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Huang Z, Zhang X, Zhang Y, Cai H, Wang S, Zhuge L, An C, Li Z. Survival and long-term quality-of-life of concurrent chemoradiotherapy versus surgery followed by radiotherapy with or without concurrent chemotherapy for the treatment of resectable stage III/IV hypopharyngeal carcinoma. Asian J Surg 2023; 46:3693-3699. [PMID: 36624003 DOI: 10.1016/j.asjsur.2022.12.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/12/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE We evaluated the utility of concurrent chemoradiotherapy (CCRT) compared to surgery followed by adjuvant radiotherapy (with or without concurrent chemotherapy) (SRT) in terms of improving the life expectancy and quality-of-life (QOL) of patients with stage III/IV hypopharyngeal squamous cell carcinomas (HPSCCs). METHODS From January 2010 to July 2018, a total of 299 patients with stage III/IV HPSCC who received surgery followed by adjuvant radiotherapy (with or without concurrent chemotherapy) (SRT, n = 111), or concurrent chemoradiotherapy (CCRT, n = 188) in our hospital were included. We measured overall survival (OS) and disease-free survival (DFS). We used the EORTC QLQ-C30, QLQ-H&N35, and Voice handicap index-30 (VHI-30) instruments to assess the long-term QOL. RESULTS The OS and DFS afforded by SRT were significantly better than those associated with CCRT (p = 0.039; p = 0.048 respectively), especially for stage N2-N3 patients. CCRT patients experienced better speech outcomes. CONCLUSION For resectable stage III/IV HPSCC patients, appropriate treatment plans should be selected comprehensively considering survival rate, QOL, patient preference and multidisciplinary treatment.
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Affiliation(s)
- Zehao Huang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, PR China
| | - Xiwei Zhang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, PR China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, PR China
| | - Huizhu Cai
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, PR China
| | - Shixu Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, PR China
| | - Lingdun Zhuge
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, PR China
| | - Changming An
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, PR China.
| | - Zhengjiang Li
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, PR China.
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Rani S, Singh K, Banipal RPS, Goyal G. Biochemical analysis of saliva in head and neck cancer patients receiving definitive chemoradiotherapy. J Cancer Res Ther 2023; 19:S669-S676. [PMID: 38384037 DOI: 10.4103/jcrt.jcrt_692_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/25/2022] [Indexed: 02/23/2024]
Abstract
BACKGROUND Radiation therapy leads to salivary gland damage that causes xerostomia, the standard radiation-induced complication during radiotherapy that affects the quality of life in head and neck cancer patients. This study was conducted at a tertiary cancer institute in Punjab state to analyze the influence of radiation therapy on various parameters and substances of saliva. MATERIALS AND METHODS Sixty head and neck cancer patients who underwent conventional radiotherapy on a Cobalt machine were included. Saliva was collected in both stimulated and unstimulated states. Stimulated whole saliva was collected by applying two to three drops of citric acid solution (2%) over the dorsum of the tongue bilaterally at 30-s intervals for 2 min. Biochemical changes in the whole saliva were evaluated by biochemical methods at baseline, completion of therapy, and 3 and 6 months post-radiotherapy completion. RESULTS The lowest concentration of proteins was seen after the therapy in unstimulated and stimulated saliva. Salivary protein levels showed a rising trend toward baseline in 3- and 6-month posttherapy samples. The peak value (0.4 mg/dl) was reached in the stimulated saliva after therapy. Salivary amylase did not show a consistent concentration graph. The salivary concentrations of sodium, potassium, and chloride showed peak values after radiotherapy. The lowest salivary pH was obtained at completion of therapy, both in unstimulated and stimulated saliva. After 3 months of chemoradiotherapy, the saliva reached a pH value of 8.3, whereas 6-month posttherapy sample showed a pH value of 8.4 in both unstimulated and stimulated saliva. CONCLUSIONS At the completion of chemoradiotherapy, the total salivary protein, albumin, and inorganic components (calcium, magnesium, phosphorus) showed a downward trend from the baseline values due to the damage caused to the acinar part of the salivary gland by radiotherapy. The rise in salivary electrolytes' concentrations is attributed to the fact that even though there is loss of absorptive property of the tubular portion of the salivary gland, it retains its secretory property. Saliva becomes thick, scarce, tenacious, and acidic during the period of chemoradiotherapy.
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Affiliation(s)
- Savita Rani
- Department of Radiation Oncology, Guru Gobind Singh Medical College Hospital, Faridkot, Punjab, India
| | - Karuna Singh
- Department of Radiation Oncology, Advance Cancer Institute and Research Centre, Bathinda, Punjab, India
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Burr A, Harari P, Wieland A, Kimple R, Hartig G, Witek M. Patterns of failure for hypopharynx cancer patients treated with limited high-dose radiotherapy treatment volumes. Radiat Oncol J 2022; 40:225-231. [PMID: 36456541 PMCID: PMC9830040 DOI: 10.3857/roj.2022.00311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/20/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Optimal radiotherapy treatment volumes for patients with locally advanced hypopharynx squamous cell carcinoma should ensure maximal tumor coverage with minimal inclusion of normal surrounding structures. Here we evaluated the effectiveness of a direct 3-mm high-dose gross tumor volume to planning target volume expansion on clinical outcomes for hypopharynx cancers. MATERIALS AND METHODS We performed a retrospective analysis of patients with hypopharynx carcinoma treated between 2004 and 2018 with primary radiotherapy using a direct high-dose gross tumor volume to planning target volume expansion and with or without concurrent systemic therapy. Diagnostic imaging of recurrences was co-registered with the planning CT. Spatial and volumetric analyses of contoured recurrences were compared with planned isodose lines. Failures were initially defined as in field, marginal, elective nodal, and out of field. Each failure was further classified as central high-dose, peripheral high-dose, central intermediate/low-dose, peripheral intermediate/low-dose, and extraneous. Clinical outcomes were analyzed by Kaplan-Meier estimation. RESULTS Thirty-six patients were identified. At a median follow-up at 52.4 months, estimated 5-year overall survival was 59.3% (95% confidence interval [CI], 36.3%-74.1%), 5-year local and nodal control was 71.7% (95% CI, 47.1%-86.3%) and 69.9% (95% CI, 57.0%-82.6%), respectively. The most common failure was in the high-dose primary target volume. The gastrostomy tube retention rate at 1 year among patients without recurrence was 13.0% (95% CI, 3.2%-29.7%). CONCLUSION Minimal high-dose target volume expansions for hypopharynx cancers were associated with favorable locoregional control. This approach may enable therapy intensification to improve clinical outcomes.
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Affiliation(s)
- Adam Burr
- Department of Human Oncology, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Paul Harari
- Department of Human Oncology, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Aaron Wieland
- Division of Otolaryngology and Head and Neck Surgery, Department of Surgery, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Randall Kimple
- Department of Human Oncology, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gregory Hartig
- Division of Otolaryngology and Head and Neck Surgery, Department of Surgery, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matthew Witek
- Department of Human Oncology, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA,Correspondence: Matthew E. Witek Department of Human Oncology, University of Wisconsin – Madison, 600 Highland Avenue, K4/B100-0600, Madison, WI 53792, USA. Tel: +1-608-263-8500 E-mail:
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Oxaliplatin Induces Immunogenic Cell Death in Human and Murine Laryngeal Cancer. JOURNAL OF ONCOLOGY 2022; 2022:3760766. [PMID: 36131787 PMCID: PMC9484908 DOI: 10.1155/2022/3760766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
Background Cisplatin resistance is observed in patients with laryngeal cancer. The present study was designed to explore the efficacy of oxaliplatin on laryngeal cancer and elucidate the underlying mechanisms. Methods Cell viability was determined by using MTT assays. Cell apoptosis was determined by using annexin V and propidium iodide (PI) staining. Flow cytometry and immunofluorescence were applied to determine the levels of calreticulin (CALR) and DiD (1,1-dioctadecyl-3,3,3,3-tetramethylindodicarbocyanine). Flow cytometry was applied to analyze the levels of CD83, CD86, IFN-γ-producing CD8+ T cells, and CD4+CD25+FoxP3+ Tregs. The levels of adenosine triphosphate (ATP) were determined by using a chemiluminescent ATP kit and cytokines were determined by using specific enzyme-linked immunosorbent assays (ELISAs). The levels of HMGB1 were determined by using Western blot and ELISA, respectively. The xenograft animal model was constructed to evaluate the antitumor effects of oxaliplatin. Results Oxaliplatin inhibited cell growth, promoted cell apoptosis, and induced the levels of CALR, ATP, and high mobility group box protein 1 (HMGB1) in Hep-2 cells. Oxaliplatin-treated Hep-2 cells increased the intensity of DiD and the levels of CD83 and CD86 in dendritic cells (DCs), as well as induced the supernatant IL-6 and TNF-α. Oxaliplatin-treated primary laryngeal cancer cell-pulsed DCs increased the IFN-γ-producing CD8+ T cells and suppressed CD4+CD25+FoxP3+ Tregs. In vivo data showed that oxaliplatin suppressed tumor growth and increased the populations of CD86+CD80+ and CD8+CD45+ cells in the tumor tissues. Conclusion Treatment with oxaliplatin inhibited laryngeal cancer cells by inducing immunogenic cell death.
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Kayani Z, Islami N, Behzadpour N, Zahraie N, Imanlou S, Tamaddon P, Salehi F, Daneshvar F, Perota G, Sorati E, Mohammadi S, Sattarahmady N. Combating cancer by utilizing noble metallic nanostructures in combination with laser photothermal and X-ray radiotherapy. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Finegersh A, Voora RS, Panuganti B, Faraji F, Holsinger FC, Brumund KT, Coffey C, Califano J, Orosco RK. Robotic surgery may improve overall survival for T1 and T2 tumors of the hypopharynx: An NCDB cohort study. Oral Oncol 2021; 121:105440. [PMID: 34329867 DOI: 10.1016/j.oraloncology.2021.105440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/08/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hypopharyngeal cancer is associated with poor survival. Robotic surgery is emerging as a treatment for hypopharyngeal tumors, but no rigorous data are available to assess its effect on survival. METHODS The National Cancer Database (NCDB) was used to identify patients with T1 and T2 hypopharyngeal tumors undergoing robotic surgery, laser surgery, and primary radiation with or without chemotherapy from 2010 to 2016. All adult patients with available staging and no distant metastasis were included. RESULTS We compared 57 patients undergoing robotic surgery, 236 undergoing laser surgery, and 5,742 undergoing primary radiation. Compared to laser surgery, patients undergoing robotic surgery were significantly more likely to have negative margins, neck dissection, lower incomes, and care at an academic center. Rates of robotic surgery also significantly increased from 2010 to 2015. After multivariate regression, robotic surgery was associated with significantly improved overall survival compared to laser surgery and primary radiation. CONCLUSION Robotic surgery improves overall survival for T1 and T2 hypopharyngeal tumors compared to laser surgery and primary radiation in this NCDB cohort. This effect may be mediated by decreased positive margin rates relative to laser surgery. Rates of hypopharyngeal robotic surgery are expected to increase with wider adoption of robotic platforms and may improve overall survival rates for hypopharyngeal cancer.
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Affiliation(s)
- Andrey Finegersh
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Rohith S Voora
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Bharat Panuganti
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Farhoud Faraji
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA
| | | | - Kevin T Brumund
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA; Division of Otolaryngology, Department of Surgery, VA San Diego Health System, La Jolla, CA, USA; Moores Cancer Center, La Jolla, CA, USA
| | - Charles Coffey
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA; Division of Otolaryngology, Department of Surgery, VA San Diego Health System, La Jolla, CA, USA; Moores Cancer Center, La Jolla, CA, USA
| | - Joseph Califano
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA; Moores Cancer Center, La Jolla, CA, USA
| | - Ryan K Orosco
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA; Moores Cancer Center, La Jolla, CA, USA.
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Bora B, Selin Ü. Carcinoma of the posterior wall of the hypopharynx: surgical treatment with larynx preservation. Braz J Otorhinolaryngol 2020; 88:174-180. [PMID: 32595079 PMCID: PMC9422742 DOI: 10.1016/j.bjorl.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/01/2020] [Accepted: 05/18/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Posterior pharyngeal wall is the most rare subsite for hypopharyngeal carcinomas. Because of its rarity, there are few studies published in the literature specifically concerning posterior pharyngeal wall carcinoma. Objectives To report our functional results in patients with the carcinoma of the posterior wall of the hypopharynx after surgical treatment by resection via a lateral or infrahyoid pharyngotomy approach, with the preservation of the larynx and reconstruction with a radial forearm free flap. Methods The study included 10 patients who underwent surgery for a carcinoma of the posterior wall of the hypopharynx over a 6 year period. The associated postoperative morbidity was investigated and functional results were analyzed. Results Nine patients had T3 lesions and one patient had a T2 lesion. The preferred approach to access the hypopharynx was a lateral pharyngotomy in 5 patients and lateral pharyngotomy combined with infrahyoid pharyngotomy in 5 patients with superior extension to oropharynx. The pharyngeal defects were reconstructed successfully with radial forearm free flaps. Four patients received adjuvant radiotherapy only, and 4 patients with N2b and N2c neck diseases received adjuvant chemoradiotherapy. The mean duration of hospitalization was 15.6 days (range, 10–21 days). All patients achieved oral intake in a median time of 74 days (range, 15–180). Decannulation was achieved in all patients and the median time for decannulation was 90 (range, 21–300 days). The mean followup duration was 38.3 months (range, 10–71 months) and 8 patients survived. One patient died due to regional recurrence in the retropharyngeal lymph nodes and 1 patient died due to systemic metastasis. Conclusion Primary surgery is still a very effective treatment modality for the carcinoma of the posterior wall of the hypopharynx and does not permanently compromise the swallowing and laryngeal functions if pharyngeal reconstruction is performed with a free flap.
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Affiliation(s)
- Başaran Bora
- Istanbul University, Faculty of Medicine, Department of Otolaryngology, Istanbul, Turkey
| | - Ünsaler Selin
- Koç University, School of Medicine, Department of Otolaryngology, Istanbul, Turkey.
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8
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Cui J, Wang L, Piao J, Huang H, Chen W, Chen Z, Yang H, Tan X, Li J, Liu G. Initial surgical versus non-surgical treatments for advanced hypopharyngeal cancer: A meta-analysis with trial sequential analysis. Int J Surg 2020; 82:249-259. [PMID: 32422386 DOI: 10.1016/j.ijsu.2020.04.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is no consensus on whether initial surgical or non-surgical treatments should be the standard treatment pattern for advanced hypopharyngeal cancer. The aim of the meta-analysis was systematically and quantitatively compare the relative efficacy between initial surgical and non-surgical therapies in patients with advanced-stage hypopharyngeal carcinoma. METHODS A comprehensive search was performed in PubMed, the ISI Web of Knowledge, the Cochrane Library, and Embase databases from inception to April 10, 2019. Citation screening, data abstraction and quality assessment were performed in duplicate. Meta-analysis with trial sequential analysis (TSA) was used to assess the primary and secondary outcomes. Besides, we used the Grading of Recommendations Assessment Development and Evaluation (GRADE) to evaluate the certainty of the body of evidence. RESULTS A total of 17 trials was appraised with 2539 patients that complied with inclusion and exclusion criterion. Pooled analyses indicated patients receiving primary surgical and non-surgical therapy did not significantly differ in overall survival (OS) (relative risk [RR] = 1.04, 95% confidence interval [CI] = 0.94 to 1.15), with TSA inconclusive. Additionally, patients treated with primary surgical experienced an increased disease free survival (DFS) probability compared with non-surgical treatment (RR 1.20, 95% CI = 1.05 to1.37), while TSA is inconclusive. Notably, non-surgical management did have a beneficial efficacy on larynx preservation (RR 0.48, 95% CI = 0.33 to 0.70), and TSA also provided conclusive evidence. GRADE indicated the level of evidence was low or very low for primary or secondary outcomes. CONCLUSION The results of our meta-analysis indicated when compared to surgical treatments, non-surgical therapy for patients with advanced hypopharyngeal carcinoma appears to have equivalent efficacy, and it offers an opportunity to preserve laryngeal function. Due to inconclusive evidence by TSA, further investigation with large randomized clinical trials (RCTs) using modern approaches should be undertaken to verify the results of this meta-analysis. TRIAL REGISTRATION PROSPERO registration number: CRD42018118563. Registered on December 19, 2018.
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Affiliation(s)
- Jie Cui
- Department of Head and Neck Surgical, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong Province, PR China.
| | - Liping Wang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, 570102, Hainan Province, PR China.
| | - Jinsong Piao
- Department of Pathology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong Province, PR China.
| | - Haiyan Huang
- Department of Head and Neck Surgical, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong Province, PR China.
| | - Weiquan Chen
- Department of Head and Neck Surgical, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong Province, PR China.
| | - Zhen Chen
- Department of Intensive Care Unit, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, 528308, Guangdong Province, PR China.
| | - Hong Yang
- Department of Head and Neck Surgical, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong Province, PR China.
| | - Xiaojun Tan
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, 570102, Hainan Province, PR China.
| | - Jiansheng Li
- Department of Radiology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong Province, PR China.
| | - Genglong Liu
- Department of Pathology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong Province, PR China.
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Susko MS, Lazar AA, Dhar S, Chan JW, Shiao SL, Chapman CH, Johnson J, Quivey JM, Ryan WR, Heaton CM, Ha PK, Yom SS. Improved Tumor Control Related to Radiotherapy Technological Development for Hypopharyngeal Cancer. Laryngoscope 2020; 131:E452-E458. [PMID: 32396214 DOI: 10.1002/lary.28726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES/HYPOTHESIS Squamous cell carcinoma of the hypopharynx (SCCHP) is associated with worse survival compared to other head and neck subsites. This report quantifies the impact of technological improvements in radiotherapy (RT) on outcomes over 6 decades. METHODS Patients with SCCHP receiving curative-intent treatment between 1962 and 2015 were retrospectively reviewed. Kaplan-Meier analyses of freedom from local recurrence (FFLR), progression-free survival (PFS), and overall survival (OS) were compared across treatment eras and radiation techniques. Multivariable Cox proportional hazards modeling was performed to specify the effect of RT technique. RESULTS One hundred thirty-four patients had a median follow-up of 17 months (IQR = 9-38). There were no differences in staging or use of surgery over time, but use of chemotherapy concurrent with RT increased (P < .001) beginning in the 2000s. The 24-month FFLR using two-dimensional RT (2D-RT), three-dimensional conformal RT (3D-CRT), and intensity-modulated RT (IMRT) was 52%, 55%, and 80%, respectively; 24-month PFS was 39%, 46%, and 73%, respectively; and 24-month OS was 27%, 40%, and 68%, respectively. OS (P = .01), PFS (P = .03), and FFLR (P = 0.02) were improved with IMRT over 2D-RT, and FFLR appeared to be improved over 3D-CRT (P = .06). Controlling for chemotherapy use and other major variables, IMRT produced a strong influence over FFLR (adjusted hazard ratio [HR] = 0.2, 95% confidence interval [CI]: 0.0-1.2, P = .08) and a benefit in OS (adjusted HR = 0.1, 95% CI: 0.0-0.4, P = .005). CONCLUSIONS Across 6 decades, patient and tumor characteristics remained similar whereas use of chemoradiation increased and IMRT was adopted. The introduction of IMRT was associated with improved FFLR, PFS, and OS, and a reduction in acute toxicity as compared to earlier radiation technologies. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E452-E458, 2021.
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Affiliation(s)
- Matthew S Susko
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Ann A Lazar
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Shwena Dhar
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Jason W Chan
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Stephen L Shiao
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California.,Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Christopher H Chapman
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California.,Department of Radiation Oncology, Kaiser Permanente, Dublin, California, U.S.A
| | - Julian Johnson
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California.,Spectrum Healthcare Partners, Portland, Maine, U.S.A
| | - Jeanne M Quivey
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Chase M Heaton
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
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Lane C, Rabbani R, Linton J, Taylor SM, Viallet N. Systematic review and meta-analysis of transoral laser microsurgery in hypopharyngeal carcinoma. Laryngoscope Investig Otolaryngol 2020; 5:66-73. [PMID: 32128432 PMCID: PMC7042655 DOI: 10.1002/lio2.351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/15/2019] [Accepted: 12/31/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transoral laser microsurgery has been suggested as an alternative treatment modality for hypopharyngeal carcinoma. The purpose of this study is to systematically review the oncologic and functional outcomes of patients with hypopharyngeal carcinoma when treated with primary transoral laser microsurgery. METHODS A comprehensive literature search was performed using PRISMA methodology on OVID MEDLINE and EMBASE. Meta-analysis was completed for oncological outcomes. RESULTS Six studies reported quality of life outcomes five reported oncologic outcomes. A median of 95% (range 0.83-0.98) patients achieving gastrostomy independence, a median of 3% (range 0%-6%) were tracheostomy dependent, and a median of 97% (Range 0.89-1.0) were able to preserve their larynx. Pooled five-year overall survival was 54% (CI, 0.50-0.58, I2 = 29%), pooled disease-specific survival was 72% (CI, 0.68-0.77, I2 = 46%), and pooled local control rate was 78% (CI, 0.72-0.85, I2 = 69%). CONCLUSION Systematic review supports improvements in functional outcomes and oncologic outcomes with transoral laser microsurgery.
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Affiliation(s)
- Ciaran Lane
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of ManitobaWinnipegCanada
| | - Rasheda Rabbani
- George & Fay Yee Center for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Janice Linton
- Neil John Maclean Health SciencesUniversity of Manitoba LibrariesWinnipegManitobaCanada
| | - S. Mark Taylor
- Division of Otolaryngology‐Head and Neck SurgeryDalhousie UniversityHalifax Regional MunicipalityNova ScotiaCanada
| | - Norbert Viallet
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of ManitobaWinnipegCanada
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Vengaloor Thomas T, Nittala MR, Bhanat E, Albert AA, Vijayakumar S. Management of Advanced-stage Hypopharyngeal Carcinoma: 25-Year Experience from a Tertiary Care Medical Center. Cureus 2020; 12:e6679. [PMID: 32104619 PMCID: PMC7026862 DOI: 10.7759/cureus.6679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction Due to conflicting data in the literature, there is a continuing debate on whether advanced hypopharyngeal carcinoma patients should be treated with definitive surgery or chemoradiotherapy. The purpose of this study is to evaluate the management and outcomes of advanced hypopharyngeal carcinoma in a tertiary care institution over the last 25 years. Methods An Institutional Review Board (IRB)-approved and HIPPA-compliant retrospective analysis was performed of patients with advanced-stage squamous cell carcinoma of the hypopharynx treated at our institution between January 1994 and December 2018. Data regarding demographics, stage, treatment, and follow-up were collected. Outcomes including median survival and overall survival were calculated using the Kaplan Meier method. All analyses were performed using SPSS v. 24. Results This study included a total of 103 advanced stage hypopharyngeal cancer patients. The median age for this cohort is 61 years (range: 41-88, SD 9.3). Of the total 103 eligible patients treated, 92 (89.3%) were male and 11 (10.7%) female; 61 (59.2%) were African Americans, 39 (37.9%) were Caucasians and three (2.9%) were other races. Seventeen patients (16.5%) had stage III disease, whereas 86 (83.5%) patients were diagnosed with Stage IV A or B disease. Seventy-two patients (69.9%) were treated with definitive chemoradiotherapy (ChemoRT group), and 31 patients (30.1%) underwent primary surgery with or without adjuvant treatments (Surgery group). The two treatment groups were similar in terms of age, gender, ethnicity, alcohol status, N staging, and subsites but were significantly different for smoking status (p = 0.035) and T staging (p = 0.024). The median follow-up was 17 months. The median survival of the overall cohort was 26 months, and five-year overall survival was 25.5%. The median survival was found to be significantly better for the surgery group as compared to the definitive chemoradiotherapy group (43 months vs 16 months, p = 0.049). The five-year overall survival (OS; 41.5% vs 18.5%, p = 0.049) and disease-free survival (DFS; 75.3% vs 56%; p = 0.029) were significantly better for patients in the surgery group compared to the chemoradiotherapy group. On multivariate Cox-regression analysis, lymph nodal status (HR = 1.27, CI: 1.00-1.62, p = 0.047) and chemoradiation treatment (HR = 1.82, CI: 1.00-3.29, p = 0.048) were associated with higher risk of mortality. Conclusion In our single institutional experience of advanced hypopharyngeal carcinoma management, the five-year overall survival rate was found to be 25.5 % and was the poorest among head and neck cancers. The patients with advanced hypopharyngeal cancer treated with surgery followed by adjuvant radiation or chemoradiation have significantly improved overall survival compared to those treated with definitive chemoradiotherapy. Further research warranted for early detection and better treatment to improve the cure rate in hypopharyngeal carcinoma patients.
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Affiliation(s)
| | - Mary R Nittala
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Eldrin Bhanat
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Ashley A Albert
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
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12
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Kwon DI, Miles BA. Hypopharyngeal carcinoma: Do you know your guidelines? Head Neck 2018; 41:569-576. [DOI: 10.1002/hed.24752] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Daniel I. Kwon
- Department of Otolaryngology-Head and Neck Surgery; Loma Linda University Health; Loma Linda California
| | - Brett A. Miles
- Department of Otolaryngology-Head and Neck Surgery; Icahn School of Medicine at Mount Sinai; New York New York
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13
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Xu X, Liu H, Gross N, Wei D, Qian Y, Li W, Wei P, Li G, Zhang F, Yang Z, Lei D, Pan X. Overexpression of miRNA 4451 is Associated With a Poor Survival of Patients With Hypopharyngeal Cancer After Surgery With Postoperative Radiotherapy. Transl Oncol 2018; 11:1244-1250. [PMID: 30103154 PMCID: PMC6091437 DOI: 10.1016/j.tranon.2018.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/24/2018] [Accepted: 07/30/2018] [Indexed: 12/30/2022] Open
Abstract
Hypopharyngeal cancer (HC) is the most common subset of head and neck cancers. These tumors often have an aggressive clinical outcome characterized by local invasion and regional nodal metastasis. Upregulated miRNAs might be useful as biomarkers for prognosis and molecular targets for these tumors. We determined tumor expression of candidate miRNAs using microarray in 8 HC patients and validated in 372 HC patients. We also used paired tumorous and mucosal tissue to verify the miRNA expression. Log-rank test and Cox model were used to evaluate the survival; and Harrell's C-index was used to compare concordance of Cox models. Our results indicated 7 miRNAs aberrantly expressed in HC. Three of these candidate miRNAs (miRNA-4415, miRNA-200a, and miRNA-30b) were selected for further qRT-PCR validation and all of them were frequently found upregulated in HC tumors; with miR-4451 being the most differentially expressed. Moreover, high expression of miR-4451 was positively correlated with advanced tumor stage and increased mortality risk (HR: 1.6, 95% CI: 1.2-2.3; adjusted HR: 1.5, adjusted 95% CI: 1.1-2.1). Finally, significantly higher expression of miR-4451 in tumors compared to in fresh adjacent normal tissues indicates an oncogenic role of miR-4451 in this tumor. Upregulated miR-4451 in HC samples were frequently found and is significantly associated with advanced stage and poor survival of HC, which may indicate an association of this miRNA with the carcinogenesis process in this tumor site; and they could serve as a prognostic biomarker as well as help develop potential new targets for therapy.
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Affiliation(s)
- Xinbo Xu
- Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, China; NHC Key Laboratory of Otorhinolaryngology, Chinese Ministry of Health, Jinan, Shandong, China
| | - Heng Liu
- Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, China; NHC Key Laboratory of Otorhinolaryngology, Chinese Ministry of Health, Jinan, Shandong, China
| | - Neil Gross
- Department of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX
| | - Dongmin Wei
- Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, China; NHC Key Laboratory of Otorhinolaryngology, Chinese Ministry of Health, Jinan, Shandong, China
| | - Ye Qian
- Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, China; NHC Key Laboratory of Otorhinolaryngology, Chinese Ministry of Health, Jinan, Shandong, China
| | - Wenming Li
- Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, China; NHC Key Laboratory of Otorhinolaryngology, Chinese Ministry of Health, Jinan, Shandong, China
| | - Peng Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Guojun Li
- Department of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Fenghua Zhang
- Thyroid and Breast Surgery Department, Hebei General Hospital, Hebei, China.
| | - Zheng Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otolaryngology, Beijing, 100730, China
| | - Dapeng Lei
- Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, China; NHC Key Laboratory of Otorhinolaryngology, Chinese Ministry of Health, Jinan, Shandong, China
| | - Xinliang Pan
- Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, China; NHC Key Laboratory of Otorhinolaryngology, Chinese Ministry of Health, Jinan, Shandong, China.
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14
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Gao P, Gong L, Wang X. Induction chemotherapy in patients with resectable laryngeal cancer: A meta-analysis. Mol Clin Oncol 2018; 9:155-162. [PMID: 30101013 PMCID: PMC6083427 DOI: 10.3892/mco.2018.1645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/06/2018] [Indexed: 01/18/2023] Open
Abstract
Head and neck squamous cell carcinoma (SCC) ranks 6th among the most frequently diagnosed carcinomas globally. Laryngeal carcinoma is quite common, and 95% of the cases are SCCs. Since the introduction of larynx-preserving surgery, induction chemotherapy (IC) has played a substantial role. The aim of IC is to shrink or downstage primary laryngeal carcinomas, increasing the chances of complete surgical removal, particularly in cases with advanced but potentially resectable lesions. The aim of the present study was to investigate the value of IC in patients with resectable laryngeal cancer. A meta-analysis was performed of randomized controlled trials (1985-2017) investigating the effect of IC on survival, disease control, larynx-preserving surgery and disease-free survival. Engauge-Digitizer software was used to construct Kaplan-Meier curves and RevMan software was used for the analysis of the data. A total of 12 trials (4,320 patients) were included. There was no significant difference in local recurrence or locoregional control between patients receiving and those not receiving IC (P>0.05). However, the experimental group (IC) exhibited a lower propensity for distant metastasis by 11.7% (95% confidence interval: 10.3-13.3%, P=0.02) compared with the control group (no IC). Among patients with laryngeal cancer, larynx preservation was possible in those who responded well to IC, without a significant decrease in survival compared with radical surgery (P<0.05). Taking into consideration these findings, IC confers an advantage in terms of lowering the risk of distant metastasis in patients with resectable laryngeal carcinoma, and enables laryngeal preservation in responders. Moreover, IC increases the overall survival rate in patients with locally advanced but resectable LC.
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Affiliation(s)
- Pei Gao
- Department of Otolaryngology, Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Liang Gong
- Department of Otolaryngology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Xuefeng Wang
- Department of Otolaryngology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P.R. China
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15
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Management of advanced hypopharyngeal carcinoma: systematic review of survival following surgical and non-surgical treatments. The Journal of Laryngology & Otology 2018; 132:385-400. [PMID: 29891019 DOI: 10.1017/s0022215118000555] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Advanced hypopharyngeal carcinoma has a dismal prognosis. The optimal treatment for these patients remains under debate. This systematic review aimed to compare survival following surgical and non-surgical treatments. METHODS A systematic review was conducted of randomised studies, with a descriptive analysis of retrospective observational studies. RESULTS Two randomised trials and 11 observational studies were included in the review. A meta-analysis of randomised trials reported a hazard ratio of 0.89 for overall survival in favour of surgical treatment (p = 0.44). Neither treatment was favoured in terms of overall survival. Observational studies did not report a survival advantage with either treatment. The five-year larynx preservation rates for non-surgically treated patients were between 38 and 58 percent. CONCLUSION Chemoradiotherapy offers similar survivorship compared to surgery in advanced disease, while also making larynx preservation feasible. It can be used as a treatment in all patients as an alternative to surgery.
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16
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Petersen JF, Timmermans AJ, van Dijk BAC, Overbeek LIH, Smit LA, Hilgers FJM, Stuiver MM, van den Brekel MWM. Trends in treatment, incidence and survival of hypopharynx cancer: a 20-year population-based study in the Netherlands. Eur Arch Otorhinolaryngol 2017; 275:181-189. [PMID: 29080963 PMCID: PMC5754418 DOI: 10.1007/s00405-017-4766-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 10/04/2017] [Indexed: 11/30/2022]
Abstract
Hypopharynx cancer has the worst prognosis of all head and neck squamous cell cancers. Since the 1990s, a treatment shift has appeared from a total laryngectomy towards organ preservation therapies. Large randomized trials evaluating treatment strategies for hypopharynx cancer, however, remain scarce, and frequently this malignancy is evaluated together with larynx cancer. Therefore, our aim was to determine trends in incidence, treatment and survival of hypopharynx cancer. We performed a population-based cohort study including all patients diagnosed with T1–T4 hypopharynx cancer between 1991 and 2010 in the Netherlands. Patients were recorded by the national cancer registry database and verified by a national pathology database. 2999 patients were identified. The incidence increased significantly with 4.1% per year until 1997 and decreased non-significantly afterwards. For women, the incidence increased with 1.7% per year during the entire study period. Total laryngectomy as primary treatment significantly decreased, whereas radiotherapy and chemoradiation increased. The 5-year overall survival significantly increased from 28% in 1991–2000 to 34% in 2001–2010. Overall survival for T3 was equal for total laryngectomy and (chemo)radiotherapy, but for T4-patients the survival was significantly better after primary total laryngectomy (± adjuvant radiotherapy). This large population-based study demonstrates a shift in treatment preference towards organ preservation therapies. The 5-year overall survival increased significantly in the second decade. The assumed equivalence of organ preservation and laryngectomy may require reconsideration for T4 disease.
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Affiliation(s)
- Japke F Petersen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Adriana J Timmermans
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Boukje A C van Dijk
- Department of Research, Comprehensive Cancer Organization The Netherlands (IKNL), Utrecht, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lucy I H Overbeek
- PALGA (The Dutch Nationwide Network and Registry of Histopathology and Cytopathology), Houten, The Netherlands
| | - Laura A Smit
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frans J M Hilgers
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Institute of Phonetic Sciences-Amsterdam Center of Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn M Stuiver
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Clinical Epidemiology Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Institute of Phonetic Sciences-Amsterdam Center of Language and Communication, University of Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
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17
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Tsou YA, Lin MH, Hua CH, Tseng HC, Chen SW, Yang SN, Liang JA, Tsai MH. Survival outcome by early chemoradiation therapy salvage or early surgical salvage for the treatment of hypopharyngeal cancer. Otolaryngol Head Neck Surg 2016; 137:711-6. [PMID: 17967633 DOI: 10.1016/j.otohns.2007.07.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2007] [Revised: 06/04/2007] [Accepted: 07/16/2007] [Indexed: 11/20/2022]
Abstract
Objective To compare survival data between patients who had surgery followed by concomitant chemoradiation therapy (CCRT) versus CCRT followed by early surgical salvage. Study Design Retrospective study. Methods We retrospectively analyzed 202 patients with hypopharyngeal carcinoma (HPC) who were treated with different treatment strategy according to the choice of the patients by surgery first or CCRT first. In 72 (35.6%) cases, the primary treatment was surgery. Postoperative radiation therapy was given to 47 patients. Radiation therapy was the primary treatment in 130 (64.4%) patients; among them, 69 (34.2%) patients received salvage surgery within 2 months after CCRT course if there was a residual tumor visible on post-CCRT CT image or clinically residual tumor. Results and Conclusion The 5-year disease-specific survival rate was 80% for stage I-II, 44.8% for stage III, and 14.3% for stage IV disease. Surgery plus concomitant chemoradiotherapy led to a better survival rate than CCRT plus salvage surgery in patients with stage III-IV HPC.
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Affiliation(s)
- Yung-An Tsou
- Department of Otolaryngology, China Medical University Hospital, Taichung, Taiwan, ROC
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18
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Reis I, Aguiar A, Alzamora C, Ferreira C, Castro V, Soares A, Lobão M. Locally advanced hypopharyngeal squamous cell carcinoma: single-institution outcomes in a cohort of patients curatively treated either with or without larynx preservation. Radiol Bras 2016; 49:21-5. [PMID: 26929457 PMCID: PMC4770393 DOI: 10.1590/0100-3984.2015.0018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Objective The present study was aimed at describing a single-institution experience in
the curative treatment of patients diagnosed with locally advanced
hypopharyngeal squamous cell carcinoma. Materials and Methods Data concerning all patients treated for locally advanced hypopharyngeal
squamous cell carcinoma between January 2006 and June 2012 were
reviewed. Results A total of 144 patients were included in the present study. The median
follow-up period was 36.6 months. Median survival was 26 months, and 2-year
and 5-year overall survival rates were, 51% and 30.5%, respectively. Median
recurrence-free survival was 18 months and 2-year and 5-year recurrence-free
survival rates were 42.8% and 28.5%, respectively. Conclusion The outcomes in the present series are in line with the literature.
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Affiliation(s)
- Isabel Reis
- MDs, Radiation Oncologists, Radiation Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Artur Aguiar
- MDs, Radiation Oncologists, Radiation Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Cristiana Alzamora
- MDs, Radiation Oncology Residents, Radiation Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Carolina Ferreira
- MDs, Radiation Oncology Residents, Radiation Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Vera Castro
- MDs, Radiation Oncologists, Radiation Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - André Soares
- MDs, Radiation Oncologists, Radiation Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Marisa Lobão
- MDs, Radiation Oncologists, Radiation Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
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Laryngeal preservation in ENT oncology. Retrospective series of 246 patients managed in the Caen University Hospital and François Baclesse Cancer Care Center between 1998 and 2008. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:129-34. [PMID: 25838235 DOI: 10.1016/j.anorl.2015.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES A 10-year retrospective study investigated factors for survival and laryngeal preservation in advanced laryngeal, hypopharyngeal or epilaryngeal neoplasia. MATERIAL AND METHOD Two hundred and forty-six patients with advanced cancer of the larynx (17.48%), hypopharynx (48.78%) or epilarynx (33.74%) undergoing primary organ-sparing treatment were included from 1998 to 2008. Treatment comprised chemotherapy followed by radiation therapy for 92.68% of patients, isolated radiation therapy for 1.6% and concomitant or sequential radiation-chemotherapy for 5.7%. General health status, history and tumor status were recorded. Factors influencing survival were analyzed by Kaplan-Meier estimator, log-rank test and Cox models. RESULTS Median overall survival of the population was 2.3 years and median laryngeal preservation 0.99 years in male patients and 2 years in female patients. Survival correlated significantly with body mass index (BMI; P=0.0004), WHO performance status (P=0.0064), alcohol consumption (P=0.0004) and cessation (P<0.0001) and also T stage (P=0.0038), initial laryngeal mobility (P=0.0002) and post-chemotherapy assessment (P<0.0001). Survival with functional larynx correlated with baseline BMI at first consultation (P=0.016), baseline WHO grade (P=0.0005), laryngeal mobility (P<0.0001), T staging (P=0.0009), and T and/or N chemotherapy response to a classical organ preservation protocol (P<0.0001). CONCLUSION Over and above established criteria, the present study highlighted the importance of general health and nutritional status during treatment.
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20
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Pyriform sinus squamous cell carcinoma: oncological outcomes in good responders of induction chemotherapy-based larynx preservation protocols. Eur Arch Otorhinolaryngol 2014; 272:1725-31. [PMID: 24854231 DOI: 10.1007/s00405-014-3081-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
Abstract
Induction chemotherapy-based larynx preservation protocols use chemotherapy to select exclusively patients with 'chemosensitive' tumors for a nonsurgical treatment with radiation therapy. This study on pyriform sinus squamous cell carcinoma (SCC) is interested in the oncological outcome of treatment based on radiation therapy when offered to patients with tumors responding to induction chemotherapy. This was a retrospective cohort study. The cohort included good responders to induction chemotherapy, subsequently treated with definite radiation therapy (with or without concomitant chemotherapy) for pyriform sinus SCC, in a tertiary referral cancer center. The primary endpoints were overall, laryngectomy-free and disease-free survival and the secondary endpoints were analysis of treatment failures and possibilities of salvage treatment. Forty-two patients fulfilled the inclusion criteria and were retained for analysis; 7% were stage II (3/42), 48% stage III (20/42) and 45% stage IV (19/42). At 1, 3 and 5 years, the overall survival was 95% (40/42), 74% (31/42), and 60% (SE ≈ 0.08), respectively. For the same intervals, the laryngectomy-free survival was 90% (38/42), 69% (29/42) and 50% (SE ≈ 0.08), respectively. The estimated 5-year disease-free survival was also 50%. Disease-free survival was significantly better for N0 patients. There was a 28% recurrence rate, mainly in the primary tumor site (9/11), with or without simultaneous nodal recurrence. Interestingly, more than one-third of all oncologic failures occurred beyond the first 3 years of follow-up. Salvage treatment was not possible or definitely inefficient in at least 2/3 of all recurrences. In candidates for larynx preservation for a pyriform sinus SCC, good response to induction chemotherapy followed by definite radiation therapy seems to be associated with a more favorable prognosis. Nevertheless, in case of locoregional recurrence the possibilities for efficient salvage treatment are limited.
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21
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Mehta PS, Harrison LB. Function and organ preservation in adult cancers of the head and neck. Expert Rev Anticancer Ther 2014; 7:361-71. [PMID: 17338655 DOI: 10.1586/14737140.7.3.361] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Treatment for primary head and neck cancer has evolved from the use of radical approaches to therapies preserving important functions. Essential to this concept is the maintenance of therapeutic efficacy. The advances of organ-sparing surgery, improved radiation techniques and fractionation, and the addition of chemotherapy and targeted systemic agents, have added to the number of patients who undergo organ-preservation therapy. Crucial functions that can be spared include speech, swallowing, vision, salivation and cosmesis. This paper examines advances in therapy that allow the preservation of these important functions, scenarios where organ and function preservation is indicated, given current technology and agents, and where there might be future improvements.
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Affiliation(s)
- Par S Mehta
- Radiation Oncology, Beth Israel Medical Center, Continuum Cancer Centers, New York, NY, USA.
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22
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Joo YH, Lee YS, Cho KJ, Park JO, Nam IC, Kim CS, Kim SY, Kim MS. Characteristics and prognostic implications of high-risk HPV-associated hypopharyngeal cancers. PLoS One 2013; 8:e78718. [PMID: 24244346 PMCID: PMC3823884 DOI: 10.1371/journal.pone.0078718] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/18/2013] [Indexed: 12/01/2022] Open
Abstract
Background High-risk human papillomavirus (HPV) is an oncogenic virus that causes oropharyngeal cancers, and it has a favorable outcome after the treatment. Unlike in oropharyngeal cancer, the prevalence and role of high-risk HPV in the etiology of hypopharyngeal squamous cell carcinoma (HPSCC) is uncertain. Objective The aim of the present study was to evaluate the effect and prognostic significance of high-risk HPV in patients with HPSCC. Methods The study included 64 subjects with HPSCC who underwent radical surgery with or without radiation-based adjuvant therapy. Primary tumor sites were the pyriform sinus in 42 patients, posterior pharyngeal wall in 19 patients, and postcricoid area in 3 patients. High-risk HPV in situ hybridization was performed to detect HPV infection. Results The positive rate of high-risk HPV in situ hybridization was 10.9% (7/64). There was a significant difference in the fraction of positive high-risk HPV among pyriform sinus cancer (16.7%), posterior pharyngeal wall cancer (0%), and postcricoid area cancer (0%) (p = 0.042). The laryngoscopic examination revealed a granulomatous and exophytic appearance in 85.7% (6/7) of patients with high-risk HPV-positive pyriform sinus cancer, but in only 31.4% (11/35) of patients with high-risk HPV-negative pyriform sinus cancer (p = 0.012). Significant correlations were found between positive high-risk HPV and younger age (p = 0.050) and non-smoking status (p = 0.017). HPV-positive patients had a significantly better disease-free survival (p = 0.026) and disease-specific survival (p = 0.047) than HPV-negative patients. Conclusions High-risk HPV infection is significantly related to pyriform sinus cancer in patients with HPSCC.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn-Soo Lee
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwang-Jae Cho
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun-Ook Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In-Chul Nam
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chung-Soo Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Sik Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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23
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Chung EJ, Lee JJ, Kim HS, Lee DJ, Jung CH, Chang YJ, Rho YS. Alternative treatment option for hypopharyngeal cancer: clinical outcomes after conservative laryngeal surgery with partial pharyngectomy. Acta Otolaryngol 2013; 133:866-73. [PMID: 23647464 DOI: 10.3109/00016489.2013.785018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The oncological and functional outcomes of hypopharyngeal cancer after conservative laryngeal surgery are fairly acceptable, making this a reasonable initial treatment option for selected patients. OBJECTIVE The purpose of this study was to assess the clinical outcomes of patients with hypopharyngeal squamous cell carcinoma (SCC) treated with conservative laryngeal surgery with partial pharyngectomy. METHODS Fifty-eight patients with hypopharyngeal SCC who underwent laryngeal preservation surgery were enrolled. The tumors were classified as cT1 in 5 (8.6%) patients, cT2 in 35 (60.3%), cT3 in 14 (24.1%), and cT4a in 4 (6.9%) patients. RESULTS Surgical outcomes: 5-year overall and disease-specific survival rates were 78% and 77.6%. Recurrent disease developed in 13 patients (22.4%). Multivariate analysis revealed that level VI metastasis confirmed by histopathological analysis, close (< 5 mm) histologic margin, advanced N stage, and posterior pharyngeal wall tumor were independent factors associated with poor disease-specific survival. Functional outcomes: 50 patients (86.2%) could obtain all their nutritional needs orally. Eight patients needed the assistance of a percutaneous endoscopic gastrostomy tube. Oral re-alimentation was achieved within a mean of 26.1 days after surgery. Fifty-one patients (87.9%) could be decannulated after a mean of 43.8 days postoperatively.
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Affiliation(s)
- Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsong Memorial Institute of Head and Neck Cancer, Hallym University, College of Medicine, Seoul, Korea
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Role of surgery in the management of head and neck cancer: a contemporary view of the data in the era of organ preservation. J Laryngol Otol 2013; 127:121-7. [PMID: 23298649 DOI: 10.1017/s0022215112002988] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Review of the literature on the role of surgery in the management of head and neck cancer in the era of organ preservation. METHOD Literature search based on the essential practice guidelines set out by the US National Comprehensive Cancer Network. RESULTS Despite the increasing popularity of non-surgical treatment options, the surgeon remains a key figure in the multidisciplinary head and neck cancer team, along with the radiation oncologist, the medical oncologist and the speech and swallowing therapist. Even when organ preservation is successful, early and late toxicity may cause serious complications, including laryngeal dysfunction with a 'frozen larynx'. When organ preservation fails, salvage surgery is often associated with increased complications and reduced survival. CONCLUSION There is a definite need to apply more rigorous standards to the use of organ preservation strategies, and to re-evaluate the role of surgery in head and neck cancer treatment.
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Serpeloni JM, Batista BL, Angeli JPF, Barcelos GRM, Bianchi MDLP, Barbosa F, Antunes LMG. Antigenotoxic properties of chlorophyll b against cisplatin-induced DNA damage and its relationship with distribution of platinum and magnesium in vivo. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2013; 76:345-353. [PMID: 23557233 DOI: 10.1080/15287394.2012.755485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The chemotherapeutic agent cisplatin (cDDP) is widely used to treat a variety of solid and hematological tumors. However, cDDP exerts severe side effects, such as nephrotoxicity, neurotoxicity, and bone-marrow suppression. The use of some dietary compounds to protect organs that are not targets in association with chemotherapy has been encouraged. This study evaluated the protective effects of chlorophyll b (CLb) on DNA damage induced by cDDP by use of single-cell gel electrophoresis (SCGE) assays. Further, this investigation also determined platinum (Pt) and magnesium (Mg) bioaccumulation in mice tissues after treatment with CLb alone and/or in association of cDDP (simultaneous treatment) by inductively coupled plasma-mass spectroscopy (ICP-MS). All parameters were studied in peripheral blood cells (PBC), kidneys, and liver of mice after administration of CLb (0.2 or 0.5 mg/kg of body weight [b.w.]), cDDP (6 mg/kg b.w.), and the combination CLb 0.2 plus cDDP or CLb 0.5 plus cDDP. Pt accumulation in liver and kidneys was higher than that found in PBC, while DNA damage was higher in kidneys and liver than in PBC. Further, treatment with CLb alone did not induce DNA damage. Evidence indicates that genotoxic effects produced by cDDP may not be related to Pt accumulation and distribution. In combined treatments, CLb decreased DNA damage in tissues, but the PT contents did not change and these treatments also showed that CLb may be an important source of Mg. Thus, our results indicate that consumption of CLb-rich foods may diminish the adverse health effects induced by cDDP exposure.
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Affiliation(s)
- Juliana Mara Serpeloni
- Department of Clinical, Toxicologic, and Bromatological Analysis, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Nishimura H, Sasaki R, Yoshida K, Miyawaki D, Okamoto Y, Kiyota N, Saito M, Otsuki N, Nibu KI. Radiotherapy for stage I or II hypopharyngeal carcinoma. JOURNAL OF RADIATION RESEARCH 2012; 53:892-899. [PMID: 22988283 PMCID: PMC3483846 DOI: 10.1093/jrr/rrs044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/16/2012] [Accepted: 06/06/2012] [Indexed: 06/01/2023]
Abstract
Hypopharyngeal squamous cell carcinoma (HPSCC) is usually diagnosed at an advanced stage, and early-stage HPSCC is relatively rare. Because of the rarity of early-stage HPSCC, few reports have been published on the efficacy of radiotherapy (RT) in its treatment. We retrospectively reviewed the clinical records of 45 consecutive patients with Stage I and II HPSCC from May 1991 to June 2010. Patient characteristics were as follows: median age, 66 years (range, 44-90 years); male/female, 39/6; and T1/T2, 27/18. The irradiation dose ranged from 60 to 72 Gy (median: 70 Gy). Of the 45 patients, 21 underwent concurrent chemotherapy. With a median follow-up period of 62 months, the 5-year overall survival rate was 81%. Local failure occurred in 5 patients, and the 5-year local control rate was 83%. All local recurrences were successfully salvaged by surgery. The 5-year functional larynx preservation rate was 92%. Acute toxicity was manageable. Grade 3 laryngeal edema and Grade 3 hypothyroidism occurred in 1 patient each. No other late adverse events of Grade 3 or greater were observed. Based on these results, RT seemed to be an effective treatment modality for early HPSCC, with favorable organ preservation and acceptable adverse events. Early detection and accurate management of local recurrence and second malignancy was deemed to be critical.
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Affiliation(s)
- Hideki Nishimura
- Division of Radiation Oncology, Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
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Yoon TM, Kim SA, Park YL, Lee KH, Sung MW, Lee JK, Lim SC, Chung IJ, Joo YE. Expression of the receptor tyrosine kinase recepteur d'origine nantais and its association with tumor progression in hypopharyngeal cancer. Head Neck 2012; 35:1106-13. [PMID: 22887469 DOI: 10.1002/hed.23090] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2012] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate expression of recepteur d'origine nantais (RON) in human hypopharyngeal squamous cell carcinoma (SCC) and to determine whether RON affects tumor cell behavior in hypopharyngeal SCC cell line and if this would serve as a target for molecular therapy in a preclinical model. METHODS Reverse transcriptase-polymerase chain reaction, immunohistochemistry, Western blotting, cell invasion, migration, proliferation, and apoptosis assays were used to assess alteration of RON expression and its impact to cancer progression in human hypopharyngeal SCC. RESULTS Immunoreactivity of RON was observed in hypopharyngeal SCC tissues relative to adjacent normal mucosa in all cases. RON protein expression was significantly increased in metastatic lymph nodes than nonmetastatic lymph nodes by Western blotting. Knockdown of RON resulted in significantly reduced cell invasion, migration, and proliferation in human hypopharyngeal SCC cells. Knockdown of RON enhanced cell apoptosis through activation of caspase 3, caspase 7, and poly ADP-ribose polymerase (PARP). CONCLUSION These results indicate that knockdown of RON expression may be associated with the reversal of invasive phenotype in hypopharyngeal SCC.
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Affiliation(s)
- Tae Mi Yoon
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School, Gwanju, Korea
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Transoral robotic surgery for hypopharyngeal squamous cell carcinoma: 3-Year oncologic and functional analysis. Oral Oncol 2012; 48:560-6. [DOI: 10.1016/j.oraloncology.2011.12.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 12/22/2011] [Accepted: 12/23/2011] [Indexed: 11/23/2022]
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Role of larynx-preserving partial hypopharyngectomy with and without postoperative radiotherapy for squamous cell carcinoma of the hypopharynx. Oral Oncol 2011; 48:168-72. [PMID: 21930416 DOI: 10.1016/j.oraloncology.2011.08.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 08/22/2011] [Accepted: 08/23/2011] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to examine the treatment outcomes of larynx-preserving partial hypopharyngectomies for hypopharyngeal carcinoma. Forty-three patients underwent partial hypopharyngectomy and reconstruction using faciocutaneous free flaps with and without postoperative radiotherapy between 1998 and 2009. Primary tumor sites were pyriform sinus in 35 and posterior pharyngeal wall in 8 patients. Thirty patients received postoperative radiotherapy. The 5-year overall and disease-specific survival rates were 63% and 67%, respectively. A significant positive correlation was found between pathologic N stage and primary site and disease-specific survival rates (N0/N1 stage; 93% vs. N2/N3 stage; 43%, p<0.001 and pyriform sinus; 80% vs. posterior pharyngeal wall; 29%, p=0.012, respectively). Recurrences occurred in 15 (35%) patients. Among them, two patients were successfully rescued. Primary partial hypopharyngectomy with laryngeal preservation can be achieved with favorable oncologic outcomes. Factors that affected prognosis were advanced stage neck disease and posterior pharyngeal wall carcinoma.
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Superficial temporal artery flap: a new option for posterior hypopharyngeal wall reconstruction. Eur Arch Otorhinolaryngol 2011; 268:1017-21. [DOI: 10.1007/s00405-011-1528-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
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Hirano S, Tateya I, Kitamura M, Kada S, Ishikawa S, Kanda T, Tanaka S, Ito J. Organ preservation surgery for advanced hypopharyngeal cancer. Acta Otolaryngol 2010:50-5. [PMID: 20879819 DOI: 10.3109/00016489.2010.487496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Organ preservation surgery with partial pharyngectomy preserving the larynx is feasible for the treatment of advanced hypopharyngeal cancer with comparable local control and preservation of function. OBJECTIVES To examine the feasibility and therapeutic effects of organ preservation surgery for advanced hypopharyngeal cancer. METHODS Fourteen patients with stage III/IV hypopharyngeal cancer were treated by partial pharyngectomy with or without partial laryngectomy to preserve the larynx. Ten cases were T1/2 primary while four cases had T3/4 tumors. Reconstruction of the pharyngolarynx was completed by primary mucosal suture in six, while free forearm flap was used in eight cases. Induction chemotherapy was administered for six cases including three with T3/4 tumors. RESULTS Five-year overall survival and disease-specific survival rates were 57.1% and 66.7%, respectively. The 5-year locoregional control rate was 66.7% and the larynx preservation rate was 100%. No patients presented with local recurrence at the pharyngolaryngeal segment, while two cases showed nodal recurrence, from which they died. Tracheal stoma was closed in 9 of 14 cases. Vocal function was excellent in five cases, moderate in five, and poor in three. Swallowing function was excellent to moderate in eight cases and poor in six.
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Affiliation(s)
- Shigeru Hirano
- Department of Otolaryngology Head and Neck Surgery, Kyoto University, Kyoto, Japan.
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Hirano S, Tateya I, Kitamura M, Kada S, Ishikawa S, Kanda T, Tanaka S, Ito J. Ten years single institutional experience of treatment for advanced hypopharyngeal cancer in Kyoto University. Acta Otolaryngol 2010:56-61. [PMID: 20879820 DOI: 10.3109/00016489.2010.487495] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Treatment of advanced hypopharyngeal cancer has become more conservative and more multidisciplinary, and the prognosis has been improved. Induction chemotherapy has the potential to extend organ preservation therapy even in cases with locally advanced primary lesion. It is also important to develop a strategy to reduce distant metastasis and to keep track of second primary cancers. OBJECTIVES To update the therapeutic outcome of advanced hypopharyngeal cancer. METHODS A total of 72 cases with stage III/IV hypopharyngeal cancer were treated at Kyoto University Hospital during 2000-2008. Surgery was performed in 56 cases; total pharyngolaryngoesophagectomy (TPLE) in 39 cases and partial pharyngectomy (PPX) preserving the larynx in 17 cases. Radiotherapy (RT) with or without concurrent chemotherapy was applied in 16 cases. Induction chemotherapy (ICT) has been applied for 14 cases since 2006 to achieve organ preservation and reduction of distant metastasis. The follow-up period varied from 12 months to 96 months (mean 32 months). Therapeutic outcomes were chart reviewed. RESULTS Five years cumulative overall and disease-specific survival (DSS) rates were 52.1% and 63.8%, respectively. DSS rates in cases treated with surgery and those with RT were 65.1% and 56.1%, respectively. N2c status showed the worst prognosis according to nodal disease classification. Local control rates for cases treated with TPLE, PPX, and RT were 97.3%, 100%, and 80.4%, respectively. The effective rate of ICT was 79%, and laryngeal preservation was achieved in 79% of the cases with ICT. Recurrence occurred in 20 cases. Approximately half of the recurrence was distant disease. In the end, 17 cases died of the primary disease, while 10 cases died of other causes, mainly second primary cancers.
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Affiliation(s)
- Shigeru Hirano
- Department of Otolaryngology Head and Neck Surgery, Kyoto University, Sakyo-ku, Kyoto, Japan.
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Chang MFT, Wang HM, Kang CJ, Huang SF, Lin CY, Fang KH, Chen EYC, Chen IH, Liao CT, Chang JTC. Treatment results for hypopharyngeal cancer by different treatment strategies and its secondary primary--an experience in Taiwan. Radiat Oncol 2010; 5:91. [PMID: 20925962 PMCID: PMC2958972 DOI: 10.1186/1748-717x-5-91] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 10/07/2010] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to evaluate treatment results in our hypopharyngeal cancer patients. Patients and Methods A total of three hundred and ninety five hypopharyngeal cancer patients received radical treatment at our hospital; 96% were male. The majority were habitual smokers (88%), alcohol drinkers (73%) and/or betel quid chewers (51%). All patients received a CT scan or MRI for tumor staging before treatment. The stage distribution was stage I: 2 (0.5%); stage II: 22 (5.6%); stage III: 57 (14.4%) and stage IV: 314 (79.5%). Radical surgery was used first in 81 patients (20.5%), and the remaining patients (79.5%) received organ preservation-intended treatment (OPIT). In the OPIT group, 46 patients received radiotherapy alone, 156 patients received chemotherapy followed by radiotherapy (CT/RT) and 112 patients received concomitant chemo-radiotherapy (CCRT). Results The five-year overall survival rates for stages I/II, III and IV were 49.5%, 47.4% and 18.6%, respectively. There was no significant difference in overall and disease-specific survival rates between patients who received radical surgery first and those who received OPIT. In the OPIT group, CCRT tended to preserve the larynx better (p = 0.088), with three-year larynx preservation rates of 44.8% for CCRT and 27.2% for CT/RT. Thirty-seven patients developed a second malignancy, with an annual incidence of 4.6%. Conclusions There was no survival difference between OPIT and radical surgery in hypopharyngeal cancer patients at our hospital. CCRT may offer better laryngeal preservation than RT alone or CT/RT. However, prospective studies are still needed to confirm this finding. Additionally, second primary cancers are another important issue for hypopharyngeal cancer management.
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Affiliation(s)
- Morgan Fu-Ti Chang
- Department of Radiation Oncology, Hsinchu General Hospital, Hsin-Chu, Taiwan
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Huang WY, Jen YM, Chen CM, Su YF, Lin CS, Lin YS, Chang YN, Chao HL, Lin KT, Chang LP. Intensity modulated radiotherapy with concurrent chemotherapy for larynx preservation of advanced resectable hypopharyngeal cancer. Radiat Oncol 2010; 5:37. [PMID: 20470428 PMCID: PMC2890614 DOI: 10.1186/1748-717x-5-37] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 05/15/2010] [Indexed: 11/17/2022] Open
Abstract
Background To analyze the rate of larynx preservation in patients of locally advanced hypopharyngeal cancer treated with intensity modulated radiotherapy (IMRT) plus concurrent chemotherapy, and compare the results with patients treated with primary surgery. Methods Between January 2003 and November 2007, 14 patients were treated with primary surgery and 33 patients were treated with concurrent chemoradiotherapy (CCRT) using IMRT technique. Survival rate, larynx preservation rate were calculated with the Kaplan-Meier method. Multivariate analysis was conducted for significant prognostic factors with Cox-regression method. Results The median follow-up was 19.4 months for all patients, and 25.8 months for those alive. The 5-year overall survival rate was 33% and 44% for primary surgery and definitive CCRT, respectively (p = 0.788). The 5-year functional larynx-preservation survival after IMRT was 40%. Acute toxicities were common, but usually tolerable. The rates of treatment-related mucositis (≥ grade 2) and pharyngitis (≥ grade 3) were higher in the CCRT group. For multivariate analysis, treatment response and cricoid cartilage invasion strongly correlated with survival. Conclusions IMRT plus concurrent chemotherapy may preserve the larynx without compromising survival. Further studies on new effective therapeutic agents are essential.
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Affiliation(s)
- Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Liu WS, Hsin CH, Chou YH, Liu JT, Wu MF, Tseng SW, Lee JK, Tseng HC, Wang TH, Su MC, Lee H. Long-term results of intensity-modulated radiotherapy concomitant with chemotherapy for hypopharyngeal carcinoma aimed at laryngeal preservation. BMC Cancer 2010; 10:102. [PMID: 20298550 PMCID: PMC3087314 DOI: 10.1186/1471-2407-10-102] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 03/18/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this retrospective study is to investigate laryngeal preservation and long-term treatment results in hypopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT) combined with chemotherapy. METHODS Twenty-seven patients with hypopharyngeal carcinoma (stage II-IV) were enrolled and underwent concurrent chemoradiotherapy. The chemotherapy regimens were monthly cisplatin and 5-fluorouracil for six patients and weekly cisplatin for 19 patients. All patients were treated with IMRT with simultaneous integrated boost technique. Acute and late toxicities were recorded based on CTCAE 3.0 (Common Terminology Criteria for Adverse Events). RESULTS The median follow-up time for survivors was 53.0 months (range 36-82 months). The initial complete response rate was 85.2%, with a laryngeal preservation rate of 63.0%. The 5-year functional laryngeal, local-regional control, disease-free and overall survival rates were 59.7%, 63.3%, 51.0% and 34.8%, respectively. The most common greater than or equal to grade 3 acute and late effects were dysphagia (63.0%, 17 of 27 patients) and laryngeal stricture (18.5%, 5 of 27 patients), respectively. Patients belonging to the high risk group showed significantly higher risk of tracheostomy compared to the low risk group (p = 0.014). CONCLUSIONS After long-term follow-up, our results confirmed that patients with hypopharyngeal carcinoma treated with IMRT concurrent with platinum-based chemotherapy attain high functional laryngeal and local-regional control survival rates. However, the late effect of laryngeal stricture remains a problem, particularly for high risk group patients.
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Affiliation(s)
- Wen-Shan Liu
- Departments of Radiation Oncology, Chung Shan Medical University Hospital, No 110, Sec 1, Chien-Kuo N Rd, Taichung 402, Taiwan
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Gourin CG, Johnson JT. A contemporary review of indications for primary surgical care of patients with squamous cell carcinoma of the head and neck. Laryngoscope 2009; 119:2124-34. [DOI: 10.1002/lary.20619] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Gupta T, Chopra S, Agarwal JP, Laskar SG, D’cruz AK, Shrivastava SK, Dinshaw KA. Squamous cell carcinoma of the hypopharynx: single-institution outcome analysis of a large cohort of patients treated with primary non-surgical approaches. Acta Oncol 2009; 48:541-48. [PMID: 18979267 DOI: 10.1080/02841860802488839] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Hypopharyngeal cancers have extensive submucosal spread, high risk of nodal involvement and relatively high propensity of distant metastases. Contemporary paradigms for hypopharyngeal cancers aim to maximize loco-regional control while attempting to preserve laryngo-pharyngeal form and function. AIMS To retrospectively review outcome of large cohort of patients with hypopharyngeal cancers treated with curative intent radiotherapy with or without systemic chemotherapy in an academic tertiary referral centre. MATERIAL AND METHODS Medical records of patients with hypopharyngeal cancers treated with primary non-surgical approaches over a 15-year period were reviewed retrospectively. Loco-regional control (LRC) and disease-free survival (DFS) were considered as outcome measures. RESULTS Electronic search of database identified 501 patients with hypopharyngeal cancers treated with definitive radiotherapy. The median age was 55 years (range 20-87 years) and median radiotherapy dose 70 Gy (range 5.4-72 Gy). With a mean follow-up period of 22 months (median 12 months), the 3-year LRC and DFS was 47.1% and 40.9% respectively. Stage (T-stage, N-stage, overall stage grouping), and age influenced outcome significantly. The 3-year LRC for T1-T2 disease was 49.7% versus 43.1% for T3- T4 stage (p0.056). The 3-year DFS was 49.4% and 36.9% respectively (p0.014). The 3-year LRC and DFS for N0; N1; and N2-3 disease was 57.3% & 54.3%; 40.5% & 35.3%; and 33% & 27% respectively with highly significant p-values. CONCLUSION This is an outcome analysis of the largest cohort of patients with hypopharyngeal cancers managed with primary non-surgical approaches. Stage and age remain the most important determinants of outcome.
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Vu KN, Day TA, Gillespie MB, Martin-Harris B, Sinha D, Stuart RK, Sharma AK. Proximal esophageal stenosis in head and neck cancer patients after total laryngectomy and radiation. ORL J Otorhinolaryngol Relat Spec 2008; 70:229-35. [PMID: 18467817 DOI: 10.1159/000130870] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Accepted: 03/15/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND There has been an increasing focus on late functional effects of head and neck cancer (HNC) treatment. This study was undertaken to evaluate the incidence of late proximal esophageal stricture in patients undergoing total laryngectomy (TL) and radiation therapy (RT). MATERIAL AND METHODS An institutional retrospective review of HNC patients treated between 1995 and 2003 with TL and RT was undertaken. Thirty-three patients with stage II-IV disease were included; 25 patients had TL and postoperative RT (group 1), while 8 patients had definitive RT with salvage laryngectomy (group 2). RESULTS The median follow-up was 28 months. At the last follow-up, 25 patients (76%) were alive and disease free. Four had died and 3 developed distant metastasis. Dysphagia or stenosis developed in 40% in group 1 and 75% in group 2 patients. The median time to dysphagia was 5.5 months for all patients. CONCLUSIONS The incidence of esophageal stenosis was 33% for all patients. Contributing factors for esophageal stenosis after TL and RT include continued alcohol and tobacco use, the dose-volume relationship of the RT and normal tissue damage from the tumor and the treatment.
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Affiliation(s)
- Kim N Vu
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, USA
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Lee MS, Ho HC, Hsiao SH, Hwang JH, Lee CC, Hung SK. Treatment results and prognostic factors in locally advanced hypopharyngeal cancer. Acta Otolaryngol 2008; 128:103-9. [PMID: 17851955 DOI: 10.1080/00016480701387116] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSIONS We suggest that concurrent chemoradiation (CCRT) is an effective definitive treatment for patients with advanced hypopharyngeal carcinoma who are unfit for or refuse surgery. A high dose of radiation (> 70 Gy) should be given to achieve acceptable local control rates and survival. OBJECTIVES The purpose of this retrospective study was to compare the treatment results of locally advanced hypopharyngeal carcinoma with two different protocols. PATIENTS AND METHODS From December 1995 to December 2004, 74 patients with locally advanced hypopharyngeal cancer were treated with CCRT or surgery plus postoperative radiotherapy (SRT). Their treatment results were reviewed by retrospective analysis. The study points included outcome, toxicity, and prognostic factors. RESULTS There was no significant difference in T and N status between the two treatment groups, nor were there significant differences in overall or disease-free survival or the incidence of distant metastasis (p >0.05). In the CCRT group and SRT group, the estimated 3-year overall survival was 39% and 44%, respectively. The SRT group had better local control than the CCRT group (p <0.05). Relatively, 27% patients retained their larynx function for more than 2 years in the CCRT group. Radiation doses >70 Gy yielded significantly better survival and local control than doses <70 Gy (p <0.05).
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Affiliation(s)
- Moon-Sing Lee
- Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Dalin, Chiayi, Taiwan
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Modalidades de preservación de órgano en carcinomas de laringe e hipofaringe. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s0001-6519(07)74970-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hypopharyngeal cancer treatment based on definitive radiotherapy: who is suitable for laryngeal preservation? The Journal of Laryngology & Otology 2007; 122:506-12. [DOI: 10.1017/s0022215107000692] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAims:To investigate prognostic factors for survival and locoregional control in patients with stage I–IVA hypopharyngeal cancer treated with laryngeal preservation radiotherapy.Methods:This study was a retrospective analysis of 108 patients with stage I–IVA squamous cell carcinoma of the hypopharynx, treated with laryngeal preservation radiotherapy. Actuarial survival, disease-specific survival and local relapse-free survival were calculated, and multivariate analyses were performed using Cox's proportional hazards model.Results:After a median follow-up duration of 39 months, the five-year local relapse-free survival rate was 35 per cent for all patients, 66 per cent for those with stage I–II disease, 46 per cent for those with stage III disease and 20 per cent for those with stage IVA disease (p = 0.004). Multivariate analyses showed that tumour and node stages were independent prognostic factors.Conclusions:Patients with stage I–II disease were suitable for laryngeal preservation radiotherapy. For most patients with stage III–IVA disease, other than those who were T1 N1 or T2 N1, the treatment results were poor.
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ESTEBANFERNANDEZ D, GOMEZGOMEZ M, CANAS B, VERDAGUER J, RAMIREZ R, PALACIOS M. Speciation analysis of platinum antitumoral drugs in impacted tissues. Talanta 2007; 72:768-73. [DOI: 10.1016/j.talanta.2006.12.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 11/21/2006] [Accepted: 12/04/2006] [Indexed: 10/23/2022]
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Quer M, León X. Organ Preservation in Laryngeal and Hypopharyngeal Cancer. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s2173-5735(07)70392-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chen SW, Yang SN, Liang JA, Tsai MH, Shiau AC, Lin FJ. Value of computed tomography-based tumor volume as a predictor of outcomes in hypopharyngeal cancer after treatment with definitive radiotherapy. Laryngoscope 2006; 116:2012-7. [PMID: 17075415 DOI: 10.1097/01.mlg.0000237804.38761.81] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the value of pretreatment computed tomography (CT) volumetric analysis for the prediction of treatment outcome in patients with hypopharyngeal cancer (HPC) treated by definitive radiotherapy (RT). METHODS From January 2000 through February 2004, 63 patients with HPC were enrolled for a retrospective analysis. The pyriform sinus was the principle site of involvement in 62 cases. All patients received with 1.8 Gy daily to a total dose of 68.4 to 73.8 Gy (median, 70.2 Gy). Contrast-enhanced CT images were transferred to a planning system. Tumor volume measurement was derived from summation of the primary and metastatic nodal tumor. RESULTS With a median follow-up of 38 (range, 24-68) months, the 5 year local relapse-free survival (LRFS) was 83% for patients with T1 to T2 disease, 46% for those with T3 disease, and 40% for those with T4 disease (P = .01). The 5 year LRFS was 75% for those with tumors less than 40 mL and 26% when volumes were 40 mL of larger (P = .0001). For patients with T3 to T4 disease, the 5 year LRFS was 70% for those with tumors less than 40 mL and 24% when volumes were 40 mL or larger (P = .0005). Multivariate analyses of local relapse-free survival revealed two prognostic factors: tumor volume more than 40 mL and the involvement of the larynx. CONCLUSIONS CT-based tumor volumes are a strong predictor of outcomes for HPC treated using definitive RT. A selected group of patients, mainly those with tumor volumes less than 40 mL, should be considered for laryngeal preservation.
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Affiliation(s)
- Shang-Wen Chen
- Department of Radiation Therapy and Oncology, China Medical University Hospital, Taichung, Taiwan.
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Abstract
Since the first total laryngectomy was undertaken, efforts have been made to avoid removing the entire larynx. For a long time, partial surgery and radiotherapy were the only options that could preserve the larynx. Development of active chemotherapy regimens has prompted an era of intensive clinical research. Induction chemotherapy followed by radiotherapy in patients with objective responses has been shown to allow conservation of the larynx in nearly two-thirds of individuals, without any effect on survival; concurrent chemoradiotherapy also provides high rates of laryngeal preservation, again without affecting survival; and induction chemotherapy followed by concurrent chemoradiotherapy is under investigation. In the meantime, partial open surgery and endoscopic carbon dioxide laser procedures are feasible in selected moderately advanced laryngopharyngeal cancers as an alternative to destructive surgery. Altered fractionation radiotherapy can also be used in management of these tumours, and targeted treatments have opened a new area of clinical research. Findings of basic research and modern imaging should provide useful approaches for selection of patients for various strategies.
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Affiliation(s)
- Jean Louis Lefebvre
- Head and Neck Department, Centre Oscar Lambret, 3 rue Combemale, 59020 Lille, France.
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Tateda M, Shiga K, Yoshida H, Saijo S, Yokoyama J, Nishikawa H, Asada Y, Matsuura K, Kobayashi T. Management of the patients with hypopharyngeal cancer: eight-year experience of Miyagi Cancer Center in Japan. TOHOKU J EXP MED 2005; 205:65-77. [PMID: 15635275 DOI: 10.1620/tjem.205.65] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study is to evaluate the results of treatment for hypopharyngeal cancer and indicate the future prospect of the treatment. Seventy-four patients with squamous cell carcinoma of the hypopharynx admitted to Miyagi Cancer Center from 1993 through 2000 are reviewed. Sixty-four patients received radical treatment, and 10 patients received palliative treatment or no treatment. The cancer was advanced (stages III and IV) in 82% of all the patients. The overall 5-year survival rate of all the patients was 38%. The overall 5-year survival rate of 64 patients received radical treatment was 43%. The ten patients who received palliative treatment or no treatment died of cancer within 16 months. Fifty-two out of the 74 patients underwent neck dissection for the neck lymph node involvement; forty of the 52 patients underwent ipsilateral neck dissection and 12 underwent bilateral neck dissection. Four out of the 40 patients, who underwent ipsilateral neck dissection alone, developed late contralateral regional recurrence but were successfully treated by contralateral neck dissection at the time of recurrence. Twenty-three out of 74 patients had multiple primary cancers synchronously or metachronously (31%). Cause of the death of six patients out of 74 patients was confirmed to be primary cancers other than hypopharyngeal cancer, as judged by physicians in other department or other hospitals. Most of the patients died due to distant metastasis from hypopharyngeal cancer or other primary cancers. We therefore conclude that contralateral elective neck dissection which is frequently chosen for the treatment of hypopharyngeal cancer surgery is unnecessary. Even if locoregional control is accomplished, distant metastasis or multiple primary cancers emerge and make prognosis poor. To improve the prognosis, we should develop some strategy against hypopharyngeal cancer for each patient. New strategies including chemoprevention and surgery against distant metasistasis are necessary.
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Affiliation(s)
- Masaru Tateda
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Japan.
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Chu PY, Chang SY. Reconstruction after resection of hypopharyngeal carcinoma: Comparison of the postoperative complications and oncologic results of different methods. Head Neck 2005; 27:901-8. [PMID: 16114006 DOI: 10.1002/hed.20262] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Radical surgery followed by radiotherapy plays an important role in the treatment of patients with hypopharyngeal cancer. However, there is no general consensus as to which is the best method of reconstruction after surgical resection. METHODS We retrospectively reviewed the records of 91 patients who underwent radical surgery and reconstruction. Postoperative complications and oncologic results of the different reconstructive methods were compared. RESULTS Reconstruction with gastric pull-up had the lowest pharyngocutaneous (PC) fistula (0%) and pharyngoesophageal (PE) stenosis rates (0%). However, the overall postoperative complication rate was high (64%). Laryngotracheal flap (LTF) reconstruction had relatively lower rates of PC fistula (3%), PE stenosis (10%), and overall complications (22%). The introduction of the LTF technique significantly decreased postoperative complications from 71% to 30% (p = .0001), with similar tumor control and survival. CONCLUSIONS Hypopharyngeal reconstruction with an LTF is a simple and effective method. The chance of using a complex flap is decreased. The postoperative complications are reduced, and the oncologic results are satisfactory.
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Affiliation(s)
- Pen-Yuan Chu
- Department of Otolaryngology, Veterans General Hospital-Taipei, National Yang-Ming University, 201, Sec 2, Shih-Pai Road, Taipei, Taiwan.
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Oueslati Z, Zeglaoui I, Touati S, Gritli S, Nasr C, Benna F, Boussen H, Mokni N, Gamoudi A, El-May A, Ladgham A. [Hypopharyngeal squamous cell carcinoma: retrospective study of 149 patients]. Cancer Radiother 2004; 8:358-63. [PMID: 15619380 DOI: 10.1016/j.canrad.2004.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Revised: 05/25/2004] [Accepted: 09/20/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE Hypopharyngeal squamous cell carcinoma is associated to one of the most unfavorable prognosis among the cancers of the head and neck. The purpose of this study is to analyze its therapeutic modalities in the Salah-Azaïz Institute (Tunis) and to compare their results. PATIENTS AND METHOD This retrospective study concerns 271 hypopharyngeal squamous cell carcinomas, compiled in the Carcinologic Surgery Department of Head and Neck of the Salah-Azaïz Institute over a period of 25 years (from 1977 to 2002). The average age of the patients was of 56 years; sex-ratio was on average of 1.2 (man/woman). The indication of a curative treatment was initially retained for 149 (55%) patients, who were the only ones retained for the analysis of results. RESULTS We retained the indication of a protocol including surgery and postoperating radiotherapy for 26.2% of the patients. Postoperation mortality rate was 5.1%; the operating rate of morbidity was 46.2%. For 13.5% of the patients, postoperating radiotherapy was permanently interrupted because of a gradual deterioration of the patients' health in the course of treatment. We retained the indication of exclusive radiotherapy for 59.7% of the patients. The average age was of 56 years and the sex-ratio of 1.2. The external radiotherapy was conventional. Radiotherapy had to be permanently interrupted in progress in 32.6% of cases on account of an deterioration of the patients' health; the rate of morbidity of the radiotherapy was 33.3%. We indicated a protocol of conservation of organ with induction chemotherapy for 21 patients (14.1%). The average age was of 53 years (28-65 years) and sex-ratio (man/woman) of 0.5. The global survival was 25.5% at one year, 18.1% at two years, 11.4% at three years and 7.4% at five years. All the patients selected for chemotherapy died in the course of treatment. The rates of survival in two and five years according to protocols surgery-radiotherapy and exclusive radiotherapy were respectively: 21.5 and 12%, and 18.3 and 10%. The difference between the rates of survival of this two protocols is not significant (P =0.08). CONCLUSION Although the induction chemotherapy entails a particularly high death rate in our series, the association surgery-radiotherapy and the exclusive radiotherapy seem to be similarly efficient for the treatment of the hypopharyngeal carcinoma.
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Affiliation(s)
- Z Oueslati
- Service de chirurgie carcinologique et ORL, institut Salah-Azaïz, Tunis, Tunisie.
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Plouin-Gaudon I, Lengelé B, Desuter G, Rombaux P, Ledeghen S, Grégoire V, Hamoir M. Conservation laryngeal surgery for selected pyriform sinus cancer. Eur J Surg Oncol 2004; 30:1123-30. [PMID: 15522562 DOI: 10.1016/j.ejso.2004.08.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2004] [Indexed: 11/18/2022] Open
Abstract
AIMS This study reports the treatment of a cohort of patients with pyriform sinus squamous cell carcinoma, using conservative surgery and radiotherapy. METHODS Thirty-four patients with pyriform sinus SCC were treated between 1986 and 2001, using partial laryngopharyngectomy with or without complementary radiotherapy. Seventy-six percent had stage III-IV lesions. Quality of life questionnaire and clinical examination were used for evaluation of laryngeal function. RESULTS Conservation surgery was undertaken. All patients underwent neck dissection. Two thirds of the patients received post-operative radiotherapy. Reconstruction was achieved by local muscular flap in 13 cases, radial forearm free flap in 18 and pectoralis major flap in three. Five-year overall and disease-specific survival rates were 50 and 65%, respectively. Successful laryngeal function preservation with local control was achieved in 80% of the patients. CONCLUSION Partial laryngopharyngectomy is a suitable treatment for early and selected advanced stage pyriform sinus carcinoma with a good functional and oncologic outcome.
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Affiliation(s)
- I Plouin-Gaudon
- Department of Head and Neck Surgery, Université Catholique de Louvain, St Luc University Hospital and Cancer Center, Brussels, Belgium
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Abstract
Despite advances in surgical and nonsurgical treatment, overall survival rates for patients who have hypopharyngeal carcinoma have not improved,and this disease still has a poor prognosis. The best results are obtained with multimodality therapy. but at best, two thirds of patients are palliated rather than cured of disease. Radical surgery with postoperative radiation therapy remains the standard of care. Organ preservation strategies have not been as successful in hypopharyngeal cancer as for cancers of other head and neck sites. Chemoradiation is an effective alternative method of aggressive treatment but may be associated with significant dysfunction of the end organ when preservation is possible. Because of poor long-term survival rates, local control remains the most important factor in planning treatment, to provide meaningful palliation and best possible quality of life.
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Affiliation(s)
- Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, 1120 15th Street, Augusta, GA 30912, USA.
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