Early-Stage Glottic Squamous Cell Carcinoma in the Era of Image-Guided Radiotherapy

A combined gene signature model for predicting radiotherapy response and relapse-free survival in laryngeal squamous cell carcinoma

BACKGROUND

Radioresistance is a major challenge in radiotherapy for laryngeal squamous cell carcinoma (LSCC), and there is currently no effective method to predict radiosensitivity in LSCC patients. This study aimed to establish a prediction model for radiotherapy response based on gene expression.

METHODS

The datasets of LSCC were obtained from the ENT department of Shanghai Ruijin Hospital and The Cancer Genome Atlas (TCGA). Lasso regression and Cox regression were used to establish the prediction model based on gene expression. Weighted gene coexpression network analysis (WGCNA) was used to analyze the correlation between gene expression and clinical characteristics. RT-qPCR was used to detect gene expression in tumor tissue to verify the accuracy of the prediction model.

RESULTS

Using a cohort of LSCC cases receiving radiotherapy collected in the TCGA database, the 3 protein-coding genes (PCGs) signature model was identified for the first time as the predictor of relapse-free survival and radiosensitivity in LSCC patients. And we explored the potential clinical value of 3 PCGs and screened out 2 long non-coding RNAs (lncRNAs) potential associated with 3 PCGs. More importantly, the LSCC cases collected by our department were used to preliminarily verify the predictive power of the 3 PCGs signature model for the radiosensitivity of LSCC, and the significant correlation between the expression levels of the 3 PCGs and the 2 lncRNAs.

CONCLUSION

We successfully establish a radiosensitivity prediction model based on the 3 PCGs Riskscore, which provides a theoretical basis for the decision-making of LSCC treatment options. Meantime, we preliminarily screen the potential associated lncRNAs of the 3 PCGs for further basic and clinical research.

Oncological and Functional Outcomes After Type III Cordectomy for Early Glottic Cancer (Tis, T1a): A Retrospective Study Based on Our 10-Year Experience

Background: The recommended treatment for early glottic cancer is trans-oral laser microsurgery, with excellent oncological and functional outcomes. The aim of this study is to evaluate oncological and functional outcomes in patients who underwent monolateral type III laser cordectomy for early glottic cancer. Methods: A total of 104 patients were enrolled. Staging, histological type, grading, assessment of surgical margins, mean time of relapse, OS, DFS, and DSS were obtained. Maximum phonation time, GIRBAS score, shimmer, jitter, fundamental frequency, and Yanagihara score were evaluated. Patients were submitted to the VHI-10 questionnaire. Results: Correlations between patients with single recurrence and the anterior commissure involvement were analyzed, as well as correlations between patients with recurrence and the status of margins. Correlations between VHI-10 scores and anterior commissure involvement were analyzed. Conclusions: The recurrence rate was higher in patients with anterior commissure involvement. A significant inversely proportional association between DSS and assessment of surgical margins was observed. The distribution of VHI-10 scores differed significatively in patients with and without anterior commissure involvement. Vocal results reflected mild dysphonia.

Machine learning approach to predict tracheal necrosis after total pharyngolaryngectomy

BACKGROUND

Tracheal necrosis is a potentially severe complication of total pharyngolarynjectomy (TPL), sometimes combined with total esophagectomy. The risk factors for tracheal necrosis after TPL without total esophagectomy remain unknown.

METHODS

We retrospectively reviewed data of 395 patients who underwent TPL without total esophagectomy. Relevant factors associated with tracheal necrosis were evaluated using random forest machine learning and traditional multivariable logistic regression models.

RESULTS

Tracheal necrosis occurred in 25 (6.3%) patients. Both the models identified almost the same factors relevant to tracheal necrosis. History of radiotherapy was the most important predicting and significant risk factor in both models. Paratracheal lymph node dissection and total thyroidectomy with TPL were also relevant. Random forest model was able to predict tracheal necrosis with an accuracy of 0.927.

CONCLUSIONS

Random forest is useful in predicting tracheal necrosis. Countermeasures should be considered when creating a tracheostoma, particularly in patients with identified risk factors.

Epidemiological, clinical and oncological outcomes of laryngeal verrucous carcinomas: a systematic review

OBJECTIVE

To investigate epidemiological, clinical and oncological outcomes of patients with laryngeal verrucous carcinomas (LVC).

METHODS

Two independent authors investigated PubMed, Scopus and Cochrane Library for studies dedicated to epidemiological, clinical and oncological outcomes of patients with LVC. The following outcomes were investigated with PRISMA criteria: age; gender; tobacco/alcohol consumption; HPV infection; anatomical, pathological, therapeutic and survival outcomes. Studies were analyzed for bias through a validated clinical tool.

RESULTS

Of the 212 identified articles, 15 retrospective studies and one prospective uncontrolled study met our inclusion criteria. Three studies reported findings from national databases. The males/females ratio is 9/1. Mean age was 60.3 years, which was younger compared to other laryngeal malignancies. The alcohol, cigarette overuse and the HPV status of patients were lacking in most studies. Glottis and supraglottis were the most common anatomical locations, corresponding to 78.7% and 12.4% of cases, respectively. The main therapeutic approaches consisted of surgery, radiotherapy, surgery followed by radiotherapy. Treatments reported 5-year overall survival and disease-specific survival of 86.3 and 90.8, respectively. The 5- and 10-year local control rate were 83.6 and 72.6, respectively. The 10-year disease-specific survival was 80.2. Heterogeneity between studies was found for inclusion criteria, comorbidity data, and treatments.

CONCLUSION

LVC is a rare laryngeal cancer associated with better survival and recurrence outcomes than laryngeal squamous cell carcinoma. The role of radiotherapy in the treatment regimen needs to be investigated in future prospective controlled studies.

Imaging for Laryngeal Malignancies: Guidelines for Clinicians

Radiology has always been an important component in the evaluation of patients with head and neck cancers. Images that are appropriately acquired and systematically interpreted provide comprehensive information on local, regional, and distant disease extent. This impacts treatment decisions for primary or recurrent disease, and aids in prognostication and patient counselling. The recent significant advances in technology and instrumentation for treatment of head neck cancers have taken place in parallel with an increasing sophistication in radiodiagnostic systems. This is especially true for laryngeal neoplasms where there is now greater focus on functional outcomes and personalised treatment, thus expanding the scope and value of imaging.

PURPOSE

To formulate evidence-based guidelines on imaging for cancers of the larynx, from diagnosis and staging to monitoring of disease control after completion of treatment.

METHODS AND MATERIALS

A multidisciplinary analysis of current guidelines and published studies on the topic was performed.

RESULTS

On the basis of evidence gathered, guidelines were drawn up; optimal suggestions were included for low-resource situations.

CONCLUSION

These guidelines are intended as an aid to all clinicians dealing with patients of laryngeal cancers. It is hoped that these will be instrumental in facilitating patient care, and in improving outcomes.

Change in Voice Quality after Radiotherapy for Early Glottic Cancer

Our aim was to track the changes in voice quality for two years after radiotherapy (RT) for early glottic cancer. A videoendostroboscopy, subjective patient and phoniatrician voice assessments, a Voice Handicap Index questionnaire, and objective acoustic measurements (F0, jitter, shimmer, maximal phonation time) were performed on 50 patients with T1 glottic carcinomas at 3, 12, and 24 months post-RT. The results were compared between the subsequent assessments, and between the assessments at 3 months and 24 months post-RT. The stroboscopy showed a gradual progression of fibrosis of the vocal folds with a significant difference apparent when the assessments at 3 months and 24 months were compared (p < 0.001). Almost all of the subjective assessments of voice quality showed an improvement during the first 2 years, but significant differences were noted at 24 months. Jitter and shimmer deteriorated in the first year after RT with a significant deterioration noticed between the sixth and twelfth months (p = 0.048 and p = 0.002, respectively). Two years after RT, only 8/50 (16%) patients had normal voices. The main reasons for a decreased voice quality after RT for early glottic cancer were post-RT changes in the larynx. Despite a significant improvement in the voice after RT shown in a few of the evaluation methods, only a minority of the patients had a normal voice two years post-RT.