %) cases after TLM without neck dissection. The main outcome measures included organ preservation, local control, functional outcome, overall, recurrence-free, and disease-specific survival. The median follow-up period was 49 months, 5 year organ preservation rate and local control rate were 80.0 and 67.2 %, 5 year overall, recurrence-free and disease-specific survival were 55.8, 61.9 and 71.8 %. The 5 year overall survival rates were 62.5 % in pN0 cases and 57.2 % in cases with pN-positive neck disease. With respect to survival, these results are comparable to total laryngectomy, while being superior to primary (chemo)radiotherapy. TLM results in a low morbidity, rapid recovery and good function and can be a valid option for organ preserving surgery of pT4a glottic and supraglottic cancer.
Collapse
|
19
|
Sewnaik A, Keereweer S, Al-Mamgani A, Baatenburg de Jong RJ, Wieringa MH, Meeuwis CA, Kerrebijn JDF. High complication risk of salvage surgery after chemoradiation failures. Acta Otolaryngol 2012; 132:96-100. [PMID: 22026439 DOI: 10.3109/00016489.2011.617779] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
CONCLUSIONS Although organ preservation can be achieved with chemoradiation protocols for laryngeal or pharyngeal cancers, salvage surgery is accompanied by high complication rates. OBJECTIVES To determine the rate of complications associated with salvage surgery after chemoradiation for laryngeal and pharyngeal cancers. METHODS A multicenter retrospective study was performed of 24 patients treated with total laryngectomy combined with total or partial pharyngectomy between 1995 and 2004 who had previously been treated with chemoradiation. The main outcome measures were early and late complication rates. Quality of life analysis was determined by two questionnaires. RESULTS The complication rate after salvage surgery was 92% in the direct postoperative period. The most frequent complication was pharyngocutaneous fistula formation. Narrowing of the esophagus and tracheostoma were the most common late sequelae. The quality of life, measured at least 2 years after salvage surgery, showed a social dysfunctioning.
Collapse
Affiliation(s)
- Aniel Sewnaik
- Department of Otolaryngology Head and Neck Surgery, Erasmus Medical Center Rotterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
20
|
Klozar J, Cada Z, Koslabova E. Complications of total laryngectomy in the era of chemoradiation. Eur Arch Otorhinolaryngol 2011; 269:289-93. [PMID: 21499870 DOI: 10.1007/s00405-011-1598-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 03/29/2011] [Indexed: 02/08/2023]
Abstract
As more total laryngectomies (TLE) are nowadays performed as salvage procedures, the rate of postoperative complications increases. The primary aim was to report the rates of postoperative local complications for total laryngectomy in patients with previous radiotherapy or chemoradiotherapy (RT/CRT) in comparison with primary TLE data. We attempted to identify patient- and tumor-related factors predictive of postoperative pharyngocutaneous fistula (PCF) formation. The secondary aims were to analyze the survival rate in relation to postoperative complications and to study prognostic factors of survival in TLE patients. A retrospective study was conducted in 208 patients. Logistic regression was used to determine the most significant risk factors for fistula formation. Survival was analyzed by the Kaplan-Meier method, log-rank test, and Cox multivariate regression. PCF developed in 20.7% of cases. In the group of patients with previous RT/CRT, the fistula rate was significantly higher (34%). In multivariate analysis, significant risk factors for fistula formation were previous radiotherapy or chemoradiotherapy (p = 0.02), higher N classification (p = 0.03), and procedure performed by a less experienced surgeon (p = 0.003). The survival and recurrence rates were not influenced by PCF formation. The overall survival rates were lower in patients with previous RT/CRT and in patients with lymph node involvement.
Collapse
Affiliation(s)
- Jan Klozar
- Department of Otolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University, Prague, Motol University Hospital, V úvalu 84, Praha 5, Prague 15006, Czech Republic.
| | | | | |
Collapse
|
21
|
van der Putten L, de Bree R, Kuik D, Rietveld D, Buter J, Eerenstein S, Leemans C. Salvage laryngectomy: Oncological and functional outcome. Oral Oncol 2011; 47:296-301. [DOI: 10.1016/j.oraloncology.2011.02.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 01/28/2011] [Accepted: 02/01/2011] [Indexed: 11/28/2022]
|
22
|
Salvage surgery for local recurrence after chemoradiotherapy or radiotherapy in hypopharyngeal cancer patients. Eur Arch Otorhinolaryngol 2010; 267:1765-9. [PMID: 20495926 DOI: 10.1007/s00405-010-1274-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2010] [Accepted: 04/30/2010] [Indexed: 10/19/2022]
Abstract
This retrospective study aimed to assess the role of salvage surgery for local recurrence in hypopharyngeal cancer (HPC) patients who had received radiotherapy (RT) or concomitant chemoradiotherapy (CRT) as an initial treatment. The local recurrence rate, salvage rate after local recurrence and overall survival rate were investigated in 104 HPC patients who received treatment between 1991 and 2005. Local recurrence in the primary site was observed in 41 patients (rate, 39.4%) of whom only 12 could undergo further salvage surgery. Disease control was achieved in seven of these patients (successful salvage rate, 17.1%). The 5-year overall survival rate was 40.6% in the RT/CRT patient group and successful salvage rates for T1, T2, T3 and T4 primary disease were 33.3% (1/3), 20.0% (4/20), 16.7% (2/12) and 0% (0/6), respectively. Severe postoperative complications such as pharyngo-cutaneous fistula were seen in six patients (50.0%). Prognosis of patients with locally recurring HPC after RT/CRT is poor at any primary T-stage and the incidence of postoperative complication is relatively high. This should be taken into consideration when the initial treatment plan is decided and the choice of salvage surgery for such recurrent cases should be carefully determined.
Collapse
|
23
|
Yu P, Hanasono MM, Skoracki RJ, Baumann DP, Lewin JS, Weber RS, Robb GL. Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy. Cancer 2010; 116:1718-24. [PMID: 20120029 DOI: 10.1002/cncr.24947] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND : Pharyngoesophageal defects traditionally have been reconstructed using a jejunal or radial forearm flap. In 2002, the authors began using the anterolateral thigh flap for pharyngoesophageal reconstruction, and it has become our preferred method. The purpose of this study was to analyze the clinical and functional outcomes achieved using this technique. METHODS : The medical records of 91 male and 23 female patients who underwent pharyngoesophageal reconstruction using an anterolateral thigh flap were retrospectively reviewed. Outcomes analyzed included length of hospital and intensive care unit stay, fistula and anastomotic stricture formation and other complications, swallowing and tracheoesophageal speech function, and survival. Most patients had primary (27%) or recurrent (42%) squamous cell carcinoma. Before reconstruction, 71% of patients had undergone surgery, radiotherapy, or both. There were 67 circumferential and 47 near-circumferential defects. RESULTS : Mean intensive care unit stay was 1.9 +/- 2.2 days, and mean hospital stay was 9.0 +/- 4.7 days. Two patients experienced total flap loss, and 1 patient had partial flap necrosis. Pharyngocutaneous fistulas and strictures occurred in 9% and 6% of patients, respectively. Ninety-one percent of patients tolerated an oral diet without the need for tube feeding. Tracheoesophageal puncture was performed for speech rehabilitation in 51 patients. Eight-one percent of patients with a secondary tracheoesophageal puncture achieved fluent speech versus 41% of patients with a primary tracheoesophageal puncture. CONCLUSIONS : This series demonstrates that excellent clinical and functional outcomes, with minimal donor site morbidity and quick recovery, are possible with pharyngoesophageal reconstruction using an anterolateral thigh flap. Cancer 2010. (c) 2010 American Cancer Society.
Collapse
Affiliation(s)
- Peirong Yu
- Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
| | | | | | | | | | | | | |
Collapse
|
24
|
León X, López M, García J, Viza I, Gich I, Quer M. Recurrent laryngeal squamous cell carcinoma: rTNM versus composite laryngeal recurrence staging system. Proposal for a modification of the CLRSS to improve patient classification. Head Neck 2008; 30:939-45. [DOI: 10.1002/hed.20798] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
25
|
Jeong WJ, Jung EJ, Hah JH, Kwon TK, Wu HG, Heo DS, Sung MW, Kim KH. Preliminary results of pre-radiation neck dissection in head and neck cancer patients undergoing organ preservation treatment. Acta Otolaryngol 2007:121-7. [PMID: 17882582 DOI: 10.1080/03655230701625001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSION Pre-RT ND in patients with HNSCC undergoing organ preservation treatment is safe, advantageous, poses no additional morbidity owing to the elective neck dissection, and may possibly improve survival outcomes. OBJECTIVE Establish the role of pre-radiation neck dissection (pre-RT ND) in patients with head & neck squamous cell carcinoma (HNSCC) undergoing organ preservation treatment. MATERIALS AND METHODS Fourteen patients with histologically confirmed HNSCC in stages III approximately IV with proven regional metastasis were enrolled in the organ preservation approach incorporating pre-RT ND at a tertiary referral center between May 1998 and August 2004. Site matched patients treated with organ preservation intent in the conventional fashion were used as controls. Data were collected for their diagnosis, management, treatment outcome, and follow up. RESULTS Disease free survival was significantly better for the pre-RT ND group. There was no significant difference in overall survival, pattern of recurrence, and primary organ preservation rate between the two groups. No significant morbidity owing to neck dissection was noted in patients who underwent neck dissection. Although the delivery of radiation to the primary site was delayed for patients in the pre-RT ND group, it did not influence the major outcomes.
Collapse
Affiliation(s)
- Woo-Jin Jeong
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
26
|
|
27
|
de Bree R, van der Putten L, Hoekstra OS, Kuik DJ, Uyl-de Groot CA, van Tinteren H, Leemans CR, Boers M. A randomized trial of PET scanning to improve diagnostic yield of direct laryngoscopy in patients with suspicion of recurrent laryngeal carcinoma after radiotherapy. Contemp Clin Trials 2007; 28:705-12. [PMID: 17459783 DOI: 10.1016/j.cct.2007.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Revised: 03/12/2007] [Accepted: 03/15/2007] [Indexed: 11/18/2022]
Abstract
The RELAPS study (REcurrent LAryngeal carcinoma PET Study) was designed to determine whether FDG-PET is of value in the selection of patients for direct laryngoscopy under general anesthesia in patients with suspicion of recurrent laryngeal carcinoma after radiotherapy. In a randomized controlled clinical trial the current diagnostic practice, i.e. all patients undergo direct laryngoscopy, will be compared to a strategy in which FDG-PET selects the patients for laryngoscopy. All eight head and neck cancer centers of the Dutch Head and Neck Oncology Cooperative Group NWHHT will participate in this multicenter trial. The study population consists of patients with clinical suspicion of recurrent T2-T4 laryngeal carcinoma after radiotherapy (without obvious signs of tumor) in whom a direct laryngoscopy under general anesthesia with taking of biopsies is indicated by the local physician. The primary efficacy endpoint is the difference in the number of futile indications for direct laryngoscopy between the conventional diagnostic arm and the FDG-PET based diagnostic arm. An indication for laryngoscopy is classified as futile if this laryngoscopy was negative and no recurrence was diagnosed within 6 months follow-up (gold standard). The FDG-PET based strategy may increase the risk of missing recurrent tumor compared to current practice. Safety endpoints include survival and morbidity due to laryngoscopy with taking of biopsies. Survival rates of both groups will have to be collected outside the time frame of the funded trial. Resectability of recurrent tumor and tumor negative surgical margins after total laryngectomy will be used as proxy endpoints. The trial will also compare quality of life and direct medical costs between both arms.
Collapse
Affiliation(s)
- Remco de Bree
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Álvarez Marcos CA, Llorente Pendás JL, Franco Gutiérrez V, Fernández Espina H, Alonso Guervós M, Suárez Nieto C, Hermsen M. Tumour Recurrence in Squamous Head and Neck Cancer. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s2173-5735(07)70324-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
29
|
Abstract
Head and neck cancer frequently presents at a late stage, leading to a poor prognosis despite optimal treatment with surgery and/or radiotherapy. Chemotherapy for advanced disease has shown little benefit as a single-modality treatment, and the use of concurrent chemoradiation is limited by problems with severe toxicity at higher doses. RADPLAT is the acronym used to describe a new technique, combining intra-arterial delivery of cisplatin with systemic neutralization by i.v. sodium thiosulphate, and concurrent radiotherapy. This allows very high cisplatin dose intensities to be used while potentially minimizing adverse systemic effects. Initial results suggest that excellent locoregional control rates are achievable in patients with unresectable disease, with a favorable side-effect profile when compared with conventional chemoradiation protocols. In addition, RADPLAT may potentially be of benefit in selected patients with resectable disease, allowing for preservation of organ function and quality of life without compromising locoregional control or survival. While current phase II data are encouraging, phase III randomized controlled trials are required in order to directly compare RADPLAT with i.v. chemoradiation therapy, the current standard of care. This article reviews the evolution of the RADPLAT concept, from initial clinical trials to its current application in the treatment of patients with advanced head and neck cancer.
Collapse
Affiliation(s)
- Lee W T Alkureishi
- Department of Plastic Surgery, Christie Hospital, Southmoor Road, Manchester, United Kingdom, and Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | | | | |
Collapse
|
30
|
Lee JH, Sun D, Cho KJ, Kim MS, Hong MH, Kim IK, Lee JS, Lee JH. Overexpression of human 27 kDa heat shock protein in laryngeal cancer cells confers chemoresistance associated with cell growth delay. J Cancer Res Clin Oncol 2006; 133:37-46. [PMID: 16906418 DOI: 10.1007/s00432-006-0143-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Accepted: 07/05/2006] [Indexed: 10/25/2022]
Abstract
PURPOSE Among the family of heat shock proteins (HSPs), HSP70 and HSP27 have been implicated in tumorigenesis and chemoresistance, probably via the prevention of apoptosis. HSP27 levels are frequently increased in large populations of tumors of the head and neck, but the mechanism of its chemoresistance is not yet fully understood. In the present study, the role of HSP27 in the resistance to cytotoxic stress was studied in Hep-2 human laryngeal cancer cells. METHOD We established a Hep-2 cell line overexpressing HSP27 and examined whether the expression of HSP27 provides resistance to heat shock and several cytotoxic agents using a MTT colorimetic assay. Cell cycle progression was assessed by flow cytometry and fluorescence staining was performed for F-actin filaments. RESULTS HSP27 overexpression induced cellular resistance to heat shock at 45 degrees C for 1 h as well as against several cytotoxic agents, including cisplatin, staurosporin and H(2)O(2). However, no difference in sensitivity to irradiation or serum starvation was found. Moreover, HSP27 overexpressing Hep-2 cells showed a delayed cell growth, compared to control cells. To determine if the decreased cell proliferation in HSP27 overexpressing cells contributed to chemoresistance, control Hep-2 cells were synchronized at the late G1 phase by treatment with mimosine. The synchronized Hep-2 cells were resistant to cisplatin and H(2)O(2), but not to irradiation or serum starvation, correlating the protection effect shown in HSP27 overexpressing cells. These results suggest that the overexpression of HSP27 in Hep-2 cells confers chemoresistance which is associated with the delay in cell growth. We also propose that the stabilization of F-actin observed in Hep-2/hsp27 cells is partly related to the delay in cell cycle progression, by showing that the induction of actin polymerization in Hep-2/neo cells results in the retardation of cell growth as well as a cytoprotective effect as observed in Hep-2/hsp27.
Collapse
Affiliation(s)
- Jung-Hee Lee
- Department of Biochemistry, College of Medicine, The Catholic University of Korea, Seoul, 137-701, South Korea.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Takayama O, Yokoyama J, Ito S. Therapeutic experience of recurrent myoepithelial carcinoma by superselective intra-arterial chemotherapy infused high-dose CDDP. Auris Nasus Larynx 2006; 33:235-8. [PMID: 16446069 DOI: 10.1016/j.anl.2005.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Revised: 10/12/2005] [Accepted: 11/11/2005] [Indexed: 11/30/2022]
Abstract
Myoepithelial carcinoma is one of several new entities added to the updated classification of salivary gland tumors by the WHO in 1991. This tumor most frequently occurs in parotid gland. This is the first report presenting the tumor in floor of the mouth. It is a rare and prognostic poor cancer. Especially, there was not good therapy for recurrent cases. We treated the patient with repeated recurrences three times and presented in bilateral parapharyngeal space to skullbase in this time. We targeted function preservation and complete cure. In order to accomplish the both objections he received the superselective intra-arterial chemotherapy infused high-dose CDDP with radiation. We confirmed tumor free in FDG-PET in 2 months after the treatment. Now, we cannot detect any recurrence in 7 months after the treatment and he can eat anything and communicate anybody as before treated. We should follow-up him carefully.
Collapse
Affiliation(s)
- Osamu Takayama
- Department of Otolaryngology, Head and Neck Surgery, Tochigi Cancer Center, 4-9-13 Younan, Utunomiya, Tochigi 320-0834, Japan
| | | | | |
Collapse
|
32
|
Licitra L, Bernier J, Grandi C, Locati L, Merlano M, Gatta G, Lefebvre JL. Cancer of the larynx. Crit Rev Oncol Hematol 2003; 47:65-80. [PMID: 12853099 DOI: 10.1016/s1040-8428(03)00017-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In Europe, laryngeal cancer accounts for only 2-5% of all cancers, the incidence being much higher among males than among females. Smoke and alcohol represent the major behavioural risk factors. Several carcinogens, occupations and vitamin deficiencies have been associated with laryngeal cancer. A genetic susceptibility to environmental risk factors and carcinogens is recognized. Hoarseness is the main symptom for which patients call for medical consultation. Mucosa is the most common histologic site of the primary lesions considered in the present chapter. Nodal involvement, the site and volume of the primary tumour, and some genes expression represent the major prognostic factors. A high death rate for not cancer-related events is to be pointed out. The loco-regional extent of the disease determines the success of cure. Surgery and radiotherapy represent the main therapeutic options. The choice between these two procedures is often controversial.
Collapse
Affiliation(s)
- Lisa Licitra
- START Project, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
| | | | | | | | | | | | | |
Collapse
|
33
|
Rubio Suárez A, Teigeiro Núñez V, Gallo Terán J, Señaris González B, Mesuro Domínguez N. Quimioterapia de inducción con vinorelbine cisplatino y uft en carcinomas avanzados faringolaríngeos: resultados de un estudio fase II. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2003; 54:697-703. [PMID: 15164709 DOI: 10.1016/s0001-6519(03)78469-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the results of an induction chemotherapy protocol with Vinorelbine, UFT and Cisplatin (UFTVP). METHODS 93 patients with laryngo-pharyngeal squamous cell carcinoma in stage III or IV were prospectively entered into a protocol to receive four cycles of UFTVP. Responders followed definitive radiation therapy. Nonresponders underwent conventional surgery with postoperative radiation. RESULTS Following chemotherapy nodal response (complete in 28% and partial in 33%) was less than that the primary site (complete in 60% and partial in 30%), p = 0.002. With a median follow-up of 62 months, the Kaplan-Meier 5-year survival was 45%. Successful larynx preservation was achieved in 50% of patients with laryngeal cancer and in 29% of patients with hypopharyngeal cancer. Lymph node metastases and pharyngeal localization were found to be significant negative factors with regards to survival. CONCLUSIONS UFTVP is an active regime of chemotherapy in advanced squamous cell carcinoma of the pharynx and larynx. Results differ according to the localization, having significantly better rates of survival and organ preservation in the laryngeal cancers that in those of the pharynx.
Collapse
Affiliation(s)
- A Rubio Suárez
- Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, 39008 Santander.
| | | | | | | | | |
Collapse
|
34
|
Ferlito A, Shaha AR, Lefebvre JL, Silver CE, Rinaldo A. Organ and voice preservation in advanced laryngeal cancer. Acta Otolaryngol 2002; 122:438-42. [PMID: 12126004 DOI: 10.1080/00016480260000166] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Alfio Ferlito
- Department of Otolaryngology-Head and Neck Surgery, University of Udine, Policlinico Universitario, Italy.
| | | | | | | | | |
Collapse
|
35
|
León X, Orús C, Quer M. [Design, maintenance, and exploitation of an oncologic database for patients with malignant tumors of the head and neck]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2002; 53:185-90. [PMID: 12073678 DOI: 10.1016/s0001-6519(02)78299-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The oncological databases are essential in the evaluation of the results of patients with malignant tumours. We present the design of the database that collects the oncological information of patients with head and neck malignant tumours diagnosed in our centre since 1984, and the needs of maintenance and possibilities of exploitation.
Collapse
Affiliation(s)
- X León
- Servicio de Otorrinolaringología, Hospital de Sant Pau, Barcelona.
| | | | | |
Collapse
|