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Alterio D, Marani S, Vigorito S, Zurlo V, Zorzi SF, Ferrari A, Volpe S, Bandi F, Vincini MG, Gandini S, Gaeta A, Fodor CI, Casbarra A, Zaffaroni M, Starzynska A, Belgioia L, Ansarin M, Aristei C, Jereczek-Fossa BA. Post-operative intensity-modulated vs 3D conformal radiotherapy after conservative surgery for laryngeal tumours of the supraglottic region: a dosimetric analysis on 20 patients. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:150-160. [PMID: 38712518 PMCID: PMC11166212 DOI: 10.14639/0392-100x-n2442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/13/2023] [Indexed: 05/08/2024]
Abstract
Objective To perform a dosimetric comparison between intensity modulated radiotherapy (IMRT) and 3D conformal radiotherapy in patients with locally advanced (stage III and IV) tumours of the supraglottic region treated with conservative surgery and post-operative radiotherapy. Methods An in-silico plan using a 3D conformal shrinking field technique was retrospectively produced for 20 patients and compared with actually delivered IMRT plans. Eighteen structures (arytenoids, constrictor muscles, base of tongue, floor of mouth, pharyngeal axis, oral cavity, submandibular glands and muscles of the swallowing functional units [SFU]) were considered. Results IMRT allowed a reduction of maximum and mean doses to 9 and 14 structures, respectively (p < .05). Conclusions IMRT achieved a reduction of unnecessary dose to the remnant larynx and the majority of surrounding SFUs. Further prospective analyses and correlations with functional clinical outcomes are required to confirm these dosimetric findings.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Simona Marani
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sabrina Vigorito
- Unit of Medical Physics, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Valeria Zurlo
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Filippo Zorzi
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Volpe
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Francesco Bandi
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Aurora Gaeta
- Department of Experimental Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Alessia Casbarra
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Starzynska
- Department of Oral Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Liliana Belgioia
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
- Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Mohssen Ansarin
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, Perugia General Hospital, University of Perugia, Perugia, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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2
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Crosetti E, Succo G, Sapino S, Bertotto I, Cirillo S, Petracchini M, Fondello G, Arrigoni G, Tascone M, Piazza C, Farina D, Ravanelli M. Twenty questions from the surgeon to the radiologist to better plan an open partial horizontal laryngectomy. Front Oncol 2024; 13:1305889. [PMID: 38328437 PMCID: PMC10847842 DOI: 10.3389/fonc.2023.1305889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Open partial horizontal laryngectomies (OPHLs) represent a valuable therapeutic option for tumors of the intermediate T-category and, in selected cases, for locally advanced tumors with low-volume extra-laryngeal extension. The eligibility of patients treated with this type of surgery has increased with the introduction of the modular approach to OPHL planning. This strategy follows the introduction of the classification proposed by the European Laryngological Society, based on the extent of horizontal resection. Optimization of the selection is the result of a meticulous work-up process involving close cooperation between experienced surgeons and radiologists, followed by final quality control by pathologists. Computed tomography and magnetic resonance imaging are study methods whose pearls and pitfalls are well known, especially when performed at a high level of expertise. In this paper, based on the experience of two high-volume centers, a checklist of 20 questions addressed by the surgeon to the radiologist before planning an OPHL was proposed. Considerations regarding case selection are reported for each of the questioned parameters. A very simple question-and-answer process is easy to understand and mainly addressed by less experienced colleagues who wish to increase their knowledge and skills in performing this type of surgery.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Giovanni Succo
- Oncology Department, University of Turin, Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Silvia Sapino
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Ilaria Bertotto
- Radiology Service, Candiolo Cancer Institute, Candiolo, Italy
| | - Stefano Cirillo
- Radiology Service, Mauriziano Umberto I Hospital, Turin, Italy
| | | | | | - Giulia Arrigoni
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Martina Tascone
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology—Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Farina
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Department of Radiology, University of Brescia, Brescia, Italy
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3
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Locatello LG, Jiang S, Chen L, Caini S, Maggiore G, Dong P, Gallo O. Oncological and functional impact of adjuvant treatments after open partial laryngeal surgery: a systematic review of the literature and a meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:2911-2926. [PMID: 36806990 PMCID: PMC10175366 DOI: 10.1007/s00405-023-07871-8] [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: 09/30/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND The oncological and functional role of postoperative radiotherapy (PORT) after open partial laryngeal surgery (OPLS) remains debatable. METHODS A systematic review and a meta-analysis of the literature were conducted according to the PRISMA guidelines. Outcomes of patients receiving OPLS with and without PORT for laryngeal cancer were summarized. RESULTS In the 10 studies that were included in the meta-analysis, no significant difference emerged in terms of pooled overall survival between OPLS patients who did and who did not receive PORT (- 0.3%, 95% CI - 5.4 to 4.9%, p = 0.922). Only one study showed a significantly higher incidence of complications in the PORT cohort. CONCLUSIONS PORT may apparently be performed after OPLS in face of adverse postoperative features without an increased risk of toxicities affecting the neolarynx. Because of the limitations in the available literature, the oncological and functional effects of PORT in this setting needs to be prospectively assessed to strengthen the evidence of this treatment strategy for laryngeal cancer.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy.,Department of Otorhinolaryngology, University Hospital "Santa Maria Della Misericordia", Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.,Department of Otolaryngology-Head & Neck Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Serena Jiang
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Lixiao Chen
- Department of Otolaryngology-Head & Neck Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | | | - Pin Dong
- Department of Otolaryngology-Head & Neck Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy. .,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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4
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Dağdelen M, Şahin M, Çatal TK, Yıldırım HC, Karaçam SÇ, Çepni K, Uzel ÖE. Selective local postoperative radiotherapy for T3-T4 N0 laryngeal cancer. Strahlenther Onkol 2022; 198:1025-1031. [PMID: 36074137 DOI: 10.1007/s00066-022-01999-y] [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: 05/23/2022] [Accepted: 08/07/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE We aimed to investigate the appropriate postoperative radiotherapy dose and selective volume in T3-4 N0 laryngeal cancer patients treated with either total or partial laryngectomy. METHODS Patients who received radiotherapy for locally advanced (T3-T4) and pathologic node-negative (N0) squamous cell laryngeal cancer were retrospectively evaluated. Radiotherapy was applied to median 60 Gy (range 54-60 Gy) as selective local radiotherapy (±stoma). The local treatment areas included postoperative bed + laryngeal area for patients with a partial laryngectomy, and the postoperative bed only for patients with total laryngectomy. RESULTS The median follow-up time was 59 months and 52 patients were included. The 2‑year, 5‑year, and 8‑year locoregional recurrence controls (LRC) were 95.6%. The 2‑year and 5‑year OS rates were 93.8% and 78.9%, respectively. The 5‑year OS for age < 60 years was 95.8%, for above 60 years 56.5%. CONCLUSION Our data suggest that local selective irradiation to the postoperative bed + stoma is enough in patients with T3-4 N0 laryngeal cancer without applying elective nodal irradiation.
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Affiliation(s)
- Meltem Dağdelen
- Department of Radiation Oncology, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Cerrahpaşa Ave. Kocamustafapaşa St. No: 34/E Fatih, Istanbul, Turkey.
| | - Merve Şahin
- Department of Radiation Oncology, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Tuba Kurt Çatal
- Department of Radiation Oncology, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Cerrahpaşa Ave. Kocamustafapaşa St. No: 34/E Fatih, Istanbul, Turkey
| | - Halil Cumhur Yıldırım
- Department of Radiation Oncology, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Cerrahpaşa Ave. Kocamustafapaşa St. No: 34/E Fatih, Istanbul, Turkey
| | - Songül Çavdar Karaçam
- Department of Radiation Oncology, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Cerrahpaşa Ave. Kocamustafapaşa St. No: 34/E Fatih, Istanbul, Turkey
| | - Kimia Çepni
- Department of Radiation Oncology, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Cerrahpaşa Ave. Kocamustafapaşa St. No: 34/E Fatih, Istanbul, Turkey
| | - Ömer Erol Uzel
- Department of Radiation Oncology, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Cerrahpaşa Ave. Kocamustafapaşa St. No: 34/E Fatih, Istanbul, Turkey
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Intensity-Modulated Radiotherapy (IMRT) following Conservative Surgery of the Supraglottic Region: Impact on Functional Outcomes. Cancers (Basel) 2022; 14:cancers14112600. [PMID: 35681579 PMCID: PMC9179846 DOI: 10.3390/cancers14112600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary The present study has been suggested by the previous experience of our group showing that patients treated with conventional radiotherapy (named 3D conformal radiotherapy—3D-CRT) performed after conservative surgery (CS) for tumors of the supraglottic regions experienced a high rate of severe long-term toxicity. Therefore, we reported the toxicity profile of a similar cohort of patients treated with a high-precision radiotherapy technique (named intensity-modulated radiotherapy—IMRT). Moreover, to investigate the advantage of IMRT, we performed a comparison with a historical cohort treated with 3D-CRT. Results showed that patients treated with IMRT achieved a very low toxicity profile and comparison with 3D-CRT was in favor of IMRTs. Therefore, we believe that the results of the present study provide preliminary findings on the potential of IMRT in improving the toxicity profile of patients treated with surgical organ preservation strategies for laryngeal tumors. Abstract The aim of the present study was to investigate the role of intensity-modulated radiotherapy (IMRT) on the toxicity profile of patients treated with conservative surgery (CS) of the supraglottic (SG) region. Data on patients treated with CS and postoperative radiotherapy (PORT)-IMRT were prospectively collected. Results. In total, 20 patients were analyzed. Of these, six patients (35%) required the positioning of a temporary tracheostomy. The functional larynx preservation rate was 95%. Females had a higher risk of both endoscopic intervention and chondronecrosis, while the median age was significantly higher in patients requiring enteral nutrition. The incidence of long-term severe toxicities was lower in patients treated with IMRT than in the historical 3D-CRT cohort. Patients who had received PORT-IMRT achieved a lower rate of permanent laryngeal and swallowing dysfunctions. Overall, results from the comparison with the historical 3D-CRT cohort favor the IMRTs.
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Is postoperative radiotherapy routinely indicated after total laryngectomy for pT3N0-1 supraglottic carcinoma? Oral Oncol 2020; 107:104825. [DOI: 10.1016/j.oraloncology.2020.104825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022]
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7
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Orosco RK, Tam K, Nakayama M, Holsinger FC, Spriano G. Transoral supraglottic laryngectomy using a next‐generation single‐port robotic surgical system. Head Neck 2019; 41:2143-2147. [DOI: 10.1002/hed.25676] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/04/2018] [Accepted: 01/09/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ryan K. Orosco
- Division of Head and Neck Surgery, Department of SurgeryUniversity of California San Diego California
| | - Kenric Tam
- Division of Head and Neck Surgery, Department of OtolaryngologyStanford University California
| | - Meijin Nakayama
- Department of Otolaryngology‐Head and Neck SurgeryYokohama City University Yokohama Japan
| | | | - Giuseppe Spriano
- Department of Otolaryngology ‐ Head & Neck Surgery“Regina Elena” National Cancer Institute Rome Italy
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8
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Alterio D, Ansarin M, Jereczek-Fossa BA, Zorzi S, Santoro L, Zerini D, Massaro M, Rondi E, Ferrario S, Piperno G, Rocca MC, Griseri M, Preda L, Chiesa F, Orecchia R. What is the price of functional surgical organ preservation in local-regionally advanced supraglottic cancer? Long-term outcome for partial laryngectomy followed by radiotherapy in 32 patients. TUMORI JOURNAL 2018; 99:667-75. [DOI: 10.1177/030089161309900605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background To achieve the goal of organ preservation, both a chemoradiotherapy and a conservative surgical approach can be proposed. The aim of the study was to review all patients treated in our Institute with conservative surgery and postoperative radiotherapy for locally advanced supraglottic tumor. Methods and study design A retrospective analysis of 32 patients treated between 2000 and 2010 was performed. Overall survival, disease-free survival and late laryngeal toxicity were evaluated. The impact of surgical procedures, radiotherapy characteristics and addition of chemotherapy on late laryngeal toxicity was studied. Results The median follow-up was 38 months. Overall survival and disease-free survival at 5 years were 73% and 66%, respectively. Three (9%) patients experienced local recurrence (after 22, 25 and 40 months, respectively) and were treated with total laryngectomy. The larynx preservation rate was 93%. Severe treatment-related late laryngeal toxicity (grade 3 and 4 laryngeal edema, laryngeal stenosis, presence of tracheotomy at last follow-up because of treatment-related toxicity, and the need for enteral nutrition) was experienced by 34% of patients. The functional larynx preservation rate was 81%. The statistically significant risk factors for severe late toxicity were: female gender, extension of the surgical procedure, removal of one arytenoid and association with concomitant chemotherapy. Conclusions We confirmed literature data on the feasibility and efficacy of a surgical organ preservation strategy. However, the high incidence of severe late toxicity requires further studies to improve patient selection and to reduce side effects.
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Affiliation(s)
- Daniela Alterio
- Division of Radiotherapy, European Institute of Oncology, Milan
| | - Mohssen Ansarin
- Department of Head and Neck Surgery, European Institute of Oncology, Milan
| | | | - Stefano Zorzi
- Department of Head and Neck Surgery, European Institute of Oncology, Milan
| | - Luigi Santoro
- Department of Experimental Oncology, European Institute of Oncology, Milan
| | - Dario Zerini
- Division of Radiotherapy, European Institute of Oncology, Milan
| | - Mariangela Massaro
- Department of Head and Neck Surgery, European Institute of Oncology, Milan
| | - Elena Rondi
- Department of Medical Physics, European Institute of Oncology, Milan
| | - Silvia Ferrario
- Division of Radiotherapy, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Gaia Piperno
- Division of Radiotherapy, European Institute of Oncology, Milan
| | | | - Mara Griseri
- Division of Radiotherapy, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Lorenzo Preda
- Division of Radiology, European Institute of Oncology, Milan
| | - Fausto Chiesa
- Department of Head and Neck Surgery, European Institute of Oncology, Milan
| | - Roberto Orecchia
- Division of Radiotherapy, European Institute of Oncology, Milan
- University of Milan, Milan
- National Center for Oncological Hadrontherapy, Pavia, Italy
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9
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Garibaldi E, Bresciani S, Airaldi C, Panaia R, Ferrara T, Delmastro E, Baiotto B, Gabriele P. Radiotherapy after Partial Laryngectomy: An Analysis of 36 Cases and a Proposal to Optimize Radiotherapy. TUMORI JOURNAL 2018; 95:198-206. [DOI: 10.1177/030089160909500211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Laryngeal cancer treatment options include radical surgery, “organ preservation surgery”, radiotherapy and chemotherapy. There is no proven evidence of a significant increase in late toxicity with adjuvant radiotherapy after conservative surgery. The aim of this retrospective study was to evaluate the toxicity, local-regional control and overall survival of adjuvant radiotherapy after conservative surgery. Methods A total of 36 patients was treated with radiotherapy after partial laryngectomy at the Radiotherapy Department of the Institute for Cancer Treatment and Research (IRCC) of Candiolo and of the Mauriziano Hospital in Turin, between 1994 and 2007. The postoperative treatment doses ranged from 45 to 70.2 Gy with conventional fractionation. The Kaplan-Meier method was applied for statistical analysis. The RTOG-EORTC scale was used to evaluate late and acute toxicity. Results Overall 5- and 10-year survival was 93% and 47%, respectively. Local control was 93.5% at 5 and was unchanged at 10 years. Grade 2 acute cutaneous and mucous toxicity was 41% and 62%, and grade 3, 6.9% and 3.5%, respectively. Only one patient required percutaneous endoscopic gastrostomy due to severe dysphagia and one patient required temporary tracheostomy for severe acute laryngeal edema (grade 3). Two patients experienced late toxicity greater than grade 3. The median dose to the residual larynx was 59.5 Gy (range, 45–70.2), and the median dose to the neck was 50.4 Gy (range, 39.6 −55.8). Conclusions The results of our study showed a dose-dependent increase in the late toxicity trend at doses over and above 60 Gy, which is higher than the cutoff dose reported in the literature. There was no indication from our data that adjuvant postoperative radiotherapy means additional toxicity. The use of highly conformal techniques can further reduce toxicity of the radiotherapy.
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Affiliation(s)
- Elisabetta Garibaldi
- Radiotherapy Unit, Istituto per la Ricerca e Cura del Cancro (IRCC), Candiolo and Mauriziano Umberto I Hospital, Turin, Italy
| | - Sara Bresciani
- Medical Physics Unit, Istituto per la Ricerca e Cura del Cancro (IRCC), Candiolo and Mauriziano Umberto I Hospital, Turin, Italy
| | - Claudia Airaldi
- Radiotherapy Unit, Istituto per la Ricerca e Cura del Cancro (IRCC), Candiolo and Mauriziano Umberto I Hospital, Turin, Italy
| | - Rocco Panaia
- Radiotherapy Unit, Istituto per la Ricerca e Cura del Cancro (IRCC), Candiolo and Mauriziano Umberto I Hospital, Turin, Italy
| | - Teresa Ferrara
- Radiotherapy Unit, Istituto per la Ricerca e Cura del Cancro (IRCC), Candiolo and Mauriziano Umberto I Hospital, Turin, Italy
| | - Elena Delmastro
- Radiotherapy Unit, Istituto per la Ricerca e Cura del Cancro (IRCC), Candiolo and Mauriziano Umberto I Hospital, Turin, Italy
| | - Barbara Baiotto
- Medical Physics Unit, Istituto per la Ricerca e Cura del Cancro (IRCC), Candiolo and Mauriziano Umberto I Hospital, Turin, Italy
| | - Pietro Gabriele
- Radiotherapy Unit, Istituto per la Ricerca e Cura del Cancro (IRCC), Candiolo and Mauriziano Umberto I Hospital, Turin, Italy
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10
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Graboyes EM, Zhan KY, Garrett-Mayer E, Lentsch EJ, Sharma AK, Day TA. Effect of postoperative radiotherapy on survival for surgically managed pT3N0 and pT4aN0 laryngeal cancer: Analysis of the National Cancer Data Base. Cancer 2017; 123:2248-2257. [PMID: 28182267 DOI: 10.1002/cncr.30586] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/12/2016] [Accepted: 01/03/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND The current study was conducted to determine the effect of postoperative radiotherapy (PORT) on overall survival in patients with surgically managed pT3-T4aN0 laryngeal squamous cell carcinoma (SCC). METHODS A review of the National Cancer Data Base from 2004 through 2013 was performed. Patients with surgically managed pT3-4aN0 laryngeal SCC with negative surgical margins were included. Univariable and multivariable Cox regression analyses were used to determine factors associated with survival. RESULTS A total of 1460 patients were included, 46.2% of whom had pT3N0 disease (674 patients) and 53.8% of whom had pT4aN0 disease (786 patients). Approximately 72.0% of the patients with pT3N0 disease (485 patients) and 50.1% of the patients with pT4aN0 disease (394 patients) received PORT. PORT was not found to be associated with improved overall survival on univariable analysis for patients with pT3N0 disease (hazard ratio [HR], 0.84; 95% confidence interval [95% CI], 0.62-1.14), but was for patients with pT4aN0 disease (HR, 0.57; 95% CI, 0.45-0.71). For patients with pT3N0 SCC of the larynx, in a multivariable Cox regression analysis adjusting for age >65 years, severity of comorbidities, larynx subsite, extent of laryngectomy, and number of lymph nodes removed, PORT was not found to be associated with improved survival (adjusted HR, 0.88; 95% CI, 0.64-1.21). For patients with pT4aN0 disease, the administration of PORT was associated with improved survival on multivariable analysis adjusting for age >65 years, severity of comorbidities, larynx subsite, number of lymph nodes removed, and type of hospital (adjusted HR, 0.58; 95% CI, 0.46-0.73). CONCLUSIONS For patients with surgically managed pT3N0 laryngeal SCC with negative margins, PORT does not appear to be associated with improved survival. Despite a survival benefit, nearly 50% of patients with pT4aN0 laryngeal SCC and negative surgical margins do not receive standard-of-care PORT. Cancer 2017;123:2248-2257. © 2017 American Cancer Society.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Kevin Y Zhan
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Elizabeth Garrett-Mayer
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Eric J Lentsch
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Anand K Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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11
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Day AT, Sinha P, Nussenbaum B, Kallogjeri D, Haughey BH. Management of primary T1-T4 glottic squamous cell carcinoma by transoral laser microsurgery. Laryngoscope 2016; 127:597-604. [PMID: 27578610 DOI: 10.1002/lary.26207] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/15/2016] [Accepted: 06/27/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS Evaluate the oncologic outcomes of patients with early and select advanced primary glottic squamous cell carcinoma (SCCa) managed by transoral laser microsurgery (TLM). STUDY DESIGN Retrospective cohort study. METHODS Ninety cases of TLM-managed primary glottic SCCa were identified retrospectively using a prospectively collected database. RESULTS Outcomes of patients with pTis-pT2a disease (n = 65) and pT2b-pT4a disease (n = 25) were, respectively: 5-year local control, 86.2% and 67.5%; 5-year disease-free survival, 64.9% and 44.9%; 5-year disease-specific survival, 96.4% and 59.0%; laryngeal preservation, 96.9% and 80%. Five of nine patients (56%) with supraglottic-glottic-subglottic tumors were local recurrence-free compared to the 70 of 81 (86%) patients with glottic, supraglottic-glottic, and glottic-subglottic tumors. Seven of 13 patients (54%) with positive or indeterminate margins were local recurrence-free compared to 68 of 77 (88%) patients with negative margins. CONCLUSIONS Given sample size considerations, this study highlights the satisfactory oncologic outcomes of TLM-treated glottic cancer and the potential importance of margin management and disease extension within the larynx. LEVEL OF EVIDENCE 4 Laryngoscope, 127:597-604, 2017.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, U.S.A
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, U.S.A
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, U.S.A
| | - Bruce H Haughey
- Department of Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, Florida, U.S.A.,Department of Surgery, University of Auckland, Auckland, New Zealand
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Kozhanov LG, Sdvizhkov AM, Reshetov IV, Kryukov AI, Kravtsov SA, Kozhanov AL, Bekov MT. [The algorithm for rehabilitation of the patients presenting with laryngeal cancer following open functionally sparing operations]. Vestn Otorinolaringol 2016; 81:43-47. [PMID: 27367349 DOI: 10.17116/otorino201681343-47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of the present study was to increase the efficiency of the treatment of the patients presenting with laryngeal cancer by the enhancement of the functional reserve of the preserved portion of the larynx and the prevention of the narrowing of its lumen. Another objective was to develop an algorithm for the rehabilitation of the patients with laryngeal localization of the tumour following open functionally sparing operations that consists of the operative and postoperative stages. During the period from 2006 to 2014, a total of 71 patients underwent functionally sparing operations. 66 of them were operated for laryngeal cancer, 1 for thyroid cancer spreading over trachea and larynx, 3 for papillomatosis. Resection of the larynx in the vertical and horizontal planes was performed in 62 and 9 patients respectively. Vertical plane surgery included the following procedures: fronto-lateral resection of the larynx in 51 patients, extended fronto-lateral resection in 10, and combined resection in 1 patient. It is concluded that the systemic approach to the treatment of the patients with laryngeal cancer and the proposed algorithm for their rehabilitation made it possible to restore the laryngeal function in 68 of the 71 patients (95.8%).
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Affiliation(s)
- L G Kozhanov
- Oncological Clinical Dispensary #1, Moscow Health Department, Moscow, Russia, 105005
| | - A M Sdvizhkov
- Oncological Clinical Dispensary #1, Moscow Health Department, Moscow, Russia, 105005
| | - I V Reshetov
- Research, Clinical and Educational Centre of Plastic Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 119991
| | - A I Kryukov
- L.I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 171152; N.I. Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia, 117997
| | - S A Kravtsov
- Oncological Clinical Dispensary #1, Moscow Health Department, Moscow, Russia, 105005
| | - A L Kozhanov
- N.I. Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia, 117997
| | - M T Bekov
- Oncological Clinical Dispensary #1, Moscow Health Department, Moscow, Russia, 105005
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Patterson JM, Hildreth A, Wilson JA. Measuring Edema in Irradiated Head and Neck Cancer Patients. Ann Otol Rhinol Laryngol 2016; 116:559-64. [PMID: 17847721 DOI: 10.1177/000348940711600801] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Edema is a common side effect of radiotherapy for head and neck cancer. Systems have been developed to record and monitor changes that occur after radiotherapy. These lack the sensitivity to record edema in specific laryngopharyngeal structures. The aim of this study was to develop a rating scale to measure edema in the larynx and pharynx. Methods: This was an exploratory study to develop a new measure, with the help of an expert panel, assessing interrater and intrarater reliability. A consensus group developed the rating scale. Eleven structures and 2 spaces were identified as areas sensitive to the development of edema. The terms no, mild, moderate, and severe were used to describe the degrees of edema. The scale was piloted and then tested for interrater and intrarater reliability on 5 speech and language therapists. They viewed 25 nasendolaryngoscopic images (23 patients who had had radiotherapy and 2 healthy volunteers). The images were rated with the scale. This process was repeated 1 week later. Results: Images were taken from patients with oral, oropharyngeal, nasopharyngeal, or laryngeal cancer. All had had radiotherapy or chemoradiotherapy. All raters were experienced in viewing larynges via nasendolaryngoscopy. The interrater reliability for scoring the edema rating scale was moderate (weighted kappa, 0.54). Lower levels of agreement were found for the tongue base, valleculae, pharyngeal walls, and anterior commissure. The intrarater reliability was very good (weighted kappa, 0.84). Conclusions: The edema rating scale can be scored with very good test-retest reproducibility and moderate levels of agreement between clinicians. Modifications to the method are suggested to increase interrater reliability.
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Affiliation(s)
- Joanne M Patterson
- Department of Surgical and Reproductive Sciences, University of Newcastle, Newcastle Upon Tyne, United Kingdom
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14
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Merlotti A, Alterio D, Vigna-Taglianti R, Muraglia A, Lastrucci L, Manzo R, Gambaro G, Caspiani O, Miccichè F, Deodato F, Pergolizzi S, Franco P, Corvò R, Russi EG, Sanguineti G. Technical guidelines for head and neck cancer IMRT on behalf of the Italian association of radiation oncology - head and neck working group. Radiat Oncol 2014; 9:264. [PMID: 25544268 PMCID: PMC4316652 DOI: 10.1186/s13014-014-0264-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 11/17/2014] [Indexed: 12/25/2022] Open
Abstract
Performing intensity-modulated radiotherapy (IMRT) on head and neck cancer patients (HNCPs) requires robust training and experience. Thus, in 2011, the Head and Neck Cancer Working Group (HNCWG) of the Italian Association of Radiation Oncology (AIRO) organized a study group with the aim to run a literature review to outline clinical practice recommendations, to suggest technical solutions and to advise target volumes and doses selection for head and neck cancer IMRT. The main purpose was therefore to standardize the technical approach of radiation oncologists in this context. The following paper describes the results of this working group. Volumes, techniques/strategies and dosage were summarized for each head-and-neck site and subsite according to international guidelines or after reaching a consensus in case of weak literature evidence.
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Affiliation(s)
- Anna Merlotti
- Radioterapia AO Ospedale di Circolo-Busto Arsizio (VA), Piazzale Professor G. Solaro, 3, 21052, Busto Arsizio, VA, Italy.
| | | | | | | | | | - Roberto Manzo
- Radioterapia Azienda Ospedaliera ASL Napoli 1-Napoli, Napoli, Italy.
| | | | - Orietta Caspiani
- Radioterapia Ospedale Fatebenefratelli, Isola Tiberina-Roma, Roma, Italy.
| | | | - Francesco Deodato
- Radioterapia Università Cattolica del S. Cuore -Campobasso, Roma, Italy.
| | - Stefano Pergolizzi
- Dipartimento SBIMOF Sezione di Scienze Radiologiche, Università di Messina, Piazza Pugliatti Salvatore, 1, 98122, Messina, ME, Italy.
| | - Pierfrancesco Franco
- Dipartimento di Oncologia, Radioterapia Oncologica, Università di Torino, Turin, Italy.
| | - Renzo Corvò
- Oncologia Radioterapica, IRCS S. Martino-IST- Istituto Nazionale per la Ricerca sul Cancro, Università Genova, Genova, Italy.
| | - Elvio G Russi
- Radioterapia Az. Ospedaliera S. Croce e Carle-Cuneo, via M. Coppino 26 12100, Cuneo, Italy.
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Marioni G, Ottaviano G, Lionello M, Fasanaro E, Staffieri C, Giacomelli L, Gattazzo S, Staffieri A, Blandamura S. A panel of biomarkers for predicting response to postoperative RT for laryngeal cancer? Am J Otolaryngol 2014; 35:771-8. [PMID: 25064017 DOI: 10.1016/j.amjoto.2014.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 06/10/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Postoperative radiotherapy (PORT) improves locoregional control and survival rates for patients with advanced laryngeal carcinoma (LSCC), but reported outcomes after PORT for LSCC vary considerably. Predictive markers (including biomarkers) are needed for LSCC to orient the choice of the most appropriate adjuvant therapy for individual patients. The aim of this study was to identify a panel of LSCC tissue markers (considering EGFR, mTOR, survivin, Bcl-2, angiogenin, endoglin [CD105], nm23-H1) capable of pinpointing patients at higher risk of recurrence among 33 LSCC cases treated with PORT. METHODS/RESULTS Univariate analysis found 4 biomarkers (mTOR, nuclear survivin, CD105, non-nuclear nm23-H1) significantly associated with LSCC recurrence. A collinearity emerged between mTOR and CD105 expressions. The predictive role of two different panels (panel 1: mTOR, nuclear survivin, non-nuclear nm23-H1; panel 2: CD105, nuclear survivin, non-nuclear nm23-H1) was considered. According to the Hosmer and Lemeshow scale, panel 1 demonstrated an outstanding discriminatory power (AUC 0.903) in predicting LSCC recurrence after PORT. Panel 2 had an excellent discriminatory power too (AUC 0.899). CONCLUSIONS Both panels of biomarkers showed an important discriminatory power in pinpointing patients at higher risk of recurrence after PORT for LSCC who could reasonably benefit from adjuvant postoperative chemo-RT.
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Abstract
Squamous cell carcinoma of the larynx continues to be the commonest head and neck cancer in many Western countries. The larynx plays a key role for many essential functions, including breathing, voice production, airway protection, and swallowing. The goals of laryngeal cancer treatment are thus to provide best possible oncologic control, while optimizing functional outcomes. In recent decades, the treatment paradigm for advanced laryngeal cancer has shifted from one of primary surgery (total laryngectomy) as gold standard, toward non-surgical organ-preserving treatment using radiotherapy or chemoradiotherapy. However, concerns have emerged regarding functional outcomes after chemoradiotherapy, as well as possible decreased overall survival in patients with laryngeal cancer. The purpose of the present review is to review surgical and non-surgical options for treatment of advanced laryngeal cancer, as well as the evidence supporting each of these.
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Canis M, Ihler F, Martin A, Wolff HA, Matthias C, Steiner W. Results of 226 patients with T3 laryngeal carcinoma after treatment with transoral laser microsurgery. Head Neck 2013; 36:652-9. [PMID: 23596018 DOI: 10.1002/hed.23338] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 01/09/2013] [Accepted: 04/05/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the feasibility of transoral laser microsurgery (TLM) in treatment of pT3 laryngeal cancer. METHODS We conducted a retrospective case series study of 226 patients with pT3 glottic (n = 122; 54%) or supraglottic laryngeal carcinoma (n = 104; 46%). All patients were treated by TLM in combination with neck dissection (63%) and with postoperative radiotherapy (18%). Our main outcome measures were local control, organ preservation, functional outcome, overall survival, recurrence-free survival, and disease-specific survival. RESULTS Median follow-up period was 57.8 months. The 5-year organ-preservation and local control rates for all patients were 87% and 71.4%, respectively. The 5-year overall, recurrence-free, and disease-specific survival were 64.4%, 63.0%, and 83.3%, respectively. CONCLUSION Results are comparable to partial or total laryngectomy, while being superior to primary chemo(radio)therapy. TLM results in low morbidity, rapid recovery, and good function and can be a valid option for organ-preserving surgery of pT3 glottic and supraglottic cancer.
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Affiliation(s)
- Martin Canis
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, Germany
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Canis M, Martin A, Ihler F, Wolff HA, Kron M, Matthias C, Steiner W. Results of transoral laser microsurgery for supraglottic carcinoma in 277 patients. Eur Arch Otorhinolaryngol 2013; 270:2315-26. [PMID: 23306348 PMCID: PMC3699705 DOI: 10.1007/s00405-012-2327-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 12/11/2012] [Indexed: 12/01/2022]
Abstract
The objective of the study was to evaluate the oncological and functional results of transoral laser microsurgery (TLM) in patients with supraglottic laryngeal squamous cell carcinoma. Between June 1980 and December 2006, 277 patients with squamous cell supraglottic carcinoma of all stages were treated by primary carbon dioxide laser microsurgery. All treatments were performed with curative intention. The goal was the complete tumor removal with preservation of functionally important structures of the larynx. The administered treatment was exclusively TLM with or without selective or modified radical neck dissection in 215 cases (78 %); TLM with postoperative radiotherapy was performed in 62 cases (22 %). Data were analyzed using the Kaplan–Meier method. The median follow-up was 65 months. We achieved a 5-year local control rate of 85 % for pT1/pT2, 82 % for pT3, and 76 % for pT4. The 5-year overall, recurrence-free and disease-specific survival rates for stages I and II were 76, 81, and 92 %, for stages III and IVa 59, 65, and 81 %, respectively. With respect to local control and survival, these results are comparable with the results achieved by conventional partial and total resection of the larynx, while being superior to primary (chemo)radiotherapy. Transoral laser microsurgery results in a low morbidity, rapid recovery, and superior function compared with standard therapy.
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Affiliation(s)
- Martin Canis
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, Robert-Koch-Str. 40, 37099 Göttingen, Germany.
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Thomas L, Drinnan M, Natesh B, Mehanna H, Jones T, Paleri V. Open conservation partial laryngectomy for laryngeal cancer: A systematic review of English language literature. Cancer Treat Rev 2012; 38:203-11. [DOI: 10.1016/j.ctrv.2011.05.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 05/01/2011] [Accepted: 05/29/2011] [Indexed: 11/25/2022]
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Ambrosch P, Fazel A. Functional organ preservation in laryngeal and hypopharyngeal cancer. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 10:Doc02. [PMID: 22558052 PMCID: PMC3341579 DOI: 10.3205/cto000075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The principles of open versus laser microsurgical approaches for partial resections of the larynx are described, oncologic as well as functional results discussed and corresponding outcomes following primary radiotherapy are opposed. Over the last decade, the endoscopic partial resection of the larynx has developed to an accepted approach in the treatment of early glottic and supraglottic carcinomas thus leading to a remarkable decline in the use of open surgery. Comparing the various surgical approaches of laryngeal partial resections, the oncological outcome of the patients, as far as survival and organ preservation are concerned, are comparable, whereas functional results of the endoscopic procedures are superior with less morbidity. The surgical procedures put together, are all superior to radiotherapy concerning organ preservation. Transoral laser microsurgery has been used successfully for vocal cord carcinomas with impaired mobility or fixation of the vocal cord, supraglottic carcinomas with infiltration of the pre- and/or paraglottic space as well as for selected hypopharyngeal carcinomas. It has been well documented that laser microsurgery achieves good oncological as well as functional results with reasonable morbidity. However, patients with those tumours have been successfully treated by open partial resections of the larynx at medical centres with appropriate expertise. The initially enthusiastic assessment of study results concerning the efficacy of various protocols of chemoradiation with the intent of organ preservation for laryngeal and hypopharyngeal carcinomas are judged more cautious, today, due to recent reports of rather high rates of late toxicity complications.
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Affiliation(s)
- Petra Ambrosch
- Department of Otorhinolaryngology - Head and Neck Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
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21
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Injection augmentation of arytenoids after partial laryngectomy: case series. The Journal of Laryngology & Otology 2010; 125:65-9. [DOI: 10.1017/s002221511000160x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:We undertook collagen injection laryngoplasty to achieve arytenoid augmentation in patients with dysphagia and persistent aspiration following partial laryngectomy, and we evaluated the efficacy of arytenoid augmentation in aiding neoglottic closure and ensuring airway safety.Methods:Two patients with persistent swallowing impairment after partial laryngectomy were studied. Swallowing was evaluated using fibre-optic endoscopy, and modified barium swallow study. Collagen was then injected into the arytenoid mucosa to achieve neoglottic competence.Results:The patients were followed up for up to two years. Both patients showed a marked improvement in neoglottic competence, as evaluated by fibre-optic and flexible endoscopy at three-month and one-year follow-up appointments.Conclusion:Arytenoid augmentation by injection laryngoplasty can be considered a safe and effective surgical tool for the treatment of dysphagia with persistent aspiration following partial laryngectomy.
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High-speed digital imaging of the neoglottis after supracricoid laryngectomy with cricohyoidoepiglottopexy. Otolaryngol Head Neck Surg 2010; 142:598-604. [PMID: 20304285 DOI: 10.1016/j.otohns.2009.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 11/11/2009] [Accepted: 12/03/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the utility of high-speed digital imaging (HSDI) in evaluating vocal kinetics of the neoglottis after supracricoid laryngectomy with cricohyoidoepiglottopexy (SCL-CHEP). STUDY DESIGN Case series. SETTING The University of Tokyo Hospital. SUBJECTS AND METHODS High-speed digital recordings of laryngeal images were obtained from six patients after SCL-CHEP to clarify the vocal kinetics of the postoperative neoglottis. Simultaneous recording of electroglottograms (EGGs) were obtained and multiline kymograms were generated on the basis of the recorded images. The distribution of frequency, amplitude, and phase in the neoglottis were visualized by using gradients of colors superimposed onto the glottal and supraglottal areas of laryngeal images to produce laryngeal topograms. Furthermore, waveforms of estimated laryngeal sound source (ELSS) were obtained on the basis of glottal inverse filtering of the vocal signal to reflect vibratory motions in the neoglottis. The vibratory part of the neoglottis was determined as a possible sound source when the frequencies of the ELSS, EGG, and laryngeal topograms, as well as the waveforms of ELSS, EGG, and kymograms, were consistent with each other. RESULTS Spaces between the arytenoid(s) and epiglottis (5 patients) or pyriform sinus mucosa (1 patient) were estimated as the major source of sound during postoperative vocalization. The possible sound source could be determined by HSDI, even in the neoglottis, with more than one vibratory position. CONCLUSION HSDI could be useful for evaluating the vocal kinetics of the neoglottis after SCL-CHEP.
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Petrović Z, Dordević V, Nesić V. Surgical treatment of the supraglottic laryngeal carcinoma. MEDICINSKI PREGLED 2008; 61:242-6. [PMID: 19102069 DOI: 10.2298/mpns0806242p] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This is a retrospective analysis of 439 patients with supraglottic laryngeal cancer primary surgically treated in the period 1976-1999. The objectives of our study were to analyze the localizations as well as local and regional tumor spread, frequency of occult and palpable cervical metastases, the incidence of local and regional recurrences, five-year survival rate and functional results of supraglottic partial horizontal laryngectomies. A retrospective analysis of operated patients was carried out. T1 tumor was prevalent in 184 (42%) patients, T2 in 228 (52%) patients, and T3 tumor in 27 (6%) of cases. Clinically negative finding of the neck was found in 369 (84%) patients, and metastasis N1 was established in 70 (16%) patients. The patients with clinically negative cervical finding underwent selective neck dissection, while N1 metastasis patients were subjected to a selective or modified radical neck dissection. Five-year disease-free survival rate was 76% (334/439).
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Affiliation(s)
- Zeljko Petrović
- Institut za otorinolaringologiju i maksilofacijalnu hirurgiju, Klinicki centar Srbije, Beograd.
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Sanguineti G, Adapala P, Endres EJ, Brack C, Fiorino C, Sormani MP, Parker B. Dosimetric Predictors of Laryngeal Edema. Int J Radiat Oncol Biol Phys 2007; 68:741-9. [PMID: 17398024 DOI: 10.1016/j.ijrobp.2007.01.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 01/03/2007] [Accepted: 01/04/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate dosimetric predictors of laryngeal edema after radiotherapy (RT). METHODS AND MATERIALS A total of 66 patients were selected who had squamous cell carcinoma of the head and neck with grossly uninvolved larynx at the time of RT, no prior major surgical operation except for neck dissection and tonsillectomy, treatment planning data available for analysis, and at least one fiberoptic examination of the larynx within 2 years from RT performed by a single observer. Both the biologically equivalent mean dose at 2 Gy per fraction and the cumulative biologic dose-volume histogram of the larynx were extracted for each patient. Laryngeal edema was prospectively scored after treatment. Time to endpoint, moderate or worse laryngeal edema (Radiation Therapy Oncology Group Grade 2+), was calculated with log rank test from the date of treatment end. RESULTS At a median follow-up of 17.1 months (range, 0.4- 50.0 months), the risk of Grade 2+ edema was 58.9% +/- 7%. Mean dose to the larynx, V30, V40, V50, V60, and V70 were significantly correlated with Grade 2+ edema at univariate analysis. At multivariate analysis, mean laryngeal dose (continuum, hazard ratio, 1.11; 95% confidence interval, 1.06-1.15; p < 0.001), and positive neck stage at RT (N0-x vs. N +, hazard ratio, 3.66; 95% confidence interval, 1.40-9.58; p = 0.008) were the only independent predictors. Further stratification showed that, to minimize the risk of Grade 2+ edema, the mean dose to the larynx has to be kept < or =43.5 Gy at 2 Gy per fraction. CONCLUSION Laryngeal edema is strictly correlated with various dosimetric parameters; mean dose to the larynx should be kept < or =43.5 Gy.
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Affiliation(s)
- Giuseppe Sanguineti
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX 77555-0711, USA.
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Bron LP, Soldati D, Monod ML, Mégevand C, Brossard E, Monnier P, Pasche P. Horizontal partial laryngectomy for supraglottic squamous cell carcinoma. Eur Arch Otorhinolaryngol 2004; 262:302-6. [PMID: 15316823 DOI: 10.1007/s00405-004-0824-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2003] [Accepted: 06/07/2004] [Indexed: 11/28/2022]
Abstract
Between 1981-1999, 75 patients treated for supraglottic SCC with horizontal supraglottic laryngectomy (HSL) at the Otolaryngology Head and Neck Surgery Department of Lausanne University Hospital were retrospectively studied. There were 16 patients with T1, 46 with T2 and 13 with T3 tumors. Among these, 16 patients (21%) had clinical neck disease corresponding to stage I, II, III and IV in 12, 39, 18 and 6 patients, respectively. All patients had HSL. Most patients had either elective or therapeutic bilateral level II-IV selective neck dissection. Six patients (8%) with advanced neck disease had ipsilateral radical and controlateral elective II-IV selective neck dissections. Adjuvant radiotherapy was given to 25 patients (30%) for either positive surgical margins (n=8), pathological nodal status (n=14) or both (n=3). Median follow-up was 48 months (range, 24-199). Five-year disease-specific survival and locoregional and local control were 92, 90 and 92.5%, respectively. Among five patients who were diagnosed with local recurrence, one had a total laryngectomy (1.4%); the others were treated by endoscopic laser surgery. Two patients had both a local and regional recurrence. They were salvaged with combined surgery and radiotherapy, but eventually died of their disease. Cartilage infiltration seems to influence both local control (P=0.03) and disease-specific survival (P=0.06). There was a trend for worse survival with pathological node involvement (P=0.15) and extralaryngeal extension of the cancer (P=0.1). All patients except one recovered a close to normal function after the treatment. Aspiration was present in 16 patients (26%) in the early postoperative period. A median of 16 days (7-9) was necessary to recover a close to normal diet. Decannulation took a median of 17 days (8-93). Seven patients kept a tracheotomy tube for up to 3 months because of persistent aspiration. There was no permanent tracheostomy or total laryngectomy for functional purposes. Horizontal supraglottic laryngectomy remains an adequate therapeutic alternative for supraglottic squamous cell carcinoma, offering an excellent oncological outcome. The postoperative functional morbidity is substantial, indicating the need for careful patient selection, but good laryngeal function recovery is the rule. The surgical alternative is endoscopic laser surgery, which may offer comparable oncological results with less functional morbidity. Nevertheless, these two different techniques need to be compared prospectively.
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Affiliation(s)
- L P Bron
- Department of Otorhinolaryngology and Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, CHUV BH-12/709, 1011 Lausanne, Switzerland.
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Milecki P, Kruk-Zagajewska A, Żmijewska-Tomczak M, Stryczyńska G. Adjuvant radiotherapy in laryngeal cancer over the last few decades: the evolution of treatment policy in the great poland cancer centre. Rep Pract Oncol Radiother 2004. [DOI: 10.1016/s1507-1367(04)71109-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hinerman RW, Mendenhall WM, Amdur RJ, Stringer SP, Villaret DB, Robbins KT. Carcinoma of the supraglottic larynx: treatment results with radiotherapy alone or with planned neck dissection. Head Neck 2002; 24:456-67. [PMID: 12001076 DOI: 10.1002/hed.10069] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To present the results of radiotherapy with or without neck dissection for squamous cell carcinoma of the supraglottic larynx treated at the University of Florida and to compare these data with those obtained after conservation surgery. METHODS AND MATERIALS Continuous-course radiotherapy alone or combined with a planned neck dissection was used to treat 274 patients with squamous cell carcinoma of the supraglottic larynx between 1964 and 1998. All patients had follow-up for a minimum of 2 years, and 250 (91%) had follow-up for 5 years or more. RESULTS At 5 years, the actuarial probability of local control after radiotherapy according to T stage was as follows: T1, 100%; T2, 86%; T3, 62%; and T4, 62%. The probability of cause-specific survival at 5 years by AJCC stage was as follows: stage I, 100%; II, 93%; III, 81% IVA, 50%; and IVB, 13%. The risk of severe late complications was 4%. Of 57 patients undergoing planned postradiotherapy neck dissection, 7% experienced a severe complication. CONCLUSIONS On the basis of our data and the literature, early or moderately advanced supraglottic carcinomas may be treated successfully with either supraglottic laryngectomy or radiotherapy. Supraglottic laryngectomy probably produces a higher initial local control rate but, based on anatomic and coexisting medical constraints, is suitable for a smaller subset of patients and has a higher risk of complications compared with radiotherapy.
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Affiliation(s)
- Russell W Hinerman
- Department of Radiation Oncology, University of Florida Health Science Center, 2000 SW Archer Road, PO Box 100385, Gainesville 32610-0385, USA.
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