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Beesley LJ, Shuman AG, Mierzwa ML, Bellile EL, Rosen BS, Casper KA, Ibrahim M, Dermody SM, Wolf GT, Chinn SB, Spector ME, Baatenburg de Jong RJ, Dronkers EAC, Taylor JMG. Development and Assessment of a Model for Predicting Individualized Outcomes in Patients With Oropharyngeal Cancer. JAMA Netw Open 2021; 4:e2120055. [PMID: 34369988 PMCID: PMC8353539 DOI: 10.1001/jamanetworkopen.2021.20055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Recent insights into the biologic characteristics and treatment of oropharyngeal cancer may help inform improvements in prognostic modeling. A bayesian multistate model incorporates sophisticated statistical techniques to provide individualized predictions of survival and recurrence outcomes for patients with newly diagnosed oropharyngeal cancer. OBJECTIVE To develop a model for individualized survival, locoregional recurrence, and distant metastasis prognostication for patients with newly diagnosed oropharyngeal cancer, incorporating clinical, oncologic, and imaging data. DESIGN, SETTING, AND PARTICIPANTS In this prognostic study, a data set was used comprising 840 patients with newly diagnosed oropharyngeal cancer treated at a National Cancer Institute-designated center between January 2003 and August 2016; analysis was performed between January 2019 and June 2020. Using these data, a bayesian multistate model was developed that can be used to obtain individualized predictions. The prognostic performance of the model was validated using data from 447 patients treated for oropharyngeal cancer at Erasmus Medical Center in the Netherlands. EXPOSURES Clinical/oncologic factors and imaging biomarkers collected at or before initiation of first-line therapy. MAIN OUTCOMES AND MEASURES Overall survival, locoregional recurrence, and distant metastasis after first-line cancer treatment. RESULTS Of the 840 patients included in the National Cancer Institute-designated center, 715 (85.1%) were men and 268 (31.9%) were current smokers. The Erasmus Medical Center cohort comprised 300 (67.1%) men, with 350 (78.3%) current smokers. Model predictions for 5-year overall survival demonstrated good discrimination, with area under the curve values of 0.81 for the model with and 0.78 for the model without imaging variables. Application of the model without imaging data in the independent Dutch validation cohort resulted in an area under the curve of 0.75. This model possesses good calibration and stratifies patients well in terms of likely outcomes among many competing events. CONCLUSIONS AND RELEVANCE In this prognostic study, a multistate model of oropharyngeal cancer incorporating imaging biomarkers appeared to estimate and discriminate locoregional recurrence from distant metastases. Providing personalized predictions of multiple outcomes increases the information available for patients and clinicians. The web-based application designed in this study may serve as a useful tool for generating predictions and visualizing likely outcomes for a specific patient.
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Affiliation(s)
| | - Andrew G. Shuman
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | | | | | | | - Keith A. Casper
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | | | - Sarah M. Dermody
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Gregory T. Wolf
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Steven B. Chinn
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Matthew E. Spector
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Robert J. Baatenburg de Jong
- Department of Otorhinolaryngology–Head and Neck Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Emilie A. C. Dronkers
- Department of Otorhinolaryngology–Head and Neck Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
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Beesley LJ, Taylor JMG. Bayesian variable selection and shrinkage strategies in a complicated modelling setting with missing data: A case study using multistate models. STAT MODEL 2020. [DOI: 10.1177/1471082x20920972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Multistate modelling is a strategy for jointly modelling related time-to-event outcomes that can handle complicated outcome relationships, has appealing interpretations, can provide insight into different aspects of disease development and can be useful for making individualized predictions. A challenge with using multistate modelling in practice is the large number of parameters, and variable selection and shrinkage strategies are needed in order for these models to gain wider adoption. Application of existing selection and shrinkage strategies in the multistate modelling setting can be challenging due to complicated patterns of data missingness, inclusion of highly correlated predictors and hierarchical parameter relationships. In this article, we discuss how to modify and implement several existing Bayesian variable selection and shrinkage methods in a general multistate modelling setting. We compare the performance of these methods in terms of parameter estimation and model selection in a multistate cure model of recurrence and death in patients treated for head and neck cancer. We can view this work as a case study of variable selection and shrinkage in a complicated modelling setting with missing data.
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Affiliation(s)
- Lauren J Beesley
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeremy MG Taylor
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
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Uchiyama Y, Sasai T, Nakatani A, Shimamoto H, Tsujimoto T, Kreiborg S, Murakami S. Distant metastasis from oral cavity-correlation between histopathology results and primary site. Oral Radiol 2020; 37:167-179. [PMID: 32468449 DOI: 10.1007/s11282-020-00440-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 04/19/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Oral cancer is the eighth most common type of cancer worldwide and a significant contributor to the global burden caused by this disease. The principal parameters considered to influence prognosis, and thus treatment selection, are size and location of the primary tumor, as well as assessment of the presence and extent of lymph node and distant metastasis (DM). However, no known report regarding the relationship between the primary site and DM has been presented. For effective treatment selection and good prognosis, the correlation of DM with anatomic site and histopathology results of the primary malignancy is important. In the present study, we performed a systematic review of published reports in an effort to determine the relationship between the anatomic site of various types of oral cavity cancer and DM. METHODS A systematic review of articles published until the end of 2018 was performed using PubMed/MEDLINE. RESULTS A total of 150 studies were selected for this review. The percentage of all cases reported with DM was 6.3%, ranging from 0.6% to 33.1% in the individual studies. The rate of incidence of tongue occurrence was 9.3%. A frequent DM site was the lungs, with adenoid cystic carcinoma the most commonly involved histopathological factor. Malignant melanoma was most frequent (43.4%) in all histopathology findings, whereas there were no cases with an acinic cell carcinoma or cystadenocarcinoma. CONCLUSIONS We found that the occurrence of DM from the primary site as well as rate of incidence was dependent on histopathological factors.
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Affiliation(s)
- Yuka Uchiyama
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Tadashi Sasai
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Atsutoshi Nakatani
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroaki Shimamoto
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tomomi Tsujimoto
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Sven Kreiborg
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.,3D Craniofacial Image Research Laboratory, University of Copenhagen, Copenhagen, Denmark
| | - Shumei Murakami
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.,3D Craniofacial Image Research Laboratory, University of Copenhagen, Copenhagen, Denmark
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Beesley LJ, Taylor JMG. EM algorithms for fitting multistate cure models. Biostatistics 2020; 20:416-432. [PMID: 29584820 DOI: 10.1093/biostatistics/kxy011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 02/16/2018] [Indexed: 11/14/2022] Open
Abstract
Multistate cure models are multistate models in which transitions into one or more of the states cannot occur for a fraction of the population. In the study of cancer, multistate cure models can be used to identify factors related to the rate of cancer recurrence, the rate of death before and after recurrence, and the probability of being cured by initial treatment. However, the previous method for fitting multistate cure models requires substantial custom programming, making these valuable models less accessible to analysts. In this article, we present an Expectation-Maximization (EM) algorithm for fitting the multistate cure model using maximum likelihood. The proposed algorithm makes use of a weighted likelihood representation allowing it to be easily implemented with standard software and can incorporate either parametric or non-parametric baseline hazards for the state transition rates. A common complicating feature in cancer studies is that the follow-up times for recurrence and death may differ. Additionally, we may have missingness in the covariates. We propose a Monte Carlo EM (MCEM) algorithm for fitting the multistate cure model in the presence of covariate missingness and/or unequal follow-up of the two outcomes, we describe a novel approach for obtaining standard errors, and we provide some software. Simulations demonstrate good algorithmic performance as long as the modeling assumptions are sufficiently restrictive. We apply the proposed algorithm to a study of recurrence and death in patients with head and neck cancer.
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Affiliation(s)
- Lauren J Beesley
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Jeremy M G Taylor
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA
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FDG-PET/CT in the surveillance of head and neck cancer following radiotherapy. Eur Arch Otorhinolaryngol 2019; 277:539-547. [DOI: 10.1007/s00405-019-05684-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/03/2019] [Indexed: 12/13/2022]
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Imbimbo M, Alfieri S, Botta L, Bergamini C, Gloghini A, Calareso G, Orlandi E, Iacovelli NA, Guzzo M, Granata R, Resteghini C, Locati L, Volpi CC, Licitra L, Bossi P. Surveillance of Patients with Head and Neck Cancer with an Intensive Clinical and Radiologic Follow-up. Otolaryngol Head Neck Surg 2019; 161:635-642. [PMID: 31286827 DOI: 10.1177/0194599819860808] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE There is no consensus on the follow-up modalities in patients with head and neck cancer. This study aims to describe the pattern and survival outcomes of recurrences/second primary cancers in patients undergoing an intensive radiologic and clinical follow-up. STUDY DESIGN Retrospective analysis. SETTING Single academic tertiary care center. SUBJECTS AND METHODS All patients with stage III-IV head and neck cancer treated with chemoradiotherapy at our institution between 1998 and 2010 were retrospectively reviewed. Persistent/recurrent disease within 6 months since the curative treatment and second primary cancers outside the upper aerodigestive tract were excluded. Data were analyzed by descriptive statistics. Surveillance was planned every 3 months in the first year, then with increasing intervals till the fifth year. RESULTS A total of 326 patients were included. Out of all detected cancer recurrences (n = 106, 32%), 38 (36%) were locoregional, 44 (41%) were distant, and 24 (23%) were second primary cancers. Approximately 70% of recurrences were clinically and/or radiologically discovered, while 30% were diagnosed due to the patients' symptoms. Of all clinically and/or radiologically discovered recurrences/second primary cancers (n = 74), 26 (35%) were curatively treated, with respect to 9 of the 32 (28%) diagnosed by symptoms. Median overall survival of recurrent curable cases did not significantly differ according to the detection modality (89 months by clinical/radiologic examination vs 85 by symptoms). CONCLUSIONS Clinical and radiologic follow-up identified more recurrences/second primary cancers than the symptom-driven monitoring, but the curability of cancer recurrence was similar regardless of detection modality. Prospective trials are needed to define the most effective follow-up strategy in head and neck cancer.
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Affiliation(s)
- Martina Imbimbo
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Alfieri
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Botta
- Evaluative Epidemiology, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristiana Bergamini
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annunziata Gloghini
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppina Calareso
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ester Orlandi
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Marco Guzzo
- Head and Neck Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta Granata
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Resteghini
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Locati
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Costanza Volpi
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lisa Licitra
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,University of Milan, Milan, Italy
| | - Paolo Bossi
- Head and Neck Cancer Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Naiman AN, Abedipour D, Ayari S, Fresnel E, Coulombeau B, Bour JB, Froehlich P. Natural History of Adult-Onset Laryngeal Papillomatosis following Multiple Cidofovir Injections. Ann Otol Rhinol Laryngol 2016; 115:175-81. [PMID: 16572605 DOI: 10.1177/000348940611500303] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: A prospective study was performed to assess the intermediate and long-term efficacy of intralesional cidofovir therapy associated with surgical excision in laryngeal papillomatosis in adults. Methods: Endoscopy with intralesional injection of cidofovir 5 mg/mL was performed 3 times at 4-week intervals. The concentration was later increased to 7.5 mg/mL and the interval between injections shortened to 2 weeks. Further treatment was performed at 3 or 6 months, depending on the evolution of the papillomas. After complete remission, the treatment was stopped and the patients were reviewed every 6 months. Results: Nineteen patients completed the protocol, with a mean of 4.5 injections each. Complete remission was obtained in 17 cases (89%) after a mean of 3.8 procedures. Remission was stable after a mean follow-up of 24 months (range, 8 to 57 months). With higher cidofovir concentrations at shorter intervals, patients needed fewer injections to achieve remission (mean, 2.1 versus 4.7 injections). Conclusions: The effectiveness of intralesional cidofovir therapy in adult-onset recurrent respiratory papillomatosis was impressive. Once obtained, complete remission was stable on intermediate or long-term follow-up. The concentration and the interval between injections seemed to influence the number of injections necessary to achieve remission.
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Affiliation(s)
- Ana Nusa Naiman
- Department of Otolaryngology, Edouard Herriot University Hospital, Lyon, France
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Peisker A, Raschke GF, Guentsch A, Luepke P, Roshanghias K, Schultze-Mosgau S. Evaluation of a post-treatment follow-up program in patients with oral squamous cell carcinoma. Clin Oral Investig 2016; 21:135-141. [DOI: 10.1007/s00784-016-1764-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
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Flynn C, Khaouam N, Gardner S, Higgins K, Enepekides D, Balogh J, MacKenzie R, Singh S, Davidson J, Poon I. The Value of Periodic Follow-up in the Detection of Recurrences after Radical Treatment in Locally Advanced Head and Neck Cancer. Clin Oncol (R Coll Radiol) 2010; 22:868-73. [DOI: 10.1016/j.clon.2010.05.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 04/14/2010] [Accepted: 05/12/2010] [Indexed: 01/20/2023]
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Wensing BM, Merkx MAW, Krabbe PFM, Marres HAM, Van den Hoogen FJA. Oral squamous cell carcinoma and a clinically negative neck: The value of follow-up. Head Neck 2010; 33:1400-5. [DOI: 10.1002/hed.21642] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 07/21/2010] [Accepted: 09/06/2010] [Indexed: 11/06/2022] Open
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Gutiérrez Castillo C, Monerris García E, Duran MD, Sancho Mestre M, Gras JR. [Papillomas & laryngeal papillomatosis. Treatment with CO₂ laser surgery. Our experience over 15 years]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61:422-7. [PMID: 20965478 DOI: 10.1016/j.otorri.2010.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 07/03/2010] [Accepted: 07/19/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The study goal was to evaluate the efficacy of CO₂ laser surgery in the treatment of laryngeal papillomatosis. We analysed several parameters such as gender, average age, relapse rate and viral serotype. MATERIAL AND METHODS A total of 26 diagnosed patients were included in this retrospective descriptive review. All of them were treated with CO₂ laser for laryngeal papillomas between 1995 and 2010. RESULTS This pathology was more prevalent in males (65.5%), with a slight predominance of a single larynx localisation over multiple lesion locations. Human papillomavirus (HPV) DNA was detected in 75.8% of the cases; genotypes 6 and 11 prevailed. Of the patients in this review, 44.8% relapsed; the relapse average was 2-3 episodes per patient. A total of 20.7% of cases were in remission (no relapse in the last 2 months); 34.5%, clearing (no apparent relapse in the last 3 years); and 41.3% in the healing stage (without relapse in the last 5 years). There was only one case that showed malignancy. CONCLUSION Papillomatosis is characterised as a pathology with an unpredictable course and with a low probability of malignancy. CO₂ laser surgery has meant a revolution in symptomatic treatment, but there is presently no curative treatment.
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Gutiérrez Castillo C, Monerris García E, Dolores Duran M, Sancho Mestre M, Ramón Gras J. Papillomas & laryngeal papillomatosis. Treatment with CO2 laser surgery. Our experience over 15 years. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010. [DOI: 10.1016/s2173-5735(10)70078-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Caballero M, Vilaseca I, Bernal-Sprekelsen M, Guilemany JM, Moragas M, Blanch JL. Distant metastases after transoral laser microsurgery for laryngeal and hypopharyngeal squamous cell carcinoma. Head Neck 2009; 30:1599-606. [PMID: 18798300 DOI: 10.1002/hed.20921] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Transoral CO(2) laser microsurgery (TLM) resection of laryngeal-hypopharyngeal squamous cell carcinomas has become a standard procedure. The objective was to evaluate whether there is a relationship between TLM and a higher incidence of distant metastases. METHODS We conducted a retrospective analysis of 340 consecutive patients with laryngeal or hypopharyngeal squamous cell carcinoma treated with TLM. RESULTS Distant metastases occurred in 24 of 340 (7.1%) patients. The mean time of distant metastases diagnosis was 19.1 months (range, 1-41) postsurgery. Univariate study demonstrated an association with alcoholism (p = .008), tumor site (p<.001), grade of differentiation (p = .032), stage (p<.001), tumor classification (T; p = .001), node involvement (N; p<.001), extracapsular node spread (p<.001), and positive surgical margin (p = .004). In multivariate logistic regression analysis, location (sinus piriform: OR = 15.37, p = .025), node involvement (N2: OR = 7.36, p = .003; N3: OR = 19.28, p = .027), and the affected surgical margin (OR 5.32; p = .005) predicted an increased likelihood of distant metastases. CONCLUSIONS Development of distant metastases after TLM in patients with squamous cell carcinoma depends mainly on the tumor site, the presence of metastatic lymph node disease, and the margin status after resection.
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Affiliation(s)
- Miguel Caballero
- Department of Otorhinolaryngology and Head & Neck Surgery, Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Ritoe SC, Verbeek ALM, Krabbe PFM, Kaanders JHAM, van den Hoogen FJA, Marres HAM. Screening for local and regional cancer recurrence in patients curatively treated for laryngeal cancer: definition of a high-risk group and estimation of the lead time. Head Neck 2007; 29:431-8. [PMID: 17120311 DOI: 10.1002/hed.20534] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND All patients treated for laryngeal cancer are offered the same follow-up schedule to detect asymptomatic locoregional recurrences. In this study, we evaluated the prognostic profile of patients for cancer recurrence and estimated the lead time. METHODS A cohort study was performed between 1990 and 1995. Cox proportional hazards model was used to analyze the prognostic factors. The effect of altering the follow-up for asymptomatic recurrence detection was determined after estimating the lead time. RESULTS The variables cT classification, smoking, and histologic grade proved to be prognostic factors. The risk of locoregional failure was 15% in the low-risk group versus 29% in the high-risk group. The estimated lead time was 2 to 4 weeks. CONCLUSION Risk profiles for locoregional relapse were defined. Intensifying the follow-up schedule is not advisable because the lead time is very short. An excessively high number of routine visits would have to be performed to increase the detection rate for asymptomatic recurrences.
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Affiliation(s)
- Savitri C Ritoe
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Merkx MAW, van Gulick JJM, Marres HAM, Kaanders JHAM, Bruaset I, Verbeek A, de Wilde PCM. Effectiveness of routine follow-up of patients treated for T1-2N0 oral squamous cell carcinomas of the floor of mouth and tongue. Head Neck 2006; 28:1-7. [PMID: 16155911 DOI: 10.1002/hed.20296] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The duration of follow-up after treatment for head and neck cancer, the depth of the routine visits, and the diagnostic tools used are determined on the basis of common acceptance rather than evidence-based practice. Patients with early-stage tumors are more likely to benefit from follow-up programs, because they have the best chance for a second curative treatment after recurrence. The purpose of this study was to determine the benefit of our 10-year follow-up program in patients with stage I and II squamous cell carcinoma (SCC) of the floor of mouth and tongue. METHODS In a longitudinal cohort study involving 102 patients who were treated with curative intent for a pT1-2N0M0 SCC of the floor of mouth and tongue from 1989-1998 with a minimum follow-up of 5 years, we evaluated the effect of routine follow-up. RESULTS During the follow-up (mean, 61 months; SD, 4 months), 10 patients had a recurrence, and 20 patients had a second primary tumor. No regional lymph node recurrences in the neck were detected. Location, T classification of the primary tumor, choice of therapy, or measure of tumor-free margins in the resection did not significantly affect the occurrence of a secondary event (p >or= .1). The secondary event was discovered during a patient-initiated visit for complaints in 14 patients and was found during routine follow-up visits in 16 patients. Only seven second primary tumors were detected after 60 months, four on routine follow-up and three on a self-initiated visit. The mean disease-free survival time after treatment of the secondary event was 72 months (SD, 17 months) in the "own initiative" group and 65 months (SD, 13 months) in the routine follow-up group; this difference was not statistically significant (p=.3). CONCLUSIONS The effectiveness of a 10-year routine follow-up, even in patients with early-stage oral SCC, is very limited. These visits on routine basis can be stopped after 5 years.
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Vilaseca I, Blanch JL, Bernal-Sprekelsen M, Moragas M. CO2 laser surgery: A larynx preservation alternative for selected hypopharyngeal carcinomas. Head Neck 2004; 26:953-9. [PMID: 15459928 DOI: 10.1002/hed.20074] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Transoral CO2 laser surgery (TLS) has demonstrated good oncologic results and low morbidity in the treatment of selected laryngeal carcinomas, but experience in hypopharyngeal carcinomas (HC) is limited. The aim of this study was to evaluate the usefulness of TLS in the treatment of selected HC. METHODS Twenty-eight patients with HC were treated with TLS and neck dissection. Tumors with preoperative invasion of thyroid cartilage at CT, deep growth into the cervical space or tongue base, and tumors crossing the posterior midline or involving the cervical esophagus were excluded. Postoperative radiation to the neck was administered when more than one lymph node was involved, when the metastasis diameter was greater than 2 cm, or when extranodal spread was found at the pathologic study. RESULTS The sample included two T1, 16 T2, nine T3, and one T4 tumors. Stage classification was: II, 21.4%; III, 28.6%; and IV, 50%. Four-year overall and disease-specific survival rates were 43.4% and 59.4%, respectively, with 78.5% function preservation. Nine patients (32.1%) did not need a nasogastric feeding tube. The mean duration of the feeding tube in the remaining patients was 15.27 +/- 27.3 days. We had two postoperative bleeding episodes that required endoscopic coagulation and three postoperative pneumonias caused by aspiration. CONCLUSIONS TLS is an alternative for the treatment of selected HC associated with a high larynx preservation rate.
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Affiliation(s)
- Isabel Vilaseca
- Department of Otorhinolaryngology, Hospital Clínic i Universitari, C/ Villarroel 170. Barcelona 08036, Spain.
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Licitra L, Bernier J, Grandi C, Locati L, Merlano M, Gatta G, Lefebvre JL. Cancer of the larynx. Crit Rev Oncol Hematol 2003; 47:65-80. [PMID: 12853099 DOI: 10.1016/s1040-8428(03)00017-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In Europe, laryngeal cancer accounts for only 2-5% of all cancers, the incidence being much higher among males than among females. Smoke and alcohol represent the major behavioural risk factors. Several carcinogens, occupations and vitamin deficiencies have been associated with laryngeal cancer. A genetic susceptibility to environmental risk factors and carcinogens is recognized. Hoarseness is the main symptom for which patients call for medical consultation. Mucosa is the most common histologic site of the primary lesions considered in the present chapter. Nodal involvement, the site and volume of the primary tumour, and some genes expression represent the major prognostic factors. A high death rate for not cancer-related events is to be pointed out. The loco-regional extent of the disease determines the success of cure. Surgery and radiotherapy represent the main therapeutic options. The choice between these two procedures is often controversial.
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Affiliation(s)
- Lisa Licitra
- START Project, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
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Ritoe SC, Krabbe PFM, Jansen MMG, Festen J, Joosten FBM, Kaanders JHAM, van den Hoogen FJA, Verbeek ALM, Marres HAM. Screening for second primary lung cancer after treatment of laryngeal cancer. Laryngoscope 2002; 112:2002-8. [PMID: 12439170 DOI: 10.1097/00005537-200211000-00017] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS As a result of smoking, patients who have received curative treatment for laryngeal cancer run a high risk of developing lung cancer. Therefore, these patients enter a screening program that aims to detect lung cancer at an asymptomatic stage. The study evaluated whether screening for lung cancer by means of regular chest x-ray examinations contributed to prolonging survival. STUDY DESIGN A longitudinal follow-up study was performed to analyze the survival of patients who had received curative treatment for squamous cell laryngeal cancer and developed lung cancer during the follow-up period. METHODS Patients with lung cancer were divided into two groups: 1) patients with asymptomatic screen-detected lung cancer and 2) patients with complaints indicating lung cancer, whose tumor was detected in the interval between screening examinations by chest x-ray films. RESULTS In the complete group of patients with laryngeal cancer, no prognostic factors could be identified for developing lung cancer. There was no prolongation of survival in the screen-detected asymptomatic lung cancer patients. The median survival of both groups was 56 months (P =.57). The date of detection of the lung cancer was clearly brought forward by screening; a difference of 8 months was found between the median detection date of the two groups (P <.001). There was no difference in tumor-specific mortality between the two groups. CONCLUSION Screening by chest x-ray examination to detect lung cancer in an asymptomatic stage after curative treatment for squamous cell laryngeal cancer does not improve survival for patients who develop lung cancer.
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Affiliation(s)
- Savitri C Ritoe
- Department of Otorhinolaryngolgy-Head and Neck Surgery, University Medical Center Nijmegen, The Netherlands
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Licitra L, Bernier J, Grandi C, Merlano M, Bruzzi P, Lefebvre JL. Cancer of the oropharynx. Crit Rev Oncol Hematol 2002; 41:107-22. [PMID: 11796235 DOI: 10.1016/s1040-8428(01)00129-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Oropharyngeal cancer is a rare tumour. Tobacco use and alcohol consumption are recognised as major risk factors. Several carcinogens, occupational exposures and vitamin deficiencies represent the most significant predisposing factors. A varying host susceptibility to carcinogens can be inferred. Carcinoma of the oropharynx has to be suspected whenever sore throat, odynophagia, and ear-ache are described by the patient. Biopsy is mandatory for the definitive diagnosis. TNM classification is crucial for treatment decision-making, while stage grouping is less important. Prognostic factors are treatment-related. Standard treatment of T1-T2 tumours is radiation therapy, for T3 and T4 tumour treatment options are controversial. More advanced tumours can be treated either with surgery followed by conventional radiotherapy or by combined chemo-radiation. Non-conventional fractionation radiotherapy in combination with chemotherapy may represent a third option. Acute toxicity needs to be managed promptly. Late sequelae are less known. Treatment of such tumours requires a multidisciplinary approach within experienced centres.
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Affiliation(s)
- Lisa Licitra
- START Project, European School of Oncology, Viale Beatrice d'Este, 37, 20122 Milan, Italy
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Abstract
OBJECTIVE Respiratory papillomas (RP) tend to recur and the difficulty in eradicating the disease makes their treatment frustrating. Meticulous CO(2) laser excisions every 2 months has been the most effective treatment to date. This article analyzes the results of this plan in 244 patients with RP in the nose, nasopharynx, pharynx, hypopharynx, larynx, trachea, lung parenchyma, and skin. METHODS Two hundred forty-four patients with recurrent RP were treated by the senior author with CO(2) laser excisions and, in some cases, podophyllum and alpha interferon. Demographics, initial distribution of papillomas, number of operations performed on each patient, and current results were evaluated. RESULTS Careful laser excisions of RPs every 2 months achieved "remission" of disease (no visible RP on indirect or often direct laryngoscopy 2 mo after last removal) in 37% of patients, "clearance" of the disease process (no RP clinically apparent for 3 y after last removal) in 6%, and "cure" (no clinical recurrence for 5 y after last removal) in 17%. Juvenile-onset RP tends to follow a more aggressive course than adult-onset RP. Four patients (1.6%) developed malignant transformation of their papillomas. Except for ones in lung parenchyma, RP in areas other than the true vocal cords tend to be cleared faster because aggressive removal does not cause hoarseness. Lung parenchyma RPs are eventually fatal because of pulmonary failure from abscesses and cysts resulting from a lack of effective treatment. CONCLUSION Frequent and meticulously performed CO(2) laser excisions can achieve significant voice and airway improvement, and some clinical "cures." However, effective antiviral medicines and/or immunologic agents are needed to achieve true cures with elimination of all human papilloma virus 6 and 11 viruses.
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Affiliation(s)
- H H Dedo
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California 94117, USA
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Nunes DN, Kowalski LP, Simpson AJ. Detection of oral and oropharyngeal cancer by microsatellite analysis in mouth washes and lesion brushings. Oral Oncol 2000; 36:525-8. [PMID: 11036246 DOI: 10.1016/s1368-8375(00)00045-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Microsatellite allele losses are characteristic features of head and neck squamous cell carcinoma and can be used as molecular markers for malignancy. We have investigated the detection of microsatellite allele loss in mouth washes and lesions brushings from 19 patients with squamous cell carcinoma of the oral cavity and oropharynx as a means of tumour detection. In 84% of the analysed cases, allele loss previously identified in the tumour of these patients, was detected in these easily obtained specimens. No alterations were found in material derived from 10 healthy individuals. Success of detection was independent of tumour stage, suggesting that this approach may be useful for early diagnosis as well as for follow-up.
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Affiliation(s)
- D N Nunes
- Laboratory of Cancer Genetics, Ludwig Institute for Cancer Research, Rna Prof. Antonio Prudente, 109 - 4th floor, 01509-010, SP, São Paulo, Brazil
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Bockmühl U, Schlüns K, Küchler I, Petersen S, Petersen I. Genetic imbalances with impact on survival in head and neck cancer patients. THE AMERICAN JOURNAL OF PATHOLOGY 2000; 157:369-75. [PMID: 10934141 PMCID: PMC1850146 DOI: 10.1016/s0002-9440(10)64549-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Chromosomal imbalances in 113 primary head and neck squamous cell carcinomas (HNSCCs) determined by comparative genomic hybridization were correlated with patients survival using custom-made computer software which enabled the assessment of individual chromosomal loci. The Kaplan-Meier analysis revealed that overrepresentations of 2q12, 3q21-29, 6p21.1, 11q13, 14q23, 14q24, 14q31, 14q32, 15q24, 16q22, and deletions of 8p21-22 and 18q11.2 were significantly associated with both shorter disease-free interval and disease-specific survival in this tumor collective. Multivariate Cox proportional hazards regression models consistently identified the gains of 3q21-29, 11q13, and the loss of 8p21-22 as independent prognostic markers carrying a higher significance than the nodal status as the only clinicopathological parameter with statistical importance. In addition, these three markers allowed a molecular dissection of the patients with low clinical risk (pN0 and pT2 tumors). Thus, the genomic data being derived from the evaluation of primary HNSCC enabled a stratification of the patients into subgroups with different survival highlighting the necessity of a genetically based tumor classification for refining diagnosis and treatment of HNSCC patients.
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Affiliation(s)
- U Bockmühl
- Department of Otorhinolaryngology, the Institute of Pathology, and the Institute of Medical Biometry, Charité Hospital, Humboldt University, Berlin, Germany
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Ninković M, Harpf C, Gunkel A, Schwabegger A, Thumfart W, Anderl H. One-stage reconstruction of defects in the hypopharyngeal region with free flaps. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1999; 33:31-9. [PMID: 10207963 DOI: 10.1080/02844319950159604] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Despite the almost universal poor prognosis, the reconstruction of combined cervical skin and hypopharyngeal defects after extensive resection of tumour should maintain optimal quality of life. From 1992 to 1996 we treated 10 patients with combined skin and hypopharyngeal defects with five fasciocutaneous free flaps, three myocutaneous latissimus dorsi free flaps, one myocutaneous VRAM (vertical rectus abdominis muscle) free flap and one free radial forearm flap. None of our flaps failed. The complications that required revision (one arterial bleeding, one arterial thrombosis, two fistula formations, one superficial wound dehiscence, one haematoma) occurred mainly in those patients having secondary reconstructions. After primary extensive oncological resection of these tumours reconstruction should be done in one stage. The primary reconstruction should provide sufficient pharyngeal lining, a satisfactory covering of cervical soft-tissue, and adequate functional rehabilitation. We have reviewed our experience and conclusions about the advantages, disadvantages, and current indications for different free flaps in the reconstruction of combined hypopharyngeal, cervico-oesophageal, and cervical skin defects.
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Affiliation(s)
- M Ninković
- Department of Plastic and Reconstructive Surgery, University Innsbruck, Austria
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Rao DN, Shroff PD, Chattopadhyay G, Dinshaw KA. Survival analysis of 5595 head and neck cancers--results of conventional treatment in a high-risk population. Br J Cancer 1998; 77:1514-8. [PMID: 9652771 PMCID: PMC2150195 DOI: 10.1038/bjc.1998.249] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
This is a study of 5595 head and neck cancer patients treated during 1987-89 at TMH, Mumbai. The study included 1970 oral cancers (ICD 140-145), 1495 oropharyngeal cancers (ICD 1410, 1453, 146), 1255 hypopharyngeal cancers (ICD 148), 125 nasopharyngeal cancers (ICD 147) and 750 laryngeal cancers (ICD 161). The clinical extent of disease at presentation was based on TNM group staging (UICC 1978). For the majority of sites, patients attended the hospital during stage III and stage IV of the disease; the only exception was for cancers of the lower lip, anterior tongue and vocal cord when between 46.2% and 56.5% of patients with localized cancer (stage I and II) were seen. Generally, surgery either alone or with radiation has been administered for oral cancer patients whereas radiation either alone or in combination with chemotherapy was administered for other head and neck sites. The overall 5-year survival rate was in the range of 20-43% for oral cancer, 8-25% for pharyngeal cancers and 25-62% for laryngeal cancer. The 5-year relative survival rates were more or less in agreement with the results published by the Eurocare study for head and neck cancers. The importance of primary prevention in head and neck cancer is stressed.
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Affiliation(s)
- D N Rao
- Division of Epidemiology and Biostatistics, Tata Memorial Hospital, Parel, Mumbai, India
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