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Azees PAA, Natarajan S, Amaechi BT, Thajuddin N, Raghavendra VB, Brindhadevi K, Pugazhendhi A. An empirical review on the risk factors, therapeutic strategies and materials at nanoscale for the treatment of oral malignancies. Process Biochem 2022. [DOI: 10.1016/j.procbio.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Voora RS, Panuganti B, Flagg M, Kumar A, Qian AS, Kotha NV, Qiao EM, Weissbrod PA, Rose B, Orosco RK. Salvage Following Transoral Laser Microsurgery for Early Glottic Cancer in National Veteran Database. Laryngoscope 2021; 131:2766-2772. [PMID: 34296772 DOI: 10.1002/lary.29740] [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: 03/11/2021] [Revised: 06/07/2021] [Accepted: 06/28/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Transoral laser microsurgery (TLM) is commonly utilized for early glottic cancer and offers favorable oncologic and functional outcomes. However, the survival implications of salvage therapy for recurrent or persistent disease have not been definitively characterized. STUDY DESIGN Retrospective, national database cohort study. METHODS Data were extracted from Veterans Health Affairs (VHA) Informatics and Computing Infrastructure (VINCI) concerning the TLM-based management of T1-T2 glottic squamous cell carcinoma patients between 2000 and 2017. Patients were characterized as either requiring TLM-only, or in cases of persistent or recurrent local disease, TLM plus change in treatment modality (radiotherapy, chemoradiotherapy, or open surgery). Predictors of overall survival (OS), cancer-specific survival (CSS), and salvage-free survival were evaluated via Cox and Fine-Gray models. RESULTS About 553 patients (70.9% T1a, 13.4% T1b, 15.7% T2) were included, with a median follow-up time of 74.5 months. The need for non-TLM salvage increased along with more advanced disease (11.7% T1a, 29.7% T1b, 32.2% T2). Compared to patients with T1a disease, those with T1b and T2 tumors initially treated with TLM had a significantly higher probability of receiving non-TLM salvage (T1b: HR 2.70, 95% CI: 1.61-4.54; T2: HR 3.02, 95% CI: 1.88-4.84). In a multivariable model, receipt of non-TLM salvage was not a significant predictor of either OS (HR = 0.91, 95% CI: 0.62-1.33, P = .624) or CSS (HR 1.21 95% CI 0.51-2.86, P = .667). CONCLUSION The majority of patients with early glottic cancer that are managed with TLM do not require additional salvage therapy. When non-TLM salvage was required, there was no decrement in OS or CSS. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Rohith S Voora
- University of California, San Diego School of Medicine, La Jolla, California, U.S.A.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A.,Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A
| | - Bharat Panuganti
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A.,Moores Cancer Center, La Jolla, California, U.S.A
| | - Mitchell Flagg
- University of California, San Diego School of Medicine, La Jolla, California, U.S.A.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A
| | - Abhishek Kumar
- Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, U.S.A
| | - Alexander S Qian
- University of California, San Diego School of Medicine, La Jolla, California, U.S.A.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, U.S.A
| | - Nikhil V Kotha
- University of California, San Diego School of Medicine, La Jolla, California, U.S.A.,Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, U.S.A
| | - Edmund M Qiao
- University of California, San Diego School of Medicine, La Jolla, California, U.S.A.,Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, U.S.A
| | - Philip A Weissbrod
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A.,Moores Cancer Center, La Jolla, California, U.S.A
| | - Brent Rose
- Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A.,Moores Cancer Center, La Jolla, California, U.S.A.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, U.S.A
| | - Ryan K Orosco
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A.,Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A.,Moores Cancer Center, La Jolla, California, U.S.A
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Locatello LG, Bruno C, Gallo O. Early glottic cancer recurrence: A critical review on its current management. Crit Rev Oncol Hematol 2021; 160:103298. [PMID: 33716199 DOI: 10.1016/j.critrevonc.2021.103298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/03/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Recurrent early glottic cancer (rEGC) poses several issues in terms of timely diagnosis, correct re-staging, and treatment. We want to critically review the latest evidence about rEGC considering its epidemiology, biology, diagnostic challenges, and treatment strategies. METHODS A systematic search of the literature using PubMed from 1990 to October 31, 2020 was performed. RESULTS There are many different treatment options available (open surgery, transoral mini-invasive surgery, radiotherapy), and many factors related to the patient's status and previous treatments must be considered when planning the best management strategy for rEGC. While its overall prognosis remains satisfactory, it is of the utmost importance to appreciate all the clinical implications derived from the choice of the initial therapeutic modality, and from a correct primary and recurrent staging. CONCLUSION The balance between oncological and voice and swallowing functions represents the fundamental principle underlying rEGC management. Future studies should focus on molecular profiling of rEGC, and on the results of the emerging radiation delivery techniques and mini-invasive procedures.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Outcomes of definitive radiotherapy for early laryngeal cancer in terms of survival and patterns of failure. The Journal of Laryngology & Otology 2019; 133:1087-1091. [DOI: 10.1017/s0022215119002433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundEarly laryngeal cancer treated with definitive radiotherapy or surgery has a high cure rate. This study evaluated the patterns of treatment failure and long-term results of early laryngeal cancers treated with definitive radiotherapy.MethodFrom January 2002 to December 2014, a total of 242 patients with early-stage laryngeal cancers were treated with radical radiotherapy.ResultsAll patients had squamous cell carcinoma of the larynx (92 per cent male and 8 per cent female). Median follow-up was 4.5 years. The majority of patients were smokers (57.4 per cent). Local failure was seen in 12.5 per cent of stage I patients and 22.8 per cent of stage II patients. The 5-year overall survival and disease specific survival were 84 per cent and 91 per cent, respectively.ConclusionIn summary, radiotherapy is a suitable treatment modality for patients with early-stage laryngeal cancer, with an overall locoregional control rate of 84 per cent. Patients who fail radiotherapy may still undergo salvage laryngectomy.
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Chatterjee S, Mallick I, Chakraborty S, Prasath S, Arunsingh M, Achari RB, Arun B, Nallathambi C, Pattatheyil A, Sen S. Helical Radiotherapy in Early Laryngeal Cancers Could Lead to Excess Local Recurrence: Lessons From a Phase II Prospective Study. Clin Oncol (R Coll Radiol) 2019; 32:e67-e75. [PMID: 31704170 DOI: 10.1016/j.clon.2019.09.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 08/06/2019] [Accepted: 08/09/2019] [Indexed: 11/17/2022]
Abstract
AIMS A prospective study was conducted to investigate the feasibility and efficacy of carotid-sparing intensity-modulated radiotherapy (CSIMRT) in early glottic cancers (EGC). MATERIALS AND METHODS Eighteen patients underwent CSIMRT using helical tomotherapy to a dose of 55 Gy/20 fractions/4 weeks. Carotid intimal thickness (CIT) at prespecified carotid levels was measured using B-mode ultrasound at 6, 18 and 36 months. Serial changes in CIT were also measured in a control prospective cohort of 18 patients with head and neck cancers receiving bilateral neck nodal radiation over the same time period (54-60 Gy/30 fraction/6 weeks). The outcomes of 18 patients undergoing CSIMRT were compared against a retrospective consecutive cohort of 41 patients with EGC to confirm comparable local control. RESULTS No significant CIT differences were identified between patients undergoing CSIMRT versus the control group. However, four patients in the CSIMRT group had a local recurrence between 8 and 39 months. In all patients the epicentre of the recurrence was noted at the anterior part of the larynx. The 5-year local recurrence-free survival was 75.1% (95% confidence interval 56.6-99.7%). By contrast, in the group of EGC patients treated without carotid sparing, local recurrence was noted only in a single patient (patient treated with helical tomotherapy) and the 5-year local recurrence-free survival was 97.1% (95% confidence interval 91.8-100%) (Log-rank P = 0.01). CONCLUSION We failed to show the safety of CSIMRT using helical tomotherapy in this population of EGC patients. Use of CSIMRT also did not translate into a substantial reduction in CIT until 36 months. Use of CSIMRT using rotational arc techniques such as helical tomotherapy may be associated with a greater risk of local recurrence due to intrafractional motion interplay effects.
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Affiliation(s)
- S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Chakraborty
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Prasath
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - M Arunsingh
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - R B Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - B Arun
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - C Nallathambi
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - A Pattatheyil
- Department of Surgical Oncology, Tata Medical Center, Kolkata, India
| | - S Sen
- Department of Radiology, Tata Medical Center, Kolkata, India
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Criteria for eligibility to cisplatin in the curative treatment of head and neck cancer: Consensus opinion from a panel of experts. Crit Rev Oncol Hematol 2018; 131:30-34. [PMID: 30293703 DOI: 10.1016/j.critrevonc.2018.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/06/2018] [Accepted: 08/22/2018] [Indexed: 11/22/2022] Open
Abstract
Squamous-cell carcinoma of the head and neck (SCCHN) is an important problem in Brazil, where epidemiological and socioeconomic features often create barriers to the implementation of combined modalities with curative potential. Cisplatin improves the efficacy of radiotherapy in the adjuvant treatment of localized SCCHN and in the definitive therapy of locally advanced disease. However, the addition of high-dose cisplatin to radiotherapy increases treatment toxicity and is not always warranted. A panel of experts convened in Sao Paulo, Brazil, for discussions and recommendations regarding the use of high-dose cisplatin in combination with radiotherapy in SCCHN. In addition to discussing their professional experience, panel members used the current literature to provide evidence-based, practical recommendations regarding sociodemographic or medical criteria that may preclude safe administration of cisplatin. It is hoped that the application of these recommendations in clinical practice may improve therapeutic results in Brazil and other countries with similar health-care environments.
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Spinato G, Stellin M, Azzarello G, Bonazza D, Zanconati F, Politi D, Cocuzza S, Di Mauro P, Ausoni S, Tonoli G, Costantini G, Maiolino L, Spinato R, Da Mosto MC, Baboci L, Del Mistro A, Serra A, Tirelli G. Multicenter research into the quality of life of patients with advanced oropharyngeal carcinoma with long-term survival associated with human papilloma virus. Oncol Lett 2017; 14:185-193. [PMID: 28693152 PMCID: PMC5494809 DOI: 10.3892/ol.2017.6152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/28/2016] [Indexed: 01/22/2023] Open
Abstract
The treatment of advanced-stage oropharyngeal squamous cell carcinoma may utilize various modes, including combining surgery with chemoradiotherapy (CTRT), or primary CTRT followed by rescue surgery. In previous literature it has been revealed how patients treated with combined modes report a low quality of life (QoL) and severe consequences following surgery, radiotherapy and chemotherapy, in the short and in the long-term. The decrease in the QoL of patients treated with high-intensity multi-modal strategies highlights the necessity of modifying treatments, particularly for young HPV-positive patients, where an increased survival rate has already been reported. The modified treatment for HPV-positive tumors in the tonsils and at the base of the tongue is based on the deintensification of therapies aiming to reduce toxicity and thereby improve QoL in the long term, whilst still maintaining therapeutic effectiveness. The aim of the present study was to evaluate the QoL in patients with a long-term survival, who were treated with combined therapy for squamous cell tumors in the tonsils and at the base of the tongue, and to compare the results observed in HPV-positive and HPV-negative patients. According to statistical analysis, differences in the general QoL and in the single scales of the European Organization for the Research and Treatment of Cancer questionnaires were not correlated with the type of therapy selected for the particular patient. QoL considered the presence of HPV, the type of treatment, the subregion of the tonsils vs. the base of the tongue and the disease stage at the time of diagnosis, and was determined to be non-influential with regard to these specific variables.
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Affiliation(s)
- Giacomo Spinato
- Ear, Nose and Throat Department, Rovigo Provincial Hospital, I-45100 Rovigo, Italy
| | - Marco Stellin
- Department of Neurosciences, Ear, Nose and Throat Clinic and Regional Center for Head and Neck Cancer, University of Padua, Treviso Provincial Hospital, I-35122 Padua, Italy
| | | | - Deborah Bonazza
- Pathology Department, Cattinara Hospital, University of Trieste, I-34149 Trieste, Italy
| | - Fabrizio Zanconati
- Pathology Department, Cattinara Hospital, University of Trieste, I-34149 Trieste, Italy
| | - Doriano Politi
- Provincial Ear, Nose and Throat Department of Venice, Mestre Hospital, I-30174 Venice, Italy
| | - Salvatore Cocuzza
- Ear, Nose and Throat Department, University of Catania, I-95125 Catania, Italy
| | - Paola Di Mauro
- Ear, Nose and Throat Department, University of Catania, I-95125 Catania, Italy
| | - Simonetta Ausoni
- Department of Biomedical Sciences, University of Padua, I-35122 Padua, Italy
| | - Giovanni Tonoli
- Ear, Nose and Throat Department, Rovigo Provincial Hospital, I-45100 Rovigo, Italy
| | - Giulio Costantini
- Psychology Department, University of Milano-Bicocca, I-20126 Milan, Italy
| | - Luigi Maiolino
- Ear, Nose and Throat Department, University of Catania, I-95125 Catania, Italy
| | - Roberto Spinato
- Provincial Ear, Nose and Throat Department of Venice, Mestre Hospital, I-30174 Venice, Italy
| | - Maria Cristina Da Mosto
- Department of Neurosciences, Ear, Nose and Throat Clinic and Regional Center for Head and Neck Cancer, University of Padua, Treviso Provincial Hospital, I-35122 Padua, Italy
| | - Lorena Baboci
- Veneto Institute of Oncology IOV-IRCCS, Immunology and Molecular Oncology Unit, Padua, I-35128 Padova, Italy
| | - Annarosa Del Mistro
- Veneto Institute of Oncology IOV-IRCCS, Immunology and Molecular Oncology Unit, Padua, I-35128 Padova, Italy
| | - Agostino Serra
- Ear, Nose and Throat Department, University of Catania, I-95125 Catania, Italy
| | - Giancarlo Tirelli
- Ear, Nose and Throat Department, Cattinara Hospital, University of Trieste, I-34149 Trieste, Italy
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8
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Eskiizmir G, Baskın Y, Yalçın F, Ellidokuz H, Ferris RL. Risk factors for radiation failure in early-stage glottic carcinoma: A systematic review and meta-analysis. Oral Oncol 2016; 62:90-100. [PMID: 27865377 DOI: 10.1016/j.oraloncology.2016.10.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/08/2016] [Accepted: 10/16/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Radiotherapy is one of the main treatment modalities for early-stage glottic carcinoma. Unfortunately, local failure may occur in a group of cases with T1-T2 glottic carcinoma. This meta-analysis sought to determine risk factors for radiation failure in patients with early-stage glottic carcinoma. METHODS A systematic and comprehensive search was performed for related studies published between 1995 and 2014. The primary end-point was 5-year local control. Data extraction and analysis were performed using the software STATA/SE 13.1 for Windows. RESULTS Twenty-seven studies were eligible. A higher risk of radiation failure was demonstrated in male patients [relative risk (RR): 0.927, p<0.001] and those with low hemoglobin level (RR: 0.891, p<0.001) with a high agreement between studies (I-squared=0.0%). Moreover, T2 tumors (RR: 0.795, p<0.001), tumors with anterior commissure involvement (RR: 0.904, p<0.001), tobacco use during/after therapy (RR: 0.824, p<0.001), and "bulky" tumors (RR: 1.270, p<0.001] or tumors bigger in size (RR: 1.332, p<0.001]. Poorly differentiated tumors had a questionable risk of local failure, although a moderate to high interstudy heterogeneity was determined. A statistically significant contribution was not detected for age, presence of comorbidity, alcohol use or subglottic extension. CONCLUSION This is the first meta-analysis which assessed the potential risk factors for radiation failure in patients with early-stage glottic carcinoma. Gender and pretreatment hemoglobin level are major influential factors associated with radiation failure in patients with early-stage glottic carcinoma. However, prospective, randomized clinical trials may permit better stratification of their relative contributions, and those who may benefit more from upfront surgery.
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Affiliation(s)
- Görkem Eskiizmir
- Celal Bayar University, Department of Otolaryngology-Head and Neck Surgery, Manisa, Turkey.
| | - Yasemin Baskın
- Dokuz Eylül University, Institute of Oncology, Izmir, Turkey
| | - Femin Yalçın
- Katip Celebi University, Department of Engineering Sciences, Izmir, Turkey
| | - Hülya Ellidokuz
- Dokuz Eylül University, Institute of Oncology, Izmir, Turkey
| | - Robert L Ferris
- University of Pittsburgh, Division of Head Neck Surgery, Pittsburgh, PA, United States
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Peretti G, Piazza C, Mensi MC, Magnoni L, Bolzoni A. Endoscopic Treatment of cT2 Glottic Carcinoma: Prognostic Impact of Different pT Subcategories. Ann Otol Rhinol Laryngol 2016; 114:579-86. [PMID: 16190089 DOI: 10.1177/000348940511400801] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The cT2 glottic squamous cell carcinomas are a heterogeneous group of lesions in terms of superficial and deep extension. As a consequence, they differ greatly in treatment indications and prognosis. The aim of the present study was to divide cT2 glottic tumors into subcategories according to radiologic and postoperative histopathologic information, in order to identify risk factors connected with determinate survival, local-regional control, and laryngeal preservation rates. Methods: We retrospectively analyzed 55 cT2 glottic lesions treated at a single institution by carbon dioxide laser with at least 2 years of follow-up. Clinical, radiologic, surgical, and histopathologic data were reviewed, and the tumors were accordingly divided into 5 subcategories: I, or pT2 with lateral supraglottic extension (19 patients); II, or pT2 with lateral subglottic extension (6 patients); III, or pT2 with supracommissural and/or subcommissural extension (10 patients); IV, or pT2 with deep vocal muscle infiltration (14 patients); and V, or pT3, for superior and/or inferior paraglottic space invasion lateral to the thyroarytenoid muscle not detected before operation by computed tomographic scan (6 patients). Results: The disease-free survival, ultimate local control with laser alone, and laryngeal preservation rates were compared for each subcategory. Statistically significant differences were found only for the pT3 subgroup (2-year rates of 16.7%, 16.7%, and 16.7% for pT3 versus 5-year rates of 80.5%, 84.7%, and 93.3% for the entire pT2 group). Conclusions: Endoscopic treatment of cT2 glottic tumors can be considered effective when the pT2 stage has been confirmed. In cT2/pT3 patients, after the first endoscopic resection that allows the correct pT staging, additional treatment should always be considered.
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Affiliation(s)
- Giorgio Peretti
- Department of Otolaryngology, University of Brescia, Spedali Civili, Brescia, Italy
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Sommat K, Yit NLF, Kwok LL. Comparison between 4-MV and 6-MV radiotherapy in T1N0 glottic cancer. Laryngoscope 2016; 127:1061-1067. [PMID: 27237064 DOI: 10.1002/lary.26067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to report the outcomes of a retrospective consecutive cohort study of patients with T1N0M0 glottic carcinoma treated with 4-MV or 6-MV radiotherapy. STUDY DESIGN Retrospective case-control study. METHODS This was a retrospective review of all patients with T1N0M0 glottic carcinoma treated with radiotherapy between January 2000 and December 2012 in the Department of Radiation Oncology at National Cancer Center Singapore. A total of 124 patients were included. Clinical endpoints of interest were: local control (LC), overall survival (OS), and disease-specific survival (DSS). Other prognostic factors for LC were also analyzed: age, gender, smoking status, T substage, dose fraction, field size, anterior commissure involvement, total dose, and overall treatment time. RESULTS Six-megavolt photon radiotherapy was used in 73 patients and 4-MV photon radiotherapy in 51 patients. Median follow-up was 4.9 years. The 5-year LC and OS were as follows: 4 MV, 91.6% and 83.4%; 6 MV, 88.8% and 82.8%; and the 5-year LC, OS, and DSS for all patients were 90.4%, 83.3%, and 98.3%. There was no significant difference in LR and OS between 4-MV and 6-MV radiotherapy (P = .92, P = .16, respectively). In the univariate analysis of LC, none of the prognostic factors was statistically significant. Twenty patients (23%) developed second primary cancers, the majority in the lungs. CONCLUSIONS Six-megavolt photon radiotherapy yields comparable results to 4-MV photons. Bolus and computed tomographic simulation are useful to ensure adequate dose coverage of target volume. Follow-up postradiotherapy should incorporate chest imaging, smoking cessation advice, and thyroid function test. LEVEL OF EVIDENCE 4 Laryngoscope, 127:1061-1067, 2017.
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Affiliation(s)
- Kiattisa Sommat
- Department of Radiation Oncology, National Cancer Center Singapore, Singapore
| | | | - Li-Lian Kwok
- Department of Clinical Trials and Epidemiology, National Cancer Center Singapore, Singapore
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Kono T, Saito K, Yabe H, Uno K, Ogawa K. Comparative multidimensional assessment of laryngeal function and quality of life after radiotherapy and laser surgery for early glottic cancer. Head Neck 2016; 38:1085-90. [PMID: 26969802 DOI: 10.1002/hed.24412] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study was designed to comparatively assess laryngeal function and quality of life (QOL) of patients after laser surgery (LS) or radiotherapy (RT) for early glottic cancer. METHODS Sixty-four patients with T1 glottic cancer treated with RT or type II cordectomy underwent both subjective and objective vocal assessments. The LS group was divided into the following: (1) vaporization with defocused mode (laser surgery [LS]-Vap); and (2) excision with focused mode using lower power (LS-Ex). RESULTS Auditory-perceptual evaluation and videostroboscopic images in the LS-Ex group worsened shortly after treatment and time-dependent recovery was quicker than in the LS-Vap group. The LS-Ex group showed equivalent posttherapeutic vocal function with the RT group by acoustics, aerodynamics, and self-assessment questionnaire analysis, whereas the LS-Vap group showed statistically significant worse function. CONCLUSION The multidimensional assessment showed that early glottic cancer could be successfully treated by either RT or LS-Ex with equivalent posttherapeutic laryngeal function and QOL. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1085-1090, 2016.
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Affiliation(s)
- Takeyuki Kono
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koichiro Saito
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Haruna Yabe
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kosuke Uno
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kaoru Ogawa
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
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Ermiş E, Teo M, Dyker KE, Fosker C, Sen M, Prestwich RJ. Definitive hypofractionated radiotherapy for early glottic carcinoma: experience of 55Gy in 20 fractions. Radiat Oncol 2015; 10:203. [PMID: 26395876 PMCID: PMC4580345 DOI: 10.1186/s13014-015-0505-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/10/2015] [Indexed: 12/05/2022] Open
Abstract
Introduction A wide variety of fractionation schedules have been employed for the treatment of early glottic cancer. The aim is to report our 10-year experience of using hypofractionated radiotherapy with 55Gy in 20 fractions at 2.75Gy per fraction. Methods Patients treated between 2004 and 2013 with definitive radiotherapy to a dose of 55Gy in 20 fractions over 4 weeks for T1/2 N0 squamous cell carcinoma of the glottis were retrospectively identified. Patients with prior therapeutic minor surgery (eg. laser stripping, cordotomy) were included. The probabilities of local control, ultimate local control (including salvage surgery), regional control, cause specific survival (CSS) and overall survival (OS) were calculated. Results One hundred thirty-two patients were identified. Median age was 65 years (range 33–89). Median follow up was 72 months (range 7–124). 50 (38 %), 18 (14 %) and 64 (48 %) of patients had T1a, T1b and T2 disease respectively. Five year local control and ultimate local control rates were: overall - 85.6 % and 97.3 % respectively, T1a - 91.8 % and 100 %, T1b - 81.6 and 93.8 %, and T2 - 80.9 % and 95.8 %. Five year regional control, CSS and OS rates were 95.4 %, 95.7 % and 78.8 % respectively. There were no significant associations of covariates (e.g. T-stage, extent of laryngeal extension, histological grade) with local control on univariate analysis. Only increasing age and transglottic extension in T2 disease were significantly associated with overall survival (both p <0.01). Second primary cancers developed in 17 % of patients. 13 (9.8 %) of patients required enteral tube feeding support during radiotherapy; no patients required long term enteral nutrition. One patient required a tracheostomy due to a non-functioning larynx on long term follow up. Conclusions Hypofractionated radiation therapy with a dose of 55Gy in 20 fractions for early stage glottic cancer provides high rates of local control with acceptable toxicity.
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Affiliation(s)
- Ekin Ermiş
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Mark Teo
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Karen E Dyker
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Chris Fosker
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Mehmet Sen
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Robin Jd Prestwich
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK.
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Effects of the administration of epidermal growth factor receptor specific inhibitor cetuximab, alone and in combination with cisplatin, on proliferation and apoptosis of Hep-2 laryngeal cancer cells. The Journal of Laryngology & Otology 2014; 128:902-8. [PMID: 25236402 DOI: 10.1017/s002221511400190x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) overexpression and prognostic value in head and neck squamous cell cancer is the basis for targeting by anti-EGFR antibodies, which increase the efficacy of radiotherapy. In order to evaluate the best therapeutic schedule, the effects of cetuximab (C225) on Hep-2 cell proliferation, alone and in combination with cisplatin, were studied. METHODS Hep-2 cells were treated with cetuximab alone or in combination with cisplatin. After determining cell viability with trypan blue, morphological features of apoptotic degeneration were analysed by fluorescence microscopy with Hoechst 33258 stain. RESULTS Cetuximab alone mildly inhibited Hep-2 proliferation and showed no pro-apoptotic effects. When administered concomitantly with cisplatin, cetuximab synergistically increased inhibition of proliferation and apoptosis. CONCLUSION The antiproliferative activity of cetuximab is consistent with its hypothesised role in inhibiting repopulation. However, the increase in the effects of pro-apoptotic agents induced by cetuximab may be even more relevant to its clinical effectiveness than the inhibition of repopulation.
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Bussu F, Sali M, Gallus R, Petrone G, Zannoni GF, Autorino R, Dinapoli N, Santangelo R, Vellone VG, Graziani C, Miccichè F, Almadori G, Galli J, Delogu G, Sanguinetti M, Rindi G, Tommasino M, Valentini V, Paludetti G. Human Papillomavirus (HPV) Infection in Squamous Cell Carcinomas Arising From the Oropharynx: Detection of HPV DNA and p16 Immunohistochemistry as Diagnostic and Prognostic Indicators—A Pilot Study. Int J Radiat Oncol Biol Phys 2014; 89:1115-1120. [DOI: 10.1016/j.ijrobp.2014.04.044] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 04/16/2014] [Accepted: 04/22/2014] [Indexed: 01/13/2023]
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Murakami N, Mori T, Yoshimoto S, Ito Y, Kobayashi K, Ken H, Kitaguchi M, Sekii S, Takahashi K, Yoshio K, Inaba K, Morota M, Sumi M, Itami J. Expression of EpCAM and prognosis in early-stage glottic cancer treated by radiotherapy. Laryngoscope 2014; 124:E431-6. [PMID: 25043563 DOI: 10.1002/lary.24839] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 06/03/2014] [Accepted: 06/25/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVES/HYPOTHESIS Treatment of head and neck squamous cell carcinoma (HNSCC) often requires radiotherapy, but relapse can occur. There is, therefore, an urgent need for the identification of a predictive novel biomarker for radiosensitivity. The epithelial cell adhesion molecule (EpCAM) has been shown to promote the transformation of malignant tumors, and EpCAM may have prognostic significance, but it is not known if EpCAM determines prognosis, especially with respect to radiotherapy. Therefore, we determined the incidence of the expression of EpCAM in HNSCC and analyzed the prognostic value in patients with early-stage glottic cancer treated with radiotherapy. STUDY DESIGN Retrospective analysis. METHODS All patients with HNSCCs examined in our hospital between January 2012 and February 2013 were analyzed prospectively for the expression of EpCAM. T1-2N0 glottic cancer patients who were primarily treated by radiation therapy between 1995 and 2008 were retrospectively investigated. Patients with or without local recurrence after radical radiation therapy were extracted. The relationship between local recurrence and histopathologic EpCAM expression was compared within these two groups. RESULTS One hundred eighteen patients with HNSCCs from the nasopharynx, oropharynx, hypopharynx, larynx, oral cavity, paranasal cavity, unknown primary, and other sites were analyzed. Positive expression of EpCAM was noted in the oropharynx, hypopharynx, and larynx (72%, 90%, and 58%, respectively). Seventeen and 22 patients with or without local recurrence were extracted, respectively. There was no difference between two groups, with the exception of EpCAM expression. CONCLUSIONS The expression of EpCAM in HNSCC was investigated. Patients with strong EpCAM expression were associated with local recurrence after primary radiation therapy. LEVEL OF EVIDENCE NA
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Affiliation(s)
- Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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Clinical history, prognostic factors, and management of facial nerve in malignant tumors of the parotid gland. Clin Exp Otorhinolaryngol 2014; 7:126-32. [PMID: 24917910 PMCID: PMC4050085 DOI: 10.3342/ceo.2014.7.2.126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 07/27/2012] [Accepted: 12/05/2012] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES We analyzed the outcomes following clinical management of parotid masses that were determined to be malignant tumors after parotidectomy. METHODS We evaluated data from 70 patients with parotid malignancies between November 1994 and December 2005. RESULTS Among salivary histotypes (n=49), the most significant prognostic parameter was cT4 stage at diagnosis (P=0.0055, log-rank) both for clinical involvement of the facial nerve and for invasion of other structures. The main cause of cancer-related death was a distant metastasis. CONCLUSION The present series confirms that the main prognostic parameter in salivary parotid malignancies was cT4 classification at diagnosis, often due to clinical involvement of the facial nerve. The oncological outcome of salivary malignancies was influenced by distant metastasis more than most other head and neck sites. We recommend dissecting and preserving the functioning VIIth cranial nerve during surgery for parotid malignancies.
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Rettori MM, de Carvalho AC, Longo ALB, de Oliveira CZ, Kowalski LP, Carvalho AL, Vettore AL. TIMP3 and CCNA1 hypermethylation in HNSCC is associated with an increased incidence of second primary tumors. J Transl Med 2013; 11:316. [PMID: 24359512 PMCID: PMC3884019 DOI: 10.1186/1479-5876-11-316] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 12/17/2013] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hypermethylation in the promoter regions is associated with the suppression of gene expression and has been considered a potential molecular marker for several tumor types, including head and neck squamous cell carcinomas (HNSCC). METHODS To evaluate the gene hypermethylation profile as a prognostic marker, this retrospective study used a QMSP approach to determine the methylation status of 19 genes in 70 HNSCC patients. RESULTS The methylation profile analysis of primary HNSCC revealed that genes CCNA1, DAPK, MGMT, TIMP3 and SFRP1 were frequently hypermethylated, with high specificity and sensitivity. TIMP3 and CCNA1 hypermethylation was significantly associated with lower rates of second primary tumor-free survival (p = 0.007 and p = 0.001; log-rank test, respectively). CONCLUSION This study, for the first time, presents CCNA1 and TIMP3 hypermethylation as a helpful tool to identify HNSCC subjects at risk of developing second primary carcinomas.
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Affiliation(s)
| | | | | | | | | | | | - André Luiz Vettore
- Cancer Molecular Biology Laboratory, Department of Biological Sciences, Federal University of São Paulo, 04039-020, São Paulo, Brazil.
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Pezier TF, Nixon IJ, Joshi A, Guerrero-Urbano T, Oakley R, Jeannon JP, Simo R. Factors predictive of outcome following primary total laryngectomy for advanced squamous cell carcinoma. Eur Arch Otorhinolaryngol 2013; 271:2503-9. [DOI: 10.1007/s00405-013-2779-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/11/2013] [Indexed: 01/22/2023]
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Priante AVM, Gross JL, Sztokfisz CZ, Nishimoto IN, Kowalski LP. Diagnosis of second primary tumor and long-term survival after single initial triple endoscopy in patients with head and neck cancer. Eur Arch Otorhinolaryngol 2013; 271:2285-92. [DOI: 10.1007/s00405-013-2768-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022]
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An individualised treatment algorithm for tumour stage 1 glottic squamous cell carcinoma. The Journal of Laryngology & Otology 2013; 127:1127-33. [DOI: 10.1017/s0022215113002363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To report and discuss the outcome of a treatment algorithm for patients with tumour stage 1 glottic squamous cell carcinoma.Method:A retrospective outcome analysis study was performed using data from a tertiary referral centre.Results:Sixty-nine patients were treated with radiotherapy and 26 with surgery, in accordance with the treatment algorithm. Five-year overall survival rates were the same for both treatment groups (92 per cent). Five-year disease-specific survival rates were 100 per cent for surgery, 98 per cent for radiotherapy and 99 per cent overall. The overall 5-year laryngeal preservation rate was 89.1 per cent, being 95.7 per cent for surgery patients and 86.7 per cent for radiotherapy patients (p = 0.502). There was no significant association between laryngeal preservation rates and age (p = 0.779), anterior commissure involvement (p = 0.081), tumour stage (1a or 1b) (p = 0.266) or treatment modality (surgery or radiotherapy; p = 0.220). There was no significant difference in local recurrence rates between the two treatment groups (19.3 per cent for radiotherapy vs 10.0 per cent for surgery; p = 0.220). The overall 5-year regional recurrence rate was 1.2 per cent.Conclusion:Tumour stage 1 glottic carcinoma can be managed with different treatment modalities, following an individualised treatment algorithm, with results comparable to published outcomes.
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Transoral laser surgery versus radiotherapy for tumour stage 1a or 1b glottic squamous cell carcinoma: systematic review of local control outcomes. The Journal of Laryngology & Otology 2013; 127:732-8. [PMID: 23835287 DOI: 10.1017/s0022215113001400] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Previous literature reviews comparing transoral laser surgery versus radiotherapy for glottic carcinoma treatment have analysed ‘early stage’ disease as one group. The current review aimed to assess local control outcomes, comparing these two treatment modalities, specifically for either tumour stage 1a or stage 1b lesions.Methods:The three authors conducted independent, structured literature searches. Simple weighted means were calculated.Results:Thirty-six publications were analysed. Three-year local control rates for tumour stage 1a tumours were 88.9 per cent for transoral laser surgery (n = 1308) and 89.3 per cent for radiotherapy (n = 2405). For tumour stage 1b tumours, the local control rates were 76.8 per cent for transoral laser surgery (n = 194) and 86.2 per cent for radiotherapy (n = 492).Conclusion:From this analysis of level four evidence, there was no demonstrable difference in local control rates for tumour stage 1a glottic squamous cell carcinoma treated by transoral laser surgery or radiotherapy. There was a trend towards improved local control of tumour stage 1b tumours treated with radiotherapy, but this finding was based on a limited number of published outcomes (n = 194).
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Adams A, Warner K, Nör JE. Salivary gland cancer stem cells. Oral Oncol 2013; 49:845-853. [PMID: 23810400 DOI: 10.1016/j.oraloncology.2013.05.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/22/2013] [Accepted: 05/31/2013] [Indexed: 12/13/2022]
Abstract
Emerging evidence suggests the existence of a tumorigenic population of cancer cells that demonstrate stem cell-like properties such as self-renewal and multipotency. These cells, termed cancer stem cells (CSC), are able to both initiate and maintain tumor formation and progression. Studies have shown that CSC are resistant to traditional chemotherapy treatments preventing complete eradication of the tumor cell population. Following treatment, CSC are able to re-initiate tumor growth leading to patient relapse. Salivary gland cancers are relatively rare but constitute a highly significant public health issue due to the lack of effective treatments. In particular, patients with mucoepidermoid carcinoma or adenoid cystic carcinoma, the two most common salivary malignancies, have low long-term survival rates due to the lack of response to current therapies. Considering the role of CSC in resistance to therapy in other tumor types, it is possible that this unique sub-population of cells is involved in resistance of salivary gland tumors to treatment. Characterization of CSC can lead to better understanding of the pathobiology of salivary gland malignancies as well as to the development of more effective therapies. Here, we make a brief overview of the state-of-the-science in salivary gland cancer, and discuss possible implications of the cancer stem cell hypothesis to the treatment of salivary gland malignancies.
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Affiliation(s)
- April Adams
- Department of Restorative Sciences, University of Michigan School of Dentistry, United States
| | - Kristy Warner
- Department of Restorative Sciences, University of Michigan School of Dentistry, United States
| | - Jacques E Nör
- Department of Restorative Sciences, University of Michigan School of Dentistry, United States; Department of Biomedical Engineering, University of Michigan College of Engineering, United States; Department of Otolaryngology, University of Michigan School of Medicine, United States.
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Amado AC, Bujor L, Monteiro Grillo I. 3D conformal hypofractionated radical radiotherapy in early glottic cancer. Rep Pract Oncol Radiother 2013; 18:261-4. [PMID: 24416562 DOI: 10.1016/j.rpor.2013.04.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 03/11/2013] [Accepted: 04/23/2013] [Indexed: 11/26/2022] Open
Abstract
AIM The purpose of this study was to evaluate acute and late toxicity and the locoregional control in patients treated with hypofractionated radical radiotherapy 2.25 Gy/fraction/day for early glottic carcinoma. MATERIALS AND METHODS A retrospective analysis was performed of 27 patients, stage T1-T2 N0 glottic squamous cell carcinoma, that underwent radical RT from April 2008 to October 2011. The mean age was 64.6 years (range 36-81). Seventeen patients were staged T1a, 3 patients T1b and 7 patients T2. All patients were 3D planned and treated in a 6 MV LINAC, 2.25 Gy/fraction/5 days per week, to a total dose between 63 Gy and 67.5 Gy. Biological Effective Dose (BED (α/β = 10)) ranged from 77.18 Gy to 82.69 Gy and EQD2 from 64.31 Gy to 68.91 Gy. Patients were evaluated in periodic follow-up. Toxicity was evaluated according to RTOG Toxicities Scales. RESULTS With a median follow-time of 24.7 months (range 3.6-44.2 months), no evidence of locoregional recurrence was observed. The treatment was well tolerated and no unscheduled interruptions in treatments for toxicity were documented, with the median overall treatment time of 41 days (range 38-48). Only grades 1 and 2 acute toxicity were observed and no evidence of severe late toxicity. CONCLUSION The authors believe that this moderately hypofractionated scheme can provide a good locoregional control for T1-T2 glottic carcinomas with no increase of toxicity. As the limitation of this work is the reduced number of patients and the lack of long term follow-up, the authors hope to update this retrospective study in the future in order to improve the power of the results.
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Affiliation(s)
- Ana Cristina Amado
- Radiotherapy Department, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Laurentiu Bujor
- Radiotherapy Department, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Isabel Monteiro Grillo
- Radiotherapy Department, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Lisbon, Portugal ; Medical Faculty of Lisbon, Lisbon University, Lisbon, Portugal
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Stomeo F, Tosin E, Morolli F, Bianchini C, Ciorba A, Pastore A, Pelucchi S. Comparison of Subjective and Objective Tools in Transoral Laser Cordectomy for Early Glottic Cancer: Importance of Voice Handicap Index. Int J Immunopathol Pharmacol 2013; 26:445-51. [DOI: 10.1177/039463201302600217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Several studies in recent years have already reported good oncologic results with laser microsurgery in the treatment of early glottic carcinoma. We conducted a longitudinal voice evaluation, in patients with early glottic cancer who underwent transoral laser cordectomy, in order to assess the voice quality outcome and its relationship with objective and subjective (voice handicap index questionnaire and GIRBAS scale) means. Twenty-four previously untreated patients underwent transoral laser cordectomy for early glottic cancer. All patients underwent subjective and objective voice assessment according to the multidimensional voice protocol recommended by the European Laryngological Society including acoustic, perceptual and stroboscopic analysis combined to patient self assessment of voice (voice handicap index-VHI). These evaluations were performed before treatment and 6 months after the treatment. Vocal fold healing was complete in all cases by 6 months following surgery. Main voice parameters (subjective and objective) resulted improved at the 6-month control after surgery. In particular, voice handicap index (VHI) and GIRBAS scale resulted reliable for voice assessment and for the postoperative follow-up. In conclusion, VHI, GIRBAS, multidimensional voice program (MDVP) and spectroacoustic parameters showed a close trend in the present study, and this confirms the validity of the voice analysis performed by each tool.
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Affiliation(s)
- F. Stomeo
- ENT Department, University Hospital of Ferrara, Italy
| | - E. Tosin
- ENT Department, University Hospital of Ferrara, Italy
| | - F. Morolli
- ENT Department, University Hospital of Ferrara, Italy
| | - C. Bianchini
- ENT Department, University Hospital of Ferrara, Italy
| | - A. Ciorba
- ENT Department, University Hospital of Ferrara, Italy
| | - A. Pastore
- ENT Department, University Hospital of Ferrara, Italy
| | - S. Pelucchi
- ENT Department, University Hospital of Ferrara, Italy
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HPV infection in squamous cell carcinomas arising from different mucosal sites of the head and neck region. Is p16 immunohistochemistry a reliable surrogate marker? Br J Cancer 2013; 108:1157-62. [PMID: 23403821 PMCID: PMC3619072 DOI: 10.1038/bjc.2013.55] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Human papillomavirus 16 infection has been proven to be associated with oropharyngeal squamous cell carcinomas (SCCs) and is probably the main reason of the reported increase in the incidence. The role of high-risk (HR) HPV for carcinogenesis of other sites in the head and neck awaits confirmation. With the aim to evaluate the prevalence of HPV infection and the reliability of different diagnostic tools in SCCs of different sites, 109 consecutive untreated head and neck SCCs were enrolled, and fresh tumour samples collected. METHODS Human papillomavirus DNA was detected by Digene Hybrid Capture 2 (HC2). Human papillomavirus E6 and E7 mRNA were detected by NucliSENS EasyQ HPVv1. P16 expression was evaluated by immunohistochemistry. RESULTS In all, 12.84% of cases were infected by HR genotypes and 1.84% by low-risk genotypes. Human papillomavirus 16 accounted for 87% of HR infections. The overall agreement between DNA and RNA detection is 99.1%. Although p16 expression clearly correlates with HPV infection (P=0.0051), the inter-rater agreement is poor (k=0.27). The oropharynx showed the highest HR HPV infection rate (47.6%) and was also the only site in which p16 immunohistochemistry revealed to be a fair, but not excellent, diagnostic assay (κ=0.61). CONCLUSION The prognostic role of HR HPV infection in oropharyngeal oncology, with its potential clinical applications, underscores the need for a consensus on the most appropriate detection methods. The present results suggest that viral mRNA detection could be the standard for fresh samples, whereas DNA detection could be routinely used in formalin-fixed, paraffin-embedded samples.
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Abstract
Cancer stem cells (CSCs), also called “cells that start the tumor,” represent in themselves one of the most topical and controversial issues in the field of cancer research. Tumor stem cells are able to self-propagate in vitro (self-renewal), giving rise both to other tumor stem cells and most advanced cells in the line of differentiation (asymmetric division). A final characteristic is tumorigenicity, a fundamental property, which outlines the tumor stem cell as the only cell able to initiate the formation of a tumor when implanted in immune-deficient mice. The hypothesis of a hierarchical organization of tumor cells dates back more than 40 years, but only in 1997, thanks to the work of John Dick and Dominique Bonnet, was there the formal proof of such an organization in acute myeloid leukemia. Following this, many other research groups were able to isolate CSCs, by appropriate selection markers, in various malignancies, such as breast, brain, colon, pancreas, and liver cancers and in melanoma. To date, however, it is not possible to isolate stem cells from all types of neoplasia, particularly in solid tumors. From a therapeutic point of view, the concept of tumor stem cells implies a complete revision of conventional antineoplastic treatment. Conventional cytotoxic agents are designed to target actively proliferating cells. In the majority of cases, this is not sufficient to eliminate the CSCs, which thanks to their reduced proliferative activity and/or the presence of proteins capable of extruding chemotherapeutics from the cell are not targeted. Therefore, the theory of cancer stem cells can pose new paradigms in terms of cancer treatment. Potential approaches, even in the very early experimental stages, relate to the selective inhibition of pathways connected with self-renewal, or more specifically based on the presence of specific surface markers for selective cytotoxic agent vehicles. Finally, some research groups are trying to induce these cells to differentiate, thus making them easier to remove. For all these reasons, we have collected existing literature on head and neck cancer stem cells that correlate the biological characteristics of this subpopulation of cancer cells with the clinical behavior of tumors.
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Affiliation(s)
- Eugenia Allegra
- Otolaryngology - Head and Neck Surgery, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Definitive radiation therapy for early glottic cancer: experience of two fractionation schedules. Clin Exp Otorhinolaryngol 2012; 5:94-100. [PMID: 22737290 PMCID: PMC3380119 DOI: 10.3342/ceo.2012.5.2.94] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 09/08/2011] [Accepted: 12/21/2011] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The authors would report the results of definitive radiation therapy (RT) for early glottic cancer by two different radiation dose schedules. METHODS From February of 1995 till June of 2008, 157 patients with T1-2N0 glottic cancer were treated with curative RT at Samsung Medical Center. All patients had squamous cell carcinoma, and there were 89 patients (56.7%) with T1a, 36 (22.9%) with T1b, and 32 (20.4%) with T2. Two different radiation dose schedules were used: 70 Gy in 35 fractions to 64 patients (40.8%, group A); and 67.5 Gy in 30 fractions to 93 patients (59.2%, group B). The median treatment durations were 50 days (range, 44 to 59 days) and 44 days (range, 40 to 67 days) in the groups A and B, respectively. RESULTS The median follow-up durations were 85 and 45 months for the groups A and B. No severe late complication of RTOG grade 3 or higher was observed, and there was no difference in acute or chronic complication between the groups. Twenty-four patients experienced treatment failure: local recurrence only in 19 patients; regional recurrence only in one; combined local and regional recurrence in four; and systemic metastasis in none. The overall 5-year disease-free survival and disease-specific survival rates were 84.7% and 94.8%. The disease-free survival rate in the group B was better (78.3% vs. 90.8%, P=0.031). This difference was significant only in T1 stage (83.4% vs. 94.6%, P=0.025), but not in T2 (62.7% vs. 60.6%, P=0.965). Univariate analysis showed that the tumor extent, cord mobility, T-stage, and the dose schedule had significant influence on the disease-free survival, and multivariate analysis showed that only the tumor extent and the dose schedule were associated with the disease-free survival. CONCLUSION Superior disease-free survival could be achieved by 2.25 Gy per fraction without increased toxicity over shorter RT duration, when compared with 2.0 Gy per fraction.
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Tong CC, Au KH, Ngan RKC, Cheung FY, Chow SM, Fu YT, Au JSK, Law SCK. Definitive radiotherapy for early stage glottic cancer by 6 MV photons. HEAD & NECK ONCOLOGY 2012; 4:23. [PMID: 22607730 PMCID: PMC3448507 DOI: 10.1186/1758-3284-4-23] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 04/29/2012] [Indexed: 11/24/2022]
Abstract
Purpose To evaluate the clinical outcome of early glottic cancer (GC) treated by primary radiotherapy (RT) with 6 MV photons. Methods and materials We retrospectively reviewed the medical records of 695 consecutive patients with T1N0 and T2N0 GC treated between 1983 and 2005 by RT in our institution. Clinical outcome in terms of local control (LC), overall survival (OS) and cause- specific survival (CSS) rate were evaluated. Results The median follow-up time was 10.5 years. The 10-year actuarial LC rates were as follows: T1A, 91%; T1B, 87%; T2, 77%. The 10-year OS were as follows: T1, 74.2%; T2, 70.7%. The 10-year CSS were as follows: T1, 97.7%; T2, 97.1%. Poorly differentiated histology and tumor biologically effective dose < 65 Gy15 were adverse factors in both LC of T1 and T2 disease. Involvement of anterior commissure was an adverse factor in both LC and CSS of T1 disease. Subglottic extension was associated with poor LC in T2 disease whereas hemoglobin <13.0 was associated with poor LC and CSS of T2 disease. Conclusion Primary RT remains an option among the various standard treatments for early GC. Clinical treatment outcome by 6MV photons is similar and comparable to historic data of Cobalt-60 and 2 MV photons.
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Affiliation(s)
- Chi-Chung Tong
- Department of Clinical Oncology, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China.
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van Gogh CDL, Verdonck-de Leeuw IM, Wedler-Peeters J, Langendijk JA, Mahieu HF. Prospective evaluation of voice outcome during the first two years in male patients treated by radiotherapy or laser surgery for T1a glottic carcinoma. Eur Arch Otorhinolaryngol 2012; 269:1647-52. [PMID: 22310839 PMCID: PMC3345110 DOI: 10.1007/s00405-012-1947-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 01/13/2012] [Indexed: 11/24/2022]
Abstract
In this prospective cohort study, we assessed voice outcome in patients before and up to 2 years after treatment for early glottic cancer either by radiotherapy or by laser surgery; 106 male patients, treated for T1aN0M0 glottic cancer either by endoscopic laser surgery (n = 67) or by radiotherapy (n = 39), participated in the study. Patients’ voices were recorded and analysed pre-treatment and 3, 6, 12 and 24 months post-treatment at their routine visit at the outpatient clinic. Average fundamental frequency (F0), percent jitter, percent shimmer and normalized noise energy (NNE) were determined. After 2 years, local control rate was 95% in the radiotherapy group and 97% in the laser surgery group. Larynx preservation rate was 95% after radiotherapy and 100% after laser surgery. Voice outcome recovers more quickly in patients treated with laser surgery in comparison to radiotherapy: 3 months after laser surgery there is no longer a difference with regard to normal voices except for the fundamental frequency, which remains higher pitched, even in the longer term. For patients treated with radiotherapy it takes longer for jitter, shimmer and NNE to become normal, where jitter remains significantly different from normal voices even after 2 years. According to these results, we believe that laser surgery is the first treatment of choice in the treatment of selected cases of T1a glottic carcinomas with good functional and oncological results.
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Affiliation(s)
- Christine D L van Gogh
- Department of Otorhinolaryngology, Head and Neck Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
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Nguyen NP, Abraham D, Desai A, Betz M, Davis R, Sroka T, Chi A, Gelumbauskas S, Ceizyk M, Smith-Raymond L, Stevie M, Jang S, Hamilton R, Vinh-Hung V. Impact of image-guided radiotherapy to reduce laryngeal edema following treatment for non-laryngeal and non-hypopharyngeal head and neck cancers. Oral Oncol 2011; 47:900-4. [DOI: 10.1016/j.oraloncology.2011.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 06/03/2011] [Accepted: 06/03/2011] [Indexed: 11/29/2022]
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Effect of surface-enhanced laser desorption/ionization time-of-flight mass spectrometry on identifying biomarkers of laryngeal carcinoma. Tumour Biol 2011; 32:1139-45. [PMID: 21826475 DOI: 10.1007/s13277-011-0216-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 07/25/2011] [Indexed: 12/11/2022] Open
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Bussu F, Miccichè F, Rigante M, Dinapoli N, Parrilla C, Bonomo P, Cadoni G, Mantini G, Galli J, Rufini V, Almadori G, Valentini V, Paludetti G. Oncologic outcomes in advanced laryngeal squamous cell carcinomas treated with different modalities in a single institution: a retrospective analysis of 65 cases. Head Neck 2011; 34:573-9. [PMID: 21692130 DOI: 10.1002/hed.21785] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 02/01/2011] [Accepted: 02/16/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Treatment for laryngeal squamous cell carcinoma (SCC) has been predominantly surgical for decades, but in the last 20 years nonsurgical modalities (radiotherapy), with the aim of organ preservation, also became predominant among advanced stages. Retrospectively evaluating our series of stage III and stage IV laryngeal SCCs, we compared the 2 main therapeutic modalities. METHODS Medical records of 65 consecutive patients with advanced laryngeal SCC, from November 2005 to January 2009, were reviewed. RESULTS Among irradiated patients 2-year organ preservation was 86% for cT2, 43% for cT3, and 17% for cT4a (p = .037, Wilcoxon test). With respect to survival, the only significant differences between surgery and radiotherapy were detected among cT4a SCCs (p = .03, Wilcoxon test), in favor of surgery. CONCLUSIONS The present results confirm the surgical recommendation for cT4a laryngeal SCCs. On the other hand, for T < 4, our results confirm that radiochemotherapy warrants a survival similar to that of total laryngectomy, thus allowing us to preserve the larynx in a relevant number of cases.
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Affiliation(s)
- Francesco Bussu
- Institute of Otorhinolaryngology, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
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Priante AVM, Castilho EC, Kowalski LP. Second primary tumors in patients with head and neck cancer. Curr Oncol Rep 2011; 13:132-7. [PMID: 21234721 DOI: 10.1007/s11912-010-0147-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This is a review on second primary tumors in patients with head and neck cancer. These patients have a high risk of developing other cancers simultaneously or subsequently. The incidence of multiple primary tumors in this population can be as high as 27%. Recurrences are the most common cause of treatment failure within the first 2 years of follow-up. After the third year the diagnosis of a second primary tumor becomes the most important cause of morbimortality in head and neck cancer patients, especially in those treated for cancers early diagnosed. Most second primary tumors occur in the upper aerodigestive tract (40%-59%), lung (31%-37.5%), and esophagus (9%-44%). Patients who develop second primary tumor have a significant reduction of survival expectancy.
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Impact and relationship of anterior commissure and time-dose factor on the local control of T1N0 glottic cancer treated by 6 MV photons. Radiat Oncol 2011; 6:53. [PMID: 21600025 PMCID: PMC3124409 DOI: 10.1186/1748-717x-6-53] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 05/21/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate prognostic factors that may influence local control (LC) of T1N0 glottic cancer treated by primary radiotherapy (RT) with 6 MV photons. METHODS We retrospectively reviewed the medical records of 433 consecutive patients with T1N0 glottic cancer treated between 1983 and 2005 by RT in our institution. All patients were treated with 6 MV photons. One hundred and seventy seven (41%) patients received 52.5 Gy in 23 fractions with 2.5 Gy/fraction, and 256 (59%) patients received 66 Gy in 33 fractions with 2 Gy/fraction. RESULTS The median follow-up time was 10.5 years. The 10-year LC rates were 91% and 87% for T1a and T1b respectively. Multivariate analysis showed LC rate was adversely affected by poorly differentiated histology (Hazard Ratio [HR]: 7.5, p = 0.035); involvement of anterior commissure (HR: 2.34, p = 0.011); fraction size of 2.0 Gy (HR: 2.17, p = 0.035) and tumor biologically effective dose (BED) < 65 Gy15 (HR: 3.38, p = 0.017). CONCLUSIONS The negative impact of anterior commissure involvement could be overcome by delivering a higher tumor BED through using fraction size of > 2.0 Gy. We recommend that fraction size > 2.0 Gy should be utilized, for radiation schedules with five daily fractions each week.
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de Jong MC, Pramana J, van der Wal JE, Lacko M, Peutz-Kootstra CJ, de Jong JM, Takes RP, Kaanders JH, van der Laan BF, Wachters J, Jansen JC, Rasch CR, van Velthuysen MLF, Grénman R, Hoebers FJ, Schuuring E, van den Brekel MW, Begg AC. CD44 Expression Predicts Local Recurrence after Radiotherapy in Larynx Cancer. Clin Cancer Res 2010; 16:5329-38. [DOI: 10.1158/1078-0432.ccr-10-0799] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Onimaru R, Hasegawa M, Yasuda K, Homma A, Oridate N, Fukuda S, Shirato H. Radiotherapy for glottic T1N0 carcinoma with slight hypofractionation and standard overall treatment time: importance of overall treatment time. Jpn J Clin Oncol 2010; 41:103-9. [PMID: 20696816 DOI: 10.1093/jjco/hyq153] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We retrospectively investigated treatment outcomes in patients with glottic T1 carcinoma treated with 65 Gy in 26 fractions four times a week and discuss the importance of the overall treatment time. METHODS Two hundred one patients with glottic T1 carcinoma were evaluated. Sixty-five Gray in 26 fractions were delivered for 200 patients, whereas 1 patient received 62.5 Gy in 25 fractions. We delivered radiotherapy once daily four times a week in this period, for a weekly dose of 10 Gy. Weekdays except Wednesday were treatment days. RESULTS The overall survival rate was 96.8 ± 1.3% (standard error) at 3 years and 90.8 ± 2.2% at 5 years. The local control rate was 91.9 ± 2.0% at 3 years and 89.8 ± 2.3% at 5 years. In patients with an overall treatment time equal to or longer than 47 days, the local control rate was 82.6 ± 6.0% at both 3 and 5 years. In the patients with overall treatment time equal to or less than 46 days, the local control rate was 94.6 ± 1.9% at 3 years and 91.8 ± 2.4% at 5 years. There was a significant difference between these two groups (P = 0.0349). A severe late radiation reaction occurred in one patient. He experienced severe laryngeal edema that required tracheotomy at 6 months after the completion of radiotherapy. The tracheotomy was closed at 14 months after completion of radiotherapy. CONCLUSIONS Overall treatment time seems to be an important factor for a good local control rate for glottic T1N0 carcinoma even when treated with slight hypofractionation.
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Affiliation(s)
- Rikiya Onimaru
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Hirasawa N, Itoh Y, Ishihara S, Kubota S, Itoh J, Fujimoto Y, Nakashima T, Naganawa S. Radiotherapy with or without chemotherapy for patients with T1-T2 glottic carcinoma: retrospective analysis. HEAD & NECK ONCOLOGY 2010; 2:20. [PMID: 20673360 PMCID: PMC2919535 DOI: 10.1186/1758-3284-2-20] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 07/30/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND To assess the results for local control (LC) and survival in patients with early-stage glottic cancer (GC) who were treated by radiotherapy (RT) with or without chemotherapy. METHODS Fifty-eight patients with T1-T2 squamous cell carcinoma of the glottis who were treated between 2001 and 2006 were analyzed retrospectively. Potential prognostic factors for LC were evaluated by univariate analysis. RESULTS The 5-year LC rate in all patients was 84.3%. The overall 5-year LC rates for patients with T1a, Tb, and T2 GC were 85.9%, 83%, and 85%, respectively. Of the 58 patients, eight developed recurrent disease at the primary site, and one had lymph node recurrences on the neck. In the final analysis, the total laryngectomy-free survival rate was 93% at five years, and the ultimate LC rates for T1a, Tb, and T2 were 100%, 90.9%, and 95.2%, respectively. In a univariate analysis of 55 patients, there was no statistical significance between the LC rate for RT alone and that for chemoradiation. Only two patients died of laryngeal carcinoma, and one died of intercurrent disease. Fifty-five patients were living disease-free at the end of the study period. The 5-year overall survival (OS) rate for all patients was 88.1%, and the 5-year OS rates for T1a, Tb, and T2 were 91.6%, 77.8%, and 89.9%, respectively. CONCLUSIONS The retrospective analysis showed a high rate of LC and larynx preservation in patients with T1-T2 GC by means of RT with or without chemotherapy. There was, however, no statistical difference in LC rates for the two types of therapy.
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Affiliation(s)
- Naoki Hirasawa
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi, Japan
| | - Yoshiyuki Itoh
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi, Japan
| | - Shunichi Ishihara
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi, Japan
| | - Seiji Kubota
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi, Japan
| | - Junji Itoh
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi, Japan
| | - Yasushi Fujimoto
- Department of Otolaryngology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi, Japan
| | - Tsutomu Nakashima
- Department of Otolaryngology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi, Japan
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Schwartz SR, Cohen SM, Dailey SH, Rosenfeld RM, Deutsch ES, Gillespie MB, Granieri E, Hapner ER, Kimball CE, Krouse HJ, McMurray JS, Medina S, O'Brien K, Ouellette DR, Messinger-Rapport BJ, Stachler RJ, Strode S, Thompson DM, Stemple JC, Willging JP, Cowley T, McCoy S, Bernad PG, Patel MM. Clinical Practice Guideline: Hoarseness (Dysphonia). Otolaryngol Head Neck Surg 2009; 141:S1-S31. [DOI: 10.1016/j.otohns.2009.06.744] [Citation(s) in RCA: 203] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 06/26/2009] [Indexed: 12/27/2022]
Abstract
Objective: This guideline provides evidence-based recommendations on managing hoarseness (dysphonia), defined as a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life (QOL). Hoarseness affects nearly one-third of the population at some point in their lives. This guideline applies to all age groups evaluated in a setting where hoarseness would be identified or managed. It is intended for all clinicians who are likely to diagnose and manage patients with hoarseness. Purpose: The primary purpose of this guideline is to improve diagnostic accuracy for hoarseness (dysphonia), reduce inappropriate antibiotic use, reduce inappropriate steroid use, reduce inappropriate use of anti-reflux medications, reduce inappropriate use of radiographic imaging, and promote appropriate use of laryngoscopy, voice therapy, and surgery. In creating this guideline the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of neurology, speech-language pathology, professional voice teaching, family medicine, pulmonology, geriatric medicine, nursing, internal medicine, otolaryngology–head and neck surgery, pediatrics, and consumers. Results The panel made strong recommendations that 1) the clinician should not routinely prescribe antibiotics to treat hoarseness and 2) the clinician should advocate voice therapy for patients diagnosed with hoarseness that reduces voice-related QOL. The panel made recommendations that 1) the clinician should diagnose hoarseness (dysphonia) in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related QOL; 2) the clinician should assess the patient with hoarseness by history and/or physical examination for factors that modify management, such as one or more of the following: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or vocal performer; 3) the clinician should visualize the patient's larynx, or refer the patient to a clinician who can visualize the larynx, when hoarseness fails to resolve by a maximum of three months after onset, or irrespective of duration if a serious underlying cause is suspected; 4) the clinician should not obtain computed tomography or magnetic resonance imaging of the patient with a primary complaint of hoarseness prior to visualizing the larynx; 5) the clinician should not prescribe anti-reflux medications for patients with hoarseness without signs or symptoms of gastroesophageal reflux disease; 6) the clinician should not routinely prescribe oral corticosteroids to treat hoarseness; 7) the clinician should visualize the larynx before prescribing voice therapy and document/communicate the results to the speech-language pathologist; and 8) the clinician should prescribe, or refer the patient to a clinician who can prescribe, botulinum toxin injections for the treatment of hoarseness caused by adductor spasmodic dysphonia. The panel offered as options that 1) the clinician may perform laryngoscopy at any time in a patient with hoarseness, or may refer the patient to a clinician who can visualize the larynx; 2) the clinician may prescribe anti-reflux medication for patients with hoarseness and signs of chronic laryngitis; and 3) the clinician may educate/counsel patients with hoarseness about control/preventive measures. Disclaimer: This clinical practice guideline is not intended as a sole source of guidance in managing hoarseness (dysphonia). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.
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Cheah NLC, Lupton S, Marshall A, Hartley A, Glaholm J. Outcome of T1N0M0 squamous cell carcinoma of the larynx treated with short-course radiotherapy to a total dose of 50 Gy in 16 fractions: the Birmingham experience. Clin Oncol (R Coll Radiol) 2009; 21:494-501. [PMID: 19375900 DOI: 10.1016/j.clon.2009.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 01/21/2009] [Accepted: 02/26/2009] [Indexed: 11/16/2022]
Abstract
AIMS To review the results of hypofractionated radiotherapy in T1N0M0 squamous cell carcinoma of the larynx. MATERIALS AND METHODS A series of 100 patients treated with radiotherapy between 1993 and 2001 was reviewed. The median age was 67 years. The median follow-up was 7 years (range 3-14 years). Radiotherapy was delivered to a total dose of 50 Gy in 16 fractions treating daily, 5 days a week over 21 days. RESULTS Locoregional control rates with radiotherapy alone were 92% at 2 years and 88% at 5 years. After salvage surgery, the ultimate locoregional control rate was 96%. The relapse-free survival rates at 2 and 5 years were 85 and 70%, respectively. The cause-specific survival rates at 2 and 5 years were 99 and 97%, respectively. Overall survival rates at 2 and 5 years were 91 and 76%, respectively. Second primary cancers occurred in 21% of patients, primarily in the lung. CONCLUSIONS Radiotherapy to a total dose of 50 Gy in 16 fractions for T1N0M0 squamous cell carcinoma of the larynx offers high locoregional control rates with voice preservation. These results from a hypofractionated radiotherapy schedule are comparable with other longer fractionation schedules and offer potential for optimising resource usage.
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Affiliation(s)
- N L C Cheah
- Cancer Centre, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
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Wildeman MAM, Gibcus JH, Hauptmann M, Begg AC, van Velthuysen MLF, Hoebers FJ, Mastik MF, Schuuring E, van der Wal JE, van den Brekel MWM. Radiotherapy in laryngeal carcinoma: can a panel of 13 markers predict response? Laryngoscope 2009; 119:316-22. [PMID: 19160427 DOI: 10.1002/lary.20069] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To find biomarkers associated with response to radiotherapy in laryngeal cancer that can be used together with clinical parameters to improve outcome prediction. METHODS In this study, 26 patients irradiated for laryngeal carcinomas with a local recurrence within two years (cases) and 33 patients without recurrence (controls) were included. All pretreatment biopsies were arrayed onto a tissue array. Immunohistochemistry was performed for 13 biomarkers that were selected from the literature as potential predictors for radioresponse in head and neck (HN) cancer: Bcl-2, Bcl-xL, p16, p21, p27, p53, cyclin D1, HIF-1alpha, CA9, COX-2, EGFR, ki-67, and pRB. RESULTS Univariate logistic regression models showed borderline statistically significant increased relative risks, with positivity for CA9, COX-2, and p53. Goeman's global testing revealed an overall association between outcome and the 13 markers together with clinical variables. The most important markers were CA9 and COX-2. CONCLUSIONS In laryngeal carcinoma, hypoxia and COX-2 overexpression provide a stronger contribution to an increased risk of local recurrence after radiotherapy compared with the well-known candidate markers p53, Bcl-2, and cyclin D1. However, no robust expression profile for the prediction of radioresistance was found.
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Affiliation(s)
- Maarten A M Wildeman
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Rewari A, Lu H, Parikh R, Yang Q, Shen Z, Haffty BG. BCCIP as a prognostic marker for radiotherapy of laryngeal cancer. Radiother Oncol 2009; 90:183-8. [PMID: 19046788 PMCID: PMC4283809 DOI: 10.1016/j.radonc.2008.10.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 10/15/2008] [Accepted: 10/23/2008] [Indexed: 01/02/2023]
Abstract
BACKGROUND Recent studies have shown that BCCIP (BRCA2 and CDKN1A interacting protein) is essential for maintaining the transactivation activity of wild type p53. We analyzed the expression of BCCIP and p53 in a cohort of laryngeal cancer treated with radiotherapy and assessed whether BCCIP and p53, alone or in combination, would correlate with local control and overall survival. METHODS One hundred twenty-three patients treated between 1975 and 2000 for early stage (stages I and II) squamous cell carcinoma of the larynx were included in the study. Treatment consisted of radiation therapy (RT) with standard fields and fractionation to a median dose of 66Gy. Tissue was collected from pre-RT biopsies and constructed in a tissue microarray, and BCCIP expression and p53 expression were determined using immunohistochemistry. RESULTS Loss of expression of BCCIP in combination with normal p53 (negative p53 staining) was associated with local recurrence (RR 2.04; 95% CI 0.99-4.56, p=0.05) and poor overall survival (RR 2.09; 95% CI 1.21-4.00, p=0.008) compared to patients who did express BCCIP. Expression of BCCIP or p53 alone was not found to be independently associated with benefits in local control or overall survival. CONCLUSIONS This study provides clinical evidence that BCCIP contributes to outcomes in patients with laryngeal cancer treated with RT. This benefit may be a result of increased radiosensitivity in patients who have functional BCCIP and p53. These data may be used to identify sub-groups of laryngeal cancer patients who are more likely to be cured with radiotherapy.
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Affiliation(s)
- Amar Rewari
- Yale University School of Medicine, New Haven, CT
| | - Huimei Lu
- The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Rahul Parikh
- The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Qifeng Yang
- The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Zhiyuan Shen
- The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Bruce G. Haffty
- Yale University School of Medicine, New Haven, CT
- The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
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Agrawal N, Ha PK. Management of Early-Stage Laryngeal Cancer. Otolaryngol Clin North Am 2008; 41:757-69, vi-vii. [DOI: 10.1016/j.otc.2008.01.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Thurnher D, Erovic BM, Frommlet F, Brannath W, Ehrenberger K, Jansen B, Selzer E, Grasl MC. Challenging a dogma – Surgery yields superior long-term results for T1a squamous cell carcinoma of the glottic larynx compared to radiotherapy. Eur J Surg Oncol 2008; 34:692-8. [PMID: 17686606 DOI: 10.1016/j.ejso.2007.06.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 06/20/2007] [Indexed: 10/23/2022] Open
Abstract
AIMS The aim of this study was to compare laser surgery, conventional endoscopic surgery and radiotherapy in the treatment of early T1a glottic cancer. METHODS We conducted a retrospective analysis of patients with early vocal cord cancer (who underwent either conventional surgery via endoscopy or laryngofissur, or primary radiotherapy) at the Medical University of Vienna. By univariate and multivariate Cox regression models the influence of treatment and other parameters on survival and locoregional control were analysed. RESULTS 337 Patients were analyzed with a mean follow-up period of 133.8 months. Overall survival rates where similar in all three treatment groups. Five-year, 10-year and 15-year estimates of disease specific survival for laser-treated patients were 100%, for conventional surgery were 100%, 98% and 98%, and for radiotherapy were 96%, 92% and 91%, respectively. Locoregional recurrences were observed after laser surgery in 10%, after conventional surgery in 13% and after radiotherapy in 30% of the patients treated. According to the log-rank test, time to relapse was significantly shorter for irradiated patients compared to patients who underwent surgery (p < 0.0001). Mortality caused by the laryngeal tumour was significantly higher in the radiotherapy group (p = 0.003). CONCLUSION Patients undergoing laser or conventional surgery have a significantly lower incidence of locoregional recurrences and longer disease-free intervals when compared to patients treated by radiotherapy.
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Affiliation(s)
- D Thurnher
- Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Should there be more molecular staging of head and neck cancer to improve the choice of treatments and thereby improve survival? Curr Opin Otolaryngol Head Neck Surg 2008; 16:117-26. [PMID: 18327030 DOI: 10.1097/moo.0b013e3282f6a4b0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Overall survival of head and neck squamous cell carcinoma patients on the whole has not dramatically improved in the last 30 years. One of the reasons is that tumour, node, metastasis classification is probably in some cases inadequate, since similar cases under a clinico-pathological point of view, may differ widely in prognosis. The most important reason for this is probably the extreme biological heterogeneity, which leads to a lack of consistency in treatment planning. The aim of the present review is to delineate the advances and the perspectives of clinical use of molecular characterization, which is an attempt to break through such molecular heterogeneity and to define, together with tumour, node, metastasis classification, homogeneous groups of patients for prognostic stratification and treatment selection. RECENT FINDINGS Among the markers evaluated in the last years, some have revealed particular promise. Epidermal growth factor receptor is probably the most reliable molecular marker at present, retaining its prognostic value independently from primary treatment. The p53 gene, the p53 protein being the main effector of DNA damage induced apoptosis, is probably the best predictor of radio/chemosensitivity. SUMMARY Even if clinical tumour, node, metastasis classification will probably retain its significance, it is now becoming possible, by molecular markers, to acquire biological information about host and tumour, to break through the above-cited molecular heterogeneity and eventually to optimize the choice of treatment.
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Wei Q, Sheng L, Shui Y, Hu Q, Nordgren H, Carlsson J. EGFR, HER2, and HER3 expression in laryngeal primary tumors and corresponding metastases. Ann Surg Oncol 2008; 15:1193-201. [PMID: 18172732 DOI: 10.1245/s10434-007-9771-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 11/22/2007] [Accepted: 11/26/2007] [Indexed: 12/21/2022]
Abstract
BACKGROUND There are several substances available to target members of the epidermal growth factor receptor (EGFR) family, both for imaging in nuclear medicine and for various forms of therapy. The level and stability of expression in both primary tumors and corresponding metastases is crucial in the assessment of a receptor as a target in systemic tumor therapy. To date, the expression of EGFR family members has only been determined in primary laryngeal carcinomas, and we have not found published data regarding the receptor status in corresponding metastatic lesions. METHODS Expression of EGFR, HER2, and HER3 was investigated immunohistochemically in both lymph node metastases and corresponding primary laryngeal squamous carcinomas (n = 40). RESULTS EGFR overexpression (2+ or 3+) was found in 87.5% (35/40) of the laryngeal primary tumors and 82.5% (33/40) of the corresponding lymph node metastases. There was a good agreement between the primary tumors and the paired metastases regarding EGFR expression. HER2 overexpression was found in only four cases (10.5%) of the studied primary tumors and in all cases the HER2 expression was retained in the paired metastases. Another two metastases gained HER2 status when compared to the corresponding primary tumors. Strong HER3 staining was found in 26.7% of both the primary tumors and the corresponding metastases. CONCLUSIONS The high frequency and stability in EGFR expression is encouraging for efforts to use EGFR targeting agents (e.g. Iressa, Tarceva, Erbitux or radiolabeled antibodies) for therapy of laryngeal carcinoma. For a few laryngeal carcinoma patients with HER2 overexpression, anti-HER2 agents could possibly be used.
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Affiliation(s)
- Qichun Wei
- Department of Radiation Oncology, The Second Affiliated Hospital, and Cancer Institute, Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, PR China.
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Second primary tumors following tobacco dependence treatments among head and neck cancer patients. Am J Clin Oncol 2007; 30:531-9. [PMID: 17921716 DOI: 10.1097/coc.0b013e318059adfc] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To estimate the cumulative percentage of second primary tumors (SPTs) in head and neck (H&N) cancer patients and primary cancers in general Nicotine Dependence Center (NDC) population controls following tobacco dependence consultation seen between 1988 and 2001. METHODS A 1:1 matched pair design and a stratified Cox proportional hazard model were used. General NDC population controls were matched on age, gender, and NDC consult (type and date) to the H&N cancer patients. The study population included 101 H&N cancer patients (66 male, 35 female) with mean (SD) age of 58.7 (10.1) years. RESULTS Baseline demographics and length of follow-up were similar between groups. However, H&N cancer patients smoked more cigarettes per day than controls (P < 0.003). For H&N cancer patients, the median time from initial H&N cancer diagnosis to NDC consult was 7 months (range, 0-292 months). Following the NDC consult, 27 H&N cancer patients developed 32 SPTs; whereas among the controls, 12 patients developed 12 other cancers (P = 0.013). There was no difference in the development of non-tobacco-related cancers (P = 0.273). However, H&N cancer patients were more likely to develop tobacco-related cancers (P = 0.01). Furthermore, there was a trend where the H&N cancer patients who continued to use tobacco were more likely to develop tobacco-related cancers than those who remained abstinent (P = 0.10). CONCLUSIONS These findings confirm that H&N cancer patients are more prone to the development of tobacco-related cancers. Further, these findings suggest that H&N cancer patients who stop using tobacco are able to decrease the development of tobacco-related SPTs.
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Parikh RR, Yang Q, Haffty BG. Prognostic significance of vascular endothelial growth factor protein levels in T1-2 N0 laryngeal cancer treated with primary radiation therapy. Cancer 2007; 109:566-73. [PMID: 17183558 DOI: 10.1002/cncr.22432] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The purpose of this study was to assess the prognostic value of vascular endothelial growth factor protein levels in a large cohort of patients with T1-T2 N0 laryngeal cancer treated with primary radiation therapy (XRT). METHODS Primary tumor specimens from a cohort of 123 patients with T1-T2 N0 laryngeal cancer treated with XRT between 1975 and 2000 were constructed into a tissue microarray. Clinical prognostic factors included age, sex, T classification, and tumor subsite. Molecular prognostic factors included vascular endothelial growth factor, epidermal growth factor receptor, and p53 expression, determined by using immunohistochemistry on tissue microarrays. The association between vascular endothelial growth factor status, covariables, and outcome was assessed. RESULTS With a median follow-up of 9.9 years, 32 (26%) were diagnosed with local relapse (5-year local relapse-free rate, 70.4%). T2 tumor stage (31.7%) was a significant predictor of local relapse (relative risk [RR], 1.71; 95% confidence interval [CI], 1.21-2.43; P<.05). Positive expression of vascular endothelial growth factor, epidermal growth factor receptor, and p53 were: 8.5%, 58.7%, and 36.4%, respectively. In univariate analysis, vascular endothelial growth factor positivity was a significant predictor of overall survival (RR = 1.62; 95% CI, 0.99-2.42; P = .05). In multivariate analysis, positive vascular endothelial growth factor status maintained significant correlation with overall survival (RR, 2.79; 95% CI, 1.49-4.95; P = .002). CONCLUSIONS Vascular endothelial growth factor positivity appeared to be a significant predictor of overall survival in a multivariate model. Further evaluation of vascular endothelial growth factor-positive laryngeal cancers treated with primary XRT is warranted.
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Almadori G, Bussu F, Navarra P, Galli J, Paludetti G, Giardina B, Maurizi M. Pilot phase IIA study for evaluation of the efficacy of folic acid in the treatment of laryngeal leucoplakia. Cancer 2006; 107:328-36. [PMID: 16770770 DOI: 10.1002/cncr.22003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND It has been previously observed that patients with head and neck squamous cell carcinoma or with laryngeal leucoplakia present a significant reduction in plasma folate levels. The current Phase IIA pilot study assessed the effectiveness of folic acid as a chemopreventive agent in patients affected by glottic laryngeal leucoplakia. METHODS Forty-three untreated patients affected by glottic laryngeal leucoplakia were enrolled in the Ear, Nose, and Throat Department (Universita Cattolica del Saco Cuore, Rome, Italy). Glottic leucoplakia was initially diagnosed by indirect laryngoscopy and successively confirmed by diagnostic direct microlaryngoscopy with a biopsy for histologic assessment. Folic acid (Folina, Schwarz Pharma, Germany) was administered orally (5 mg every 8 hours) for 6 months. Patients were monitored every 30 days by videolaryngoscopy. RESULTS Twelve (28%) patients had no response, 19 (44%) had a partial response, and 12 (28%) had a complete response. The mean increase in serum folate levels (10.06 +/- 0.53) and the mean decrease in homocysteine serum (3.65349 +/- 0.85526) at the end of the study were highly significant (P = .0001). CONCLUSIONS The larynx is 1 of the sites of major interest and a good model for the development of chemopreventive agents, but so far the proposed agents have shown no clear efficacy on precancerous lesions or on the development of second malignancies.
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Affiliation(s)
- Giovanni Almadori
- Institute of Otolaryngology, Universita Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy.
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Itoh Y, Fuwa N. Retrospective analysis: concurrent chemoradiotherapy using protracted continuous infusion of low-dose cisplatin and 5-fluorouracil for T2N0 glottic cancer. ACTA ACUST UNITED AC 2006; 24:277-81. [PMID: 16958401 DOI: 10.1007/s11604-005-1517-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Accepted: 12/18/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE Treatment with conventional radiotherapy alone for local control of T2 glottic cancer (T2GC) is insufficient. To improve local control of T2GC, we have simultaneously administered continuous intravenous infusions of low-dose cisplatin and 5-fluorouracil (5-FU) in combination with irradiation. MATERIALS AND METHODS We performed this combination therapy in a total of 11 consecutive patients with previously untreated invasive squamous cell carcinoma (T2GC). Cisplatin was administered at 4 mg/m2/day and 5-FU at 200 mg/m2/day for 120 h, except during weekends, beginning on the day irradiation with a once-daily fraction at 2 Gy was started. RESULTS An initial local control rate of the primary tumor was achieved in 10 of the 11 patients (91%), and ultimate laryngeal preservation by cordectomy was achieved in all cases. Regarding adverse reactions, grade 3 or 4 hemotoxicity did not develop in any of the patients. Grade 3 laryngitis was observed in four patients (36%), but none of these patients required interruption of treatment owing to acute laryngeal reactions. CONCLUSION Instead of radiotherapy alone, this combination chemoradiotherapy is suggested with the possibility of improving local control of T2GCs.
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Affiliation(s)
- Yoshiyuki Itoh
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
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