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Meliante PG, Battilocchi L, Costantino A, Lee K, Moon SJ, Ralli M, Minni A, Capaccio P, Pignataro L, de Vincentiis M, Kim SH. Transoral robotic vertical partial laryngectomy (hemilaryngectomy) extended to the hypopharynx. Head Neck 2024; 46:708-712. [PMID: 38221740 DOI: 10.1002/hed.27634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/30/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024] Open
Abstract
Locally advanced laryngeal cancers treatment often involves total laryngectomy, which some patients are unwilling to undergo, even if this choice reduces their survival probability. Therefore, the objective of laryngeal oncologic surgery is not only to remove the tumor, but also to preserve the organ and its functions. To overcome these concerns, several partial laryngectomy techniques have been developed. This article describes the surgical technique and a case study of a 64-year-old male patient with locally advanced laryngeal squamous cell carcinoma who underwent vertical partial laryngectomy extending to the subglottis and hypopharynx using transoral robotic surgery (TORS) with a da Vinci Single Port surgical robot. The video and article provide a detailed description of the surgical technique, which resulted in successful tumor removal with excellent oncological and functional outcomes.
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Affiliation(s)
- Piero Giuseppe Meliante
- Department of Sense Organs, Sapienza University of Rome, Rome (RM), Italy
- Azienda Ospedaliera Policlinico Umberto I, Viale dell'Università, Rome (RM), Italy
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ludovica Battilocchi
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Costantino
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Kyuin Lee
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seo Jin Moon
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome (RM), Italy
- Azienda Ospedaliera Policlinico Umberto I, Viale dell'Università, Rome (RM), Italy
| | - Antonio Minni
- Department of Sense Organs, Sapienza University of Rome, Rome (RM), Italy
- Azienda Ospedaliera Policlinico Umberto I, Viale dell'Università, Rome (RM), Italy
| | - Pasquale Capaccio
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco de Vincentiis
- Department of Sense Organs, Sapienza University of Rome, Rome (RM), Italy
- Azienda Ospedaliera Policlinico Umberto I, Viale dell'Università, Rome (RM), Italy
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Heirman AN, de Kort DP, Petersen JF, Al-Mamgani A, Eerenstein SEJ, de Kleijn BJ, Hoebers F, Tijink BM, Stuiver MM, van der Molen L, Dirven R, Halmos GB, van den Brekel MWM. Decisional Conflict in Patients with Advanced Laryngeal Carcinoma: A Multicenter Study. Laryngoscope 2024. [PMID: 38366759 DOI: 10.1002/lary.31336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES Decision-making for patients with a locally advanced laryngeal carcinoma (T3 and T4) is challenging due to the treatment choice between organ preservation and laryngectomy, both with different and high impact on function and quality of life (QoL). The complexity of these treatment decisions and their possible consequences might lead to decisional conflict (DC). This study aimed to explore the level of DC in locally advanced laryngeal carcinoma patients facing curative decision-making, and to identify possible associated factors. METHODS In this multicenter prospective cohort study, participants completed questionnaires on DC, level of shared decision-making (SDM), and a knowledge test directly after counseling and 6 months after treatment. Descriptive statistics and Spearman correlation tests were used to analyze the data. RESULTS Directly after counseling, almost all participants (44/45; 98%) experienced Clinically Significant DC score (CSDC >25, scale 0-100). On average, patients scored 47% (SD 20%) correct on the knowledge test. Questions related to radiotherapy were answered best (69%, SD 29%), whilst only 35% (SD 29%) of the questions related to laryngectomy were answered correctly. Patients' perceived level of SDM (scale 0-100) was 70 (mean, SD 16.2), and for physicians this was 70 (SD 1.7). CONCLUSION Most patients with advanced larynx cancer experience high levels of DC. Low knowledge levels regarding treatment aspects indicate a need for better patient counseling. LEVEL OF EVIDENCE Level IV Laryngoscope, 2024.
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Affiliation(s)
- Anne N Heirman
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Daan P de Kort
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Japke F Petersen
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Simone E J Eerenstein
- Department of Otolaryngology/Head and Neck Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Bertram J de Kleijn
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank Hoebers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bernard M Tijink
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn M Stuiver
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Division of Psychosocial Research and Epidemiology, Center for Quality of Life, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Richard Dirven
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Gyorgy B Halmos
- Department of Otolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Amsterdam Center of Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
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Upton M, Reddy N, Aker M, James K, Wang M, Mendelsohn AH. Laryngeal cancer treatment decision making: A conjoint analysis of general public attitudes and priorities. Laryngoscope Investig Otolaryngol 2023; 8:886-894. [PMID: 37621286 PMCID: PMC10446275 DOI: 10.1002/lio2.1103] [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: 01/25/2023] [Revised: 05/09/2023] [Accepted: 06/08/2023] [Indexed: 08/26/2023] Open
Abstract
Objective Patients with advanced laryngeal cancer are typically presented with divergent treatment options, namely chemoradiation versus total laryngectomy. This study aims to understand general perspectives of the factors involved in this decision-making process. Methods Surveys were constructed using specialized conjoint analysis software. Seven attributes integral to the decision-making process for advanced laryngeal cancer treatment were included. Results Three hundred one healthy adult volunteers completed the decision-making program. The relative impact of each treatment attribute on decision making across all participants was scored with an average importance score (standard deviation) as follows: Lifespan 22.2% (±8.5), Voicing 21.4% (±5.9), Swallowing 19.1% (±7.3), Cancer Cure 14.9% (±6.2), Mode of Breathing 11.0% (±3.7), Self-Image 6.7% (±2.9), and Treatment Type 4.8% (±3.0). Conclusions General public opinion ranked lifespan, voicing, and swallowing aspects as similarly important, and all were ranked more important than probability of cure. These data demonstrate a variety of priorities among participants and the need for tailored discussions when determining treatment choice for advanced laryngeal cancer. Level of Evidence Level 4.
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Affiliation(s)
- Montana Upton
- Department of Otolaryngology—Head and Neck SurgeryVanderbilt UniversityNashvilleTennesseeUSA
| | - Neha Reddy
- UCLA Department of Head and Neck SurgeryLos AngelesCaliforniaUSA
| | - Mamdouh Aker
- UCLA Department of Head and Neck SurgeryLos AngelesCaliforniaUSA
| | - Kevin James
- UCLA Department of Head and Neck SurgeryLos AngelesCaliforniaUSA
| | - Marilene Wang
- UCLA Department of Head and Neck SurgeryLos AngelesCaliforniaUSA
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McDermott JD, Amini A, Molina E, Stokes WA, Karam SD. Treatment outcomes and cost comparisons for older adults with T4 laryngeal squamous cell cancer. Head Neck 2023; 45:664-674. [PMID: 36563300 PMCID: PMC10626713 DOI: 10.1002/hed.27284] [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: 05/12/2021] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To evaluate treatment modalities of T4 larynx cancer in older adults using SEER-Medicare. METHODS The database was queried for patients aged 66 and older with nonmetastatic T4 laryngeal squamous cell cancer from 2006 to 2015. Treatment modalities compared were surgery plus chemoradiation (SCR), surgery plus radiation (SR), chemoradiation (CR), surgery (S), and radiation (R). Multivariate analysis and Kaplan-Meier methods were used to explore the relationship of treatment modality and survival. Total cancer-related costs were calculated. RESULTS A total of 438 patients met inclusion criteria. Patients receiving CR or SR had similar CSS to SCR (HR 1.36 and HR 1.24, respectively). Those receiving S (HR 2.00) or R (HR 2.41) had significantly worse CSS. Similar findings were observed for OS. Cancer care-related costs were not significantly different but highest in SCR ($162215) and lowest in R ($121421). CONCLUSION Older patients with T4 larynx cancer had similar survival rates when treated with CR, SR, and SCR. Average total health care costs were not significantly different between modalities. Patients not eligible for triple-modality could consider these other treatment options.
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Affiliation(s)
- Jessica D McDermott
- Department of Medical Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope, Duarte, California, USA
| | - Elizabeth Molina
- Department of Health Systems, Management, and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - William A Stokes
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
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Hannan A, Zaidi F, Taylor S, Sharma A, Delfino K, Rao K. Contribution of surgery in management of T4b head and neck cancers: A retrospective review. Am J Otolaryngol 2022; 43:103543. [DOI: 10.1016/j.amjoto.2022.103543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
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Predictors for Adherence to Treatment Strategies in Elderly HNSCC Patients. Cancers (Basel) 2022; 14:cancers14020423. [PMID: 35053585 PMCID: PMC8774262 DOI: 10.3390/cancers14020423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary The aim of this study was to find predictors for adherence to a therapy recommended by a multidisciplinary tumour board regarding 1125 elderly patients (70–100 years) with head and neck squamous cell carcinoma (HNSCC). The 5-year overall survival was significantly higher in adherent patients (45.1% versus 19.2%). Nonadherent patients were significantly more often smokers, drinkers, and had a worse tumour stage and lower health status (Karnofsky performance status). In contrast to the chronological patient age, the biological age (Charlson Comorbidity Index) was a significant predictor for adherence. The evaluated predictors for nonadherence need to be verified prospectively. Abstract Finding a cure may be less important than ensuring the quality of life in elderly patients with head and neck squamous cell carcinoma (HNSCC). The aim of this study was to determine predictors for adherence. Clinical and pathological data from patients ≥70 years with HNSCC (initial diagnoses 2004–2018) were investigated retrospectively. Evaluated clinical predictors included biological age (Charlson Comorbidity Index; CCI), patient health (Karnofsky Performance Status; KPS) and therapy data. A total of 1125 patients were included. The median age was 75 years, 33.1% reached CCI ≥ 6, and 53.7% reached KPS ≤ 70%. In total, 968 patients were adherent, whereas 157 were nonadherent. Nonadherent patients were significantly more often smokers (p = 0.003), frequent drinkers (p = 0.001), had a worse health status (p ≤ 0.001) and a lower biological age (p = 0.003), an advanced T classification and lymph node involvement or UICC stage (each p ≤ 0.001). Approximately 88.0% of the included patients received a curative treatment recommendation. A total of 6.9% discontinued the therapy, and 7.0% refused the therapy. With the increasing complexity of a recommended therapy, adherence decreased. The 5-year overall survival was significantly higher in adherent patients (45.1% versus 19.2%). In contrast to the chronological patient age, biological age is a significant predictor for adherence. The evaluated predictors for nonadherence need to be verified prospectively.
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Cohen O, Brauer PR, Judson BL, Burtness BA, Earles J, Mehra S. Guideline - Adherence in advanced stage head and neck cancer is associated with improved survival - A National study. Oral Oncol 2021; 125:105694. [PMID: 34971883 DOI: 10.1016/j.oraloncology.2021.105694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Understanding the prevalence of guideline non-adherence among patients with advanced head and neck cancer (HNC) and its impact on survival may facilitate increased adherence. Our objective was to perform a detailed analysis of overall National Comprehensive Care Network (NCCN) guideline adherence in a national cohort. METHODS Using the National Cancer Database, we analyzed site-specific NCCN guideline adherence for treatment of 100,074 overall stage III and IVA HNC patients from 2004 to 2013. Main outcomes were guideline adherence rates and overall survival (OS). Adherence was categorized by treatment: surgery/ radiation. Reasons were categorized as: (1) high risk; (2) refusal; (3) not planned. RESULTS After exclusion, the care of 25,620 patients was defined as non-adherent (25.6%), yet adherence rates significantly improved across the study's years. After multivariate analysis, non-adherence was associated with age ≥ 65, female gender, black race, comorbidity score ≥ 1, insurance status, clinical staging, primary site, and facility type. Patients not managed according to NCCN guidelines had a significantly reduced OS compared with patients treated on-guideline (hazard ratio (HR) = 1.51 (95 %CI 1.48-1.54), p < 0.001). 'Not planned' patients had reduced OS when compared to adherent patients (HR = 1.27 (95 %CI 1.23-1.30), p < 0.001). Off-guideline treated patients due to 'risk factors' had a decrease in overall survival (OS) compared with other reasons (p < 0.001 for all). CONCLUSIONS Despite improvement over time, non-adherence to NCCN guidelines for advanced stage HNC remains high. Non-adherence is associated with decreased OS, regardless of the reason. Despite concerns from both patient and physician, efforts should be made to increase guideline awareness and adherence.
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Affiliation(s)
- Oded Cohen
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA
| | - Philip R Brauer
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Benjamin L Judson
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA
| | - Barbara A Burtness
- Yale Cancer Center, New Haven, CT, USA; Division of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Joseph Earles
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA
| | - Saral Mehra
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA.
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Smith BD, Osazuwa-Peters OL, Cannon TY, Reed WT, Puscas L, Osazuwa-Peters N. Nonsurgical Risk Factors Associated With Pharyngocutaneous Fistula in Patients Who Have Undergone Laryngectomy. JAMA Otolaryngol Head Neck Surg 2021; 147:966-973. [PMID: 34591065 DOI: 10.1001/jamaoto.2021.2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pharyngocutaneous fistula (PCF) is a serious complication after total laryngectomy. Despite the well-described clinical risk factors for PCF and its association with poor quality of life, there is a paucity of data on the nonclinical factors that may be associated with this complication. Objective To determine whether nonclinical risk factors (eg, age, sex, race and ethnicity) are associated with an increased risk of developing a PCF after total laryngectomy, and whether or not the method of reconstruction explains any differences found. Design, Setting, and Participants This retrospective multicenter cohort study used data from a nationally validated, risk-adjusted, outcomes-based, surgical quality improvement database (the National Surgical Quality Improvement Program) to examine outcomes in patients who underwent a total laryngectomy from 2005 to 2018. The database was queried from January 1, 2005, to December 31, 2018; data analyses were performed from September 1, 2020, to March 31, 2021. Main Outcomes and Measures The primary outcome was development of a PCF within 30 days of a total laryngectomy. Patient characteristics, including age, sex, race and ethnicity, comorbidities, and mode of reconstruction, were analyzed. Results A cohort of 1573 adult patients (median age [IQR], 63 [56-71] years; 1280 [81.4%] men; 293 [18.6%] women; 1001 [63.6%] non-Hispanic White individuals) had undergone a total laryngectomy during the study period and were included in the analyses. The overall rate of PCF formation was 4.3% (68 of 1573 patients). Hispanic patients had the highest rate (9.5%; 9 of 95 patients) of PCF formation, which was more than twice the rate among non-Hispanic White patients (3.8%; 38 of 1001) and non-Hispanic Black patients (4.7%; 11 of 236). After adjusting for clinical and other covariates, women were 1.9 times more likely to develop a PCF compared with men (adjusted odds ratio, 1.90; 95% CI, 1.08-3.35). We also found that the odds of developing a PCF were 3-fold higher among Hispanic patients compared with non-Hispanic White patients (adjusted odds ratio, 2.96; 95% CI, 1.36-6.47). The type of reconstruction did not differ across age or race and ethnicity after controlling for clinical risk factors. Conclusions and Relevance This multicenter cohort study found that 2 nonclinical risk factors-Hispanic ethnicity and female sex-were associated with an increased risk of PCF formation. Knowledge of these risk factors should be included in patient-physician decision-making as well as future interventions to decrease the rate of PCF formation after laryngectomy.
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Affiliation(s)
- Blaine D Smith
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Oyomoare L Osazuwa-Peters
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Trinitia Y Cannon
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - William T Reed
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Liana Puscas
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Duke Cancer Institute, Durham, North Carolina
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Patriquin G, Hatchette JE, Hatchette TF. Canadian physicians' knowledge, attitudes, and beliefs about the risk of HTLV infection in solid organ transplantation. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2020; 5:124-126. [PMID: 36341315 PMCID: PMC9608730 DOI: 10.3138/jammi-2019-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/15/2020] [Indexed: 06/16/2023]
Affiliation(s)
- Glenn Patriquin
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Jill E Hatchette
- Research Services, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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van Sluis KE, Kornman AF, van der Molen L, van den Brekel MWM, Yaron G. Women's perspective on life after total laryngectomy: a qualitative study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:188-199. [PMID: 31674722 PMCID: PMC7079180 DOI: 10.1111/1460-6984.12511] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 05/06/2023]
Abstract
BACKGROUND Physical and psychosocial challenges are common after total laryngectomy. The surgery leads to lifelong changes in communication, airway, swallowing and appearance. As we move towards health models driven by patient-centred care, understanding the differential impacts of surgical procedures on subgroups of patients can help improve our care models, patient education and support systems. This paper discusses the experiences of women following total laryngectomy. AIMS To gain an insight into the impact of total laryngectomy on women's daily life while identifying their specific rehabilitation needs. METHODS & PROCEDURES This paper is based on in-depth, semi-structured interviews with eight women who had undergone total laryngectomy. These interviews were conducted with women at least 1 year after they had undergone total laryngectomy, and the participants did not have recurrent disease. Using an interview guide, participants were encouraged to discuss their everyday experiences, while also focusing on issues typical to women. The transcribed interview data were analysed by thematic analysis, taking interpretative phenomenological analysis as a lead. OUTCOMES & RESULTS The interviews revealed three main themes: disease and treatment as a turning point, re-establishing meaningful everyday activities, and persistent vulnerability. Participants reported experiencing challenges in their rehabilitation process due to physical disabilities, dependency on others and experienced stigma. Women-specific challenges arose in dealing with the altered appearance and voice, performing care activities, and the spousal relationship (including intimacy). CONCLUSIONS & IMPLICATIONS Women who undergo total laryngectomy are likely to experience issues in returning to work, the performance of informal care-work, the spousal relationship, intimacy and social interaction due to stigmatization. Medical pretreatment counselling and multidisciplinary rehabilitation programmes should help patients form realistic expectations and prepare them for the changes they will face. A gender- and age-matched laryngectomized patient visitor can contribute to this process. Rehabilitation programmes should incorporate the partner and offer psychosocial support for women following total laryngectomy to return to their former roles in family life, social life and work-related activities.
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Affiliation(s)
- Klaske E. van Sluis
- Department of Head and Neck Oncology and SurgeryNetherlands Cancer Institute‐Antoni van LeeuwenhoekAmsterdamthe Netherlands
- Amsterdam Center for Language and CommunicationUniversity of AmsterdamAmsterdamthe Netherlands
| | - Anne F. Kornman
- Department of Head and Neck Oncology and SurgeryNetherlands Cancer Institute‐Antoni van LeeuwenhoekAmsterdamthe Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and SurgeryNetherlands Cancer Institute‐Antoni van LeeuwenhoekAmsterdamthe Netherlands
| | - Michiel W. M. van den Brekel
- Department of Head and Neck Oncology and SurgeryNetherlands Cancer Institute‐Antoni van LeeuwenhoekAmsterdamthe Netherlands
- Amsterdam Center for Language and CommunicationUniversity of AmsterdamAmsterdamthe Netherlands
| | - Gili Yaron
- Department of Head and Neck Oncology and SurgeryNetherlands Cancer Institute‐Antoni van LeeuwenhoekAmsterdamthe Netherlands
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
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Patel SA, Qureshi MM, Dyer MA, Jalisi S, Grillone G, Truong MT. Comparing surgical and nonsurgical larynx‐preserving treatments with total laryngectomy for locally advanced laryngeal cancer. Cancer 2019; 125:3367-3377. [DOI: 10.1002/cncr.32292] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 05/01/2019] [Accepted: 05/08/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Sagar A. Patel
- Department of Radiation Oncology, Boston Medical Center Boston University School of Medicine Boston Massachusetts
- Harvard Radiation Oncology Program Harvard Medical School Boston Massachusetts
| | - Muhammad M. Qureshi
- Department of Radiation Oncology, Boston Medical Center Boston University School of Medicine Boston Massachusetts
| | - Michael A. Dyer
- Department of Radiation Oncology, Boston Medical Center Boston University School of Medicine Boston Massachusetts
| | - Scharukh Jalisi
- Department of Otolaryngology‐Head and Neck Surgery, Boston Medical Center Boston University School of Medicine Boston Massachusetts
| | - Gregory Grillone
- Department of Otolaryngology‐Head and Neck Surgery, Boston Medical Center Boston University School of Medicine Boston Massachusetts
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center Boston University School of Medicine Boston Massachusetts
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Anschuetz L, Shelan M, Dematté M, Schubert AD, Giger R, Elicin O. Long-term functional outcome after laryngeal cancer treatment. Radiat Oncol 2019; 14:101. [PMID: 31186027 PMCID: PMC6558792 DOI: 10.1186/s13014-019-1299-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/16/2019] [Indexed: 12/23/2022] Open
Abstract
Background The functional outcome after the treatment of laryngeal cancer is tightly related to the quality of life of affected patients. The aim of this study is to describe the long-term morbidity and functional outcomes associated with the different treatment modalities for laryngeal cancer. Methods Retrospective chart review of 477 patients undergoing curatively intended treatment for laryngeal cancer at our tertiary referral center from 2001 to 2014: Details on patient and disease characteristics, diagnostics and treatment related functional outcomes were analyzed. Results With a median follow-up of 51 months, the crude rate of functional larynx preservation was 74.6%. Radiotherapy +/− chemotherapy was the dominant treatment modality (n = 359–75.3%), whereas 24.7% (n = 118) underwent primary surgery, with 58.5% (69) receiving adjuvant treatment. The 5-year laryngectomy-free survival was 57% (95% CI, 48–66%) after surgery vs. 69% (95% CI, 64–75%) after chemoradiotherapy (p < 0.01). In stage III-IVB, these rates were 26% (95% CI, 16–39%) vs. 47% (95% CI, 36–59%), respectively (p < 0.01). Aspiration occurred in 7%, tracheostomy was necessary in 19.8% and feeding tube placement in 25.4%. Feeding tube and tracheostomy necessity was higher in the initially surgically treated group. Primary surgery (HR: 1.67, 95% CI: 1.19–2.32; p < 0.01), stage III-IVB (HR: 4.07, 95% CI: 2.97–5.60; p < 0.01) and tumor recurrence (HR: 3.83, 95% CI: 2.79–5.28; p < 0.01) remained as adverse factors for laryngectomy-free survival. Conclusions Preserving the laryngeal function after cancer treatment is challenging. Advanced tumor stages, primary surgery and recurrence are related to a poor functional outcome. Therefore, the criteria for initial decision-making needs to be further refined. Electronic supplementary material The online version of this article (10.1186/s13014-019-1299-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lukas Anschuetz
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Marco Dematté
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.,Department of Otorhinolaryngology, Head & Neck Surgery, Head and Neck and Sensory Organs Department, Sant'Orsola-Malpighi Hospital, University of Bologna, 40138, Bologna, Italy
| | - Adrian D Schubert
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
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13
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Subramaniam N, Balasubramanian D, Reddy R, Thankappan K, Iyer S. Organ Preservation Protocols in T4 Laryngeal Cancer: a Review of the Literature. Indian J Surg Oncol 2019; 10:149-155. [PMID: 30948891 DOI: 10.1007/s13193-018-0840-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 11/23/2018] [Indexed: 11/29/2022] Open
Abstract
Population-based studies indicate that chemoradiation has become the most popular treatment for advanced laryngeal cancers; however, by extrapolating trial results to the general population, several issues have emerged, such as reduced overall survival, non-functional laryngeal preservation, and poor response to treatment. Although included in these trials, T4 laryngeal and hypopharyngeal cancers with cartilage invasion formed a small percentage of these patients and questions over whether they were appropriately staged remain unanswered. Literature on the use of chemoradiation in this set of patients, including the challenges, treatment considerations, and factors predicting response to treatment and outcomes, was reviewed. Current evidence indicates that all patients of T4 laryngeal and hypopharyngeal cancer are not suitable candidates for organ preservation; this modality should be offered only to select patients with good performance status and access to rehabilitative care and regular follow-up in order to achieve good results.
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Affiliation(s)
- Narayana Subramaniam
- 1Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Deepak Balasubramanian
- 1Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Rithvik Reddy
- 2Department of Surgery, Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Krishnakumar Thankappan
- 1Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Subramania Iyer
- 1Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
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14
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Petersen JF, Berlanga A, Stuiver MM, Hamming-Vrieze O, Hoebers F, Lambin P, van den Brekel MWM. Improving decision making in larynx cancer by developing a decision aid: A mixed methods approach. Laryngoscope 2019; 129:2733-2739. [PMID: 30663068 PMCID: PMC6899876 DOI: 10.1002/lary.27800] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/10/2018] [Accepted: 12/19/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Patients diagnosed with advanced larynx cancer face a decisional process in which they can choose between radiotherapy, chemoradiotherapy, or a total laryngectomy with adjuvant radiotherapy. Clinicians do not always agree on the best clinical treatment, making the decisional process for patients a complex problem. METHODS Guided by the International Patient Decision Aid (PDA) Standards, we followed three developmental phases for which we held semi-structured in-depth interviews with patients and physicians, thinking-out-loud sessions, and a study-specific questionnaire. Audio-recorded interviews were verbatim transcribed, thematically coded, and analyzed. Phase 1 consisted of an evaluation of the decisional needs and the regular counseling process; phase 2 tested the comprehensibility and usability of the PDA; and phase 3 beta tested the feasibility of the PDA. RESULTS Patients and doctors agreed on the need for development of a PDA. Major revisions were conducted after phase 1 to improve the readability and replace the majority of text with video animations. Patients and physicians considered the PDA to be a major improvement to the current counseling process. CONCLUSION This study describes the development of a comprehensible and easy-to-use online patient decision aid for advanced larynx cancer, which was found satisfactory by patients and physicians (available on www.treatmentchoice.info). The outcome of the interviews underscores the need for better patient counseling. The feasibility and satisfaction among newly diagnosed patients as well as doctors will need to be proven. To this end, we started a multicenter trial evaluating the PDA in clinical practice (ClinicalTrials.gov Identifier: NCT03292341). LEVEL OF EVIDENCE NA Laryngoscope, 129:2733-2739, 2019.
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Affiliation(s)
- Japke F Petersen
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Adriana Berlanga
- Department of Radiation Oncology (MAASTRO), Research Institute GROW, Maastricht University, Maastricht, The Netherlands
| | - Martijn M Stuiver
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Clinical Epidemiology Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Olga Hamming-Vrieze
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frank Hoebers
- Department of Radiation Oncology (MAASTRO), Research Institute GROW, Maastricht University, Maastricht, The Netherlands
| | - Philippe Lambin
- Department of Radiation Oncology (MAASTRO), Research Institute GROW, Maastricht University, Maastricht, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands.,Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands
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15
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Crippen MM, Elias ML, Weisberger JS, Brady JS, Eloy JA, Baredes S, Park RCW. Refusal of Cancer‐Directed Surgery in Head and Neck Squamous Cell Carcinoma Patients. Laryngoscope 2018; 129:1368-1373. [DOI: 10.1002/lary.27116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/12/2017] [Accepted: 01/08/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Meghan M. Crippen
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Marcus L. Elias
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Joseph S. Weisberger
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Jacob S. Brady
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New JerseyRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
- Department of Neurological SurgeryRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Soly Baredes
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New JerseyRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Richard Chan Woo Park
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical SchoolNewark New Jersey U.S.A
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16
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Patriquin G, Hatchette JE, Hatchette TF. Risk acceptance of human T-lymphotropic virus infection in solid organ transplantation-A survey of Atlantic Canadian ambulatory patients. Transpl Infect Dis 2018; 20:e12958. [PMID: 29959880 DOI: 10.1111/tid.12958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/28/2018] [Accepted: 06/22/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human T-lymphotropic virus (HTLV) has an estimated prevalence of 12 per 100 000 in the general Canadian population (with higher rates in distinct groups) and is most commonly transmitted by breast feeding, sexual intercourse, sharing injection tools, and blood transfusions. A minority of those infected will develop severe disease. Health Canada mandates that people who are positive for HTLV are not suitable to be solid organ donors. Given the apparent low-disease burden of HTLV in Canada, we explored HTLV risk tolerance among patients, in the context of organ transplantations. METHODS Using telephone, and in-person questionnaires, we assessed willingness of patients to accept the risk of HTLV infection in hypothetical scenarios in which they required an organ transplant for survival. RESULTS Seventy-four outpatients attending various medical clinics participated in the survey. In a standard gamble scenario, 37.5% of respondents would have accepted a solid organ transplant regardless of HTLV risk, as compared to 27.3% and 24.6% accepting organ transplantation if there was a risk of human immunodeficiency virus (HIV) or of human virus Y (HVY; a fictitious virus describing HTLV in terms of neurological outcomes), respectively. Similarly, the median longevity traded to ensure a virus-free organ was 4-5 years regarding all viruses, except for HVY, for which the median time exchanged to ensure a virus-free organ was 10 (out of a possible 20) years. CONCLUSIONS These data suggest that patients, though willing to accept some risk of viral infection, would not be willing to forgo HTLV screening of solid organs.
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Affiliation(s)
- Glenn Patriquin
- Division of Medical Microbiology, Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jill E Hatchette
- Research Services, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Division of Medical Microbiology, Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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17
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Costa JM, López M, García J, León X, Quer M. Impacto de la laringectomía total en la situación laboral. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 69:74-79. [DOI: 10.1016/j.otorri.2017.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/25/2017] [Indexed: 12/12/2022]
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18
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Costa JM, López M, García J, León X, Quer M. Impact of Total Laryngectomy on Return to Work. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.otoeng.2017.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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19
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Laccourreye O, Bonfils P, Malinvaud D, Ménard M, Giraud P. Survival and laryngeal preservation tradeoff in advanced laryngeal cancer: From the otorhinolaryngology patient to the managing physician. Head Neck 2017; 39:1984-1989. [PMID: 28786181 DOI: 10.1002/hed.24833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/27/2017] [Accepted: 04/17/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to document the tradeoff between survival and laryngeal preservation in advanced-stage laryngeal cancer amenable to chemoradiation or total laryngectomy. METHODS We conducted a prospective analysis based on a questionnaire completed by 209 laryngeal cancer specialists and 269 volunteers from an otorhinolaryngology clinic. RESULTS Of the responders, 34.5% would not consider any decrease in survival to preserve their larynx. This percentage varied from 52% in otorhinolaryngologists to 27.3% in radiotherapists and 28.6% in volunteers (P < .001). Among the responders prepared to trade, the percentage of survival they were willing to trade to preserve their larynx varied from 5% to 100% (median 30%). On univariate analysis, 3 variables significantly affected this percentage: (1) the living status (single or not); (2) the existence of children; and (3) the study group (volunteers, radiation therapists, or otorhinolaryngologists) to whom the responders belong. CONCLUSION The significant variations noted should develop modes of practice that cater to this and stimulate further research in this field.
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Affiliation(s)
- Ollivier Laccourreye
- Department of Otorhinolaryngology - Head Neck Surgery, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Pierre Bonfils
- Department of Otorhinolaryngology - Head Neck Surgery, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - David Malinvaud
- Department of Otorhinolaryngology - Head Neck Surgery, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Madeleine Ménard
- Department of Otorhinolaryngology - Head Neck Surgery, Université Paris Descartes Sorbonne Paris Cité, Paris, France
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20
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van Loon Y, Stiggelbout AM, Hakkesteegt MM, Langeveld TPM, Baatenburg de Jong RJ, Sjögren EV. Utility approach to decision-making in extended T1 and limited T2 glottic carcinoma. Head Neck 2017; 39:779-785. [PMID: 28199035 DOI: 10.1002/hed.24689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND It is still undecided if endoscopic laser surgery or radiotherapy is the preferable treatment in extended T1 and limited T2 glottic tumors. Health utilities assessed from patients can aid in decision-making. METHODS Patients treated for extended T1 or limited T2 glottic carcinoma by laser surgery (n = 12) or radiotherapy (n = 14) assigned health utilities using a visual analog scale (VAS), time tradeoff (TTO) technique and scored their voice handicap using the Voice Handicap Index (VHI). RESULTS VAS and TTO scores were slightly lower for the laser group compared to the radiotherapy group, however, not significantly so. The VHI showed a correlation with the VAS score, which was very low in both groups and can be considered (near) normal. CONCLUSION Patients show no clear preference for the outcomes of laser surgery or radiotherapy from a quality of life (QOL) or voice handicap point of view. These data can now be incorporated into decision-making models. © 2017 Wiley Periodicals, Inc. Head Neck, 2017 © 2016 Wiley Periodicals, Inc. Head Neck 39: 779-785, 2017.
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Affiliation(s)
- Yda van Loon
- Department of Ear, Nose, and Throat, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke M Hakkesteegt
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ton P M Langeveld
- Department of Ear, Nose, and Throat, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob J Baatenburg de Jong
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Elisabeth V Sjögren
- Department of Ear, Nose, and Throat, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
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21
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Abstract
Answer questions and earn CME/CNE Laryngeal cancer remains one of the most common tumors of the respiratory tract. Fortunately, significant advancements have been made over the past decade in the treatment of laryngeal cancer. Although surgery has been the historical mainstay for localized disease and still is an integral part of treatment, nonsurgical options like radiation and systemic therapy have emerged as viable options. In addition, in the metastatic setting, novel agents are showing promise for this patient population. The care for patients with laryngeal cancer continues to evolve and truly requires a multidisciplinary team-based approach. Unique morbidities, such as loss of natural voice, respiration, and airway protection during swallowing, are observed with this disease and require special consideration. CA Cancer J Clin 2017;67:31-50. © 2016 American Cancer Society.
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Affiliation(s)
- Conor E Steuer
- Assistant Professor, Department of Hematology Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Mark El-Deiry
- Associate Professor, Department of Otolaryngology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Jason R Parks
- Resident, Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Kristin A Higgins
- Assistant Professor, Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Nabil F Saba
- Professor and Director of the Head and Neck Medical Oncology Program, Department of Hematology Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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22
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Forastiere AA, Weber RS, Trotti A. Organ Preservation for Advanced Larynx Cancer: Issues and Outcomes. J Clin Oncol 2015; 33:3262-8. [PMID: 26351339 DOI: 10.1200/jco.2015.61.2978] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To provide a review of the clinical data, controversies, and limitations that underpin current recommendations for approaches to larynx preservation for locally advanced larynx cancer requiring total laryngectomy. METHODS The key findings from pivotal randomized controlled trials are discussed, including quality of life, late effects, and function assessments. Trials investigating taxane inclusion in induction chemotherapy and trials of epidermal growth factor receptor inhibition for radiosensitization are put into perspective for larynx cancer. Controversies in the management of T4 primaries and the opportunities for conservation laryngeal surgery are reviewed. RESULTS There are data from clinical trials to support induction chemotherapy, followed by radiotherapy (preferred approach in Europe) and concomitant cisplatin plus radiotherapy (preferred in North America) for nonsurgical preservation of the larynx. Treatment intensification by a sequential approach of induction, followed by concomitant treatment, is investigational. Transoral laryngeal microsurgery and transoral robotic partial laryngectomy have application in selected patients. CONCLUSION The management of locally advanced larynx cancer is challenging and requires an experienced multidisciplinary team for initial evaluation, response assessment, and support during and after treatment to achieve optimal function, quality of life, and overall survival. Patient expectations, in addition to tumor extent, pretreatment laryngeal function, and coexisting chronic disease, are critical factors in selecting surgical or nonsurgical primary treatment.
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Affiliation(s)
- Arlene A Forastiere
- Arlene A. Forastiere, Johns Hopkins University and Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Randal S. Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; and Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
| | - Randal S Weber
- Arlene A. Forastiere, Johns Hopkins University and Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Randal S. Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; and Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Andy Trotti
- Arlene A. Forastiere, Johns Hopkins University and Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Randal S. Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; and Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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23
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Dronkers EAC, Mes SW, Wieringa MH, van der Schroeff MP, Baatenburg de Jong RJ. Noncompliance to guidelines in head and neck cancer treatment; associated factors for both patient and physician. BMC Cancer 2015; 15:515. [PMID: 26163015 PMCID: PMC4499219 DOI: 10.1186/s12885-015-1523-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/26/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Decisions on head and neck squamous cell carcinoma (HNSCC) treatment are widely recognized as being difficult, due to high morbidity, often involving vital functions. Some patients may therefore decline standard, curative treatment. In addition doctors may propose alternative, nonstandard treatments. Little attention is devoted, both in literature and in daily practice, to understanding why and when HNSCC patients or their physicians decline standard, curative treatment modalities. Our objective is to determine factors associated with noncompliance in head and neck cancer treatment for both patients and physicians and to assess the influence of patient compliance on prognosis. METHODS We did a retrospective study based on the medical records of 829 patients with primary HNSCC, who were eligible for curative treatment and referred to our hospital between 2010 and 2012. We analyzed treatment choice and reasons for nonstandard treatment decisions, survival, age, gender, social network, tumor site, cTNM classification, and comorbidity (ACE27). Multivariate analysis using logistic regression methods was performed to determine predictive factors associated with non-standard treatment following physician or patient decision. To gain insight in survival of the different groups of patients, we applied a Cox regression analysis. After checking the proportional hazards assumption for each variable, we adjusted the survival analysis for gender, age, tumor site, tumor stage, comorbidity and a history of having a prior tumor. RESULTS 17 % of all patients with a primary HNSCC did not receive standard curative treatment, either due to nonstandard treatment advice (10 %) or due to the patient choosing an alternative (7 %). A further 3 % of all patients refused any type of therapy, even though they were considered eligible for curative treatment. Elderliness, single marital status, female gender, high tumor stage and severe comorbidity are predictive factors. Patients declining standard treatment have a lower overall 3-year survival (34 % vs. 70 %). CONCLUSIONS Predictive factors for nonstandard treatment decisions in head and neck cancer treatment differed between the treating physician and the patient. Patients who received nonstandard treatment had a lower overall 3-year survival. These findings should be taken into account when counselling patients in whom nonstandard treatment is considered.
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Affiliation(s)
- Emilie A C Dronkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, 's Gravendijkwal 230, room D112, 3015 CE, Rotterdam, The Netherlands.
| | - Steven W Mes
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, 's Gravendijkwal 230, room D112, 3015 CE, Rotterdam, The Netherlands.
| | - Marjan H Wieringa
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, 's Gravendijkwal 230, room D112, 3015 CE, Rotterdam, The Netherlands.
| | - Marc P van der Schroeff
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, 's Gravendijkwal 230, room D112, 3015 CE, Rotterdam, The Netherlands.
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, 's Gravendijkwal 230, room D112, 3015 CE, Rotterdam, The Netherlands.
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24
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Hamilton DW, Bins JE, McMeekin P, Pedersen A, Steen N, De Soyza A, Thomson R, Paleri V, Wilson JA. Quality compared to quantity of life in laryngeal cancer: A time trade-off study. Head Neck 2015; 38 Suppl 1:E631-7. [PMID: 25832305 DOI: 10.1002/hed.24061] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/02/2015] [Accepted: 03/27/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The purpose of this study was to use time trade-off to assess the factors influencing patients' decisions in advanced laryngeal cancer. Time trade-off is a well-established method of assessing how individuals value a particular health state. METHODS We developed vignettes depicting life after chemoradiotherapy or laryngectomy. One hundred fourteen participants ranked them, assigned utility values, and rated the importance of survival on treatment choice. RESULTS Chemoradiotherapy was preferred by 62% and laryngectomy by 38%. Chemoradiotherapy optimal outcome had the highest mean utility value (0.64) followed by total laryngectomy optimal outcome (0.56). Total laryngectomy poor outcome (0.33) was equivalent to chemoradiotherapy poor outcome (0.32).The average survival advantage required for a participant to change their preferred choice was 2.1 years. CONCLUSION The functional treatment outcome had a greater effect on health state utility values than treatment modality. In many individuals, larynx conservation may not be the primary consideration in treatment preference. © 2015 Wiley Periodicals, Inc. Head Neck 38: E631-E637, 2016.
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Affiliation(s)
- David W Hamilton
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Peter McMeekin
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ami Pedersen
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Nicholas Steen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anthony De Soyza
- Institute of Cellular Medicine, Respiratory Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Respiratory Medicine Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Vinidh Paleri
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
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25
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Goepfert RP, Yom SS, Ryan WR, Cheung SW. Development of a chemoradiation therapy toxicity staging system for oropharyngeal carcinoma. Laryngoscope 2014; 125:869-76. [PMID: 25388529 DOI: 10.1002/lary.25023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Develop an innovative tool to standardize representation of treatment toxicity and enable shared decision making by mapping provider-based outcome descriptions to four overall stages of toxicity from chemoradiation therapy for oropharyngeal carcinoma. STUDY DESIGN Cross-sectional, provider-based questionnaire. METHODS Five short-term and five long-term treatment outcomes of cisplatin and intensity-modulated radiation therapy for oropharyngeal carcinoma were chosen by a focus group of head and neck oncologists. A pilot survey was developed in an online platform, and feedback from extramural head and neck oncologists was used to refine it for institutional review board submission and formal deployment. Respondents were surgical, radiation, and medical oncologists with experience in treating oropharyngeal carcinoma. One hundred five responses were analyzed, of which 67% were from providers with >10 years in practice and 79% were from providers who treat >15 new oropharyngeal carcinoma patients per year. RESULTS A particular overall chemoradiation toxicity class is accounted for by two adjoining distress levels (>90% occurrence) for both short-term and long-term outcomes. Providers deemed mucositis and nausea, and pain and xerostomia the most distressing short-term and long-term toxicities, respectively. Providers were split as to their impression of the relative importance that patients place on short-term versus long-term outcomes when considering treatment options. CONCLUSIONS A clinical tool to represent overall chemoradiation toxicity considering short-term and long-term outcomes has been developed by analyzing provider-centric responses to a realistic clinical scenario. Results from this pilot study enhance patient counseling and shared decision making, and serve as foundational information for a prospective, longitudinal patient-centric observational study.
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Affiliation(s)
- Ryan P Goepfert
- Departments of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
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Abstract
PURPOSE OF REVIEW Treatment of laryngeal carcinoma continues to evolve, and whereas there was a transition from total laryngectomy to chemoradiation in response to the Veterans Affairs study and Radiation Therapy Oncology Group (RTOG) 91-11, recent data suggest the role of partial laryngectomy must be revisited. RECENT FINDINGS Recent data have shown that laryngeal preservation does not equate with laryngeal function. Data are accumulating in support of operative management of advanced laryngeal carcinoma away from chemoradiation for select patients. In particular, supracricoid laryngectomy may be a viable option for intermediate and selected advanced laryngeal carcinoma while maintaining laryngeal function. SUMMARY The evolution of treatment for advanced laryngeal carcinoma is focusing treatment on maintaining locoregional control while also maintaining a functional larynx.
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Laccourreye O, Malinvaud D, Ménard M, Consoli S, Giraud P, Bonfils P. Otorhinolaryngologists' personal treatment preferences (total laryngectomy or laryngeal preservation) when faced with advanced stage laryngeal cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:339-343. [PMID: 24993784 DOI: 10.1016/j.anorl.2014.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 01/20/2014] [Accepted: 01/29/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the treatment options that otorhinolaryngologists would consider if faced with advanced stage laryngeal cancer amenable to total laryngectomy or an organ preservation protocol. MATERIAL AND METHODS Prospective study conducted in a French Teaching Hospital based on questionnaires filled in by 163 otorhinolaryngologists in 2012, studying the percentage chance of cure that they would be prepared to trade-off to preserve their larynx, defining the additional information that they would like to receive and identifying any statistical associations between these parameters and various medical and socioeconomic variables. RESULTS A total of 42.3% of otorhinolaryngologists would not consider the slightest trade-off to preserve their larynx and preferred to undergo total laryngectomy. In the group of otorhinolaryngologists who would consider a larynx preservation protocol (57.6%), the percentage chance of cure that they would be willing to trade-off to preserve their larynx ranged between 5 to 100% (median: 15%) and 4.2% of them were willing to trade-off all chances of cure (100%) to avoid total laryngectomy. The percentage of otorhinolaryngologists who would not consider trading off the slightest chance of survival to preserve their larynx increased from 29.3 to 49.5% (P=0.01) when they participated in multidisciplinary consultation meetings. In the group of otorhinolaryngologists who would consider a larynx preservation protocol, the median percentage survival trade-off that they would consider in order to preserve their larynx (i) decreased from 20 to 10% (P=0.004) when they participated in multidisciplinary consultation meetings and (ii) increased regularly with their number of years of practice (P=0.03) and their age (P=0.025). Finally, 25.1% of otorhinolaryngologists wanted to receive additional information, although none of the variables analysed affected this desire for more information. CONCLUSION Treatment options considered by otorhinolaryngologists faced with advanced stage laryngeal cancer were almost equally divided between total laryngectomy and larynx preservation. Number of years of practice and regular participation in head and neck cancer multidisciplinary consultation meetings were variables that significantly influenced this choice.
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Affiliation(s)
- O Laccourreye
- Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, université Paris Descartes Sorbonne Paris Cité, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France.
| | - D Malinvaud
- Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, université Paris Descartes Sorbonne Paris Cité, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - M Ménard
- Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, université Paris Descartes Sorbonne Paris Cité, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - S Consoli
- Service de psychiatrie, université Paris Descartes Sorbonne Paris Cité, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - P Giraud
- Service d'oncologie-radiothérapie, université Paris Descartes Sorbonne Paris Cité, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - P Bonfils
- Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, université Paris Descartes Sorbonne Paris Cité, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
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Mackley HB, Teslova T, Camacho F, Short PF, Anderson RT. Does Rurality Influence Treatment Decisions in Early Stage Laryngeal Cancer? J Rural Health 2014; 30:406-11. [DOI: 10.1111/jrh.12069] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Heath B. Mackley
- Department of Radiation Oncology, Penn State Hershey Cancer Institute; Penn State College of Medicine; Hershey Pennsylvania
| | - Tatiana Teslova
- Department of Radiation Oncology, Penn State Hershey Cancer Institute; Penn State College of Medicine; Hershey Pennsylvania
| | - Fabian Camacho
- Department of Public Health Sciences; Penn State College of Medicine; Hershey Pennsylvania
| | - Pamela F. Short
- Department of Health Policy and Administration; Penn State University; University Park Pennsylvania
| | - Roger T. Anderson
- Department of Public Health Sciences; Penn State College of Medicine; Hershey Pennsylvania
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Laccourreye O, Malinvaud D, Ménard M, Consoli S, Giraud P, Bonfils P. Total laryngectomy or laryngeal preservation for advanced laryngeal cancer. Impact of the functional risk upon the patient's preferences. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:93-7. [PMID: 24529928 DOI: 10.1016/j.anorl.2013.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 12/27/2012] [Accepted: 06/10/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse, based on an anonymous questionnaire, the treatment decision envisaged and the impact of the medical information delivered in patients facing the diagnosis of an advanced laryngeal cancer amenable to total laryngectomy or a laryngeal preservation protocol. MATERIAL AND METHODS Prospective study conducted in a French teaching hospital based on questionnaires filled in by 269 patients attending the otorhinolaryngology clinic. RESULTS A total of 28.6% of patients would not consider any trade-off of cure to preserve their larynx; 1.4% of patients were willing to trade all chances of cure in order to avoid total laryngectomy. The median percentage of cure that patients were ready to loose in order to preserve their larynx was 33% (range: 5 to 100%); 47.9% of patients wanted to receive additional information before making their decision with a significant increase among patients with a level of education beyond secondary school (P=0.0006) and among patients with a family history of cancer (P=0.038). The additional information most frequently requested concerned the complications related to the laryngeal preservation protocol (34.1%) and the cure rate (28.6%). After receiving information about the risk of tracheostomy and permanent gastrostomy following the laryngeal preservation protocol, the percentage of subjects who would not consider any trade-off in order to preserve their larynx increased to 31.2% and 56.1%, respectively. CONCLUSION Laryngeal preservation is not a major objective of treatment shared by patients filling a questionnaire devoted to the choice of treatment when facing an advanced laryngeal cancer. Specific information concerning the expected results and the inherent risks involved in the various treatment options must be provided in every case.
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Affiliation(s)
- O Laccourreye
- Université Paris Descartes Sorbonne Paris Cité, Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France.
| | - D Malinvaud
- Université Paris Descartes Sorbonne Paris Cité, Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - M Ménard
- Université Paris Descartes Sorbonne Paris Cité, Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - S Consoli
- Université Paris Descartes Sorbonne Paris Cité, Service de psychiatrie, Hôpital ruropéen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - P Giraud
- Université Paris Descartes Sorbonne Paris Cité, Service de radiothérapie-oncologie, Hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - P Bonfils
- Université Paris Descartes Sorbonne Paris Cité, Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
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Francis E, Matar N, Khoueir N, Nassif C, Farah C, Haddad A. T4a laryngeal cancer survival: retrospective institutional analysis and systematic review. Laryngoscope 2014; 124:1618-23. [PMID: 24338374 DOI: 10.1002/lary.24557] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 11/23/2013] [Accepted: 12/09/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the survival outcomes of a homogeneous group of pT4a laryngeal cancer patients treated at our institution by primary total laryngectomy and neck dissection with adjuvant therapy when indicated, and to systematically review studies reporting overall survival outcomes in T4a laryngeal cancer. STUDY DESIGN Systematic review of PubMed and Embase databases. METHODS Records of 108 laryngeal cancer patients treated by total laryngectomy were reviewed. pT4a cases treated by primary total laryngectomy between 1998 and 2010 were included. Overall and disease-free survival at 2 and 5 years were reported. A systematic review was performed including all published studies reporting overall survival outcomes by treatment modality in T4 laryngeal cancer patients. RESULTS Thirty cases met the inclusion criteria. At 2 years, overall and disease-free survival were 81.3% and 78%, respectively. The 5-year overall and disease-free survival rates were 60%. The systematic review retrieved 24 articles. Overall survival at 2 years ranged from 12% to 21.2% with radiotherapy, <30% to 65% with chemoradiotherapy, and from 30% to 100% with surgery. At 5 years, it ranged from 0% to 75% with radiotherapy, 16% to 50.4% with chemoradiotherapy, and 10% to 80.9% with surgery. CONCLUSIONS Primary total laryngectomy provides a high survival rate for pT4a laryngeal cancer patients. Randomized controlled trials including homogenous patients are still needed before shifting to organ preservation protocols in these patients. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Evana Francis
- Department of Otolaryngology-Head and Neck Surgery, Hôtel Dieu de France Hospital, Beirut, Lebanon; Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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Nakayama M, Okamoto M, Hayakawa K, Miyamoto S, Ishiyama H, Komori S, Okamoto T, Seino Y, Kano K, Soda I, Sekiguchi A, Kawakami S. Clinical outcomes of 849 laryngeal cancers treated in the past 40 years: are we succeeding? Jpn J Clin Oncol 2013; 44:57-64. [PMID: 24174633 DOI: 10.1093/jjco/hyt162] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE We analyzed the clinical outcomes of 849 laryngeal cancers treated in the past 40 years, which overlapped with the era of the global treatment shift. METHODS To compare the chronological outcomes, patients were divided into four groups according to their registration year as 1972-82, 1983-92, 1993-2002 and 2003-12; treatment trends, larynx preservation rate and overall survival rate were compared. RESULTS There were 104, 173, 253 and 319 patients registered in 1972-82, 1983-92, 1993-2002 and 2003-12, respectively. Five-year overall survival rates were 74, 76.5, 75.6 and 82.2% in 1972-82, 1983-92, 1993-2002 and 2003-12, respectively. The five-year larynx preservation rates were 65.5, 75.7, 75.4 and 80.9% in 1972-82, 1983-92, 1993-2002 and 2003-12, respectively. CONCLUSIONS The number of patients treated at our institute increased, and the overall survival and larynx preservation rates exhibited favorable improvements over the past four decades. In the analysis of nonsurgical options, S1 combined radiotherapy showed superiority over concurrent chemoradiotherapy and radiotherapy in larynx preservation, and S1 combined radiotherapy, concurrent chemoradiotherapy and Tegafur Uracil combined radiotherapy showed superiority over radiotherapy in overall survival. In nonsurgical approaches, proper case selection is the key to success and may be much more important than pursuing radiotherapy dose escalation. In the analysis of surgical options, laser and supracricoid laryngectomy with cricohyoidoepiglottopexy contributed to larynx preservation in early- and intermediate-stage cancers, respectively. Supracricoid laryngectomy with cricohyoidoepiglottopexy demonstrated overall survival not worse than total laryngectomy, which is the prerequisite treatment basis for larynx preservation options. We must make extra efforts in pursuing an ideal balance between nonsurgical and surgical larynx preservation options.
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Affiliation(s)
- Meijin Nakayama
- *Department of Otorhinolaryngology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 252-0374, Japan.
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