Salvage of recurrent hypopharyngeal carcinoma after primary curative treatment

CDCA3 promotes the proliferation and migration of hypopharyngeal squamous cell carcinoma cells by activating the Akt/mTOR pathway

Hypopharyngeal squamous cell carcinoma (HSCC) is a highly invasive and fatal tumor with a poor prognosis in head and neck tumors. It is urgent to further study the molecular mechanism of HSCC progression and identify new effective therapeutic targets. Cell division cycle-related protein 3 (CDCA3) was reported overexpressed in several cancers and involved in tumor progression. However, the biological role of CDCA3 and its potential mechanism in HSCC remain undetermined. Reverse transcription quantitative polymerase chain reaction (RT-PCR) and immunohistochemistry were used to detect the expression levels of CDCA3 in HSCC tissue and matched peritumoral tissue. The effects of CDCA3 on cell proliferation, invasion, and migration were explored using the Celigo image cytometry assay, MTT assay, flow cytometric analysis, cell invasion, and migration assays. The results showed that CDCA3 was upregulated in HSCC tissue and FaDu cell line. Knockdown of CDCA3 inhibited the proliferation, invasion, and migration of FaDu cells and promoted apoptosis of FaDu cells. Furthermore, knockdown of CDCA3 blocked the cell cycle in the G0/G1 phase. Mechanistically, CDCA3 may play a role in tumor progression of HSCC through the Akt/mTOR signaling pathway. In summary, these results suggest that CDCA3 serves as an oncogene in HSCC and may be used as a prognostic indicator and a potential therapeutic target for HSCC.

Salvage surgery for recurrent squamous cell carcinoma of the head and neck: Systematic review and meta-analysis

The present study aims to estimate a pooled hazard ratio (HR) comparing overall survival (OS) for salvage surgery compared to nonsurgical management of recurrent head and neck squamous cell carcinoma (HNSCC). PubMed/MEDLINE and Embase-Ovid were searched on March 5, 2020, for English-language articles reporting survival for salvage surgery and nonsurgical management of recurrent HNSCC. Meta-analysis of HR estimates using random effects model was performed. Fifteen studies reported survival for salvage surgery and nonsurgical management of recurrence. Five-year OS ranged from 26% to 67% for the salvage surgery groups, compared to 0% to 32% for the nonsurgical management groups. Six studies reported HRs comparing salvage surgery to nonsurgical management; the pooled HR was 0.25 (95% CI [0.16, 0.38]; p < 0.0001). Selection for salvage surgery was associated with one quarter of the mortality rate associated with nonsurgical management in light of confounding factors including subsite and treatment intent.

Clinical outcome in recurrent and/or metastatic head and neck cancer patients after discontinuation of nivolumab monotherapy due to immune-related adverse events

BACKGROUND

Significant immune-related adverse events (irAEs) requiring therapy discontinuation sometimes occur. The influence of discontinuation on disease control after an irAE is unclear.

OBJECTIVES

The aim of this study was to investigate whether or not patients continued to show a response or durable disease control even after stopping therapy following an irAE.

MATERIAL AND METHODS

The response after nivolumab monotherapy discontinuation was examined for 14 patients in whom therapy was stopped without progression.

RESULTS

The best response was CR in 5 (36%) patients, PR in 8 (57%) patients and SD in 1 (7%) patient. The estimated 1-year overall and progression-free survival rates were 92.9% and 78.6%, respectively. The best response during nivolumab therapy in patients who developed PD was CR in 0 of 5 patients (0%), PR in 3 of 8 patients (38%) and SD in 1 patient (100%). Patients obtaining CR tended to have a lower risk of PD than those with PR or SD.

CONCLUSIONS AND SIGNIFICANCE

Patients with CR status may continue to show a response or durable disease control even after stopping therapy due to an irAE.

Oncological results of salvage treatment in patients with hypopharyngeal carcinoma

INTRODUCTION AND OBJECTIVE

The aim of this study is to analyse the variables related to the feasibility of salvage surgery with radical intention in patients with a local recurrence of hypopharyngeal carcinoma, and to evaluate the oncological performance of this type of surgery.

METHODS

Retrospective study of 96 patients with hypopharyngeal carcinoma with local tumour recurrence RESULT: Only 27 patients (28.1%) were considered for surgical salvage treatment. The variables related to feasibility of salvage surgery were non-surgical initial treatment of the tumour and a disease-free interval greater than 6 months. All 69 patients non-candidates for salvage surgery died as a result of tumour progression in a period of less than 2.5 years. The 5-year disease-specific survival rate for the patients treated with salvage surgery was 39.5%. The only variable significantly related to disease-specific survival was the status of the resection margins. Patients with extensive tumour recurrence (rT3-T4) or with simultaneous nodal involvement had a lower survival rate, but the differences did not reach statistical significance.

CONCLUSION

Only 28% of the patients with hypopharyngeal carcinoma with local recurrence of the tumour were eligible for salvage surgery with radical intention. The patients treated with salvage surgery had a 5 -year disease-specific survival of 39.5%.

To do or not to do: salvage management for hypopharyngeal cancer after chemoradiation therapy

PURPOSES

The management of recurrent hypopharyngeal cancer after primary curative-intent radiation or chemoradiation therapy is inconclusive. The benefit of salvage surgery may be reduced by its high complication rate. The improvement of medical care modalities may change the survival after management for loco-reginal recurrences. The present study aims to determine the role of salvage surgery.

METHODS

From December 2007 to November 2013, 46 patients with recurrent hypopharyngeal squamous cell carcinoma (HPSCC) after radiation or chemoradiation therapy and without double cancers were recruited. Two year loco-regional failure and overall survival were analyzed and compared between failure patterns.

RESULTS

Five-year survival was 24% in patients after loco-regional recurrences. Those who received salvage surgery for loco-regional recurrences had significantly better survival (P < 0.001). Among patients with salvage surgery, 2-year overall survival was significantly higher in recurrent (n = 11) than persistent (n = 24) disease (90 vs 38%, P = 0.006).

CONCLUSIONS

Salvage surgery provides better oncologic outcomes in patients with HPSCC, especially for patients with recurrences after 6 months since completion of primary radiation or chemoradiation. The present data of outcomes can be provided for pretreatment consultation for loco-regional recurrent hypopharyngeal cancers.

Salvage Transoral Videolaryngoscopic Surgery for radiorecurrent hypopharyngeal and supraglottic cancer

OBJECTIVE

To evaluate the feasibility of Transoral Videolaryngoscopic Surgery (TOVS) for radiorecurrent supraglottic and hypopharyngeal cancer, and to compare survival and complications between primary and radiorecurrent cases.

METHODS

Twelve cases of salvage TOVS for radiorecurrent cancer and 53 cases of TOVS as an initial treatment (primary cases) were evaluated. Days to resume soft diet, Functional Outcomes of Swallowing Scale (FOSS), postoperative complications, epithelization days and survival outcomes were assessed by retrospective chart review.

RESULTS

FOSS score was significantly worse in salvage cases compared with primary cases. Bleeding and airway compromise was slightly greater in salvage cases than in primary cases; however, this was not statistically significant. Wound healing was significantly delayed in salvage cases compared with primary cases (P<0.001). In primary cases, wounds were re-epithelized within 60 days in 83% of patients and within 90 days in almost all patients, while in salvage cases 42% of patients required more than 90 days for wound healing. In salvage cases, the 5-year overall survival, disease specific survival rate, local control rate, and laryngeal preservation rate was 85.7%, 85.7%, 62.5%, and 78.0%, respectively, and 85.7%, 98.0%, 91.3%, and 97.8%, respectively, for primary cases. Local control rate was significantly better in primary cases than in salvage cases.

CONCLUSION

Salvage TOVS was feasible in highly selected cases. After serial transoral surgery, the final laryngeal preservation rate was satisfactory. Swallowing function in salvage cases tended to be worse than in primary cases, and a significantly longer time was required for wound healing.