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Maimaitituerxun M, Kamilijiang P, Maimaiti A, Yasheng Y, Yong J, Qukuerhan A, Mutalifu M, Kuyaxi P, Mierzhakemu M, Aierken A, Jueraiti J, Alimu N. Nomogram for predicting survival in T1-T2 stage patients with supraglottic squamous cell carcinoma. Discov Oncol 2024; 15:147. [PMID: 38717631 PMCID: PMC11078915 DOI: 10.1007/s12672-024-01015-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/05/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Supraglottic squamous cell carcinoma (SGSCC) is characterized by low differentiation, rapid growth, and inconspicuous initial manifestations. Early detection and prompt treatment can significantly improve survival rates. The main focus of treatment is to maintain optimal laryngeal function. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) database, we conducted univariate and multivariate Cox regression analyses to identify independent prognostic factors for T1-T2 SGSCC. We also enrolled 109 patients with T1-T2 SGSCC from the First Affiliated Hospital of Xinjiang Medical University as an external validation set. In addition, we developed a nomogram to predict the prognosis of T1-T2 SGSCC, assessed the predictive accuracy and discriminatory ability of the nomogram using the area under the curve (AUC), C-index, receiver operating characteristic (ROC) curve and calibration curve, and confirmed the clinical validity of the nomogram using decision curve analysis (DCA). RESULTS Our investigation identified nine prognostic indicators for T1-T2 SGSCC: age (≥ 65 years), marital status, American Joint Committee on Cancer (AJCC) stage (II-IV), grade (III-IV), M stage (M1), radiotherapy, chemotherapy, sex (female), and surgery. These variables were used to create accurate nomograms that predict overall and specific survival rates at 1, 3, and 5 years. The nomograms demonstrated superior prognostic value and accuracy compared to AJCC staging. Laryngectomy with partial laryngectomy is the preferred treatment option for T1-T2 SGSCC cases, providing superior overall survival (OS) and cancer-specific survival (CSS). Radiotherapy also improves OS and CSS. Our results were based on a comprehensive analysis of various indicators, including the C-index, ROC curve, calibration curve, and DCA curve. CONCLUSION Nomograms provide significant advantages in treatment decision making and diagnosis. Laryngectomy with partial laryngectomy is the most appropriate method for T1-T2 SGSCC cases. However, radiotherapy can also be used. Thus, patients with T1-T2 SGSCC should be evaluated to determine if combination therapy is the optimal treatment approach. Nevertheless, further research is needed to understand the role of chemotherapy. Overall, this study identified nine key predictors of future outcomes, aiding healthcare professionals in assessing risks and making treatment decisions for T1-T2 SGSCC patients.
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Affiliation(s)
- Mulading Maimaitituerxun
- Department of Otorhinolaryngology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Paiheriding Kamilijiang
- Department of Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Aierpati Maimaiti
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Yalikun Yasheng
- Department of Otolaryngology, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Jun Yong
- Department of Otolaryngology, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Ayiheng Qukuerhan
- Department of Otolaryngology, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Muredili Mutalifu
- Department of Otolaryngology, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Pilidong Kuyaxi
- Department of Otolaryngology, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Muzhapaier Mierzhakemu
- Department of Otolaryngology, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Aierpati Aierken
- Department of Otolaryngology, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Jiulalai Jueraiti
- Department of Otolaryngology, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Nilipaer Alimu
- Department of Otolaryngology, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China.
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Kodaira T, Kagami Y, Machida R, Shikama N, Sekino Y, Ito Y, Ishikura S, Saito Y, Matsumoto Y, Konishi K, Murakami N, Akimoto T, Fukushima Y, Toshiyasu T, Katano A, Nagata Y, Ogawa H, Uno T, Hamamoto Y, Nishimura Y, Mizowaki T. Long-Term Follow-up of a Randomized Controlled Trial on Accelerated Radiation Therapy Versus Standard Fractionated Radiation Therapy for Early Glottic Cancer (JCOG0701A3). Int J Radiat Oncol Biol Phys 2023; 117:1118-1124. [PMID: 37414261 DOI: 10.1016/j.ijrobp.2023.06.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/22/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE We previously reported the primary results of JCOG0701, a randomized, multicenter, phase 3, noninferiority trial comparing accelerated fractionation (Ax) to standard fractionation (SF) for early glottic cancer. In the primary results, although the similar efficacy of 3-year progression-free survival and toxicity of Ax compared with SF was observed, the noninferiority of Ax was not confirmed statistically. To evaluate the long-term follow-up results of JCOG0701, we conducted JCOG0701A3 as an ancillary study of JCOG0701. METHODS AND MATERIALS In JCOG0701, 370 patients were randomly assigned to receive SF of 66 to 70 Gy (33-35 fractions; n = 184) or Ax of 60 to 64.8 Gy (25-27 fractions; n = 186). The data cutoff date for this analysis was in June 2020. Overall survival, progression-free survival, and late adverse events including central nervous system ischemia were analyzed. RESULTS With a median follow-up period of 7.1 years (range, 0.1-12.4), progression-free survival of the SF and Ax arms were 76.2% and 78.2% at 5 years and 72.7% and 74.8% at 7 years (P = .44). OS of the SF and Ax arms were 92.7% and 89.6% at 5 years and 90.8% and 86.5% at 7 years (P = .92). Among 366 patients with a protocol treatment, the cumulative incidence of late adverse events of the SF and Ax arms were 11.9% and 7.4% at 8 years (hazard ratio, 0.53; 95% CI, 0.28-1.01; P = .06). Central nervous system ischemia of grade 2 or higher was observed in 4.1% for the SF arm and 1.1% for the Ax arm (P = .098). CONCLUSIONS After long-term follow-up, Ax showed comparable efficacy to SF and a tendency for better safety. Ax may be suitable for early glottic cancer because of its convenience in minimizing treatment time, cost, and labor.
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Affiliation(s)
- Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center, Nagoya, Japan.
| | - Yoshikazu Kagami
- Department of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Ryunosuke Machida
- JCOG Data Center/Operation office, National Cancer Center Hospital, Tokyo, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - Yuta Sekino
- JCOG Data Center/Operation office, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Satoshi Ishikura
- Division of Radiation Oncology, Tokyo Bay Makuhari Clinic for Advanced Imaging, Cancer Screening, and High-Precision Radiotherapy, Chiba, Japan
| | - Yoshihiro Saito
- Department of Radiation Oncology, Saitama Cancer Center Hospital, Saitama, Japan
| | - Yasuo Matsumoto
- Department of Radiation Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuo Akimoto
- Department of Radiation, National Cancer Center Hospital East, Oncology, Kashiwa, Japan
| | - Yuuki Fukushima
- Department of Radiology, Sapporo Medical University, Sapporo, Japan
| | - Takashi Toshiyasu
- Department of Radiation Oncology, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Atsuto Katano
- Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Hiroshima University, Hiroshima, Japan
| | - Hirofumi Ogawa
- Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takashi Uno
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yasushi Hamamoto
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Fang L, Tuohuti A, Shi L, Chen X. Comparison of prognostic and treatment between T1a and T1b glottic cancer: a propensity score-matched SEER database analysis. Eur Arch Otorhinolaryngol 2023; 280:3313-3322. [PMID: 37039896 DOI: 10.1007/s00405-023-07953-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE The prognoses of T1a and T1b glottic cancers are still controversial. This study aimed to compare the prognosis difference between the two groups based on the population-based Surveillance, Epidemiology, and End Results database (SEER). METHODS Data for patients with T1a or T1b glottic cancers were extracted from the SEER database. The bias between T1a and T1b glottic cancers was minimized with Propensity Score Matching (PSM), and disease-specific survival (DSS) was analyzed using the Kaplan-Meier method, log-rank test, and Cox proportional hazards models. RESULTS A total of 5,272 patients were extracted from the database, including 847 patients with T1b glottic cancer that were 1:1 propensity score-matched with patients with T1a glottic cancer. After propensity score-matching, there was no statistical difference in disease-specific survival between T1a and T1b patients, whilst survival was impaired by old age. However, on the multivariate analysis, the T1a stage was associated with improved DSS compared with the T1b stage. CONCLUSION Our analysis showed that T1a glottic cancers didn't have a significantly better prognosis compared with T1b after PSM. However, the DSS of T1a patients is superior to that of T1b patients in multivariate analysis.
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Affiliation(s)
- Lucheng Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
- Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Aikebaier Tuohuti
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
- Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Licai Shi
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiong Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
- Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
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Syal A, Lott DG, Zhang N, Karle WE. Prognostic and Treatment Differences Between T1a and T1b Glottic Cancer. Laryngoscope 2022; 132:2187-2193. [PMID: 35060629 DOI: 10.1002/lary.30030] [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: 09/30/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study was designed to evaluate significant differences in treatment and survival outcomes between patients with T1a and T1b glottic cancer. METHODS Patients within the SEER Research Plus, 18 Registries dataset who were diagnosed with Stage I T1a or T1b cancer of the glottis between 2004 and 2015 were included in this study. Data prior to 2004 could not be included, as the SEER database did not distinguish between T1a and T1b glottic cancer until that year. RESULTS The 5-year disease-specific survival for T1a patients was significantly better than that of patients diagnosed with T1b glottic cancer. Age and year of diagnosis were also independent factors that impacted mortality. More patients who were diagnosed with T1b glottic cancer underwent external beam radiation than those diagnosed with T1a glottic cancer. CONCLUSION Our data shows that there are several independent factors effecting mortality including T classification, age at time of diagnosis, and year of diagnosis. T1a glottic cancers also show a significantly better prognosis compared with T1b. T1b glottic cancers are much more likely to be treated with primary radiotherapy compared with surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Amit Syal
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - David G Lott
- Department of Otolaryngology, Division of Laryngology, Mayo Clinic in Arizona, Phoenix, Arizona, U.S.A
| | - Nan Zhang
- Department of Quantitative Health Science, Mayo Clinic in Arizona, Phoenix, Arizona, U.S.A
| | - William E Karle
- Department of Otolaryngology, Division of Laryngology, Mayo Clinic in Arizona, Phoenix, Arizona, U.S.A
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Biau J, Pointreau Y, Blanchard P, Khampan C, Giraud P, Lapeyre M, Maingon P. Radiotherapy for laryngeal cancers. Cancer Radiother 2021; 26:206-212. [PMID: 34953705 DOI: 10.1016/j.canrad.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We present the update of the recommendations of the French society of oncological radiotherapy on radiotherapy of laryngeal cancers. Intensity modulated radiotherapy is the standard of care radiotherapy for the management of laryngeal cancers. Early stage T1 or T2 tumours can be treated either by radiotherapy or conservative surgery. For tumours requiring total laryngectomy (T2 or T3), an organ preservation strategy by either induction chemotherapy followed by radiotherapy or chemoradiotherapy with cisplatin is recommended. For T4 tumours, a total laryngectomy followed by radiotherapy is recommended when feasible. Dose regimens for definitive and postoperative radiotherapy are detailed in this article, as well as the selection and delineation of tumour and lymph node target volumes.
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Affiliation(s)
- J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France.
| | - Y Pointreau
- Centre Jean-Bernard, clinique Victor-Hugo, (Institut interrégional de cancérologie), 9, rue Beauverger, 72000 Le Mans, France; Service de radiothérapie, centre régional universitaire de cancérologie Henry-S.-Kaplan, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - P Blanchard
- Département de radiothérapie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - C Khampan
- Département de physique médicale, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, 84918 Avignon cedex 9, France
| | - P Giraud
- Service d'oncologie radiothérapie. université Paris Descartes, Sorbonne Paris-Cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - P Maingon
- Service de radiothérapie, APHP, Sorbonne Université, groupe hospitalier La Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Mucha-Małecka A, Małecki K, Amrogowicz N, Biesaga B, Modrzejewski M. Prognostic factors in elderly patients with T1 glottic cancer treated with radiotherapy. Sci Rep 2021; 11:17717. [PMID: 34489495 PMCID: PMC8421427 DOI: 10.1038/s41598-021-96146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/08/2021] [Indexed: 12/05/2022] Open
Abstract
The aim of the study was the evaluation of the effectiveness of radiotherapy in elderly T1 glottic cancer patients and prognostic factors with particular focus on comorbidities. Five-year overall survival, disease-specific survival, and local control rates were 63%, 92%, and 93%, respectively. Multivariate analysis showed that the following factors had statistically significant impact on local relapse risk and cancer death risk: diabetes, underweight, and fraction dose of 2 Gy. High number of comorbidities, high CCI, and underweight negatively influenced overall survival. A retrospective analysis was performed in a group of 131 T1N0M0 glottic cancer patients aged 70 and above treated with irradiation at the National Institute of Oncology in Cracow between 1977 and 2007. In the analyzed group men prevailed (92%) of mean age of 74 years. Each patient was diagnosed with at least one comorbidity with the following comorbid conditions being most frequent: hypertension, ischemic heart disease, and chronic obstructive pulmonary disease. In the studied group, the effect of comorbidities on overall survival was evaluated using Charlson Comorbidity Index (CCI). Twenty five (19%) patients showed underweight. All patients were irradiated once daily, 5 days a week, to a total dose of 60-70 Gy with a fraction dose of 2 or 2.5 Gy. Radiotherapy is an effective treatment modality in elderly T1 glottic cancer patients. Diabetes as comorbidity, underweight, and conventional dose fractionation decrease the probability of curative effect of radiotherapy in this group of patients, while high number of comorbidities diminishes the probability of long-term survival.
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Affiliation(s)
- Anna Mucha-Małecka
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland.
| | - Krzysztof Małecki
- Department of Radiotherapy for Children and Adults, University Children's Hospital of Cracow, Wielicka 265, 30-663, Cracow, Poland
- Faculty of Health Sciences, Jagiellonian University in Cracow, Michałowskiego 12, 31-126, Cracow, Poland
| | - Natalia Amrogowicz
- 1St Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Beata Biesaga
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland
- Department of Tumour Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
| | - Maciej Modrzejewski
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
- Department of Otolaryngology, Head and Neck Surgery, 5th Military Hospital with Polyclinic, Wroclawska 1-3, 30-901, Cracow, Poland
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Abstract
OBJECTIVES To investigate the utilisation of different treatment modalities for patients with laryngeal cancer (LC) during last decade in Poland. SETTING Retrospective population-based study. PARTICIPANTS Patients with LC treated between January 2009 and December 2018. PRIMARY AND SECONDARY OUTCOME MEASURES The contemporary utilisation of treatment modalities of LC: surgery with intent of radical resection (total or partial laryngectomy), radiotherapy (RT) and chemoradiotherapy (CRT). RESULTS There was determined the overall number of 22 957 new diagnosis of LC from 2010 to 2018 and confirmed the steady decrease in the incidence rate of LC in the following years from 7.7 to 6.03. The mean age of patients with LC was raising by an average of 0.3832 of year per year. There was observed decrease in number of total laryngectomies (TLs) in subsequent years (from 1122 in 2009 to 776 in 2018). The number of procedures involving partial laryngeal resection was within stable ranges however the upward trend was observed separately for vocal cordectomy. There was established decreased involvement of surgery in LC treatment from 52.8% in 2009 to 24.3% in 2016 with the subsequent rise to 33.7% in 2018. The percentage of patients receiving RT increased from 23.8% in 2009 to 42.1% in 2013 with the next decrease to 25.7% in 2018. The utilisation of CRT in LC treatment was progressively increasing over analysed years from 23.4% in 2009 reaching 40.6% in 2018. CONCLUSIONS The presented data revealed an increase in total number of organs preserving treatment modality with CRT in subsequent years with decreasing number of TLs in Polish patients with LC.
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Affiliation(s)
- Anna Rzepakowska
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Warszawa, Poland
| | - Michał Żurek
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Warszawa, Poland
- Department of Analyses and Strategies, Polish Ministry of Health, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Warszawa, Poland
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Nuyts S, Bollen H, Eisbruch A, Corry J, Strojan P, Mäkitie AA, Langendijk JA, Mendenhall WM, Smee R, DeBree R, Lee AWM, Rinaldo A, Ferlito A. Unilateral versus bilateral nodal irradiation: Current evidence in the treatment of squamous cell carcinoma of the head and neck. Head Neck 2021; 43:2807-2821. [PMID: 33871090 DOI: 10.1002/hed.26713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 12/21/2022] Open
Abstract
Cancers of the head and neck region often present with nodal involvement. There is a long-standing convention within the community of head and neck radiation oncology to irradiate both sides of the neck electively in almost all cases to include both macroscopic and microscopic disease extension (so called elective nodal volume). International guidelines for the selection and delineation of the elective lymph nodes were published in the early 2000s and were updated recently. However, diagnostic imaging techniques have improved the accuracy and reliability of nodal staging and as a result, small metastases that used to remain undetected and were thus in the past included in the elective nodal volume, will now be included in high-dose volumes. Furthermore, the elective nodal areas are situated close to the parotid glands, the submandibular glands and the swallowing muscles. Therefore, irradiation of a smaller, more selected volume of the elective nodes could reduce treatment-related toxicity. Several researchers consider the current bilateral elective neck irradiation strategies an overtreatment and show growing interest in a unilateral nodal irradiation in selected patients. The aim of this article is to give an overview of the current evidence about the indications and benefits of unilateral nodal irradiation and the use of SPECT/CT-guided nodal irradiation in squamous cell carcinomas of the head and neck.
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Affiliation(s)
- Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Heleen Bollen
- Laboratory of Experimental Radiotherapy, Department of Oncology, Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Avrahram Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - June Corry
- Division of Medicine, Department of Radiation Oncology, St. Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Primoz Strojan
- Department of Radiation Oncology, Institute of Oncology, University of Ljubljana, Ljubljana, Slovenia
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - William M Mendenhall
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, New South Wales, Australia
| | - Remco DeBree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anne W M Lee
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
| | - Alessandra Rinaldo
- Department of Otolaryngology, University of Udine School of Medicine, Udine, Italy
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Udine, Italy
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Novel predictive tools and therapeutic strategies for patients with initially diagnosed glottic cancer in the United States. Eur Arch Otorhinolaryngol 2021; 279:399-413. [PMID: 33821328 DOI: 10.1007/s00405-021-06788-4] [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: 01/26/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of this study is to identify valuable prognostic factors, build clinical prediction nomograms, and recommend the optimal therapeutic strategy for patients with initially diagnosed glottic cancer. METHODS Patients were extracted from the SEER database. Cox regression analyses, survival analyses, an internal validation, the propensity score analysis, and the competing risk analysis were performed. RESULTS Nine overlapped factors were considered as valuable prognostic factors. Furthermore, nomograms were established for clinical prediction models to assess the 1-, 3-, and 5-year overall survival (OS) and cancer-specific survival (CSS). C-indexes, receiver operating characteristic curves, calibration curves, and decision curve analyses proved that nomograms showed better predictive accuracy, ability, and prognostic value compared to the American Joint Committee on Cancer stage. For patients in stage I, primary site surgery alone would acquire best OS and CSS. For patients in stage II, primary site surgery and/or radiation would gain better OS and CSS. For patients in stage III, radiation plus chemotherapy or primary site surgery (alone or plus radiation) would acquire better OS and CSS. Moreover, for patients in stage IV, primary site surgery plus radiation would gain better OS and CSS. CONCLUSIONS Nomograms could be useful for patients' counseling and guide therapeutic decision-making. Primary site surgery alone may likely be the optimal therapy for stage I glottic cancer, and primary site surgery and/or radiation may be the recommended therapy for stage II glottic cancer. The combination treatment would be the preferred choice for advanced-stage (stage III & IV) glottic cancer, and the role of chemotherapy needs to be further explored.
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Kim KN, Dyer MA, Qureshi MM, Shah NK, Grillone GA, Faden DL, Jalisi SM, Truong MT. Hypofractionated radiotherapy and surgery compared to standard radiotherapy in early glottic cancer. Am J Otolaryngol 2020; 41:102544. [PMID: 32505989 DOI: 10.1016/j.amjoto.2020.102544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Early-stage glottic laryngeal cancer is treated with surgery or radiotherapy (RT), but limited randomized data exists to support one modality over the other. This study evaluates survival differences in early glottic cancer patients treated with either surgery or RT. MATERIALS AND METHODS 14,498 patients with early glottic cancer diagnosed from 2004 to 2015 and treated with surgery or RT were identified in the National Cancer Database. Kaplan-Meier method was used to analyze differences in overall survival (OS) by treatment (surgery vs. RT) and radiation dose fractionation. Cox regression modeling and propensity score-matched (PSM) analysis were performed. Adjusted hazard ratios (aHR) with 95% confidence intervals (95% CI) were computed. RESULTS Median follow-up and median OS for all patients were 49.5 and 118 months, respectively. The estimated 5-year OS for surgery and RT was 77.5% and 72.6%, respectively (P < 0.0001). On multivariate analysis, aHR (95% CI) for surgery compared to RT was 0.87 (0.81-0.94, P = 0.0004). Compared to RT regimen 63-67.5 Gray (Gy) in 28-30 fractions, worse survival was noted for RT regimen 66-70 Gy in 33-35 fractions (aHR 1.15, 95% CI 1.07-1.23, P = 0.0003). When compared with hypofractionated RT (63-67.5 Gy in 28-30 fractions), patients undergoing surgery no longer showed improved OS (aHR 0.94, 95% CI 0.86-1.02, P = 0.154). The finding was confirmed on PSM analysis (surgery aHR 0.95, 95% CI 0.87-1.05, P = 0.322). CONCLUSION In early glottic tumors, patients treated with surgery demonstrated improved survival compared to RT, but when hypofractionation was considered, there were no significant differences in OS between patients undergoing surgery or RT.
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Korpics MC, Turchan WT, Rooney MK, Koshy M, Spiotto MT. Patterns of Care and Outcomes of Intensity-Modulated Radiotherapy and 3D Conformal Radiotherapy for Early Stage Glottic Cancer: A National Cancer Database Analysis. Cancers (Basel) 2019; 11:cancers11121996. [PMID: 31842271 PMCID: PMC6966448 DOI: 10.3390/cancers11121996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/28/2019] [Accepted: 12/10/2019] [Indexed: 01/04/2023] Open
Abstract
Early stage glottic cancer has traditionally been treated with 3D conformal radiotherapy (3DCRT). However, intensity-modulated radiotherapy (IMRT) has been recently adopted as an alternative to decrease toxicity. Here, we compared the usage and outcomes of IMRT and 3DCRT for patients with early stage squamous cell carcinoma (SCC) of the glottic larynx. Using the National Cancer Database, we identified patients with Stage I–II SCC of the glottis who received 55–75 Gy using IMRT (n = 1623) or 3DCRT (n = 2696). Median follow up was 42 months with a 5-year overall survival (OS) of 72%. Using a nominal logistic regression, race, ethnicity, year of diagnosis and fraction size were associated with the receipt of IMRT (p < 0.05). Using Kaplan–Meier methods and Cox proportional hazards models as well as a propensity matched cohort, there was no difference in OS for patients who received IMRT versus 3DCRT (hazard ratio (HR), 1.08; 95% confidence interval (95% CI), 0.93–1.26; p = 0.302). However, there was a survival benefit for patients receiving slight hypofractionation as compared to conventional fractionation (HR, 0.78; 95% CI, 0.69–0.92; p = 0.003). IMRT was associated with similar survival as 3DCRT, supporting the implementation of this potentially less toxic modality without compromising survival.
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Affiliation(s)
- Mark C. Korpics
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL 60637, USA; (M.C.K.); (W.T.T.); (M.K.R.); (M.K.)
- Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
| | - W. Tyler Turchan
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL 60637, USA; (M.C.K.); (W.T.T.); (M.K.R.); (M.K.)
- Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
| | - Michael K. Rooney
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL 60637, USA; (M.C.K.); (W.T.T.); (M.K.R.); (M.K.)
- Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
| | - Matthew Koshy
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL 60637, USA; (M.C.K.); (W.T.T.); (M.K.R.); (M.K.)
- Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
| | - Michael T. Spiotto
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL 60637, USA; (M.C.K.); (W.T.T.); (M.K.R.); (M.K.)
- Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
- Correspondence: ; Tel.: +1-773-702-2751
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12
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Outcome of Early-Stage Glottic Laryngeal Carcinoma Patients Treated with Radical Radiotherapy Using Different Techniques. JOURNAL OF ONCOLOGY 2019; 2019:8640549. [PMID: 31781218 PMCID: PMC6874992 DOI: 10.1155/2019/8640549] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/19/2019] [Accepted: 10/10/2019] [Indexed: 11/17/2022]
Abstract
Purpose The aim was to evaluate the treatment outcomes and prognostic characteristics of patients with early-stage glottic laryngeal carcinoma who underwent radical radiotherapy (RT) with different techniques. Patients and Methods Radiotherapy was applied using the 2D conventional technique between 1991 and 2004 (130 patients), 3DCRT until 2014 (125 patients), and by VMAT until January 2017 (44 patients). Clinical T stages were 38 (12.7%) for Tis, 209 (69.9%) for T1, and 52 (17.4%) for T2. Radiotherapy technique and energy, anterior commissure involvement, and stage were analyzed as prognostic factors. Results The median total dose was 66 (50–70) Gy, and median follow-up time was 72 (3–288) months; 5-year disease-specific survival (DSS) rates were 95.8%, 95.5%, and 88.6%, respectively, in Tis, T1, and T2 stages. In multivariate analyses, anterior commissure involvement was found significant for all survival and local control rates. The patients treated with VMAT technique had better local control and DSS rates. However, these results were not statistically significant. Conclusion In early-stage laryngeal carcinomas, radical RT is a function sparing and effective treatment modality, regardless of treatment techniques.
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13
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Elicin O, Putora PM, Siano M, Broglie MA, Simon C, Zwahlen D, Huber GF, Ballerini G, Beffa L, Giger R, Rothschild S, Negri SV, Dulguerov P, Henke G. A Review of Controversial Issues in the Management of Head and Neck Cancer: A Swiss Multidisciplinary and Multi-Institutional Patterns of Care Study-Part 2 (Radiation Oncology). Front Oncol 2019; 9:1126. [PMID: 31709186 PMCID: PMC6822015 DOI: 10.3389/fonc.2019.01126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/09/2019] [Indexed: 11/21/2022] Open
Abstract
Background: The Head and Neck Cancer Working Group of Swiss Group for Clinical Cancer Research (SAKK) has investigated the level of consensus (LOC) and discrepancy in everyday practice of diagnosis and treatment in head and neck cancer. Materials and Methods: An online survey was iteratively generated with 10 Swiss university and teaching hospitals. LOC below 50% was defined as no agreement, while higher LOC were arbitrarily categorized as low (51–74%), moderate (75–84%), and high (≥85%). Results: Any LOC was achieved in 62% of topics (n = 60). High, moderate, and low LOC were found in 18, 20, and 23%, respectively. Regarding Head and Neck Surgery, Radiation Oncology, Medical Oncology, and biomarkers, LOC was achieved in 50, 57, 83, and 43%, respectively. Conclusions: Consensus on clinical topics is rather low for surgeons and radiation oncologists. The questions discussed might highlight discrepancies, stimulate standardization of practice, and prioritize topics for future clinical research.
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Affiliation(s)
- Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marco Siano
- Department of Medical Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Medical Oncology, Hôpital Riviera-Chablais, Vevey, Switzerland
| | - Martina A Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Christian Simon
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Daniel Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Graubünden, Chur, Switzerland.,Department of Radiation Oncology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Gerhard F Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Giorgio Ballerini
- Department of Radiation Oncology, Clinica Luganese SA, Lugano, Switzerland
| | - Lorenza Beffa
- Department of Radiation Oncology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sacha Rothschild
- Department of Medical Oncology, University Hospital of Basel, Basel, Switzerland
| | - Sandro V Negri
- Department of Otorhinolaryngology, Lindenhofspital, Bern, Switzerland
| | - Pavel Dulguerov
- Department of Otorhinolaryngology, Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Guido Henke
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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14
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Elicin O, Ermiş E, Oehler C, Aebersold DM, Caparrotti F, Zimmermann F, Studer G, Henke G, Adam L, Anschuetz L, Ozsahin M, Guckenberger M, Shelan M, Kaydıhan N, Riesterer O, Prestwich RJD, Spielmann T, Giger R, Şen M. Influencing Factors on Radiotherapy Outcome in Stage I-II Glottic Larynx Cancer-A Multicenter Study. Front Oncol 2019; 9:932. [PMID: 31616637 PMCID: PMC6763757 DOI: 10.3389/fonc.2019.00932] [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: 06/05/2019] [Accepted: 09/05/2019] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Larynx cancer represents one of the most frequently diagnosed head and neck malignancies, which is most often confined to the glottic area. The aim of this study was to report the oncological outcome and identify prognostic factors in early-stage glottic squamous cell carcinoma treated with radiotherapy. Material and Methods: Patients (n = 761) diagnosed and treated in 10 centers between 1990 and 2015 were retrospectively analyzed. Probabilities of loco-regional control (LRC) and overall survival (OS) were calculated and possible prognostic factors were analyzed using Cox proportional hazards models. Results: The median follow-up was 63 months (range: 2-243). Three hundred and sixty-four, 148 and 249 patients had cT1a, cT1b, and cT2 stage I-II disease, respectively. Five and 10-years LRC/OS rates in the whole cohort were 83/82% and 80/68%, respectively. Three patients developed distant recurrences. In univariate analysis, male sex (HR: 3.49; 95% CI: 1.47-11.37; p < 0.01), T2 vs. T1a (HR: 1.62; 95% CI: 1.08-2.43; p = 0.02) and anterior commissure involvement (ACI) (HR: 1.66; 95% CI: 1.38-2.45; p < 0.01) were associated with impaired LRC. In multivariate analysis, male sex (HR: 3.42; 95% CI: 1.44-11.17; p < 0.01) and ACI (HR: 1.51; 95% CI: 1.01-2.28; p = 0.047) remained poor prognostic factors. No relation of treatment technique and biologically equivalent dose (BED) to oncological outcome was identified except for higher BED10(L = 25; T = 1) yielding better LRC in T1a tumors (p = 0.04) in univariate analyses. Conclusion: Our results highlight the negative impact of ACI on tumor control. A less-expected finding was the impact of sex on tumor control. Further research is needed to validate its prognostic value and investigate any related biologic or behavioral factors, which may be modified to improve oncologic outcome.
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Affiliation(s)
- Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ekin Ermiş
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Clinical Oncology, Leeds Cancer Center, St. James's Institute of Oncology, Leeds, United Kingdom
| | - Christoph Oehler
- Department of Radiation Oncology, Cantonal Hospital of Graubunden, Chur, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Francesca Caparrotti
- Department of Radiation Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Frank Zimmermann
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Gabriela Studer
- Department of Radiation Oncology, Cantonal Hospital of Lucerne, Lucerne, Switzerland.,Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland
| | - Guido Henke
- Department of Radiation Oncology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Lukas Adam
- Department of Radiation Oncology, Cantonal Hospital of Graubunden, Chur, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mahmut Ozsahin
- Department of Radiation Oncology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nuri Kaydıhan
- Department of Radiation Oncology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland
| | - Robin J D Prestwich
- Department of Clinical Oncology, Leeds Cancer Center, St. James's Institute of Oncology, Leeds, United Kingdom
| | - Thierry Spielmann
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mehmet Şen
- Department of Clinical Oncology, Leeds Cancer Center, St. James's Institute of Oncology, Leeds, United Kingdom
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15
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Mucha-Małecka A, Chrostowska A, Urbanek K, Małecki K. Prognostic factors in patients with T1 glottic cancer treated with radiotherapy. Strahlenther Onkol 2019; 195:792-804. [PMID: 31214734 PMCID: PMC6704086 DOI: 10.1007/s00066-019-01481-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 06/03/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Presentation of long-term results of radiation treatment in patients with T1 glottic cancer and evaluation of prognostic factors. METHODS We performed a retrospective analysis in a group of 569 patients with T1 squamous cell glottic carcinoma treated with radiotherapy at the Center of Oncology in Cracow between 1977 and 2007. In all, 503 (88%) patients presented with T1a stage disease and 66 (12%) with T1b. Anterior commissure infiltration was present in 179 (31%) patients. Average hemoglobin level prior to therapy was 13.9 g/dl. Using the body mass index (BMI), 114 (20%) patients were underweight, and 91 (16%) were overweight. Median time between collecting tumor specimen and beginning of radiotherapy was 56 days (range 14-145 days). Treatment regimen was normofractionated with single fraction ≤2 Gy in 102 (18%) and hypofractionated in 467 (82%) patients. RESULTS The 5‑ and 10-year overall survival (OS), disease-specific survival (DSS) and local control (LC) rates were 85 and 68%, 88 and 86%, 89 and 87%, respectively. Multivariate analysis showed that tobacco smoking, low hemoglobin level (<13 g/dl), anterior commissure infiltration, fraction dose ≤2 Gy and time from collecting specimen to beginning of therapy longer than 30 days had negative impact on LC and DSS. Patients' age over 60 years, worse performance status and malnutrition (BMI <18.5) had negative impacts on OS. CONCLUSIONS Radiotherapy is a highly effective treatment method in patients with T1N0M0 glottic cancer. LC and DSS may be improved following hypofractionation, smoking cessation, and shortening of waiting-time until start of treatment. OS was mainly influenced by nutritional and performance status.
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Affiliation(s)
- A Mucha-Małecka
- Clinic of Oncology and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland.
| | - A Chrostowska
- Clinic of Oncology and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
| | - K Urbanek
- Clinic of Oncology and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
| | - K Małecki
- Department of Radiotherapy for Children and Adults, University Children's Hospital of Cracow, Wielicka 265, 30-663, Cracow, Poland
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16
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Salas-Salas BG, Domínguez-Nuez DJ, Cabrera R, Ferrera-Alayón L, Lloret M, Lara PC. Hypofractionation vs. conventional radiotherapy fractionation in the conservative treatment of T1 glottic cancer: a prospective cohort study. Clin Transl Oncol 2019; 22:151-157. [DOI: 10.1007/s12094-019-02118-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
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17
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Altered-fractionation radiotherapy improves local control in early-stage glottic carcinoma: A systematic review and meta-analysis of 1762 patients. Oral Oncol 2019; 93:8-14. [DOI: 10.1016/j.oraloncology.2019.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/26/2019] [Accepted: 04/05/2019] [Indexed: 12/25/2022]
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18
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Ali SA, Smith JD, Hogikyan ND. The White Lesion, Hyperkeratosis, and Dysplasia. Otolaryngol Clin North Am 2019; 52:703-712. [PMID: 31078307 DOI: 10.1016/j.otc.2019.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Laryngeal mucosal precursor lesions represent a challenging clinical entity. Updated classification systems allow for grade-based categorization. Multiple management options exist, with treatment decisions made jointly by physician and patient and focused on both appropriate lesion treatment and preservation of laryngeal structure and function. Traditional methods include cold steel and CO2 laser excision, with newer modalities using angiolytic lasers for lesion ablation. Both operating room-based and office-based treatment options exist, and there are advantages and disadvantages to each approach. Research is ongoing to advance the understanding of lesion biology, and to optimize prevention and treatment.
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Affiliation(s)
- S Ahmed Ali
- Department of Otolaryngology - Head & Neck Surgery, Michigan Medicine, 1904 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5312, USA
| | - Joshua D Smith
- Department of Otolaryngology - Head & Neck Surgery, Michigan Medicine, 1904 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5312, USA
| | - Norman D Hogikyan
- Department of Otolaryngology - Head & Neck Surgery, Michigan Medicine, 1904 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5312, USA.
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19
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Biau J, Lapeyre M, Troussier I, Budach W, Giralt J, Grau C, Kazmierska J, Langendijk JA, Ozsahin M, O'Sullivan B, Bourhis J, Grégoire V. Selection of lymph node target volumes for definitive head and neck radiation therapy: a 2019 Update. Radiother Oncol 2019; 134:1-9. [DOI: 10.1016/j.radonc.2019.01.018] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/15/2018] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
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20
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Mendelsohn AH, Remacle MJ. Vocal Fold Cancer Transoral Laser Microsurgery Following European Laryngological Society Laser Cordectomy Classification. Front Oncol 2018; 8:231. [PMID: 29988339 PMCID: PMC6023964 DOI: 10.3389/fonc.2018.00231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/05/2018] [Indexed: 11/13/2022] Open
Abstract
Background The surgical treatment of glottic, or vocal cord, cancer has seen considerable progression over the past several decades. Specifically, there has been a stark transition from open partial laryngectomy surgery to endoscopic laser microsurgical techniques which have been inspired in large part by two landmark studies: Professor Wolfgang Steiner's original case series describing transoral laser microsurgery for glottic cancer (1993) and the European Laryngological Society's (ELS) classification scheme (2000). We performed a comprehensive review of published literature to characterize the pattern of this novel modality as compared with two landmark studies over the past four decades. Methods An English literature search was conducted on PubMed for available original investigations on surgical treatment of glottic laryngeal cancer published over the past 40 years. Our Boolean criteria included the following terms: cancer, glottic, laryngeal, surgery, endoscopic, and laser. The publication rates were calculated as annual compound growth as well as corrected growth rates as defined by the Fisher equation for inflation effects. Results Our review identified 13,372 studies covering larynx cancer and 3,557 studies covering glottic cancer original studies. Among these, we analyzed the compound annual growth rates and correct growth rates for three distinct publication periods or epochs, prior to 1993, 1993-1999, and 2000-2017. For all but two of the search term groups covering both glottic cancer as well as larynx cancer, there was a substantial growth improvement in the time period following the ELS classification scheme as compared with the growth rate of the time period following Steiner's case series. Conclusion The progress toward minimally invasive treatment of glottic cancer has progressed steadily over the past several decades. Analysis of publication show increased growth during the time period following the ELS classification scheme over the time period following Steiner's landmark study. A mistake would be concluding any diminished importance of Professor Steiner's work, instead, our analysis demonstrates the wide-spread adoption of the endoscopic laser cordectomy procedure following the ELS classification system. Complex surgical techniques such as transoral laser microsurgery are optimally disseminated within well-defined classification schemes, though further validation is warranted.
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Affiliation(s)
- Abie H Mendelsohn
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Marc Joseph Remacle
- Department of Otorhinolaryngology Head and Neck Surgery, Centre Hospitalier de Luxembourg - Clinique d'Eich, Luxembourg, Luxembourg
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21
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Zhan C, Yang X, Song X, Yan L. Radiotherapy vs surgery for T1-2N0M0 laryngeal squamous cell carcinoma: A population-based and propensity score matching study. Cancer Med 2018; 7:2837-2847. [PMID: 29733513 PMCID: PMC6051150 DOI: 10.1002/cam4.1525] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/07/2018] [Accepted: 04/09/2018] [Indexed: 01/06/2023] Open
Abstract
There are conflicting reports about whether radiotherapy or surgery is optimal for early‐stage laryngeal squamous cell carcinoma (LSCC), although both have recently been recommended. Patients with T1‐2N0M0 LSCC in the population‐based SEER database who underwent radiotherapy or surgery were reviewed. Propensity score matching was used to eliminate the baseline variations. After matching, 1913 pairs of patients were included. Overall, patients who received radiotherapy had worse cancer‐specific survival than patients with surgery. After stratification, the survival in patients who received radiotherapy was worse with respect to the following characteristics: ≤60 years of age; T1a glottis cancer; well‐differentiated tumors; and with married status. In other patients, survival outcomes were similar in patients who received radiotherapy and underwent surgery. Our results indicate that radiotherapy is not preferable in early‐stage LSCC patients who are ≤60 years of age, have T1a glottis cancer or well‐differentiated tumors, or are married. In other patients, both radiotherapy and surgery are comparable. However, our results cannot be a reference before controlled, prospective trials are performed.
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Affiliation(s)
- Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaodong Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xinmao Song
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Li Yan
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
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22
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In Regards to Stokes et al and Bledsoe et al. Int J Radiat Oncol Biol Phys 2018; 100:804-805. [DOI: 10.1016/j.ijrobp.2017.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/08/2017] [Indexed: 11/20/2022]
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23
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Stokes WA, Karam SD. In Reply to Overgaard et al. Int J Radiat Oncol Biol Phys 2018; 100:805-807. [DOI: 10.1016/j.ijrobp.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022]
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24
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Overgaard J. RE: Hypofractionated Radiotherapy for Patients with Early-Stage Glottic Cancer: Patterns of Care and Survival. J Natl Cancer Inst 2017; 110:430-431. [DOI: 10.1093/jnci/djx229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/28/2017] [Indexed: 01/21/2023] Open
Affiliation(s)
- Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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Stokes WA, Amini A, Jackson MW, Plimpton SR, Kounalakis N, Kabos P, Rabinovitch RA, Rusthoven CG, Fisher CM. Patterns of Fractionation and Boost Usage in Adjuvant External Beam Radiotherapy for Ductal Carcinoma in Situ in the United States. Clin Breast Cancer 2017; 18:220-228. [PMID: 28797765 DOI: 10.1016/j.clbc.2017.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/06/2017] [Accepted: 06/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND While the roles of hypofractionated (HFxn) radiotherapy and lumpectomy boost in the adjuvant management of invasive breast cancer are supported by the results of clinical trials, randomized data supporting their use for ductal carcinoma in situ (DCIS) are forthcoming. We sought to evaluate current national trends and identify factors associated with HFxn and boost usage using the National Cancer Database. PATIENTS AND METHODS We queried the National Cancer Database for women diagnosed with DCIS from 2004 to 2014 undergoing external beam radiotherapy after breast conservation surgery. Patients were categorized as receiving either conventional fractionation (CFxn) or HFxn and as either receiving or not receiving a boost. Multiple logistic regression was performed to identify demographic, clinical, and treatment factor associations. RESULTS A total of 101,615 women were identified, with 87,641 (86.2%) receiving CFxn, 13,974 (13.8%) receiving HFxn, and most patients in each group (84.9% and 57.7%, respectively) receiving a boost. Implementation of HFxn increased from 4.3% in 2004 to 33.0% in 2014, and the use of a boost declined from 83.3% to 74.6%. HFxn receipt was independently associated with later year of diagnosis, older age, higher income, greater distance from treatment facility, greater facility volume, academic facility type, Western residence, smaller lesions, and nonreceipt of a boost. Factors associated with boost receipt included earlier year of diagnosis, younger age, higher income, community facility type, adverse pathologic features, and nonreceipt of HFxn. CONCLUSION Although CFxn with a boost remains the most common external beam radiotherapy strategy for DCIS, implementation of HFxn without a boost appears to be increasing. Practice patterns at present seem to be driven by guidelines for invasive breast cancer and nonclinical factors.
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Affiliation(s)
- William A Stokes
- Department of Radiation Oncology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Arya Amini
- Department of Radiation Oncology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Matthew W Jackson
- Department of Radiation Oncology, University of Colorado Denver School of Medicine, Aurora, CO
| | - S Reed Plimpton
- Department of Radiation Oncology, University of California, Irvine, School of Medicine, Irvine, CA
| | - Nicole Kounalakis
- Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO
| | - Peter Kabos
- Department of Medicine, University of Colorado Denver School of Medicine, Aurora, CO
| | - Rachel A Rabinovitch
- Department of Radiation Oncology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Christine M Fisher
- Department of Radiation Oncology, University of Colorado Denver School of Medicine, Aurora, CO.
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