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Eker C, Surmelioglu O, Dagkiran M, Kaya O, Tanrisever I, Arpaci B, Kaya B, Yucel Karakaya SP, Onan E. Transoral laser microsurgery for T1 glottic cancer with anterior commissure: Identifying clinical and radiological variables that predict oncological outcome. Eur Arch Otorhinolaryngol 2024; 281:2597-2608. [PMID: 38424299 PMCID: PMC11023970 DOI: 10.1007/s00405-024-08513-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The involvement of the anterior commissure (AC) is regarded to be a risk factor for poor results after transoral laser microsurgery (TLM) for early glottic cancer. The objective of this study was to determine how AC-related clinical and radiological factors affected oncological outcomes in a cohort of patients with T1 stage early glottic carcinoma involving the anterior commissure who were treated with TLM with negative surgical margins. METHODS Retrospective analysis was performed on clinical, radiological, and follow-up data of patients consecutively treated with TLM at a tertiary academic center between November 2011 and August 2021 for T1 glottic squamous cell carcinoma involving the anterior commissure. Recurrence-free survival (RFS), local control with laser alone (LCL), laryngeal preservation (LP), and overall survival (OS) rates (Kaplan-Meier) were the primary outcome metrics. RESULTS In our series, 5-year OS probability was 75.1%, RFS was 64.8%, LCL was 73.8%, and LP was 83.4%. OS and RFS were higher in patients with early stages of AC pattern than in patients with advanced stage (p = 0.004, p = 0.034, respectively). Vertical extension ratio was found to be associated with OS and RFS (p = 0.023, p = 0.001, respectively), and thyroid cartilage interlaminar angle with LCL by multiple Cox regression analysis (p = 0.041). CONCLUSION TLM remains a valuable treatment option for AC involvement. AC3 type involvement and elevated vertical extension ratio were associated with negative prognosis. There have been signs that thyroid cartilage with a narrow angle increases recurrence. Alternative modalities should be kept in mind in the treatment decision of these cases.
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Affiliation(s)
- Caglar Eker
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey.
| | - Ozgur Surmelioglu
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Muhammed Dagkiran
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Omer Kaya
- Faculty of Medicine, Department of Radiology, Cukurova University, Adana, Turkey
| | - Ilda Tanrisever
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Burak Arpaci
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Bedir Kaya
- Faculty of Medicine, Department of Radiology, Cukurova University, Adana, Turkey
| | | | - Elvan Onan
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
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Yariv O, Amitai N, Nachalon Y, Moore A, Popovtzer A. Outcome of radiotherapy for the treatment of laryngeal squamous cell carcinoma in the very elderly population. J Laryngol Otol 2024; 138:443-447. [PMID: 36776099 DOI: 10.1017/s002221512300018x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Treatment selection for squamous cell carcinoma patients aged over 84 years is controversial. This retrospective chart review examined and compared characteristics of laryngeal squamous cell carcinoma in very elderly (over 84 years) and younger patients (approximately 65 years). The secondary objective was to further evaluate the outcome of radiotherapy as a treatment modality in this patient population. METHODS Of all 23 very elderly patients with laryngeal squamous cell carcinoma treated with radiotherapy, with or without surgery, in the Davidoff Cancer Center, from 1992 to 2012, 19 had sufficient data for analysis, and comprised the study group. RESULTS Median age at diagnosis was 86 years. Disease stage at diagnosis was I, II, III and IVA in 53 per cent, 21 per cent, 21 per cent and 5 per cent, respectively. Median radiotherapy dose was 60 Gy given in 25 fractions. Three patients had recurrence. No patient discontinued treatment because of toxicity. Median overall survival was 3.6 years (range, 0-10 years). CONCLUSION Very elderly laryngeal squamous cell carcinoma patients may derive a similar survival advantage as younger counterparts. Modern radiotherapy is effective and safe for treating laryngeal squamous cell carcinoma in this study population. Further, large-scale studies are needed.
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Affiliation(s)
- Orly Yariv
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Amitai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otorhinolaryngology - Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Yuval Nachalon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otorhinolaryngology - Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Assaf Moore
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aron Popovtzer
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ling Z, Hu G, Wang Z, Ma W, Wang X, Zhu J, Zeng Q. Prognostic analysis of surgical treatment for T3 glottic laryngeal cancer based on different tumor extension patterns. Eur Arch Otorhinolaryngol 2024; 281:1379-1389. [PMID: 38110749 DOI: 10.1007/s00405-023-08374-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/23/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND AND OBJECTIVES To investigate the prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer. METHODS We conducted a retrospective analysis of clinical data of 91 patients with T3 glottic laryngeal cancer. RESULTS We found that the posterior invasion being significantly associated with involvement of the lamina of cricoid cartilage (P < 0.001), arytenoid cartilage (P = 0.001), and subglottic (P = 0.001). There was no statistical difference in survival outcomes between the total laryngectomy (TL) group and the partial laryngectomy (PL) group, but in the PL group, tumors with anterior invasion were associated with a better 5-year DFS than tumors with posterior invasion (HR: 4.681, 95% CI: 1.337-16.393, P = 0.016), and subglottic involvement was associated with worse LRRFS (HR: 3.931, 95% CI: 1.054-14.658, P = 0.041). At the same time, we found that involvement of the lamina of cricoid cartilage was an independent risk factor for postoperative laryngeal stenosis in PL patients (HR: 11.67, 95% CI: 1.89-71.98, P = 0.008). CONCLUSION Selectively performed PL can also achieve favorable oncological outcomes comparable to those of TL. Posterior invasion and subglottic involvement are independent prognostic factors for recurrence after PL in T3 glottic laryngeal cancer, and involvement of the lamina of cricoid cartilage is associated with postoperative laryngeal stenosis. The tumor invasion pattern of patients with laryngeal cancer should be further subdivided to allow for selection of a more individualized treatment plan.
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Affiliation(s)
- Zhiming Ling
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Guohua Hu
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Zhihai Wang
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Wei Ma
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xiaoqiang Wang
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Jiang Zhu
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Quan Zeng
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Suresh A, Balouch B, Martha VV, Sataloff RT. Laryngeal Applications of Platelet Rich Plasma and Platelet Poor Plasma: A Systematic Review. J Voice 2024; 38:248.e1-248.e13. [PMID: 34384663 DOI: 10.1016/j.jvoice.2021.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/12/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Platelet rich plasma (PRP) and platelet poor plasma (PPP) are regenerative therapies that offer the potential for improving care for disorders of the larynx. The laryngeal applications of these substances have been examined in both animals and humans. The goal of this systematic review is to examine the various applications of PRP and PPP in laryngology, assess the protocols for preparation and application of these substances and evaluate the outcomes and complications in both humans and animals. METHODS A search of PUBMED was conducted in April 2021 using combinations of keywords of "platelet rich plasma" and "platelet poor plasma" with keywords such as "larynx," "vocal folds," "laryngology," and others. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMSA) guidelines were followed. Articles were reviewed by two independent coauthors and included based on selection criteria pertinent to the goals of this study. The risk of bias in the included studies was assessed by two independent co-authors using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials and JBI Critical Appraisal Checklist for Quasi-Experimental Studies. Data regarding the pathologies treated using PRP and PPP, PRP, and PPP preparation protocols, application protocols, human voice outcomes, histopathological animal outcomes, and complications were extracted from each of the studies and presented in tables. RESULTS Seven studies were included based on the selection criteria. PRP or PPP were used for vocal fold scar, sulcus, atrophy and palsy; acute vocal fold injury; glottic insufficiency, and graft healing. PRP or PPP were derived from autologous blood in a one- or two-step centrifugation process and administered via injection, soaking of cartilage grafts or topical application. Mean and median voice handicap index-10 (VHI-10) and voice handicap index (VHI) scores decreased following PRP or PPP injections in two human studies and one human study showed a similar VHI-10 score before and after PRP treatment. Videostroboscopy showed the absence of injection site reactions and at least temporary improvement in glottic gap or vibratory function following treatment in some patients. Other objective measures of voice outcomes in human studies showed improved phonatory function in the one-to-four-month period following PRP or PPP injections, with some patients experiencing a subjective decrease or return to baseline in phonatory function following the initial improvement period. Animal studies found elevated levels of growth factors, organized collagen deposition, decreased granulation tissue, increased vascularization, and increased cartilage proliferation in PRP treated laryngeal tissue. DISCUSSION PRP and PPP might have the potential to be safely used in the larynx and at least temporarily influence wound healing and vocal function. Further study using comparable outcome measurement tools is required to assess their role and efficacy in treating acute vocal fold injury, chronic vocal fold pathologies, graft healing, and other laryngeal applications.
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Affiliation(s)
- Aishwarya Suresh
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Bailey Balouch
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Vishnu V Martha
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Department of Otolaryngology and Communication Sciences Research, Lankenau Institute for Medical Research, Philadelphia, Pennsylvania.
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Noy R, Shkedy Y, Habashi N, Billan S, Cohen J. Oncological outcomes and failure patterns of laser cordectomy in recurrent glottic cancer. Am J Otolaryngol 2024; 45:104109. [PMID: 37948822 DOI: 10.1016/j.amjoto.2023.104109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Laser cordectomy is a widely accepted treatment modality for selected cases of early glottic cancers, but its role as a salvage treatment remains unclear. We aimed to investigate the oncological outcomes and failure patterns of salvage cordectomy. MATERIALS AND METHODS This was a retrospective cohort study of patients who underwent cordectomy for early glottic cancer between 2013 and 2022 at a tertiary referral center. The main outcome measures were overall survival, larynx-preservation rate, tracheostomy dependency rate, and disease-free survival. RESULTS A total of 142 patients (mean age: 63 years, interquartile range [IQR]: 45-72, 123[86.9 %] males) were analyzed. There were 38 (26.8 %) recurrences after a mean of 22 months (IQR: 17-26). Among them, 25 (17.6 %) underwent salvage cordectomy, while 13 (9.1 %) received other salvage treatments (11[7.7 %] (chemo)radiotherapy and 2[1.4 %] total laryngectomy). In comparison to the other salvage treatments, salvage cordectomy demonstrated lower tracheostomy rates (0 vs. 31 %, p = 0.05), comparable 5-year disease-free survival (62 % vs. 54 %, p = 0.4), higher 5-year larynx preservation rate (92 % vs. 54 %, p = 0.02), and improved 5-year overall survival rate (84 % vs. 62 %, p = 0.01). Factors associated with salvage cordectomy failure were age >60 years (odds ratio [OR]: 1.3, 95 % confidence interval [CI]: 1.15-1.53), smoking continuation (OR: 3.73, 95 % CI: 3.5-4.4), heavy smoking (OR: 1.24, 95 % CI:1.07-2.15), and pT1b + (OR: 2.26, 95 % CI: 2.1-2.9). CONCLUSIONS Salvage cordectomy offers favorable larynx preservation rates and oncological outcomes for recurrent disease amenable to conservative surgery. Smoking, advanced age, and advanced tumor stages are associated with salvage cordectomy failure.
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Affiliation(s)
- Roee Noy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Yotam Shkedy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nadeem Habashi
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Salem Billan
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Department of Oncology Radiation Division, Rambam Health Care Campus, Haifa, Israel.
| | - Jacob Cohen
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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6
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Rydell R, Andreasson J, Gustafsson Baldwin S, Clarhed N. Minimal invasive LASER-resection vs. radiotherapy as primary treatment of early glottic cancer. A population-based study with, up to 16 years follow up of survival, rate of laryngectomy and voice function. Acta Otolaryngol 2024; 144:58-64. [PMID: 38294703 DOI: 10.1080/00016489.2023.2299674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Early glottic cancer can be treated with laser resection or radiotherapy. In an earlier study, we found that voice function after laser resection was inferior to that after radiotherapy. OBJECTIVES This study was designed to determine if reduced margins at laser resection improved voice function without impairing oncologic results. METHOD A total of 268 patients with previously untreated T1-T2 glottic carcinoma were studied. They were primarily treated with either radiotherapy (n = 119) or laser resection (n = 149). Survival, need for additional treatment (radiotherapy and/or total layngectomi) and voice function was compared. RESULT Median follow up time was 7 years with range 0.5-16.6. There was no difference in the overall survival (p = .065) or disease-specific survival. (p = .126). After radiotherapy 32/119 patients and after laser resection 57/149 patients had recurrence. Total rate of laryngectomy was 24% in the radiotherapy group, and 8% in the laser resection group (p = .001). Voice analysis (T1A) showed more roughness in the radiotherapy group, otherwise no difference. CONCLUSIONS By reducing the surgical margins, we have achieved a better voice function (T1A) but more patients have needed repeated laser excisions and some have also needed supplementary radiotherapy. The risk of laryngectomy and survival were apparently not affected.
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Affiliation(s)
- Roland Rydell
- Department of Clinical Sciences Lund, Otorhinolaryngology/Head and Neck Surgery, Lund University, Skane University Hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Josefine Andreasson
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Sara Gustafsson Baldwin
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Nathalie Clarhed
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Lund University, Skane University Hospital, Lund, Sweden
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Reale M, Bardon ML, Ciavarro G, Pedrazzi G, Santoro GP. Value and role of surgical margins in transoral laser microsurgery of the larynx, literature review and clinical considerations. Eur Arch Otorhinolaryngol 2024; 281:23-30. [PMID: 37740744 DOI: 10.1007/s00405-023-08238-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/10/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE There is no agreement on the most appropriate post-operative pathway for the management of positive margins after laser cordectomy for early stage glottic tumours (T1-2N0M0). This literature review and meta-analysis aim to evaluate the post-operative treatment with the best oncological results among follow-up, radiotherapy (RT) and surgical second look. The parameters utilized were incidence of recurrence, overall (OS), disease-specific (DSS) and disease-free (DFS) survival and larynx preservation (LP). METHODS The articles were found through a string typed into PubMed from 2007 to 2022. The studies with detailed oncological results were selected according to inclusion criteria, and then the meta-analysis was carried out. RESULTS Sixteen studies met the inclusion criteria for 2808 patients. The positive margin was found in 748 patients (26.6%), of which 416 were referred to follow-up, 89 to RT and 242 to a surgical second look. A false positive margin was found in 58/104 patients (56%). The recurrence rate in patients with positive margins was significantly higher (p = 0.003). In OS, DSS, DFS and LP, the odds ratio (OR) value was always greater than 1, assessing the role of the positive margin as a risk factor. CONCLUSIONS Prospective studies will be necessary to establish the role of positive margin as a prognostic factor. A surgical second look in case of positive margin seems to be the best option for the patient in terms of lower risk of recurrence and better oncological results. Better collaboration between surgeon and pathologist would be desirable to limit the real and false positive margins.
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Affiliation(s)
- M Reale
- Department of Otolaryngology and Otoneurosurgery, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - M L Bardon
- Department of Otolaryngology and Otoneurosurgery, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy.
| | - G Ciavarro
- Department of Otolaryngology and Otoneurosurgery, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - G Pedrazzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - G P Santoro
- Department of Otolaryngology and Otoneurosurgery, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
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Panuganti BA, Carico C, Jeyarajan H, Flagg M, Tamayo P. Transcriptional subtypes of glottic cancer characterized by differential activation of canonical oncogenic programming. Head Neck 2023; 45:2851-2861. [PMID: 37682073 PMCID: PMC10901072 DOI: 10.1002/hed.27514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND There is a paucity of data concerning molecular heterogeneity among glottic squamous cell carcinoma, and the clinical implications thereof. METHODS Data corresponding to glottic squamous cell carcinoma were derived from The Cancer Genome Atlas. The Onco-GPS computational methodology was levied to derive four patterns of transcriptional activity and three functional subtypes of glottic cancer. RESULTS Thirty glottic cancer samples stratified to three distinct oncogenic states (S0-S2) based on a Onco-GPS model containing four transcriptional components (F0-F3). Membership in S2 and association with transcriptional component F0 conveyed an invasive phenotype, with transcriptional activity strongly reflecting EMT programming (including TGF-B and NF-KB signaling). S2 membership also correlated with inferior disease-specific survival (HR 9.027, 95% CI 1.021-79.767), and higher incidences of extracapsular spread and perineural invasion. CONCLUSIONS We present a functional taxonomy of glottic cancer, with subtypes demonstrating differential upregulation of canonical oncogenic networks and survival implications.
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Affiliation(s)
- Bharat A Panuganti
- Department of Otolaryngology - Head and Neck Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham Veteran Affairs Health Care System, Birmingham, Alabama, USA
- The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Christine Carico
- The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Harishanker Jeyarajan
- Department of Otolaryngology - Head and Neck Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Mitchell Flagg
- University of California-San Diego School of Medicine, San Diego, California, USA
| | - Pablo Tamayo
- University of California-San Diego School of Medicine, San Diego, California, USA
- Moores Cancer Center, Center for Novel Therapeutics and Division of Genomics and Precision Medicine, University of California-San Diego School of Medicine, San Diego, California, USA
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Razavian NB, D'Agostino RB, Shenker RF, Hughes RT. Intensity-Modulated Radiation Therapy for Early-Stage Squamous Cell Carcinoma of the Glottic Larynx: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2023; 117:652-663. [PMID: 37150263 DOI: 10.1016/j.ijrobp.2023.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 04/03/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE Early-stage squamous cell carcinoma of the glottic larynx is commonly treated with 2-dimensional or 3-dimensional conventional radiation therapy (CRT). Despite its use in other head and neck cancers, intensity-modulated radiation therapy (IMRT) remains controversial in this patient population. METHODS AND MATERIALS A systematic review was performed by querying 3 databases (Pubmed, Embase, Web of Science) for articles published between December 1, 2000 and September 2, 2022. Included studies reported outcomes in at least 10 patients treated with IMRT for early-stage glottic cancer. Data were extracted and reported following PRISMA standards. Pooled outcomes were estimated using random-effects models. Primary outcome was the rate of local failure (LF) following IMRT. Secondary outcomes included rates of regional failure (RF) following IMRT and rates of LF and RF following CRT. RESULTS A total of 15 studies (14 retrospective, 1 prospective) consisting of 2083 patients were identified. IMRT was used in 873 patients (64% T1, 28% T2). Multiple treatment (partial larynx, single vocal cord carotid sparing) and image-guided radiation therapy techniques were used. The pooled crude rate of LF was 7.6% (95% confidence inverval [CI], 3.6%-11.5%) and actuarial LF rates at 3 and 5 years were 6.3% (95% CI, 2.2%-10.3%) and 9.0% (95% CI, 4.4%-13.5%), respectively. The pooled crude rate of RF after IMRT was 1.5% (95% CI, 0.5%-2.5%). On metaregression analysis, increased rate of LF was significantly associated with T2 disease (P < .001) and grade 2 to 3 histology (P < .001). Treatment with CRT was reported in 738 patients (76% T1, 22% T2). Among the studies reporting outcomes of both modalities, there was no significant difference in LF (log odds ratio; P = .12) or RF (log odds ratio; P = .58) between IMRT or CRT. CONCLUSIONS In patients with early-stage glottic cancer, retrospective data suggests local and regional control are similar for patients treated with IMRT and CRT. Additional prospective studies with uniform methods of volume delineation and image guidance are needed to confirm the efficacy of IMRT.
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Affiliation(s)
- Niema B Razavian
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Ralph B D'Agostino
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Rachel F Shenker
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, North Carolina.
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Viani GA, Moraes FY, Marta GN, Kowalski LP, Gouveia AG. Real-world evidence for oncological outcomes after radiotherapy or surgery for T1a-T1b glottic squamous cell carcinoma: A population-based cohort study. Head Neck 2023; 45:2505-2514. [PMID: 37555376 DOI: 10.1002/hed.27470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Compare outcomes after surgery (S) or radiotherapy (RT) for T1a-T1b glottic squamous cell carcinoma (T1GSCC) in a population-based cohort study. METHODS Patients diagnosed with T1GSCC from 1999 to 2020 were identified from a public database. Clinical, demographic, and social data were extracted. Treatment and patient groups and subgroups were compared with log-rank test, Cox proportional test, and propensity-score matched (PSM). RESULTS Eight hundred and eighty-eight patients with T1GSCC were included in the study, with a median follow-up of 61 months. The 5- and 10-year overall survival (OS) S versus RT were 76% versus 71% and 60% versus 52% (p = 0.02), respectively. In the subgroup analysis, S was associated with better OS for T1b, male, and public service patients (p < 0.05). In the PSM cohort of S versus RT with 110 patients each, there was no significant difference in the OS, CSS, and LC. CONCLUSIONS T1GSCC has favorable outcomes with S or RT.
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Affiliation(s)
- Gustavo Arruda Viani
- Department of Medical Imagings, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Fabio Ynoe Moraes
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Gustavo Nader Marta
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Department of Radiation Oncology, Hospital Sirio Libanês, São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center (ACCCC), Sao Paulo, Brazil
- Department of Head and Neck Surgery, São Paulo State Cancer Institute (ICESP), School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Andre Guimaraes Gouveia
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Department of Radiation Oncology, Americas Centro de Oncologia Integrado, Rio de Janeiro, Brazil
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11
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Yang Y, Wang YL, Wei LZ, Wang JX, Huang FT, Huang GW. Is CO 2 laser microsurgery better than radiotherapy in early glottic cancer: a meta-analysis. Lasers Med Sci 2023; 38:223. [PMID: 37758965 PMCID: PMC10533611 DOI: 10.1007/s10103-023-03890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
The choice between radiotherapy (RT) and CO2 laser surgery (CO2-LS) for early glottic cancer remains controversial. We systematically examined electronic databases in order to identify prospective trials comparing patients who had undergone CO2-LS or RT to treat early glottic cancer. Eleven studies involving 1053 patients were included. In the selected literature, the parameter setting of CO2 laser equipment can be summarized as wavelength 10.6 µm, superpulsed mode, continuous setting, power tailored on target structures (1-3 W for subtle resections and 4-15 W for cutting a larger tumor), and approximately 2080-3900 W/cm2 of laser energy. Using RevMan 5.3, we estimated pooled odds ratios (ORs) for dichotomous variables and pooled mean differences (MDs) for continuous variables, along with associated 95% confidence intervals (CIs). The heterogeneity in the treatment variables was measured using Higgins' inconsistency test and expressed as I2 values. The continuous variables were then depicted as histograms developed using PlotDigitizer 2.6.8. Compared to patients treated with CO2-LS, those treated with RT had better jitter (MD 1.27%, 95% CI 1.21 ~ 1.32, P < 0.001), and high scores on the "Grade (MD 6.54, 95% CI 5.31 ~ 7.76, P < 0.001), Breathiness (MD 9.08, 95% CI 4.02 ~ 14.13, P < 0.001), Asthenia (MD 2.13, 95% CI 0.29 ~ 3.98, P = 0.02), and Strain (MD 3.32, 95% CI 0.57 ~ 6.07, P = 0.02)" scale. Patients treated with CO2-LS had worse local control rates (OR 3.14, 95% CI 1.52 ~ 6.48, P = 0.002) while lower incidence of second primary tumor (OR 0.30, 95% CI 0.15 ~ 0.61, P < 0.001). It is hoped that retrospective analysis can provide suggestions for early glottis patients to choose personalized treatment.
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Affiliation(s)
- Yong Yang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, No.6 of Shuangyong Road, Nanning, 530021, Guangxi, China
- Department of Otolaryngology-Head and Neck Surgery, The First People's Hospital of Nanning, Nanning, 530021, Guangxi, China
| | - Yong-Li Wang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, No.6 of Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Li-Zhi Wei
- Department of Otolaryngology-Head and Neck Surgery, The First People's Hospital of Nanning, Nanning, 530021, Guangxi, China
| | - Ju-Xin Wang
- Department of Otolaryngology-Head and Neck Surgery, The First People's Hospital of Nanning, Nanning, 530021, Guangxi, China
| | - Fang-Ting Huang
- Department of Otolaryngology-Head and Neck Surgery, The First People's Hospital of Nanning, Nanning, 530021, Guangxi, China
| | - Guang-Wu Huang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, No.6 of Shuangyong Road, Nanning, 530021, Guangxi, China.
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Mowery YM. Splitting the Difference With Intensified Radiation Therapy Alone for Borderline Early Stage Glottic Cancer. Int J Radiat Oncol Biol Phys 2023; 117:9. [PMID: 37574250 DOI: 10.1016/j.ijrobp.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/01/2022] [Indexed: 08/15/2023]
Affiliation(s)
- Yvonne M Mowery
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina; Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
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Chen S, Gong H, Huang N, Yang F, Wang M. Horizontal middle partial laryngectomy with cricothyroidopexy: an effective treatment for stage T1b glottic carcinoma. Acta Otolaryngol 2023; 143:823-828. [PMID: 37837405 DOI: 10.1080/00016489.2023.2265436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/22/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND The current treatment options for T1b glottic carcinoma often lead to poor treatment outcomes or voice quality. OBJECTIVES This study evaluates the therapeutic efficacy of horizontal middle partial laryngectomy with cricothyroidopexy (HMPL-CTP) for stage T1b glottic carcinoma. MATERIAL AND METHODS A retrospective analysis was conducted on 73 patients with T1b glottic carcinoma. The patients were categorized into three groups: Group A (n = 22) underwent transoral laser microsurgery (TLMS), Group B (n = 21) received frontolateral vertical partial laryngectomy (FVPL), and Group C (n = 30) underwent HMPL-CTP. The study analyzed the 5-year overall survival rate (OS), recurrence rate, phonatory status, and incidence of laryngeal stenosis. RESULTS Voice quality scores varied significantly in the three groups, while the 5-year OS were similar. The local recurrence rate is higher in Group A than in the other two groups. The laryngeal stenosis rate in Group B is higher than in Groups A and C. Adhesions in the anterior commissure were observed in 18 cases in Group A and nine cases in Group C. CONCLUSIONS AND SIGNIFICANCE HMPL-CTP demonstrates efficacy as a treatment for stage T1b glottic carcinoma, offering favorable preservation of laryngeal function and minimal complications.
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Affiliation(s)
- Shiyan Chen
- Department of Otolaryngology Head and Neck, Fuzong Clinical College, Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Hongxun Gong
- Department of Otolaryngology Head and Neck, Fuzong Clinical College, Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Ning Huang
- Department of Otolaryngology Head and Neck, Fuzong Clinical College, Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Fan Yang
- Department of Otolaryngology Head and Neck, Fuzong Clinical College, Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Maoxin Wang
- Department of Otolaryngology Head and Neck, Fuzong Clinical College, Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
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Arboleda LPA, Neves AB, Kohler HF, Vartanian JG, Candelária LM, Borges MF, Fernandes GA, de Carvalho GB, Kowalski LP, Brennan P, Santos‐Silva AR, Curado MP. Overview of glottic laryngeal cancer treatment recommendation changes in the NCCN guidelines from 2011 to 2022. Cancer Rep (Hoboken) 2023; 6:e1837. [PMID: 37288471 PMCID: PMC10432469 DOI: 10.1002/cnr2.1837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The treatment of glottic cancer remains challenging, especially with regard to morbidity reduction and larynx preservation rates. The National Comprehensive Cancer Network (NCCN) has published guidelines to aid decision-making about this treatment according to the tumor site, clinical stage, and patient medical status. AIM The present review was conducted to identify changes in the NCCN guidelines for glottic cancer treatment made between 2011 and 2022 and to describe the published evidence concerning glottic cancer treatment and oncological outcomes in the same time period. METHODS AND RESULTS Clinical practice guidelines for head and neck cancer published from 2011 up to 2022 were obtained from the NCCN website (www.NCCN.org). Data on glottic cancer treatment recommendations were extracted, and descriptive analysis was performed. In addition, a review of literature registered in the PubMed database was performed to obtain data on glottic cancer management protocols and treatment outcomes from randomized controlled trials, systematic reviews, and meta-analyses published from 2011 to 2022. In total, 24 NCCN guidelines and updates and 68 relevant studies included in the PubMed database were identified. The main guideline changes made pertained to surgical and systemic therapies, the consideration of adverse features, and new options for the treatment of metastatic disease at initial presentation. Early-stage glottic cancer received the most research attention, with transoral endoscopic laser surgery and radiotherapy assessed and compared as the main treatment modalities. Reported associations between treatment types and survival rates for this stage of glottic cancer appear to be similar, but functional outcomes can be highly compromised. CONCLUSION NCCN panel members provide updated recommendations based on currently accepted treatment approaches for glottic cancer, constantly reviewing new surgical and non-surgical techniques. The guidelines support decision-making about glottic cancer treatment that should be individualized and prioritize patients' quality of life, functionality, and preferences.
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Affiliation(s)
| | | | - Hugo Fontan Kohler
- Head and Neck Surgery and Otorhinolaryngology DepartmentA.C. Camargo Cancer CenterSão PauloBrazil
| | - José Guilherme Vartanian
- Head and Neck Surgery and Otorhinolaryngology DepartmentA.C. Camargo Cancer CenterSão PauloBrazil
| | | | - Matheus Ferraz Borges
- Group of Epidemiology and Statistics on CancerA.C. Camargo Cancer CenterSão PauloSPBrazil
| | | | | | - Luiz Paulo Kowalski
- Head and Neck Surgery and Otorhinolaryngology DepartmentA.C. Camargo Cancer CenterSão PauloBrazil
- Head and Neck Surgery Department, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Paul Brennan
- International Agency for Research on CancerGenomic Epidemiology BranchLyonFrance
| | | | - Maria Paula Curado
- Group of Epidemiology and Statistics on CancerA.C. Camargo Cancer CenterSão PauloSPBrazil
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15
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D'Ascanio L, Latini G, di Stadio A. Potentially Misleading Details Regarding the Association of Primary Tumor Volume With Survival in Patients With T3 Glottic Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:560. [PMID: 37103931 DOI: 10.1001/jamaoto.2023.0690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Luca D'Ascanio
- Department of Otolaryngology-Head & Neck Surgery, Azienda Ospedali Riuniti Marche Nord, Pesaro-Fano, Italy
| | - Gino Latini
- Department of Otolaryngology-Head & Neck Surgery, Azienda Ospedali Riuniti Marche Nord, Pesaro-Fano, Italy
| | - Arianna di Stadio
- Department GF Ingrassia, Otolaryngology, University of Catania, Catania, Italy
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16
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Malik NH, Fu R, Eskander A. Potentially Misleading Details Regarding the Association of Primary Tumor Volume With Survival in Patients With T3 Glottic Cancer-Reply. JAMA Otolaryngol Head Neck Surg 2023; 149:560-561. [PMID: 37103925 DOI: 10.1001/jamaoto.2023.0693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Nauman H Malik
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Rui Fu
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Abstract
PURPOSE The purpose of this study was to explore the effects of medical masks on the voice quality of patients with voice disorders. METHOD We included 106 patients diagnosed with voice disorders. Among them, 59 were diagnosed with vocal-fold benign lesions, 27 with insufficient glottis closure, and 20 with precancerous lesions/early-stage glottic carcinoma. Perceptual parameters (GRBAS [grade, roughness, breathiness, asthenia, strain] scale), acoustic parameters (f o, sound pressure level [SPL], jitter, shimmer, noise-to-harmonic ratio [NHR], and cepstral peak prominence [CPP]), and maximum phonation time (MPT) without and with medical masks were analyzed. Changes in the GRBAS scale after wearing medical masks were also evaluated. RESULTS With medical mask wearing, the G, R, and B scales in the vocal-fold benign lesion and insufficient glottic closure groups decreased, with a statistical significance seen in the G and R scales of the vocal-fold benign lesion group (G 1.07 ± 0.59, 0.95 ± 0.68, p < .01; R 1.07 ± 0.59, 0.95 ± 0.68, p < .01). The B scale in the precancerous lesions/early-stage glottic carcinoma (95%) and vocal-fold benign lesion groups (83%) and R scale in the insufficient glottic closure group (77.8%) were stable with mask wearing. f o and SPL in the vocal-fold benign lesion group and f o and jitter in the insufficient glottic closure group increased significantly with medical masks. The NHR and CPP in each group changed little, and all the parameters in the precancerous lesions/early-stage glottic carcinoma group showed no significant change. CONCLUSIONS The effects of medical masks on the voice quality of patients with voice disorders were associated with the type of the disease, degree of hoarseness, and subjective scale influencing specific voice disorder. When wearing medical masks, the pitch and loudness of patients increased as compensation. Medical masks had the least impact on the precancerous lesions/early-stage glottic carcinoma group.
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Affiliation(s)
- Yuhong Lin
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, China
| | - Liyu Cheng
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, China
| | - Qingcui Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, China
| | - Wen Xu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, China
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18
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Mohd Ramli SS, Mat Baki M. Glottic Staphylococcus aureus in a patient with systemic lupus erythematosus: videolaryngostroboscopic characteristics. BMJ Case Rep 2022; 15:e245840. [PMID: 35228218 PMCID: PMC8886378 DOI: 10.1136/bcr-2021-245840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/04/2022] Open
Abstract
Systemic lupus erythematous (SLE) is an autoimmune disease commonly treated with steroid which leads to immunosuppression and increased susceptibility to infection. Chronic laryngitis with whitish lesion on the true vocal fold in SLE may be caused by opportunistic organisms, such as tuberculous, fungal and Staphylococcus aureus infections. Videolaryngostroboscopy may be helpful in leading to the diagnosis and optimum treatment of glottic S. aureus A woman in her 40s with SLE presented with progressively worsening hoarseness for 2 months, accompanied by sore throat and odynophagia. Videoendoscopy showed erythematous and oedematous bilateral vocal fold with whitish lesion seen at the edge of middle one-third while the videolaryngostroboscopic evaluation showed there was severe asymmetry of the bilateral vocal folds, with severely reduced amplitude during phonation where the vocal cords were not vibrating, aperiodic vibratory cycles and 'always open', incomplete closure of vocal cord pattern. Later, endolaryngeal microsurgery and biopsy of the lesion confirmed of glottic S. aureus Her symptoms and followed up videolaryngostroboscopy showed resolution to normal findings after 6 weeks of cloxacillin. S. aureus infection of the glottis is a differential diagnosis in a chronic laryngitis with leucoplakic lesion in an immunosuppressive patient. Videolaryngostroboscopy has an important role in diagnosis, evaluation and treatment decision.
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Affiliation(s)
- Siti Sarah Mohd Ramli
- Department of Otorhinolarynology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Marina Mat Baki
- Department of Otorhinolarynology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
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Feng HY, Zhou Y, Zhou SP, Tian FY, Xiao JYMYP, Xiao Y, Mo BY, Xie H, Zhu HP. Surgical strategies for glottic carcinoma with a giant thyroid tumor A case report and literature review. Ann Ital Chir 2021; 10:S2239253X21033041. [PMID: 35232898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED Description of strategies for preventing surgical complications in the treatment of laryngeal carcinomas associated with giant thyroid cancer. For this study, the clinical data of an elderly patient with laryngeal carcinoma associated with a large thyroid tumor, diabetes and hypertension were used. The patient's tumor was removed with simultaneous surgery performed by the thyroid surgery department and the laryngeal surgery department; the patient was followed for more than 3 years and the scars of tracheal granulation and laryngeal adhesions were removed with repeated laser interventions. The literature review was carried out on the Wanfang database, on the China How Net database and on the MEDLINE database via Computer. The final research keywords used for the study were "squamous cell carcinoma" and "glottis" or "larynx" / "larynx", "surgery", "thyroid cancer" and "simultaneous surgery". RESULTS After completion of the intervention, the nasogastric tube and tracheal cannula were successfully removed, the glottis was successfully reconstituted and oral respiration, phonation and oral feeding were normally resumed. CONCLUSION The multidisciplinary approach for the simultaneous removal of a laryngeal carcinoma associated with a bulky thyroid tumor in elderly subjects with multi-system and multi-organ damage has been successfully implemented. There are only a few such cases presented in the literature to illustrate risk prevention strategies for postoperative complications, including postoperative infection, extubation difficulties and loss of speech, which deserve to be known. KEY WORDS Glottic carcinoma, Thyroid tumor, Laser surgery multidisciplinary, Tracheal cannula, Vocal cords.
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20
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Mucha-Małecka A, Małecki K, Amrogowicz N, Biesaga B, Modrzejewski M. Prognostic factors in elderly patients with T1 glottic cancer treated with radiotherapy. Sci Rep 2021; 11:17717. [PMID: 34489495 PMCID: PMC8421427 DOI: 10.1038/s41598-021-96146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/08/2021] [Indexed: 12/05/2022] Open
Abstract
The aim of the study was the evaluation of the effectiveness of radiotherapy in elderly T1 glottic cancer patients and prognostic factors with particular focus on comorbidities. Five-year overall survival, disease-specific survival, and local control rates were 63%, 92%, and 93%, respectively. Multivariate analysis showed that the following factors had statistically significant impact on local relapse risk and cancer death risk: diabetes, underweight, and fraction dose of 2 Gy. High number of comorbidities, high CCI, and underweight negatively influenced overall survival. A retrospective analysis was performed in a group of 131 T1N0M0 glottic cancer patients aged 70 and above treated with irradiation at the National Institute of Oncology in Cracow between 1977 and 2007. In the analyzed group men prevailed (92%) of mean age of 74 years. Each patient was diagnosed with at least one comorbidity with the following comorbid conditions being most frequent: hypertension, ischemic heart disease, and chronic obstructive pulmonary disease. In the studied group, the effect of comorbidities on overall survival was evaluated using Charlson Comorbidity Index (CCI). Twenty five (19%) patients showed underweight. All patients were irradiated once daily, 5 days a week, to a total dose of 60-70 Gy with a fraction dose of 2 or 2.5 Gy. Radiotherapy is an effective treatment modality in elderly T1 glottic cancer patients. Diabetes as comorbidity, underweight, and conventional dose fractionation decrease the probability of curative effect of radiotherapy in this group of patients, while high number of comorbidities diminishes the probability of long-term survival.
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Affiliation(s)
- Anna Mucha-Małecka
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland.
| | - Krzysztof Małecki
- Department of Radiotherapy for Children and Adults, University Children's Hospital of Cracow, Wielicka 265, 30-663, Cracow, Poland
- Faculty of Health Sciences, Jagiellonian University in Cracow, Michałowskiego 12, 31-126, Cracow, Poland
| | - Natalia Amrogowicz
- 1St Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Beata Biesaga
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland
- Department of Tumour Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
| | - Maciej Modrzejewski
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
- Department of Otolaryngology, Head and Neck Surgery, 5th Military Hospital with Polyclinic, Wroclawska 1-3, 30-901, Cracow, Poland
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Lina I, Tsai HW, Ding D, Davis R, Motz KM, Hillel AT. Characterization of Fibroblasts in Iatrogenic Laryngotracheal Stenosis and Type II Diabetes Mellitus. Laryngoscope 2021; 131:1570-1577. [PMID: 32857885 PMCID: PMC7914267 DOI: 10.1002/lary.29026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/29/2020] [Accepted: 07/27/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Iatrogenic laryngotracheal stenosis (iLTS) is the pathological narrowing of the glottis, subglottis, and/or trachea due to scar tissue. Patients with type 2 diabetes mellitus (T2DM) are over 8 times more likely to develop iLTS and represent 26% to 53% of all iLTS patients. In this investigation, we compared iLTS scar-derived fibroblasts in patients with and without T2DM. STUDY DESIGN Controlled ex vivo study. METHODS iLTS scar fibroblasts were isolated and cultured from subglottic scar biopsies in iLTS patients diagnosed with or without type 2 diabetes (non-T2DM). Fibroblast proliferation, fibrosis-related gene expression, and metabolic utilization of oxidative phosphorylation (OXPHOS) and glycolysis were assessed. Contractility was measured using a collagen-based assay. Metabolically targeted drugs (metformin, phenformin, amobarbital) were tested, and changes in fibrosis-related gene expression, collagen protein, and contractility were evaluated. RESULTS Compared to non-T2DM, T2DM iLTS scar fibroblasts had increased α-smooth muscle actin (αSMA) expression (8.2× increased, P = .020), increased contractility (mean 71.4 ± 4.3% vs. 51.7 ± 16% Δ area × 90 minute-1 , P = .016), and reduced proliferation (1.9× reduction at 5 days, P < .01). Collagen 1 (COL1) protein was significantly higher in the T2DM group (mean 2.06 ± 0.19 vs. 0.74 ±.44 COL1/total protein [pg/μg], P = .036). T2DM iLTS scar fibroblasts had increased measures of OXPHOS, including basal respiration (mean 86.7 vs. 31.5 pmol/minute/10 μg protein, P = .016) and adenosine triphosphate (ATP) generation (mean 97.5 vs. 25.7 pmol/minute/10 μg protein, P = .047) compared to non-T2DM fibroblasts. Amobarbital reduced cellular contractility; decreased collagen protein; and decreased expression of αSMA, COL1, and fibronectin. Metformin and phenformin did not significantly affect fibrosis-related gene expression. CONCLUSION T2DM iLTS scar fibroblasts demonstrate a myofibroblast phenotype and greater contractility compared to non-T2DM. Their bioenergetic preference for OXPHOS drives their increased contractility, which is selectively targeted by amobarbital. LEVEL OF EVIDENCE NA Laryngoscope, 131:1570-1577, 2021.
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Affiliation(s)
- Ioan Lina
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - Hsiu-Wen Tsai
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - Dacheng Ding
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - Ruth Davis
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - Kevin M Motz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
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Dheeraj K, Kumar R, Pinnaka LB. 6 "I" for endoscopic surgical management of early glottic squamous cell carcinomas. Oral Oncol 2021; 118:105308. [PMID: 33896730 DOI: 10.1016/j.oraloncology.2021.105308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Kondamudi Dheeraj
- Department of Otorhinolaryngology and Head-Neck Surgery, Teaching Block, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head-Neck Surgery, Teaching Block, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Lakshmi Bhavana Pinnaka
- Department of Neuroanaesthesia and Critical Care, Medanta-The Medicity, Gurugram 122001, Harayana, India
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23
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龚 洪, 周 梁, 陶 磊, 张 明, 吴 海, 陈 小, 李 筱, 李 采, 周 健. [Pathologic tumor volume predicting survival outcomes of patients with local advanced glottic carcinoma]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021; 35:316-320. [PMID: 33794628 PMCID: PMC10128446 DOI: 10.13201/j.issn.2096-7993.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Indexed: 11/12/2022]
Abstract
Objective:The aim of this study was to evaluate the predicting role of tumor volume as evaluated by postoperative pathologic examination on overall survival(OS) and disease free survival(DFS) in patients with local advanced glottic carcinoma. Methods:In this study, the records of 406 consecutive patients with local advanced glottic carcinoma(T3-T4 stages) who underwent surgery ± chemoradiotherapy from January 2005 to December 2010 were retrospectively reviewed and followed up. The demographic characteristics, disease staging, and pathologic tumor volume were analyzed. The optimal cutoff values of tumor volume for OS and DFS were obtained by using receiver operating characteristic(ROC) curves. The association of tumor volume with T stages were assessed by using Logistic regression model, and the relationship between tumor volume and OS and DFS rates were evaluated by using Cox regression models. Results:The 5-and 10-year OS rates were 62.9% and 55.4%, respectively. The 5-and 10-year DFS rates were 55.5% and 50.8%, respectively. The mean tumor volume was(5.1±6.7) cm³, T4 stage patients had higher tumor volume than those of patients with T3 stage(P<0.001). The factor of tumor volume was correlated with T stages by using Logistic regression analyses(OR=13.81, 95%CI: 6.03-31.59, P<0.001). The optimal cutoff values of tumor volume that were both at 3 cm³ for OS and DFS rates were obtained by using ROC curve plots. The OS and DFS rates of glottic carcinoma patients with tumor volume ≤ 3 cm³ were better when compared with those of patients with tumor volume>3 cm³(P<0.001). Upon multivariate analyses, tumor volume was strongly correlated with poorer OS and DFS rates and remained independent prognostic factors for both the OS and DFS of patients with glottic carcinoma(OS: HR=1.59, 95%CI: 1.09-2.32, P=0.017; DFS: HR=1.54, 95%CI: 1.08-2.20, P=0.016). Conclusion:This study demonstrates that tumor volume is correlated with T stages, and this factor is an independent predictive factor of survival outcomes in patients with local advanced glottic carcinoma.
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Affiliation(s)
- 洪立 龚
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科(上海,200031)Department of Otolaryngology Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China
| | - 梁 周
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科(上海,200031)Department of Otolaryngology Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China
| | - 磊 陶
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科(上海,200031)Department of Otolaryngology Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China
| | - 明 张
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科(上海,200031)Department of Otolaryngology Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China
| | - 海涛 吴
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科(上海,200031)Department of Otolaryngology Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China
| | - 小玲 陈
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科(上海,200031)Department of Otolaryngology Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China
| | - 筱明 李
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科(上海,200031)Department of Otolaryngology Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China
| | - 采 李
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科(上海,200031)Department of Otolaryngology Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China
| | - 健 周
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科(上海,200031)Department of Otolaryngology Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China
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24
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Gelbard A, Wanjalla C, Wootten CT, Drake WP, Lowery AS, Wheeler DA, Cardenas MF, Sikora AG, Pathak RR, McDonnell W, Mallal S, Pilkinton M. The Proximal Airway Is a Reservoir for Adaptive Immunologic Memory in Idiopathic Subglottic Stenosis. Laryngoscope 2021; 131:610-617. [PMID: 32603507 PMCID: PMC7951501 DOI: 10.1002/lary.28840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES/HYPOTHESIS Characterization of the localized adaptive immune response in the airway scar of patients with idiopathic subglottic stenosis (iSGS). STUDY DESIGN Basic Science. METHODS Utilizing 36 patients with subglottic stenosis (25 idiopathic subglottic stenosis [iSGS], 10 iatrogenic post-intubation stenosis [iLTS], and one granulomatosis with polyangiitis [GPA]) we applied immunohistochemical and immunologic techniques coupled with RNA sequencing. RESULTS iSGS, iLTS, and GPA demonstrate a significant immune infiltrate in the subglottic scar consisting of adaptive cell subsets (T cells along with dendritic cells). Interrogation of T cell subtypes showed significantly more CD69+ CD103+ CD8+ tissue resident memory T cells (TRM ) in the iSGS airway scar than iLTS specimens (iSGS vs. iLTS; 50% vs. 28%, P = .0065). Additionally, subglottic CD8+ clones possessed T-cell receptor (TCR) sequences with known antigen specificity for viral and intracellular pathogens. CONCLUSIONS The human subglottis is significantly enriched for CD8+ tissue resident memory T cells in iSGS, which possess TCR sequences proven to recognize viral and intracellular pathogens. These results inform our understanding of iSGS, provide a direction for future discovery, and demonstrate immunologic function in the human proximal airway. Laryngoscope, 131:610-617, 2021.
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Affiliation(s)
- Alexander Gelbard
- Dept. of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Celestine Wanjalla
- Dept. of Medicine, Division of Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher T. Wootten
- Dept. of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wonder P. Drake
- Dept. of Molecular and Human Genetics, Baylor College of Medicine, Houston Texas
| | - Anne S Lowery
- Dept. of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David A. Wheeler
- Dept. of Molecular and Human Genetics, Baylor College of Medicine, Houston Texas
| | - Maria F. Cardenas
- Dept. of Molecular and Human Genetics, Baylor College of Medicine, Houston Texas
| | - Andrew G. Sikora
- Bobby R. Alford Dept. of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston Texas
| | - Ravi R. Pathak
- Bobby R. Alford Dept. of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston Texas
| | | | - Simon Mallal
- Dept. of Molecular and Human Genetics, Baylor College of Medicine, Houston Texas
| | - Mark Pilkinton
- Dept. of Medicine, Division of Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee
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25
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Luo MS, Huang GJ, Liu HB. Prognostic factors of patients with initially diagnosed T1a glottic cancer: Novel nomograms and a propensity-score matched cohort analysis. Medicine (Baltimore) 2020; 99:e23004. [PMID: 33157944 PMCID: PMC7647548 DOI: 10.1097/md.0000000000023004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/24/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022] Open
Abstract
The option of T1a glottic cancer treatments remarkably varied in different countries. This study aimed to construct predictive models to predict overall survival (OS) and cancer-specific survival (CSS) of patients with initially diagnosed T1a glottic cancer. And we used propensity score matching (PSM) to reassess the effect of treatments.Data of patients with initially diagnosed T1a glottic cancer were extracted from the Surveillance, Epidemiology, and End Results database. Patients with complete information were randomly divided into the training and the validation cohorts (7:3). Cox regression was conducted to screen significant predictors of the OS and the CSS. PSM was performed to mimic randomized controlled trials. Survival analyses were performed by Kaplan-Meier survival methods, and log-rank tests were utilized.A total of 2342 patients met the inclusion criteria. Survival analyses showed that patients who underwent primary site surgery would have better OS and CSS. Univariate analyses and multivariate analyses proved that stage, N stage, primary site surgery, and chemotherapy significantly affected both the OS and the CSS. Predictive nomograms were established to predict patients' prognosis. Finally, the OS and the CSS for patients who underwent primary site surgery alone were significantly longer than those who underwent radiation alone before and after PSM.We constructed nomograms predicting the OS and the CSS of patients with initially diagnosed T1a glottic cancer. Compared to our previous studies, this study indicated that primary site surgery may be superior to radiation and chemotherapy. At present, chemotherapy should be not recommended for T1a glottic cancer patients.
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Affiliation(s)
- Meng-Si Luo
- Department of Anesthesiology, Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong
| | - Guan-Jiang Huang
- Department of Otorhinolaryngology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang
| | - Hong-Bing Liu
- Department of Otolaryngology-head and neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Hutnik R, Zlatopolsky A, Mehraban-Far S, Alrassi J, McMillan N, Amadi C, Fujita K, Mortensen M. Laryngopharyngeal reflux: Comparing improvements in reflux symptom index with reflux finding score. Am J Otolaryngol 2020; 41:102730. [PMID: 32956939 DOI: 10.1016/j.amjoto.2020.102730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/30/2020] [Accepted: 09/08/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE The objective of this study was to determine the correlation of reported symptom improvement in laryngopharyngeal reflux (LPR) with physical findings on laryngoscopic examination following medical therapy. MATERIALS AND METHODS This IRB-approved, retrospective, single-institution study included all patients who were diagnosed and medically treated for LPR from Jan. 1, 2015-October 21st, 2019. Only patients who received at least six weeks of treatment with a proton pump inhibitor and those with pre- and post-treatment Reflux Symptom Index; RSI (n = 91) and Reflux Finding Score; RFS (n = 33) were included in the study. RESULTS A total of 91 patients were included in the analysis (61.54% female). There was a 19.99% improvement in total RSI (p = 0.0034) and a 25.20% improvement in total RFS (p = 0.0011) following at least six weeks of treatment (average = 253 ± 213 SD days). RSI symptoms were significantly decreased between pre- and post-treatment for hoarseness (p = 0.0005), clearing of the throat (p = 0.0066), excess throat mucus or postnasal drip (p = 0.0004), troublesome cough (p = 0.0231), and heartburn/chest pain (p = 0.0053). RFS demonstrated a statistically significant decrease in only subglottic edema (p < 0.0001) and ventricular obliteration (p = 0.0295). Pearson's correlation test did not demonstrate a relationship between RSI and RFS in the pre- and post-treatment analyses alone, but did demonstrate a statistically significant relationship when analyzed across all captured pre and post data (r = 0.265, p = 0.006). CONCLUSIONS RSI and RFS are complimentary to one another when assessing for treatment response, but improvement in RSI does not correlate with that in RFS.
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Affiliation(s)
- Robert Hutnik
- Stony Brook Medicine, Department of Surgery, Stony Brook, NY, United States of America
| | - Aaron Zlatopolsky
- Stony Brook Medicine, Department of Surgery, Stony Brook, NY, United States of America
| | - Sina Mehraban-Far
- Stony Brook Medicine, Department of Surgery, Stony Brook, NY, United States of America
| | - James Alrassi
- SUNY Downstate Health Sciences University, Department of Otolaryngology, Brooklyn, NY, United States of America
| | - Nadia McMillan
- Beth Israel Deaconess Medical Center, Department of Neurology, Boston, MA, United States of America
| | - Chima Amadi
- Stony Brook Medicine, Department of Surgery, Stony Brook, NY, United States of America
| | - Kevin Fujita
- Yale School of Medicine, Department of Surgery, Division of Otolaryngology, New Haven, CT, United States of America
| | - Melissa Mortensen
- Albany Medical College, Department of Otolaryngology, Albany, NY, United States of America.
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Suzuki G, Yamazaki H, Aibe N, Masui K, Shimizu D, Kimoto T, Nishimura T, Kawabata K, Nagasawa S, Machida K, Yoshino Y, Watanabe S, Sugiyama Y, Arai A, Hirano S, Yamada K. Comparison of Three Fractionation Schedules in Radiotherapy for Early Glottic Squamous Cell Carcinoma. In Vivo 2020; 34:2769-2774. [PMID: 32871813 PMCID: PMC7652429 DOI: 10.21873/invivo.12101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/20/2020] [Accepted: 06/24/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Radiotherapy is widely accepted as the treatment of choice for early glottic squamous cell carcinoma (EGSCC), although it varies greatly with respect to dose, dose per fraction, and treatment techniques. The study aim was to evaluate the use of accelerated fractionation strategy (AFS) for EGSCC in standard clinical practice. PATIENTS AND METHODS Patients treated with definitive radiotherapy for EGSCC between 2008 and 2019 were retrospectively identified and received either conventional fractionation, hypofractionation, or hyperfractionation. RESULTS One hundred six patients were analyzed, and 19, 71, and 16 patients underwent conventional fractionation, hypofractionation, and hyperfractionation, respectively. The median follow-up was 56 months. The 5-year local control and overall survival rates were 79% and 83%; 78% and 79%; and 87% and 77%, respectively, and no significant difference was observed between the fractionation schedules. CONCLUSION Our findings confirmed the utility of AFS in standard clinical practice and support its use for patients with EGSCC.
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Affiliation(s)
- Gen Suzuki
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Hideya Yamazaki
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Norihiro Aibe
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Koji Masui
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Daisuke Shimizu
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Takuya Kimoto
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Takeshi Nishimura
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Kanako Kawabata
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Shinsuke Nagasawa
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Kazutaka Machida
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Yuki Yoshino
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Sho Watanabe
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Yoichiro Sugiyama
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Akihito Arai
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Kei Yamada
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
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Hamauchi S, Yokota T, Onozawa Y, Ogawa H, Onoe T, Kamijo T, Iida Y, Onitsuka T, Yasui H. Chemoradiotherapy for high-risk stage II laryngeal cancer. Int J Clin Oncol 2020; 25:1596-1603. [PMID: 32445024 DOI: 10.1007/s10147-020-01705-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/07/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Definitive radiotherapy (RT) for stage II laryngeal cancer is known to be less effective for locoregional control and survival (LRCS) in patients with high-risk factors (e.g., subglottic extension, impaired cord mobility, or bulky tumor size) than in low-risk patients. The purpose of this study was to evaluate the safety and efficacy of chemoradiotherapy (CRT) for stage II laryngeal cancer patients with high-risk factors METHODS: Sixty-five consecutive patients with stage II laryngeal cancer who received radiotherapy (RT) alone or CRT were retrospectively analyzed. The patients were classified into three groups: RT, low risk (RT-low, n = 26); RT, high risk (RT-high, n = 25); and CRT, high risk (CRT-high, n = 14). RESULTS The glottis was the most common primary tumor site in all groups. Most patients in the CRT-high group received platinum-based CRT. The 5-year locoregional control and survival (LRCS) rates were 88.3, 44.2, and 85.7% in the RT-low, RT-high, and CRT-high groups, respectively. In multivariate analysis, high-risk disease and CRT were significantly associated with 5-year LRCS rates. CONCLUSION CRT may provide better locoregional control than RT alone in high-risk stage II laryngeal cancer.
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Affiliation(s)
- Satoshi Hamauchi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Yusuke Onozawa
- Division of Medical Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hirofumi Ogawa
- Division of Radiation Oncology and Proton Therapy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tsuyoshi Onoe
- Division of Radiation Oncology and Proton Therapy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tomoyuki Kamijo
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yoshiyuki Iida
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tetsuro Onitsuka
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hirofumi Yasui
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan
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29
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Deininger-Czermak E, Heimer J, Tappero C, Thali MJ, Gascho D. The added value of postmortem magnetic resonance imaging in cases of hanging compared to postmortem computed tomography and autopsy. Forensic Sci Med Pathol 2020; 16:234-242. [PMID: 32221850 DOI: 10.1007/s12024-020-00233-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the added value of postmortem magnetic resonance imaging (MRI) compared to postmortem computed tomography (CT) and autopsy in cases of fatal hanging. In addition, the study analyzed the strengths of each examination method regarding typical injuries in these cases. We investigated a cohort of 25 decedents who underwent CT, MRI and autopsy. Two radiologists assessed all MR images of the head and neck as well as the corresponding CT images. The results were compared to autopsy findings by retrospectively analyzing the autopsy reports. Postmortem MRI revealed intramuscular hemorrhages in a large number of cases, however, autopsy did not confirm all of the detected hemorrhages. CT and autopsy detected fractures in several cases, whereas MRI showed a fracture in just one single case. Other previously described vital signs and relevant findings, such as fracture-related gas bubbles, soft tissue emphysema or pneumomediastinum, were observed in only a few individual cases. MRI provided added diagnostic value in the detection of soft tissue injuries and lymph node swelling in fatal hangings. As an adjunct to autopsy, postmortem MRI may reveal additional hemorrhages, which might be missed at autopsy. Since standard MRI demonstrated low sensitivity for the detection of fractures, an additional imaging modality or autopsy is required to overcome this limitation.
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Affiliation(s)
- Eva Deininger-Czermak
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland.
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
| | - Jakob Heimer
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
| | - Carlo Tappero
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
- Department of Radiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
| | - Dominic Gascho
- Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse, 190/52, CH-8057, Zurich, Switzerland
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30
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Chung SY, Lee CG. Feasibility of single vocal cord irradiation as a treatment strategy for T1a glottic cancer. Head Neck 2019; 42:854-859. [PMID: 31854475 DOI: 10.1002/hed.26052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/15/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Generally, radiotherapy for patients with early glottic cancer includes treatment of the whole larynx. This study was conducted to evaluate the treatment outcomes and toxicity in patients who received single vocal cord irradiation (SVCI) for T1a classification glottic cancer. METHODS A total of 34 patients diagnosed with clinical T1aN0M0 classification squamous cell carcinoma of the glottis who received radiotherapy to the single vocal cord were included for analysis. RESULTS Median follow-up period was 41.3 months (range, 6.4-124.5 months). The 3-year and 5-year local control (LC) rates were both 96.8%. Grade 3 radiation dermatitis was observed as severe acute toxicity in two (6%) patients. No patients experienced any severe late toxicity events during follow-up. CONCLUSIONS SVCI showed good LC, low acute and late toxicities, and reasonable voice recovery. SVCI may be considered a feasible treatment strategy for patients with T1a glottic cancer.
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Affiliation(s)
- Seung Yeun Chung
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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31
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Sano D, Tanabe T, Kubota A, Miyamoto S, Tanigaki Y, Okami K, Komatsu M, Ikoma R, Suzuki K, Akazawa Y, Kobayashi S, Yamada Y, Oridate N. Addition of S-1 to radiotherapy for treatment of T2N0 glottic cancer: Results of the multiple-center retrospective cohort study in Japan with a propensity score analysis. Oral Oncol 2019; 99:104454. [PMID: 31675682 DOI: 10.1016/j.oraloncology.2019.104454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/03/2019] [Accepted: 10/19/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This multicenter retrospective cohort study aimed to evaluate the significance of adding S-1 to radiotherapy (RT) for the treatment of T2N0 glottic cancer using a propensity score matched analysis in Japan. MATERIALS AND METHODS This study was conducted on 287 patients with T2N0 glottic cancer who were treated with definitive RT or chemoradiotherapy with S-1 (S-1 RT) between April 2007 and March 2017. Propensity score matched analysis was performed to ensure the well-balanced characteristics of the groups of patients who received RT alone and S-1 RT. Overall, progression-free and laryngectomy-free survivals and local control and laryngeal preservation rates were compared. RESULTS Fifty-four pairs of patients were selected after performing propensity score matched analysis. Clinical characteristics were well-balanced between the two groups. The overall survival of patients in the S-1 RT group was significantly better than those in the RT alone group (P = 0.008). The progression-free and laryngectomy-free survivals of patients in the S-1 RT group were also better than those in the RT alone group; however, the differences were not significant. In contrast, patients in the S-1 RT group had slightly lower local control and laryngeal preservation rates compared with those in the RT alone group. The incidence of dermatitis in the S-1 RT group was significantly higher than that in the RT alone group in the matched population (P = 0.013). CONCLUSIONS The addition of S-1 to RT for the treatment of T2N0 glottic cancer was not associated with better local control and laryngeal preservation rates in this study.
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Affiliation(s)
- Daisuke Sano
- Department of Otorhinolaryngology, Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan.
| | - Teruhiko Tanabe
- Department of Otorhinolaryngology, Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan
| | - Akira Kubota
- Department of Head and Neck Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Shunsuke Miyamoto
- Department of Otorhinolaryngology, Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Yuji Tanigaki
- Department of Otorhinolaryngology, Fujisawa City Hospital, Fujisawa, Kanagawa, Japan
| | - Kenji Okami
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokai University Hospital, Isehara, Kanagawa, Japan
| | - Masanori Komatsu
- Department of Otorhinolaryngology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Ryo Ikoma
- Department of Otorhinolaryngology, Yokohama Minami Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Kazumasa Suzuki
- Department of Otorhinolaryngology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
| | - Yoshihiro Akazawa
- Department of Otorhinolaryngology, St. Marianna University Hospital, Kawasaki, Kanagawa, Japan
| | - Sei Kobayashi
- Department of Otorhinolaryngology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Yoshihiro Yamada
- Department of Otorhinolaryngology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Nobuhiko Oridate
- Department of Otorhinolaryngology, Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan
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Proboka G, Rasa A, Olmane E, Isajevs S, Tilgase A, Alberts P. Treatment of a stage III rima glottidis patient with the oncolytic virus Rigvir: A retrospective case report. Medicine (Baltimore) 2019; 98:e17883. [PMID: 31702662 PMCID: PMC6855627 DOI: 10.1097/md.0000000000017883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/23/2019] [Accepted: 10/09/2019] [Indexed: 12/28/2022] Open
Abstract
RATIONALE Of all the parts of the larynx, the glottis has the highest frequency of cancer. With disease progression, the vocal cord movement is affected and for advanced stages its anatomical and functional preservation is rarely achievable, if at all. PATIENT CONCERNS Here we describe a 72-year-old patient who presented with hoarseness for a year and was only able to whisper. DIAGNOSIS A computed tomography (CT) scan of the vocal cords (without contrast) showed higher density tissue. Histological examination disclosed a well-differentiated verrucous squamous cell carcinoma of the glottis. INTERVENTIONS The patient was treated with the oncolytic ECHO-7 virus Rigvir without any of the standard treatments. OUTCOMES As shown by CT scans, the patient has been stabilized, and the laryngeal functions are preserved with the virotherapy still ongoing. The patient was diagnosed over 4.2 years ago. LESSONS Considering the present patient being treated with Rigvir without any standard treatment, the results suggest that Rigvir therapy could be a possible treatment for glottic cancer.
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Affiliation(s)
- Guna Proboka
- Latvian Oncology Centre, Riga Eastern Clinical University Hospital
| | | | - Evija Olmane
- Department of Radiology, Pauls Stradiņš Clinical University Hospital
| | - Sergejs Isajevs
- Department of Pathology, Riga Eastern Clinical University Hospital
- Department of Pathology, Faculty of Medicine, University of Latvia, Riga, Latvia
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Żurek M, Rzepakowska A, Osuch-Wójcikiewicz E, Niemczyk K. Learning curve for endoscopic evaluation of vocal folds lesions with narrow band imaging. Braz J Otorhinolaryngol 2019; 85:753-759. [PMID: 30126768 PMCID: PMC9443050 DOI: 10.1016/j.bjorl.2018.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/16/2018] [Accepted: 07/10/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction The endoscopic methods are progressing and becoming more common in routine clinical diagnosis in the field of otorhinolaryngology. Relatively large amount of researches have proved high accuracy of narrow band imaging endoscopy in differentiating benign and malignant lesions within vocal folds. However, little is known about learning curve in narrow band imaging evaluation of laryngeal lesions. Objective The aim of this study was to determine the learning curve for the narrow band imaging evaluation of vocal folds pathologies depending on the duration of the procedure. Methods Records of 134 narrow band imaging that were analyzed in terms of the duration of the procedure and the accuracy of diagnosis confirmed by histopathological diagnosis were enrolled in the study. The narrow band imaging examinations were performed sequentially by one investigator over a period of 18 months. Results The average duration of narrow band imaging recordings was 127.82 s. All 134 studies were divided into subsequent series of several elements. An evident decrease in time of investigation was noticed between 13th and 14th series, when the examinations were divided into 5 elements series, which corresponds to the difference between 65th and 70th subsequent narrow band imaging examination. Parallel groups of 67 examinations were created. Group 1 included 1st to 67th subsequent narrow band imaging examination; Group 2 – 68th to 134th narrow band imaging examinations. The non-parametric U Mann–Whitney test confirmed statistically significant difference between the mean duration of narrow band imaging examination in both groups 160.5 s and 95.1 s, respectively (p < 10−7). Sensitivity and specificity of narrow band imaging examination in the first group were respectively: 83.7% and 76.7%. In the second group, these indicators amounted 98.1% and 80% respectively. Conclusions A minimum of 65th–70th narrow band imaging examinations are required to reach a plateau phase of the learning process in assessment of glottis lesions. Analysis of learning curves is useful for the development of training programs and determination of a mastery level.
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Affiliation(s)
- Michał Żurek
- Medical University of Warsaw, Students Scientific Research Group by Otolaryngology Department, Warszawa, Poland
| | - Anna Rzepakowska
- Medical University of Warsaw, Otolaryngology Department, Warszawa, Poland.
| | | | - Kazimierz Niemczyk
- Medical University of Warsaw, Otolaryngology Department, Warszawa, Poland
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Dhambri S, Dhaha M, Tibini M, Jbali S, Kedous S, Touati S, Gritli S. Oncologic outcomes of early glottic cancers with anterior commissure involvement treated with advanced laser cordectomies. Tunis Med 2019; 97:978-983. [PMID: 32173845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The contribution of transoral laser microsurgery (TLM) in the management of early glottic cancer is now well established. The anterior commissure (AC) is a delicate anatomic subsite due to its difficult access and the high risk of tumour spread from this site to the thyroid cartilage, the subglottis and the pre epiglottic space. These reasons make the endoscopic approach controversial in case of AC involvement. METHODS This is a single centre retrospective study performed between the years 2012 and 2015. Eighteen patients treated with advanced Va laser cordectomies were included. RESULTS All tumours were staged T1 (78% were T1a and 12% T1b). After laser surgery 4 patients (22.22%) had positive margins. These patients were candidate to second look procedure allowing detection and treatment of residual disease. Oncologic outcomes were studied. Two patients experienced local relapses within a mean delay of 7 months. The local control rate was 88.9% while the local control using laser only was 83.33%. One patient underwent a total laryngectomy (TL) followed by adjuvant radiation therapy (RT) after a massive recurrence in the AC with infiltration of the thyroid cartilage. The laryngeal preservation rate was 94.44%. The 3 years overall survival rate reached 100% while the 3 years disease free survival was 88.9%. CONCLUSION the TLM offers acceptable oncologic outcomes in the treatment of T1 laryngeal cancer with AC involvement.
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Lee LA, Fang TJ, Li HY, Huang CG, Chen TC, Liao CT, Kang CJ, Chang KP, Yen TC. Low expression of pRB predicts disease relapse in early glottic cancer treated with transoral laser microsurgery. Laryngoscope 2018; 129:E220-E226. [PMID: 30382590 DOI: 10.1002/lary.27612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS To elucidate the associations among the immunohistochemical expression of tumor markers, clinicopathological variables, and disease-free survival (DFS) in patients with early-stage glottic squamous cell carcinoma (SCC) who underwent transoral laser microsurgery (TLM) as the primary treatment. STUDY DESIGN Retrospective chart review. METHODS The records of consecutive patients with Tis-T2N0 glottic SCC who underwent TLM between August 1, 2012 and October 31, 2015 were reviewed. Expression of Bcl-2, pRB, p16INK4A , p53, c-Myc, E-cadherin, and EGFR was examined using tissue microarrays containing tumor specimens through immunohistochemistry. Three-year DFS rates were calculated. RESULTS A total of 65 consecutive patients were identified, of which 28 were excluded due to insufficient tissue (n = 22) and low biomarker quality (n = 6). Therefore, 37 patients with complete records were included. The included patients were significantly older and had a more advanced type of cordectomy than did the excluded patients (P = .015 and .009, respectively). According to the findings of univariate analysis, age, betel quid chewing, type of cordectomy, BCL-2 expression, and pRB expression significantly predicted 3-year DFS. According to the findings of multivariate analysis, age (adjusted hazard ratio: 0.94, 95% CI: 0.88-1.00), betel quid chewing (adjusted hazard ratio: 5.07, 95% CI: 1.32-19.44), and pRB expression (adjusted hazard ratio: 0.02, 95% CI: 0.00-0.28) were independent predictors of 3-year DFS. CONCLUSIONS Low pRB expression is a potential biomarker for predicting disease relapse after primary TLM for early-stage glottic SCC and may help to identify high-risk patients who can subsequently undergo intensive management. LEVEL OF EVIDENCE 4 Laryngoscope, 129:E220-E226, 2019.
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Affiliation(s)
- Li-Ang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology-Head and Neck Surgery
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology-Head and Neck Surgery
| | - Chung-Guei Huang
- the Department of Laboratory Medicine
- Department of Medical Biotechnology and Laboratory Science
- Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
| | | | - Chun-Ta Liao
- Department of Otorhinolaryngology-Head and Neck Surgery
| | | | | | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Linkou-Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Sava HW, Dedivitis RA, Gameiro GR, Pfuetzenreiter EG, de Almeida RC, Matos LL, Cernea CR. Morphological Evaluation of Thyroid Cartilage Invasion in Early Glottic Tumors Involving the Anterior Commissure. ORL J Otorhinolaryngol Relat Spec 2018; 80:259-270. [PMID: 30121650 DOI: 10.1159/000491490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 06/23/2018] [Indexed: 04/13/2024]
Abstract
INTRODUCTION The anterior commissure is an area of glottic cancer infiltration, even in early stages. OBJECTIVE To evaluate the invasion by tumors into the anterior commissure cartilage in surgical specimens of frontolateral laryngectomy. METHODS Forty-eight patients who had undergone frontolateral laryngectomy for T1b/T2 squamous cell carcinoma were included. Epidemiological and clinical aspects as well as morphological histopathological analysis were evaluated. RESULTS Of the 48 patients, 42 (87.5%) had T1b lesions and 6 (12.5%) had T2. Thirty-four cases (70.8%) showed healthy tissue between the tumor and the thyroid cartilage, 10 cases (20.8%) had a tumor in close proximity to the cartilage, and in 4 cases (8.3%) there was cartilage invasion. There was no major risk of adverse outcome in the groups with infiltration or tumor adjacent to the cartilage. Level of differentiation, mitotic index, nuclear irregularity, and the presence of nucleolus and tumor necrosis were not related to cartilage invasion. CONCLUSION The infiltration of thyroid cartilage occurred in 8.3% of tumors and did not change the outcome in patients submitted to frontolateral laryngectomy. The morphological characteristics did not present any statistical significance.
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Affiliation(s)
- Henrique Wendling Sava
- Department of Head and Neck Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | | | | | | | - Leandro Luongo Matos
- Department of Head and Neck Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Claudio Roberto Cernea
- Department of Head and Neck Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
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Oppersma E, Doorduin J, Gooskens PJ, Roesthuis LH, van der Heijden EHFM, van der Hoeven JG, Veltink PH, Heunks LMA. Glottic patency during noninvasive ventilation in patients with chronic obstructive pulmonary disease. Respir Physiol Neurobiol 2018; 259:53-57. [PMID: 30026086 DOI: 10.1016/j.resp.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Non-invasive ventilation (NIV) provides ventilatory support for patients with respiratory failure. However, the glottis can act as a closing valve, limiting effectiveness of NIV. This study investigates the patency of the glottis during NIV in patients with acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). METHODS Electrical activity of the diaphragm, flow, pressure and videolaryngoscopy were acquired. NIV was randomly applied in pressure support (PSV) and neurally adjusted ventilatory assist (NAVA) mode with two levels of support. The angle formed by the vocal cords represented glottis patency. RESULTS Eight COPD patients with acute exacerbation requiring NIV were included. No differences were found in median glottis angle during inspiration or peak inspiratory effort between PSV and NAVA at low and high support levels. CONCLUSIONS The present study showed that glottis patency during inspiration in patients with an acute exacerbation of COPD is not affected by mode (PSV or NAVA) or level of assist (5 or 15 cm H2O) during NIV.
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Affiliation(s)
- Eline Oppersma
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands; Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands; Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Jonne Doorduin
- Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands; Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Petra J Gooskens
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands; Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Lisanne H Roesthuis
- Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Erik H F M van der Heijden
- Department of Pulmonology, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Johannes G van der Hoeven
- Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Peter H Veltink
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands.
| | - Leo M A Heunks
- Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands; Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Postbox 7057, 1007MB, Amsterdam, The Netherlands.
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Puxeddu R, Argiolas F, Bielamowicz S, Satta M, Ledda GP, Puxeddu P. Surgical Therapy of T1 and Selected Cases of T2 Glottic Carcinoma: Cordectomy, Horizontal Glottectomy and CO2 Laser Endoscopic Resection. Tumori 2018; 86:277-82. [PMID: 11016703 DOI: 10.1177/030089160008600403] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Among the different laryngeal neoplasms, glottic carcinoma is known to be one of the most suitable for functional management. Nevertheless, the best treatment for T1 and T2 glottic carcinoma, whether an open neck procedure, endoscopy or radiotherapy, with reference to recurrence, survival, and functional results, has long been debated. Study design From February 1983 to September 1997, 83 patients with well to undifferentiated glottic carcinoma (48 pT1a, 14 pT1b, and 21 selected cases of pT2 with impairment of vocal cord mobility) were submitted to surgery at the Otorhinolaryngologic Section of the Department of Surgical Sciences and Organ Transplantations of Cagliari University. Surgical treatment included 30 laryngofissures with simple or enlarged cordectomy, 22 horizontal glottectomies and 31 endoscopic laser resections. A retrospective review of the records of the patients was performed in order to obtain a better understanding of the outcome of the three different surgical procedures in our institution. Results According to the Kaplan-Meier method, the probability of remaining free of local recurrence 3 years after primary surgery was 0.90 for the T1 group and 0.85 for the T2 group. The distribution of recurrences for cordectomy, glottectomy and CO2 laser at 3 years showed a cumulative probability of remaining free of disease after primary surgery of 0.86, 0.85 and 0.88. The probability of remaining free of local recurrence 3 years after salvage surgery was 0.96 for the T1 group and 0.95 for the T2 group. Analyzing the phenomena for type of surgical procedure, local control at 3 years after salvage surgery for cordectomy, glottectomy and exclusive CO2 laser was 0.93, 0.90 and 0.92, respectively. In the endoscopic group, local control rate after any type of salvage therapy modified the percentage at 3 years to 100%. Anterior commissure spread (AC1-AC2) resulted in a difference (not statistically significant) in local control between the group of patients without and with anterior commissure involvement. Laryngeal preservation was achieved in 93.7% (45/48) of patients who survived after salvage surgery following open neck procedures and in 100% of patients originally submitted to the endoscopic approach. Conclusions In our experience, although open laryngeal procedures can be still considered a valid option in the treatment of T1 and selected cases of T2 glottic carcinoma, endoscopic laser excision offered an oncologically adequate alternative to the traditional techniques, with minimum discomfort for the patient and satisfactory preliminary functional results.
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Affiliation(s)
- R Puxeddu
- Department of Surgical Sciences and Organ Transplantations, University of Cagliari, Italy.
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Abstract
The incidence of tuberculosis has progressively decreased in developed countries after the advent of antituberculous chemotherapy, but has recently been increasing again mainly due to migratory flows. Although common in the past and considered to be a prelethal event, laryngeal involvement has become a rarity. We report the case of a 52-year-old female smoker who complained of persistent aphonia. Videostroboscopy showed bilateral vocal fold erythroleukoplakias. A chest X-ray and CT scan aroused the suspicion of lung tuberculosis, which was confirmed by Ziehl-Neelsen staining for acid-alcohol-fast bacilli on bronchoalveolar lavage. Antituberculous chemotherapy rapidly improved the quality of her voice and led to complete disappearance of the vocal fold lesions. In conclusion, laryngeal tuberculosis may mimic an early glottic multifocal carcinoma and should therefore, despite its rarity, always be considered in the differential diagnosis of erythroleukoplakia-like lesions in order to avoid improper surgical treatment and voice damage.
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Affiliation(s)
- Giovanna Cantarella
- Department of Otolaryngology, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
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Galindo GE, Peterson SD, Erath BD, Castro C, Hillman RE, Zañartu M. Modeling the Pathophysiology of Phonotraumatic Vocal Hyperfunction With a Triangular Glottal Model of the Vocal Folds. J Speech Lang Hear Res 2017; 60:2452-2471. [PMID: 28837719 PMCID: PMC5831616 DOI: 10.1044/2017_jslhr-s-16-0412] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 04/19/2017] [Indexed: 05/08/2023]
Abstract
PURPOSE Our goal was to test prevailing assumptions about the underlying biomechanical and aeroacoustic mechanisms associated with phonotraumatic lesions of the vocal folds using a numerical lumped-element model of voice production. METHOD A numerical model with a triangular glottis, posterior glottal opening, and arytenoid posturing is proposed. Normal voice is altered by introducing various prephonatory configurations. Potential compensatory mechanisms (increased subglottal pressure, muscle activation, and supraglottal constriction) are adjusted to restore an acoustic target output through a control loop that mimics a simplified version of auditory feedback. RESULTS The degree of incomplete glottal closure in both the membranous and posterior portions of the folds consistently leads to a reduction in sound pressure level, fundamental frequency, harmonic richness, and harmonics-to-noise ratio. The compensatory mechanisms lead to significantly increased vocal-fold collision forces, maximum flow-declination rate, and amplitude of unsteady flow, without significantly altering the acoustic output. CONCLUSION Modeling provided potentially important insights into the pathophysiology of phonotraumatic vocal hyperfunction by demonstrating that compensatory mechanisms can counteract deterioration in the voice acoustic signal due to incomplete glottal closure, but this also leads to high vocal-fold collision forces (reflected in aerodynamic measures), which significantly increases the risk of developing phonotrauma.
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Affiliation(s)
- Gabriel E. Galindo
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
| | - Sean D. Peterson
- Mechanical and Mechatronics Engineering, University of Waterloo, Ontario, Canada
| | - Byron D. Erath
- Department of Mechanical & Aeronautical Engineering, Clarkson University, Potsdam, NY
| | - Christian Castro
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
- School of Speech and Hearing Sciences, Universidad de Valparaíso, Chile
| | - Robert E. Hillman
- Center for Laryngeal Surgery & Voice Rehabilitation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | - Matías Zañartu
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
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Brandstorp-Boesen J, Sørum Falk R, Boysen M, Brøndbo K. Impact of stage, management and recurrence on survival rates in laryngeal cancer. PLoS One 2017; 12:e0179371. [PMID: 28708883 PMCID: PMC5510803 DOI: 10.1371/journal.pone.0179371] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/30/2017] [Indexed: 02/06/2023] Open
Abstract
A retrospective, longitudinal study of 1,616 patients with primary laryngeal squamous cell carcinoma (LSCC) at a single center in Norway during 1983–2010 was undertaken to investigate overall survival, disease specific survival, disease-free survival, prognostic factors for overall survival, and impact of recurrence among all-stage laryngeal cancer patients over 15 years' follow-up. The prognostic impact of gender, age, smoking/alcohol, subsite, tumour, node and metastasis staging, period and modality of treatment were evaluated using Kaplan-Meier and Cox proportional hazard analyses. The importance of recurrence on survival was assessed based on case fatality rates. Five-year overall survival was 56.8%, 64.0% and 38.8%, and disease-specific survival was 80.2%, 87% and 61.6%, respectively, for the entire cohort and for glottic and supraglottic LSCC. Old age, advanced-stage LSCC and supraglottic cancer were associated with lower overall survival. The risk of disease-specific death plateaued after five years and varied significantly by subsite. Multivariate analysis of glottic LSCC revealed that surgical treatment improved overall survival, whereas old age, alcohol, T3-T4 status, positive N-status and no treatment were associated with worse survival. In supraglottic LSCC, age, alcohol, and positive N-status had a significant impact on overall survival by multivariate analysis. Five-year overall survival and disease-specific survival among patients with recurrent disease were 34% and 52%, respectively. In conclusion, marked difference in overall survival between glottic and supraglottic LSCC underline the importance of subsite-specific survival analysis. T-status and primary surgical management is essential only for glottic LSCC, emphasizing the importance of correct disease classification. Inferior outcomes in supraglottic LSCC are associated with old age, positive N-status, and improved follow-up routines are necessary. Primary tumor control is essential since recurrence impairs survival considerably in all subsites. The potential benefit of a primary surgical approach towards T3 LSCC awaits further investigation.
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Affiliation(s)
- Jesper Brandstorp-Boesen
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
- Department of Otorhinolaryngology, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- * E-mail:
| | - Ragnhild Sørum Falk
- Oslo Centre for Biostatistics and Epidemiology, Research Support Service, Oslo University Hospital, Oslo, Norway
| | - Morten Boysen
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
- Department of Otorhinolaryngology, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Kjell Brøndbo
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
- Department of Otorhinolaryngology, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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42
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Abstract
BACKGROUND Transoral laser microsurgery (TLM) is used to treat early and select cases of moderately advanced glottic cancer, with results equivalent to those of conventional conservative surgery and radiotherapy (RT). As surgeons and researchers become more experienced and familiar with TLM, they can focus on mechanisms to earlier detect local recurrence, to more effectively preserve laryngeal function. This study analyzed the predictors of local recurrence in glottic cancer patients who underwent TLM. METHODS Our study focused on 93 consecutive patients with glottic cancer who received TLM between 2003 and 2009, and were analyzed retrospectively. All of these patients were treated by the same surgeon. The local control and survival rate were calculated with Kaplan-Meier method and compared using the log-rank test. Additionally, the Cox proportional hazard model was used for multivariate analysis. RESULTS The 5-year local control, overall survival, and disease-specific survival rates were 87%, 95%, and 96%, respectively. The final laryngeal preservation rate was 98%. Independent predictors of local recurrence were arytenoid cartilage invasion (hazard ratio [HR], 6.5; 95% confidence interval [CI], 2.1-26.6), difficult laryngeal exposure (HR, 4.6; 95% CI, 1.5-17.3), previous microlaryngoscopic surgery (HR 3.1; 95% CI, 1.3-10.5), positive surgical margin (HR, 2.7; 95% CI, 1.1-9.7), and endophytic tumors (HR, 2.6; 95% CI, 1.1-7.6). CONCLUSION TLM is a reliable modality to treat early and select cases of moderately advanced glottic cancer with good final laryngeal preservation rate. Our study found that independent factors of local recurrence included arytenoid cartilage invasion, difficult laryngeal exposure, previous microlaryngoscopic surgery, positive surgical margin and endophytic tumors. These findings may help to follow-up glottic cancer patients after TLM.
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Affiliation(s)
- Chia-Fan Chang
- Department of Otolaryngology, Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Pen-Yuan Chu
- Department of Otolaryngology, Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
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43
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Ding C, Chun SG, Sumer BD, Nedzi LA, Abdulrahman RE, Yordy JS, Lee P, Hrycushko B, Solberg TD, Ahn C, Timmerman RD, Schwartz DL. Phantom-to-clinic development of hypofractionated stereotactic body radiotherapy for early-stage glottic laryngeal cancer. Med Dosim 2017; 42:90-96. [PMID: 28438431 DOI: 10.1016/j.meddos.2017.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 01/01/2017] [Accepted: 01/28/2017] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to commission and clinically test a robotic stereotactic delivery system (CyberKnife, Sunnyvale, CA) to treat early-stage glottic laryngeal cancer. We enrolled 15 patients with cTis-T2N0M0 carcinoma of the glottic larynx onto an institutional review board (IRB)-approved clinical trial. Stereotactic body radiotherapy (SBRT) plans prescribed 45 Gy/10 fractions to the involved hemilarynx. SBRT dosimetry was compared with (1) standard carotid-sparing laryngeal intensity-modulated radiation therapy (IMRT) and (2) selective hemilaryngeal IMRT. Our results demonstrate that SBRT plans improved sparing of the contralateral arytenoid (mean 20.0 Gy reduction, p <0.001), ipsilateral carotid Dmax (mean 20.6 Gy reduction, p <0.001), contralateral carotid Dmax (mean 28.1 Gy reduction, p <0.001), and thyroid Dmean (mean 15.0 Gy reduction, p <0.001) relative to carotid-sparing IMRT. SBRT also modestly improved dose sparing to the contralateral arytenoid (mean 4.8 Gy reduction, p = 0.13) and spinal cord Dmax (mean 4.9 Gy reduction, p = 0.015) relative to selective hemilaryngeal IMRT plans. This "phantom-to-clinic" feasibility study confirmed that hypofractionated SBRT treatment for early-stage laryngeal cancer can potentially spare dose to adjacent normal tissues relative to current IMRT standards. Clinical efficacy and toxicity correlates continue to be collected through an ongoing prospective trial.
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Affiliation(s)
- Chuxiong Ding
- Department of Radiation Oncology, Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Stephen G Chun
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Baran D Sumer
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lucien A Nedzi
- Department of Radiation Oncology, Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ramzi E Abdulrahman
- Department of Radiation Oncology, Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Pam Lee
- Department of Radiation Oncology, Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Brian Hrycushko
- Department of Radiation Oncology, Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Timothy D Solberg
- Department of Radiation Oncology, Abramson Comprehensive Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Chul Ahn
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Robert D Timmerman
- Department of Radiation Oncology, Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - David L Schwartz
- Department of Radiation Oncology, Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX.
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44
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Bertolin A, Lionello M, Salis G, Rizzotto G, Lucioni M. Two-stage CO 2-laser-assisted bilateral cordectomy for cT1b glottic carcinoma. Am J Otolaryngol 2017; 38:183-187. [PMID: 28153526 DOI: 10.1016/j.amjoto.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/17/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of the present paper was to investigate the oncological safety of two-stage bilateral cordectomy for the treatment of cT1b glottic SCC, and to compare its oncological outcome and synechia development rate with those of single-stage procedures. MATERIALS AND METHODS A retrospective cohort study was performed at the Otolaryngology Unit of Vittorio Veneto Laryngeal Cancer Center (Italy). The prognostic significance of clinical, pathological and surgical factors was also investigated, in terms of recurrence rate and disease-free survival, in a univariate statistical setting. RESULTS Our results indicate that patients treated with primary two-stage bilateral cordectomy achieved local control in 96% of cases, with 95% disease-specific and 88% overall survival rates, and a 95% organ preservation rate, with anterior synechiae developing in 1 case. Involvement of the deep surgical margins correlated with a worse prognosis. Patients developed anterior synechiae less frequently after two-stage bilateral cordectomy, and experienced no higher recurrence rate or shorter disease-free survival than patients treated with a single-stage procedure. CONCLUSIONS Two-stage bilateral cordectomy is a safe and effective procedure. In selected patients it could be considered the primary approach for the treatment of early glottic cT1b carcinomas.
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Affiliation(s)
- Andy Bertolin
- Otolaryngology Unit, Vittorio Veneto Hospital, Vittorio Veneto, via C. Forlanini 71, Treviso, Italy
| | - Marco Lionello
- Otolaryngology Unit, Vittorio Veneto Hospital, Vittorio Veneto, via C. Forlanini 71, Treviso, Italy.
| | - Gianni Salis
- Otolaryngology Unit, Vittorio Veneto Hospital, Vittorio Veneto, via C. Forlanini 71, Treviso, Italy; Otolaryngology Unit, Tempio Pausania Hospital, Tempio Pausania, via G. Deledda 19, Olbia-Tempio, Italy
| | - Giuseppe Rizzotto
- Otolaryngology Unit, Vittorio Veneto Hospital, Vittorio Veneto, via C. Forlanini 71, Treviso, Italy
| | - Marco Lucioni
- Otolaryngology Unit, Vittorio Veneto Hospital, Vittorio Veneto, via C. Forlanini 71, Treviso, Italy
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45
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Affiliation(s)
- Mohammad Kharazmi
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University SE-751 85 Uppsala, Sweden
- Department of Oral and Maxillofacial Surgery, Västmanland Hospital Västerås, SE-721 89 Västerås, Sweden
- CONTACT Mohammad Kharazmi, Section of Orthopaedics, Department of Surgical Sciences, Uppsala University SE-751 85 Uppsala, Sweden. E-mail:
| | - Håkan Scheer
- Department of Anaesthesiology and Intensive Care, Västmanland Hospital Västerås, SE-731 30 Västerås, Sweden
| | - Pär Hallberg
- Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
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46
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McNeil ML, Wilke DR, Taylor SM. Patient preferences in early glottic cancer treatment. Ear Nose Throat J 2016; 95:281-283. [PMID: 27434477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Patients with early-stage glottic cancer are primarily treated with one of three options: endoscopic laser excision, external-beam radiation, or open conservation surgery. We sought to determine patient preferences for treatment when presented with a choice between CO2 laser resection and radiation (open conservation surgery was not offered because the endoscopic approach is preferred at our institution). This prospective cohort study was conducted at the Dalhousie University Faculty of Medicine in Halifax, Canada. Our patient population was made up of 54 men and 10 women, aged 30 to 84 years (mean: 65.0 ± 11.2). Their disease were staged as follows: carcinoma in situ, n = 11; T1a = 21; T1b = 6; and T2 = 26. Patients were quoted identical cure rates for the two treatment modalities. The controversial issue of voice outcomes was discussed, but no leading information was given to the study cohort. All 64 patients chose CO2 laser resection as opposed to radiation therapy for definitive treatment.
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Affiliation(s)
- Michael L McNeil
- Corresponding author: Michael L. McNeil, MD, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University Faculty of Medicine, Suite 3044 Dickson Bldg., 5820 University Ave., Halifax, NS B3H 1V7, Canada. From the Division of Otolaryngology-Head and Neck Surgery, Department of Surgery (Dr. McNeil and Dr. Taylor), and the Department of Radiation Oncology (Dr. Wilke), Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
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47
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Abstract
Objectives: Polydimethylsiloxane (PDMS) particles are a nonresorbable material that allows for permanent vocal fold augmentation. This study investigated morbidity and voice quality in patients treated for unilateral vocal fold paralysis by injection of PDMS particles. Methods: Fourteen patients who had neurogenic unilateral vocal fold paralysis of different causes were included in this prospective study. Each patient underwent videostroboscopic assessment before and after operation. Friedrich's dysphonia index (DI), a score system combining subjective and objective parameters, was used to describe voice quality. A DI of 0 reflects a normal voice, and a DI of 3 stands for complete aphonia. The PDMS particles were injected into the paraglottic space by microlaryngoscopy under general anesthesia. Results: The median follow-up was 4.1 months. There was no complication attributable to the injection of PDMS particles. The mean DI was 2.8 before operation. After the operation, voice quality improved significantly in each patient, as reflected by a mean postinjection DI of 1.4. Conclusions: Particles of PDMS provide a relatively safe and minimally invasive option for permanent vocal fold augmentation. The functional results in terms of voice improvement are comparable to those obtained with other techniques, including thyroplasty. In the European Community, PDMS particles are officially approved for use in the human larynx.
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Affiliation(s)
- Christian Sittel
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany
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48
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Abstract
Management of glottal dysplasia can be difficult and often results in a suboptimal treatment outcome. The surgeon and patient must cooperatively balance decisions regarding the effects of possible malignancy, vocal dysfunction, and recurrences leading to multiple use of general anesthetics. A pilot study was done in 57 cases (36 patients and 97 vocal folds) without complication to evaluate the effectiveness of a 585-nm pulsed dye laser (PDL; 450-μs pulse width, 19 to 76-J/cm2 fluence, 1- to 2-mm spot size) in the treatment of vocal fold keratosis. Forty of the 57 cases had bilateral treatment. Phonomicrosurgical resection was done in 35 of the 57 cases after PDL treatment. Of this group, 10 cases were found to have hyperplasia, 21 dysplasia, 4 carcinoma in situ, and 1 carcinoma. One patient had phonomicrosurgical resection before PDL treatment. In 21 of the 57 cases, the disease was irradiated without resection (4 unilateral lesions and 17 bilateral lesions). Approximately 80% of the patients in this series had a greater than 70% reduction in the size of the lesion with the use of the PDL irrespective of whether they underwent resection. Clinical observation revealed no new anterior commissure web formation despite bilateral anterior commissure treatment in 28 of the 57 cases. The PDL enhanced the epithelial excision by improving hemostasis and by creating an optimal dissection plane between the basement membrane and the underlying superficial lamina propria. In this initial trial, the PDL provided relatively safe and effective treatment for glottal dysplasia. Analysis of patterns of recurrence will require longer follow-up.
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Affiliation(s)
- Ramon A Franco
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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49
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Abstract
Objectives: Posterior glottic stenosis (PGS) is a disabling disease commonly induced by endolaryngeal injury from intubation or surgery. Few experiments on PGS prevention, however, have been performed. The purpose of this study was to investigate the preventive effect of mitomycin C (MMC) on PGS in a randomized, controlled animal study. Methods: Twenty-six rabbits underwent laser injury of 6 W, continuous-focus mode on the posterior glottis. There were 6 uninjured controls. Thirteen animals were treated by a single topical use of 0.4 mg/mL MMC solution on the injured posterior glottis for 5 minutes, and 13 were sham-treated controls. The posterior glottis of all groups was blindly evaluated by telescopic examination under direct laryngoscopy 2 months after injury and was harvested for histologic analyses. Results: Scar, granulation tissue, and synechia formation of the posterior glottis were clearly induced by laser injury. Microscopic examination showed increased collagen content and fibroblast proliferation in the region. The use of MMC significantly decreased the incidence of such gross and microscopic changes of the posterior glottis (p < .05). Conclusions: This study suggests that topical MMC can be helpful in preventing the progression of PGS from mucosal injury of the posterior glottis.
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otolaryngology-Head and Neck Surgery, Cancer Research Institute, Chungnam National University College of Medicine, Daejeon, South Korea
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50
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Abstract
Objectives: This pilot study was designed to 1) identify predictors of difficult laryngeal exposure in obese patients, 2) develop strategies for efficient intubation and intraoperative visualization of the glottis, and 3) devise perioperative protocols for difficult laryngoscopies. Methods: We undertook a retrospective study over a 1-year period of 14 consecutive patients with a body mass index of more than 30 kg/m2 who underwent elective direct laryngoscopy under general anesthesia. Measurements of height, weight, neck circumference, Mallampati score, and Cormack-Lehane classification of the airway were recorded. Problems encountered during anesthesia induction and emergence were also noted. The laryngologist recorded on a visual analog scale the degree of difficulty encountered in obtaining a binocular stereoscopic view and magnification, illumination, and suspension. Results: Anatomic challenges during difficult laryngoscopy included decreased neck extension, redundant folds of tissue in the oropharynx and hypopharynx, and upper airway collapsibility. Overall, there was an association between the incidence of difficult laryngeal exposure and the Cormack-Lehane score (r = .57; p = .03), but the Mallampati score was of limited utility to the laryngologist. Neck size in female patients correlated with the Cormack-Lehane score (p = .02). Neither weight nor body mass index were predictive of a difficult laryngeal exposure. Straight blade laryngoscopes with a distal flange allowed greater depth of insertion and provided the best visualization of the glottis. Conclusions: An appropriate clinical examination may help predict a difficult airway. However, further studies are warranted to fully characterize the anatomic predictors of a difficult laryngeal exposure.
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Affiliation(s)
- Adrianna M Hekiert
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia 19104, USA
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