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Almas S, Jeffery CC. Late laryngeal dysfunction in head and neck cancer survivors. Laryngoscope Investig Otolaryngol 2023; 8:1272-1278. [PMID: 37899877 PMCID: PMC10601572 DOI: 10.1002/lio2.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/05/2023] [Accepted: 07/16/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives Head and neck cancer (HNC) survivorship issues are areas of increasing research interest. Laryngeal dysfunction in HNC patients is particularly important given the importance of the larynx in voice, swallowing, and airway protection. The objective of our study is to characterize late laryngeal dysfunction in a cohort of long-term HNC survivors. Methods HNC survivors who were at least 2 years post-treatment were recruited prospectively for standard collection of videolaryngoscopy findings, videofluoroscopic swallowing studies, and assessment of clinical outcomes. Descriptive statistics were performed and clinical presentation and outcomes were compared between survivors >10 years and <10 years post-treatment. Additional factor analysis to correlate clinical outcomes with clinical variables was performed. Results Thirty participants were analyzed with a mean age of 66 years. The majority were male (80%) patients treated for oropharyngeal squamous cell carcinoma (67%). Within the cohort, 43% underwent primary chemoradiation therapy and had 13% radiation alone. Common presenting symptoms included swallowing dysfunction (83%), voice change (67%), and chronic cough (17%). Laryngeal findings on video laryngoscopy include vocal fold motion abnormalities (VFMA) in over half of participants (61%) and mucosal changes in 20%. A weak correlation was found between time since treatment and laryngeal dysfunction (r = .182, p = .34), and no correlation was found between age, sex, time since treatment, or primary site and the presence or absence of VFMA, G-tube status, or tracheostomy-tube status. Conclusion Late laryngeal dysfunction in HNC survivors contributes to significant morbidity, is difficult to treat, and remains static decades after treatment for their original cancer. Lay Summary The voice-box, or the larynx, plays an important role in voice, swallowing and airway protection. It is particularly vulnerable to radiation-related damage and changes. This study demonstrates the sequelae of long-term damage of the larynx in head and cancer survivors. Level of Evidence IV.
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Affiliation(s)
- Sarah Almas
- Division of Otolaryngology‐Head and Neck Surgery, Department of Surgery, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - Caroline C. Jeffery
- Division of Otolaryngology‐Head and Neck Surgery, Department of Surgery, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
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Lee DS, Lee JJ, Sinha P, Puram SV, Jackson RS, Adkins DR, Oppelt P, Brenneman R, Thorstad WL, Pipkorn P. Risk Factors for Functional Outcomes in Advanced Laryngeal Squamous Cell Carcinoma. Laryngoscope 2023; 133:594-600. [PMID: 35611799 PMCID: PMC9691786 DOI: 10.1002/lary.30166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/23/2022] [Accepted: 04/13/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Chemoradiation for patients with laryngeal squamous cell carcinoma (SCC) may achieve organ preservation, but appropriate patient selection remains unknown. This study investigates pre-treatment risk factors associated with functional and survival outcomes after radiation-based therapy in patients with advanced laryngeal SCC. METHODS A retrospective cohort study was performed on 75 adult patients with stage III or IV laryngeal SCC receiving definitive radiation-based therapy from 1997 to 2016 at a tertiary care center. Tracheostomy and gastrostomy dependence were the primary functional outcomes. Multivariable logistic regressions were performed to evaluate relationships between pre-treatment factors and tracheostomy and gastrostomy dependence. Time-to-event analyses were performed to determine risk factors associated with overall survival. RESULTS Among 75 patients included in the analysis, 30 (40%) patients were tracheostomy dependent and 31 (41%) were gastrostomy tube dependent. The median length of follow-up was 31 months (range = 1 to 142 months). Pre-treatment tracheostomy was a significant predictor of post-treatment tracheostomy (aOR = 13.9, 95% CI = 3.35 to 57.5) and moderate-severe comorbidity was a significant predictor of post-treatment gastrostomy dependence (aOR = 2.96, 95% CI = 1.04 to 8.43). The five-year overall survival was 51% (95% CI = 38 to 64%). Pre-treatment gastrostomy tube dependence was associated with an increased risk of death (aHR = 2.45, 95% CI = 1.09 to 5.53). CONCLUSIONS Baseline laryngeal functional status and overall health in advanced laryngeal SCC are associated with poor functional outcomes after radiation-based therapy, highlighting the importance of patient selection when deciding between surgical and non-surgical treatment plans. Laryngoscope, 133:594-600, 2023.
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Affiliation(s)
- David S. Lee
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jake J. Lee
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Parul Sinha
- Department of Otolaryngology – Head and Neck Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Sidharth V. Puram
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Douglas R. Adkins
- Department of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peter Oppelt
- Department of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Randall Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Wade L. Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Nagai T, Wakabayashi H, Nishioka S, Momosaki R. Association between board-certified physiatrist involvement and functional outcomes in sarcopenic dysphagia patients: a retrospective cohort study of the Japanese Sarcopenic Dysphagia Database. J Rural Med 2023; 18:21-27. [PMID: 36700126 PMCID: PMC9832312 DOI: 10.2185/jrm.2022-026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 10/07/2022] [Indexed: 01/06/2023] Open
Abstract
Objective: Dysphagia rehabilitation is an important area in geriatric nutrition due to the commonality of sarcopenic dysphagia in older adults. However, there have been no reports on the efficacy of treatment by board-certified physiatrists (BCP) in patients with sarcopenic dysphagia. This study therefore aimed to investigate whether intervention by board-certified physiatrists affects the functional prognosis of patients with sarcopenic dysphagia. Materials and Methods: Of 467 patients enrolled in the Japanese Sarcopenic Dysphagia database between November 2019 and March 2021, 433 met the study eligibility criteria. The patients were divided into two groups based on whether or not they received intervention by a BCP. The clinical characteristics and outcomes of the two groups were compared. Statistical analyses were performed by inverse probability weighting (IPW). Results: BCPs were involved in the management of 57.0% of patients with sarcopenic dysphagia. These patients had a significantly higher increase in the Barthel index both before and after IPW correction than those not managed by a BCP (P=0.001 and P=0.016, respectively). However, sarcopenic dysphagia significantly improved in the non-BCP group before IPW correction (P<0.001), although there was no significant difference after IPW correction (P=0.301). Conclusion: BCP management was significantly associated with higher activities of daily living (ADL), but not with an improvement in sarcopenic dysphagia. To provide and manage effective rehabilitation, it is necessary to familiarize patients with the management and training of sarcopenic dysphagia rehabilitation for BCP in order to cope in regions with few rehabilitation units.
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Affiliation(s)
- Takako Nagai
- Department of Rehabilitation Medicine, Nihon University
Hospital, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical
University Hospital, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki
Rehabilitation Hospital, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University
Graduate School of Medicine, Japan
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Mohamad I, Almousa A, Taqash A, Mayta E, Abuhijla F, Ghatasheh H, Ababneh H, Wahbeh L, Abuhijlih R, Hussein T, Al‐Gargaz W, Hosni A. Primary radiation therapy for advanced-stage laryngeal cancer: A laryngo-esophageal dysfunction disease-free survival. Laryngoscope Investig Otolaryngol 2022; 7:1866-1874. [PMID: 36544959 PMCID: PMC9764778 DOI: 10.1002/lio2.972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/30/2022] [Accepted: 10/29/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To evaluate the outcomes of advanced-stage laryngeal squamous cell carcinoma (SCC) patients treated with functional-preservation strategy with a specific focus on laryngo-esophageal dysfunction disease-free survival (LEDDFS). Methods and materials A retrospective review was conducted of stage III-IVB laryngeal SCC patients who were treated with curative-intent radiotherapy (RT) (2007-2018). Patients were preferentially managed with upfront chemoradiation (CCRT); except for those with cN2-3, cT4, or large volume cT3 (induction chemotherapy followed by RT or CCRT is an option), and those who were unfit or declined chemotherapy (received altered RT). The primary endpoint was 3-year LEDDFS, and secondary endpoints were 3-year local failure (LF), regional failure (RF), distant metastasis (DM), overall survival (OS), disease-free survival (DFS), and acute and late toxicities. Cox proportional hazard tests were used for multivariable analysis (MVA). Results A total of 213 cases were included. With a median follow-up of 37 months, the 3-year LEDDFS was 50%, while the 3-year OS, DFS, LF, RF, and DM were 81%, 74%, 9%, 5%, and 7%, respectively. On MVA, cT4-category was the only predictor of inferior LEDDFS (HR: 0.47, [95% CI: 0.29-0.74], p < .01). The most common grade ≥ 3 acute and late radiation therapy oncology group (RTOG) toxicity were esophageal toxicity: 16.7% and 29.6%, respectively. Conclusions Primary RT resulted in favorable oncologic and functional outcomes in only half of the advanced-stage laryngeal cancer patients. Future clinical trials are required to investigate further treatment options aiming to improve the oncologic and maintain functional outcomes with utilization of LEDDFS as the primary endpoint. Level of evidence 4.
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Affiliation(s)
- Issa Mohamad
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Abdelatif Almousa
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Ayat Taqash
- Department of BiostatisticsKing Hussein Cancer CenterAmmanJordan
| | - Ebrahim Mayta
- Department of Surgical OncologyKing Hussein Cancer CenterAmmanJordan
| | - Fawzi Abuhijla
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Hamza Ghatasheh
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Hazem Ababneh
- Department of Radiation OncologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Lina Wahbeh
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Ramiz Abuhijlih
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Tariq Hussein
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Wisam Al‐Gargaz
- Department of Surgical OncologyKing Hussein Cancer CenterAmmanJordan
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer CentreUniversity Health Network, University of TorontoTorontoOntarioCanada
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Li L, Han J, Zhang S, Dong C, Xiao X. KIF26B-AS1 Regulates TLR4 and Activates the TLR4 Signaling Pathway to Promote Malignant Progression of Laryngeal Cancer. J Microbiol Biotechnol 2022; 32:1344-1354. [PMID: 36224753 PMCID: PMC9668086 DOI: 10.4014/jmb.2203.03037] [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: 03/21/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022]
Abstract
Laryngeal cancer is one of the highest incidence, most prevalently diagnosed head and neck cancers, making it critically necessary to probe effective targets for laryngeal cancer treatment. Here, real-time quantitative reverse transcription PCR (qRT-PCR) and western blot analysis were used to detect gene expression levels in laryngeal cancer cell lines. Fluorescence in situ hybridization (FISH) and subcellular fractionation assays were used to detect the subcellular location. Functional assays encompassing Cell Counting Kit-8 (CCK-8), 5-ethynyl-2'-deoxyuridine (EdU), transwell and wound healing assays were performed to examine the effects of target genes on cell proliferation and migration in laryngeal cancer. The in vivo effects were proved by animal experiments. RNA-binding protein immunoprecipitation (RIP), RNA pulldown and luciferase reporter assays were used to investigate the underlying regulatory mechanisms. The results showed that KIF26B antisense RNA 1 (KIF26B-AS1) propels cell proliferation and migration in laryngeal cancer and regulates the toll-like receptor 4 (TLR4) signaling pathway. KIF26B-AS1 also recruits FUS to stabilize TLR4 mRNA, consequently activating the TLR4 signaling pathway. Furthermore, KIF26B-AS1 plays an oncogenic role in laryngeal cancer via upregulating TLR4 expression as well as the FUS/TLR4 pathway axis, findings which offer novel insight for targeted therapies in the treatment of laryngeal cancer patients.
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Affiliation(s)
- Li Li
- Department of Otolaryngology, Head and Neck Surgery, The First People’s Hospital of Lianyungang City, No.182, Tongguan Road, Haizhou District, Lianyungang City, Jiangsu Province 222100, P.R. China
| | - Jiahui Han
- Department of Otolaryngology, Head and Neck Surgery, The First People’s Hospital of Lianyungang City, No.182, Tongguan Road, Haizhou District, Lianyungang City, Jiangsu Province 222100, P.R. China
| | - Shujia Zhang
- Department of Otolaryngology, Head and Neck Surgery, The First People’s Hospital of Lianyungang City, No.182, Tongguan Road, Haizhou District, Lianyungang City, Jiangsu Province 222100, P.R. China
| | - Chunguang Dong
- Department of Otolaryngology, Head and Neck Surgery, The First People’s Hospital of Lianyungang City, No.182, Tongguan Road, Haizhou District, Lianyungang City, Jiangsu Province 222100, P.R. China
| | - Xiang Xiao
- Department of Otolaryngology, Head and Neck Surgery, The First People’s Hospital of Lianyungang City, No.182, Tongguan Road, Haizhou District, Lianyungang City, Jiangsu Province 222100, P.R. China,Corresponding author Phone: +0518-85607019 Fax: +0518-85607019 E-mail:
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Morioka R, Matsuda Y, Kato A, Okui T, Okuma S, Tatsumi H, Kanno T. Oral functional impairment may cause malnutrition following oral cancer treatment in a single-center cross-sectional study. Sci Rep 2022; 12:14787. [PMID: 36042270 PMCID: PMC9428164 DOI: 10.1038/s41598-022-19177-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Oral dysfunction and dysphagia after oral cancer treatment are linked to altered nutritional status. We aimed to identify specific oral functions related to nutritional status. We conducted a cross-sectional study from September 2019 to December 2021, recruited 75 participants (median age: 72.0 years), including 52 males and 23 females, collected background data, and evaluated oral function. The Mini Nutritional Assessment-Short Form (MNA-SF) scores were divided into three groups (normal nutritional status, at risk of malnutrition, and malnourished), and a multi-group comparison was conducted for each oral function measurement (microorganisms, oral dryness, occlusal force, tongue pressure, masticatory function, and Eating Assessment Tool [EAT-10]). The primary tumor site was the tongue in 31 patients (41.3%), gingiva in 30 (40.0%), and others in 14 (18.7%). Multiple comparisons revealed significant differences in occlusal force, tongue pressure, masticatory function, and EAT-10 levels, categorized as Type I (Transport type) and Type III (Occlusion type) postoperative oral dysfunctions, between each MNA-SF group. Multiple regression analysis showed a statistically significant association with MNA-SF in terms of masticatory function and EAT-10 levels, categorized as Type I. Type I and Type III are risk factors for malnutrition, confirming that different types of postoperative oral dysfunction require unique nutritional guidance.
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Affiliation(s)
- Reon Morioka
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Yuhei Matsuda
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Akira Kato
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Tatsuo Okui
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Satoe Okuma
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Hiroto Tatsumi
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
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Effects of Ultrafine Single-Nanometer Oxygen Bubbles on Radiation Sensitivity in a Tumor-Bearing Mouse Model. Int J Mol Sci 2022; 23:ijms23126838. [PMID: 35743281 PMCID: PMC9224848 DOI: 10.3390/ijms23126838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 12/02/2022] Open
Abstract
Radiation therapy against cancer cells often causes radiation resistance via accumulation of hypoxia-inducible factor 1 subunit alpha (HIF-1α) under hypoxic conditions and severe side effects. Radiation sensitizers without side effects are required to overcome hypoxia-induced radiation resistance and decrease radiation-related side effects in patients with refractory cancer. We previously developed oxygen nanobubble water (NBO2 water) and demonstrated that it suppresses hypoxia-induced radiation resistance in cancer cell lines within the single-nanometer range. This study aimed to elucidate whether NBO2 water could act as a radiosensitizer via regulation of HIF-1α in a tumor-bearing mouse model. Six-week-old female BALB/c mice subcutaneously injected with tumor cells received control water or NBO2 water for 28 days, after which biochemical examinations and radiation treatment were performed. Hypoxic tumor regions were detected immunohistochemically. We found that NBO2 water sensitized radiation reactivity in the xenografted tumors. Notably, NBO2 water administration downregulated the accumulation of HIF-1α in xenografted tumors and did not affect the vital organs of healthy mice. The combination of radiation and single-nanometer NBO2 water without severe side effects may be a promising therapeutic option to improve radiation sensitivity in cancer patients without tolerance to invasive treatments.
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Joo HA, Lee YS, Jung YH, Choi SH, Nam SY, Kim SY. Risk Stratification of Dysphagia After Surgical Treatment of Hypopharyngeal Cancer. Front Surg 2022; 9:879830. [PMID: 35662815 PMCID: PMC9162264 DOI: 10.3389/fsurg.2022.879830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveHypopharyngeal cancer is managed by either surgical resection or radiation therapy-based treatment. In choosing the treatment modality, the patient’s swallowing function should be considered to achieve optimal treatment outcomes. This study aimed to stratify the risk factors predictive of postoperative dysphagia in hypopharyngeal cancer.Study DesignRetrospective study.SettingTertiary referral center.MethodsWe enrolled 100 patients who were diagnosed with hypopharyngeal cancer and underwent curative surgery between January 2010 and December 2019, and retrospectively reviewed their medical records.ResultsPostoperative dysphagia occurred in 29 patients (29%) who required a tracheostomy tube or percutaneous gastrostomy tube for feeding or preventing aspiration; additionally, the overall survival rate was lower in those patients than in those without dysphagia. The univariate analysis revealed that postoperative dysphagia was associated with clinical T stage (p = 0.016), N stage (p = 0.002), and surgical resection extent of the larynx and pharynx (p < 0.001). Patients who underwent total laryngectomy with total/partial pharyngectomy were more likely to have dysphagia than those in the larynx-preserving pharyngectomy groups (odds ratio [OR] = 3.208, 95% confidence interval [CI] 1.283–8.024, p = 0.011). Concerning the posterior pharyngeal wall (PPW), which has an important role in swallowing, patients who underwent resection of ≥1/2 of the PPW were more likely to have dysphagia (OR = 7.467, 95% CI 1.799–30.994, p = 0.003).ConclusionsSurgical resection extent was proportionally associated with dysphagia in hypopharyngeal cancer patients. Patients with smaller lesions but no laryngeal invasion had better postoperative swallowing function than patients with larger lesions or laryngeal involved lesions. Preserving the larynx and hypopharyngeal mucosa (especially the PPW) as much as possible can help preserve postoperative swallowing function.
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Zhu X, Liu D, Zong M, Wang J. Effect of swallowing training combined with nutritional intervention on the nutritional status and quality of life of laryngeal cancer patients with dysphagia after operation and radiotherapy. J Oral Rehabil 2022; 49:729-733. [PMID: 35352383 DOI: 10.1111/joor.13328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/06/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dysphagia is a common complication in patients with laryngeal cancer after surgery and radiotherapy. OBJECTIVES To explore the effect of swallowing training administered in combination with nutritional intervention on the nutritional status and quality of life of laryngeal cancer patients with dysphagia after surgery and radiotherapy. METHODS Sixty-six patients with laryngeal cancer who developed dysphagia were randomly divided into control group and intervention group (n=33 in each group). Patients in both groups received total laryngectomy and prophylactic radiotherapy and were provided routine health counseling and swallowing training. Patients in the intervention group were additionally provided with nutritional intervention. All patients were evaluated using video fluoroscopic swallowing examination (VFSE), Patient-Generated Subjective Global Assessment on nutritional status (PG-SGA) score, and Quality of Life Questionnaire-core 30 (QLQ-c30) score immediately after radiotherapy and three months later. RESULTS Prior to swallowing training, there was no significant between-group difference with respect to VFSE evaluation, PG-SGA score, or QLQ-c30 score. Both groups showed improvement in these measures at three months after radiotherapy; however, the improvement in the intervention group was significantly better than that in the control group. CONCLUSIONS Swallowing training combined with nutritional intervention can improve swallowing function, nutritional status, and the quality of life of laryngeal cancer patients with dysphagia after operation and radiotherapy.
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Affiliation(s)
- Xuewei Zhu
- Department of otolaryngology head and neck surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dahai Liu
- Department of Lymph and Vascular Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Minru Zong
- Department of Rehabilitation, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jianfeng Wang
- Department of Radiotherapy, China-Japan Union Hospital of Jilin University, Changchun, China
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de Oliveira Faria S, Hurwitz G, Kim J, Liberty J, Orchard K, Liu G, Barbera L, Howell D. Identifying Patient-Reported Outcome Measures (PROMs) for Routine Surveillance of Physical and Emotional Symptoms in Head and Neck Cancer Populations: A Systematic Review. J Clin Med 2021; 10:jcm10184162. [PMID: 34575271 PMCID: PMC8470145 DOI: 10.3390/jcm10184162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
The aims of this review were to identify symptoms experienced by head and neck cancer (HNC) patients and their prevalence, as well as to compare symptom coverage identified in HNC specific patient-reported outcome measures (PROMs). Searches of Ovid Medline, Embase, PsychInfo, and CINAHL were conducted to identify studies. The search revealed 4569 unique articles and identified 115 eligible studies. The prevalence of reported symptoms was highly variable among included studies. Variability in sample size, timing of the assessments, and the use of different measures was noted across studies. Content mapping of commonly used PROMs showed variability and poor capture of prevalent symptoms, even though validation studies confirmed satisfactory reliability and validity. This suggests limitations of some of the tools in providing an accurate and comprehensive picture of the patient's symptoms and problems.
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Affiliation(s)
- Sheilla de Oliveira Faria
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
- Correspondence: ; Tel.: +55-11-3061-8278
| | - Gillian Hurwitz
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Jaemin Kim
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Jacqueline Liberty
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Kimberly Orchard
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
- Dalla Lana School of Public Health, Toronto, ON M5T 3M7, Canada
- Temerty Faculty of Medicine, Toronto, ON M5S 1A8, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Lisa Barbera
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
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Iritani K, del Mundo DAA, Iwaki S, Masuda K, Kanzawa M, Furukawa T, Teshima M, Shinomiya H, Morimoto K, Otsuki N, Nibu K. Prognostic factors after transoral resection of early hypopharyngeal cancer. Laryngoscope Investig Otolaryngol 2021; 6:756-763. [PMID: 34401500 PMCID: PMC8356885 DOI: 10.1002/lio2.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/08/2021] [Accepted: 06/10/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE This study aimed to investigate risk factors predictive of local recurrence and/or lymph node metastasis after transoral resection of early hypopharyngeal cancer. METHODS Forty-nine consecutive patients who underwent transoral videolaryngoscopic surgery (TOVS) as an initial treatment for hypopharyngeal cancer were evaluated. On univariate and multivariate analysis, local recurrence rates were assessed respectively using log-rank test and cox regression analysis according to the following parameters: subsite, pT, mucosal margin, lymphatic invasion, vessel invasion, tumor thickness (> 4 mm vs ≤4 mm), history of esophageal cancer, and multiple Lugol-voiding lesions (LVLs) in the esophagus. Categorical variables were evaluated for their associations with lymph node metastasis using chi-squared test or Fisher's exact test. RESULT The subsites of primary lesions were piriform sinus in 24 patients, posterior wall in 15 patients, and postcricoid in 10 patients. Thirty patients had esophageal cancer. Local recurrence occurred in 14 patients. Three patients had lymph node metastasis at the time of diagnosis and four patients developed lymph node metastasis after the initial treatment, resulting a total of seven patients having lymph node metastasis. While mucosal margin and LVLs showed significant associations with local recurrence on univariate analysis, only LVLs remained as a significant risk factor on multivariate analysis (P = .0395; hazard ratio = 8.897; 95% confidence interval, 1.113-71.15). Most cases of local recurrence were satisfactorily controlled by repeated TOVS. While multivariate analysis could not be performed due to the small number of the patients with lymph node metastases, venous invasion (P = .0166) and tumor thickness (P = .0092) were significantly associated with lymph node metastasis on univariate analysis. CONCLUSIONS Local recurrence was more frequent in patients with LVLs, but most of them were salvaged by repeated TOVS. Patients with venous invasion and/or tumor thickness greater than 4 mm should be followed up with special attention to lymph node metastasis.Level of Evidence: 3.
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Affiliation(s)
- Keisuke Iritani
- Department of Otolaryngology‐Head and Neck SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Daryl Anne A. del Mundo
- Department of Otolaryngology‐Head and Neck SurgeryKobe University Graduate School of MedicineKobeJapan
- Department of OtorhinolaryngologyUniversity of the Philippines Manila‐ Philippine General HospitalManilaPhilippines
| | - Shinobu Iwaki
- Division of Rehabilitation MedicineKobe University HospitalKobeJapan
| | - Kuriko Masuda
- Department of Otolaryngology‐Head and Neck SurgeryKobe University Graduate School of MedicineKobeJapan
- Pennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Maki Kanzawa
- Department of Diagnostic PathologyKobe University Graduate School of MedicineKobeJapan
| | - Tatsuya Furukawa
- Department of Otolaryngology‐Head and Neck SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Masanori Teshima
- Department of Otolaryngology‐Head and Neck SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Hirotaka Shinomiya
- Department of Otolaryngology‐Head and Neck SurgeryKobe University Graduate School of MedicineKobeJapan
| | | | - Naoki Otsuki
- Department of OtolaryngologyKindai University HospitalOsakaJapan
| | - Ken‐ichi Nibu
- Department of Otolaryngology‐Head and Neck SurgeryKobe University Graduate School of MedicineKobeJapan
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Late radiation effects in survivors of head and neck cancer: State of the science. Crit Rev Oncol Hematol 2021; 162:103335. [PMID: 33992801 DOI: 10.1016/j.critrevonc.2021.103335] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 01/15/2023] Open
Abstract
Head and neck squamous cell carcinoma is one of the most common neoplasms. Radiotherapy (RT) plays an essential role in the management of such cases. Despite advances in the technique, hyposalivation, xerostomia, dysphagia, trismus, radiation caries, and osteoradionecrosis remain significant late complications of RT. The aim of this narrative review was to summarize and update the main findings related to late side effects of radiotherapy in survivors of head and neck cancer (HNC). Such effects limit the ability to speak, ingest food and medications, and breathe and also exert a negative impact on social well-being and quality of life. This review highlights research in the field for both researchers and clinicians, assisting in the prevention and management of these adverse conditions. The findings can contribute to improving preventive management and multidisciplinary interventions for HNC patients.
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13
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Deng K, Yao J, Zeng S, Wen M, Huang J, Zhu T, Liu S, Zuo J. The effect of surgery plus intensity-modulated radiotherapy on treatment in laryngeal cancer: A clinical retrospective study. J Cancer Res Clin Oncol 2021; 148:517-525. [PMID: 33860848 DOI: 10.1007/s00432-021-03637-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE As a common head and neck tumor, laryngeal cancer has attracted heightened attention for its treatment and prognosis. Surgery and radiotherapy were mainly therapeutic approaches in laryngeal cancer, and intensity-modulated radiotherapy (IMRT) was a precision treatment way in radiotherapy. However, the therapeutic effect of surgery plus IMRT in laryngeal cancer was rarely reported. This study aims to determine the effect of IMRT on the treatment of patients with laryngeal cancer. METHODS A total of 125 patients with laryngeal cancer were collected and retrospectively analyzed based on their clinical data and follow-up results. These patients had a clear treatment plan for surgery and intensity-modulated radiotherapy. RESULTS Smoking, lymph node metastasis, TNM staging and therapeutic approaches could affect the survival of patients with laryngeal cancer. It was shown that the laryngeal function retention rate in the simple IMRT group was significantly higher than the simple surgery group and surgery plus IMRT group. The 5-year survival rate of surgery plus IMRT, simple surgery and simple IMRT were 82.86%, 53.85% and 43.33%, respectively. The locoregional recurrences rate of surgery plus IMRT, simple surgery and simple IMRT were 14.29%, 34.62% and 43.33%. CONCLUSION Surgery plus IMRT was a feasible and efficacious treatment technique for patients with laryngeal cancer, which effectively prolong the survival time of patients.
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Affiliation(s)
- Kun Deng
- The Laboratory of Translational Medicine, Hengyang Medical School, University of South China, 28 Changsheng Road, Hengyang, 421001, Hunan, People's Republic of China
| | - Jingwei Yao
- Nanhua Hospital of University of South China, Hengyang, 421002, Hunan, People's Republic of China
| | - Shuqing Zeng
- The First Affiliated Hospital of University of South China, Hengyang, 421000, Hunan, People's Republic of China
| | - Meiling Wen
- The First Affiliated Hospital of University of South China, Hengyang, 421000, Hunan, People's Republic of China
| | - Jialu Huang
- The Laboratory of Translational Medicine, Hengyang Medical School, University of South China, 28 Changsheng Road, Hengyang, 421001, Hunan, People's Republic of China
| | - Tao Zhu
- The First Affiliated Hospital of University of South China, Hengyang, 421000, Hunan, People's Republic of China
| | - Shanyan Liu
- Nanhua Hospital of University of South China, Hengyang, 421002, Hunan, People's Republic of China
| | - Jianhong Zuo
- The Laboratory of Translational Medicine, Hengyang Medical School, University of South China, 28 Changsheng Road, Hengyang, 421001, Hunan, People's Republic of China. .,Nanhua Hospital of University of South China, Hengyang, 421002, Hunan, People's Republic of China. .,The First Affiliated Hospital of University of South China, Hengyang, 421000, Hunan, People's Republic of China. .,Clinical Laboratory, The Third Affiliated Hospital of University of South China, Hengyang, 421900, Hunan, People's Republic of China.
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Nilsen ML, Belsky MA, Scheff N, Johnson JT, Zandberg DP, Skinner H, Ferris R. Late and Long-Term Treatment-Related Effects and Survivorship for Head and Neck Cancer Patients. Curr Treat Options Oncol 2020; 21:92. [DOI: 10.1007/s11864-020-00797-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2020] [Indexed: 12/26/2022]
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