Treatment of hypopharyngeal carcinoma with primary chemoradiotherapy: functional morbidity

Oncological outcomes from surgical vs. non-surgical treatments for advanced hypopharyngeal squamous cell carcinoma: a surveillance, epidemiology, and end results-based study

OBJECTIVE

Patients with advanced hypopharyngeal squamous cell carcinomas (HSCCs) have poor prognoses. The use of surgical or non-surgical treatments for these patients remains a topic of debate. This study compared survival following surgical and non-surgical treatments of patients with advanced HSCC based on the Surveillance, Epidemiology and End Results (SEER) database.

METHODS

Patients diagnosed with hypopharyngeal cancer from 2004 to 2018 were identified from the SEER database. Patients were divided into non-surgical group and surgical group, and patients in the surgical group were further divided into three groups: surgery-only, surgery with adjuvant radiation therapy and surgery with adjuvant chemoradiation therapy. The primary endpoint was overall survival (OS), and the secondary outcome was cancer-specific survival (CSS). Outcomes were analyzed using Kaplan-Meier analysis. A multivariate Cox regression analysis was also used to identify independent prognostic factors.

RESULTS

The records of 1568 eligible patients with stage III or IV HSCC were examined. Receipt of surgery was associated with a longer OS [hazard ratio (HR) = 0.47, 95% confidence interval (CI): 0.4-0.56] and a longer CSS (HR = 0.47, 95% CI: 0.38-0.57) after adjusting for age, sex, race, tumor site, tumor size, tumor grade, TNM stage, AJCC stage, number of carcinomas, prior cancer, receipt of radiotherapy, and receipt of chemotherapy. The results for OS were similar in an exploratory analysis of different patient subgroups.

CONCLUSION

Among patients with advanced HSCC in the SEER database, treatment with surgery was associated with longer OS and CSS than treatment with a non-surgical modality.

Preservation of Internal Branch of Superior Laryngeal Nerve during Surgery for Hypopharyngeal Cancer

OBJECTIVES

This study was performed to evaluate the significance of intraoperative preservation of the internal branch of the superior laryngeal nerve (ibSLN) during surgery for hypopharyngeal squamous cell carcinoma (HSCC).

METHODS

Twelve patients with HSCC underwent surgery between January 2017 and December 2018. Sensation in the hypopharyngeal mucosa was tested using a flexible laryngeal endoscope on postoperative day 5.

RESULTS

Surgeries were successfully performed in 10 patients with HSCC arising from the internal wall of the pyriform fossa and in 2 patients with HSCC arising from the posterior wall of the hypopharynx. The main trunk of the ibSLN was preserved in all patients. Testing of sensation in the hypopharyngeal mucosa revealed the presence of the cough reflex in all patients. All patients achieved a full normal oral diet at a median of 8.5 days (range, 6-11 days) and removal of the tracheal tube at a median of 10 days (range, 7-12 days).

CONCLUSIONS

Our results showed that preservation of the ibSLN during surgery for HSCC is feasible and important in the recovery of sensation in the hypopharyngeal mucosa.

Metformin Suppresses Hypopharyngeal Cancer Growth by Epigenetically Silencing Long Non-coding RNA SNHG7 in FaDu Cells

Local recurrence after therapy remains a challenging problem for hypopharyngeal cancer (HPC) due to the chemotherapy resistance. Metformin is associated with reduced cancer risk through promoting global DNA methylation in cancer cells by controlling S-adenosylhomocysteine (SAHH) activity. However, the mechanisms by which metformin inhibits HPC remain elusive. In this study, we aim to investigate the role of metformin in HPC and illustrate the mechanism by which metformin regulates long non-coding RNAs (lncRNAs) expression. CCK-8 and annexin-V/PI double staining were performed to analyze the cell viability and apoptosis. LncRNA microarray analysis, QPCR, methylation specific PCR, Western blot and RNA Immunoprecipitation were performed to analyze the molecular mechanism, Here, we report that metformin inhibits FaDu cell proliferation in time- and dose-dependent manner by suppressing lncRNA SNHG7. Further investigations revealed that SNHG7 interacted with SAHH and metformin decreased SNHG7 expression by activating SAHH activity. Increased SAHH activity resulted in upregulating DNMT1 expression, leading to hypermethylation of SNHG7 promotor. In addition, upregulation of SNHG7 was associated with advanced stage. The patients with high SNHG7 have lower overall survival than that of with low SNHG7. Interestingly, SNHG7 levels were higher in taxol resistant patients than in taxol sensitive patients. Metformin sensitizes FaDu cells to taxol and irradiation through decreasing SNHG7. In conclusion, our recent study demonstrates that metformin inhibits FaDu cell proliferation by decreasing SNHG7 expression via SAHH-mediated DNA methylation. These findings indicate that combined metformin with paclitaxel or irradiation would be a novel therapeutic strategy to overcome resistance and prevent recurrence in HPC.

Open-neck organ preservation surgery for hypopharyngeal cancer: indications, techniques, limits, and outcomes

PURPOSE OF REVIEW

To appraise the practice and role of open-neck organ preserving surgery for hypopharyngeal squamous cell carcinoma and to update the current indications, techniques, limits, and outcomes.

RECENT FINDINGS

The role of primary surgery for hypopharyngeal carcinoma has shifted over the past two decades to primary nonsurgical management with the use of induction or concurrent chemoradiotherapy. The preferred and most suitable tumours for open-neck surgery are the small-volume T stage diseases, with small to medium-volume neck metastases, however such patients are exceedingly rare. Nonetheless, more advanced tumours with cartilage invasion, vocal cord paralysis, or located at piriform apex and postcricoid area, previously unsuitable for open-neck organ preserving surgery, can now be excised and repaired, minimizing morbidity and improving quality of patients' life. Much of this surgical progress has been developed by innovative surgeons using free tissue transfer, accurate placement surgery, reconstruction of a neoglottis, and perfecting the pharyngoesophageal anastomosis. Current practice of open-neck organ preserving surgery for hypopharyngeal carcinoma has been mainly reported in Asia: Korea, Taiwan, Japan, and China.

SUMMARY

There are some patients who are deemed unsuitable and/or unwilling for current treatment by nonsurgical approaches, and open-neck organ preserving laryngopharyngeal surgery may be a more suitable alternative than selecting a 'lesser or modified' chemo or bioradiotherapy regimen, resulting in a prolonged quantity and quality of life.

Overall survival with and without laryngeal function preservation in 580 patients with hypopharyngeal squamous cell carcinoma

The aims of the present study were to review the experience of different surgical reconstruction methods for hypopharyngeal squamous cell carcinoma (HSCC) and compared the survival of patients with and without laryngeal function (LF) preservation. The clinical characteristics of 580 patients were retrospectively obtained and analyzed. Survival curves were analyzed using the Kaplan‑Meier method for survival and Cox models for hazard ratios (HRs) with 95% confidence intervals (CIs). LF was preserved in 403 cases and not preserved in 177 cases. The 3‑ and 5‑year survival rates were 70.9 and 52.7%, respectively, in the LF preservation group and 48.4 and 30.5%, respectively, in the no LF preservation group. Compared with the patients without LF preservation, patients with LF preservation had a significantly reduced risk of overall death (HR=0.63, 95% CI: 0.50-0.80). LF preservation positively affects the prognosis of patients with HSCC.

Placebo-Controlled, Double-Blind, Randomized Study of a Dry Guarana Extract in Patients with Head and Neck Tumors Undergoing Chemoradiotherapy: Effects on Fatigue and Quality of Life

Fatigue is a common symptom in patients with head and neck carcinoma who undergo chemoradiotherapy. Guarana (Paullinia cupana) is a plant that grows in the Brazilian Amazon region that was used previously to treat fatigue induced by chemotherapy.

METHODS

In this phase II prospective study, we evaluated 60 patients with stage I-IV head and neck squamous cell carcinoma before, during, and after chemoradiotherapy. The patients were randomized into two arms: placebo versus guarana at a dose of 50 mg twice a day during the chemoradiotherapy treatment. We used the FACT-HN, EORTC-HN35, and EORTC-Q30 questionnaires to assess fatigue and quality of life (QOL).

RESULTS

A significant worsening of QOL in the overall (p = 0.0054), functional (p = 0.018), and symptom (p = 0.0042) domains after the second cycle of chemotherapy was observed in patients using guarana compared to the placebo group. No significant differences in any QOL domain for either the guarana or placebo group were observed when the first and the fourth evaluations of each domain in each group were compared. Regarding the FACT-HN35 questionnaire, the guarana group showed improvement after the first cycle of chemoradiotherapy with respect to pain (p = 0.0133), social eating (p = 0.0227), swallowing (p = 0.0254), coughing (p = 0.0107), and weight loss (p = 0.012); however, after treatment completion (after the third cycle) weight loss worsened (p = 0.0074) and greater use of a nasogastric tube (p = 0.051), in addition to increased use of analgesics (p = 0.0253), was observed in the guarana group. Regarding the EORTC-QOL C30 questionnaire, improvement of symptoms in the three domains (functional, overall, and symptoms) was observed in patients using guarana. No significant difference was observed between the groups regarding toxicity as graded by the Common Terminology Criteria for Adverse Events (CTCAE) scale.

CONCLUSION

We propose that guarana is not beneficial for this patient population.

TRAIL and TRAIL receptors in patients with laryngeal cancer

BACKGROUND

Tumor necrosis factor-related associated-inducing ligand (TRAIL) is a death ligand currently under clinical trials for laryngeal carcinoma.

METHODS

Paraffin-embedded tissues from 40 patients with laryngeal carcinoma and 20 patients with benign laryngeal pathologies were retrospectively analyzed using immunohistochemistry in terms of distribution and intensity, and for final analysis of immunoreactivity of receptors, H-score was used. The study group was assessed in terms of localization, lymph node staging, tumor stage, overall survival, disease-free survival, locoregional control, perineural invasion, and vascular invasion.

RESULTS

The H-score of decoy-R2 (DcR2) staining were increased significantly in tumor tissue (p = .04). A significantly greater increase in terms of H-score of DR5 receptor staining (p = .06) was detected in tumor tissue.

CONCLUSION

TRAIL-mediated gene therapy may not be effective. Indeed, the findings may indicate treatment resistance. TRAIL and TRAIL receptor levels were not associated with prognosis © 2015 Wiley Periodicals, Inc. Head Neck 38: E535-E541, 2016.

Prevalence of swallowing and speech problems in daily life after chemoradiation for head and neck cancer based on cut-off scores of the patient-reported outcome measures SWAL-QOL and SHI

The objective of this study is to assess swallowing and speech outcome after chemoradiation therapy for head and neck cancer, based on the patient-reported outcome measures Swallowing Quality of Life Questionnaire (SWAL-QOL) and Speech Handicap Index (SHI), both provided with cut-off scores. This is a cross-sectional study. Department of Otolaryngology/Head and Neck Surgery of a University Medical Center. Sixty patients, 6 months to 5 years after chemoradiation for head and neck squamous cell carcinoma. Swallowing Quality of Life Questionnaire (SWAL-QOL) and SHI, both validated in Dutch and provided with cut-off scores. Associations were tested between the outcome measures and independent variables (age, gender, tumor stage and site, and radiotherapy technique, time since treatment, comorbidity and food intake). Fifty-two patients returned the SWAL-QOL and 47 the SHI (response rate 87 and 78 %, respectively). Swallowing and speech problems were present in 79 and 55 %, respectively. Normal food intake was noticed in 45, 35 % had a soft diet and 20 % tube feeding. Patients with soft diet and tube feeding reported more swallowing problems compared to patients with normal oral intake. Tumor subsite was significantly associated with swallowing outcome (less problems in larynx/hypopharynx compared to oral/oropharynx). Radiation technique was significantly associated with psychosocial speech problems (less problems in patients treated with IMRT). Swallowing and (to a lesser extent) speech problems in daily life are frequently present after chemoradiation therapy for head and neck cancer. Future prospective studies will give more insight into the course of speech and swallowing problems after chemoradiation and into efficacy of new radiation techniques and swallowing and speech rehabilitation programs.