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Crosetti E, Succo G, Sapino S, Bertotto I, Cirillo S, Petracchini M, Fondello G, Arrigoni G, Tascone M, Piazza C, Farina D, Ravanelli M. Twenty questions from the surgeon to the radiologist to better plan an open partial horizontal laryngectomy. Front Oncol 2024; 13:1305889. [PMID: 38328437 PMCID: PMC10847842 DOI: 10.3389/fonc.2023.1305889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Open partial horizontal laryngectomies (OPHLs) represent a valuable therapeutic option for tumors of the intermediate T-category and, in selected cases, for locally advanced tumors with low-volume extra-laryngeal extension. The eligibility of patients treated with this type of surgery has increased with the introduction of the modular approach to OPHL planning. This strategy follows the introduction of the classification proposed by the European Laryngological Society, based on the extent of horizontal resection. Optimization of the selection is the result of a meticulous work-up process involving close cooperation between experienced surgeons and radiologists, followed by final quality control by pathologists. Computed tomography and magnetic resonance imaging are study methods whose pearls and pitfalls are well known, especially when performed at a high level of expertise. In this paper, based on the experience of two high-volume centers, a checklist of 20 questions addressed by the surgeon to the radiologist before planning an OPHL was proposed. Considerations regarding case selection are reported for each of the questioned parameters. A very simple question-and-answer process is easy to understand and mainly addressed by less experienced colleagues who wish to increase their knowledge and skills in performing this type of surgery.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Giovanni Succo
- Oncology Department, University of Turin, Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Silvia Sapino
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Ilaria Bertotto
- Radiology Service, Candiolo Cancer Institute, Candiolo, Italy
| | - Stefano Cirillo
- Radiology Service, Mauriziano Umberto I Hospital, Turin, Italy
| | | | | | - Giulia Arrigoni
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Martina Tascone
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology—Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Farina
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Department of Radiology, University of Brescia, Brescia, Italy
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2
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Campo F, Mazzola F, Bianchi G, Manciocco V, Ralli M, Greco A, Sperduti I, de Vincentiis M, Pellini R. Partial laryngectomy for naïve pT3N0 laryngeal cancer: Systematic review on oncological outcomes. Head Neck 2023; 45:243-250. [PMID: 36177857 DOI: 10.1002/hed.27205] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/26/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022] Open
Abstract
The first aim was to define the oncologic outcomes of open partial laryngectomy (OPL) in naïve pT3 laryngeal cancer. The second aim was to analyze the outcomes after OPL versus total laryngectomy (TL). A literature search was conducted in three databases (MEDLINE, EMBASE, and Cochrane Library) until January 2022. In 805 patients treated with OPL, 5-year OS, DSS, DFS and LFS were 80.5% (95% CI 70.6-87.6), 83.4% (95% CI 75.7-89), 77.4% (95% CI 66.3-85.7) and 77.9% (95% CI 68.7-85), respectively. Three articles compared TL versus OLP: 5-year OS, DSS and DFS risk difference were 0.100 (95% CI -0.092 to 0.291), 0.067 (95% CI -0.085 to 0.220) and 0.018 (95% CI -0.164 to 0.201) respectively. OPL for selected pT3 laryngeal cancer is able to guarantee a high percentage of oncological success. Accurate patient selection is of utmost importance to differentiate advanced disease amenable to conservative surgery.
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Affiliation(s)
- Flaminia Campo
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy
- Department of "Organi di Senso", Sapienza University of Rome, Rome, Italy
| | - Francesco Mazzola
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Giulia Bianchi
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Valentina Manciocco
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Massimo Ralli
- Department of "Organi di Senso", Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Department of "Organi di Senso", Sapienza University of Rome, Rome, Italy
| | - Isabella Sperduti
- Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | | | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy
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3
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Xie J, Liu H, Wu P, Chen L, Ge P, Chen S, Zhang S, Lu Z. Predictors of Thyroid Gland Invasion in Total Laryngectomy for Advanced Laryngeal Squamous Cell Carcinoma. EAR, NOSE & THROAT JOURNAL 2022:1455613221098300. [PMID: 35533678 DOI: 10.1177/01455613221098300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: Thyroidectomy for advanced laryngeal squamous cell carcinoma (LSCC) is controversial. This study aimed to identify predictors of thyroid gland invasion in patients with LSCC and management of the thyroid gland during total laryngectomy. Patients and Methods: Clinical data and pathological characteristics of 113 patients, who underwent laryngectomy with thyroidectomy for advanced LSCC in Guangdong Provincial People's Hospital between 2009 and 2019, were retrospectively analyzed. The incidence and predictors of thyroid gland invasion were analyzed, and a new predictor was proposed using a parallel test. Results: Of 113 patients, 25.7% exhibited thyroid invasion. A new predictor that combined the lower third of thyroid cartilage invasion and thyroid gland invasion on computed tomography/magnetic resonance imaging (CT/MRI) was associated with pathological thyroid gland invasion (P = 0.001; sensitivity, 88.2%; negative predictive value, 95%). Conclusion: Thyroidectomy may be required during total laryngectomy in those with invasion of the lower third of thyroid cartilage and/or thyroid gland invasion revealed on CT/MRI instead of being performed routinely.
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Affiliation(s)
- Jiaxuan Xie
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- 66477Shantou University Medical College, Shantou, China
| | - Hui Liu
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- 66477Shantou University Medical College, Shantou, China
| | - Peiyan Wu
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Liangsi Chen
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Pingjiang Ge
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shaohua Chen
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Siyi Zhang
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhongming Lu
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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4
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de Vincentiis M, Greco A, Campo F, Candelori F, Ralli M, Di Traglia M, Colizza A, Cambria F, Zocchi J, Manciocco V, Spriano G, Pellini R. Open partial horizontal laryngectomy for T2-T3-T4a laryngeal cancer: oncological outcomes and prognostic factors of two Italian hospitals. Eur Arch Otorhinolaryngol 2022; 279:2997-3004. [PMID: 34978589 DOI: 10.1007/s00405-021-07238-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to analyse the oncologic results of open partial horizontal laryngectomy (OPHL) and to assess the prognostic factors that could affect the survival of patients affected by T2, T3 and T4a laryngeal cancer. Using this data, we aim to identify clinical criteria to select patients amenable to conservative surgery, and to facilitate a more targeted approach in the management of advanced laryngeal cancer. METHODS A retrospective study was performed in patients who underwent OPHL type II for laryngeal squamous cell carcinoma from January 2005 to December 2018. We analysed a total of 170 patients; 21(12.36%) cases were staged as pT2, 116 (68.23%) as pT3 and 33 (19.41%) as pT4a. RESULTS Five-year overall survival (OS) was 80.9%, 79.3%, 70.4% for T2, T3 and T4 respectively. Disease-specific survival (DSS) was 90.4%, 85.3% and 77.4%. Posterior tumour extension, perineural invasion and N status showed to considerably influence survival in both uni- and multivariate analyses. CONCLUSION The oncological outcomes from our study show that OPHL for advanced laryngeal cancer can guarantee a high percentage of success. Accurate patient selection is of utmost importance to differentiate advanced disease amenable to conservative surgery, and treatment options should consider selected criteria based on tumour and patient features.
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Affiliation(s)
- Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Flaminia Campo
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.,Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Candelori
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Mario Di Traglia
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
| | - Francesca Cambria
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Jacopo Zocchi
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Valentina Manciocco
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Spriano
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Mahajan A, Shukla S, Mali R, Agarwal U, Sable N, Vaish R, Ankathi S, Patil V, Janu A, Prabhash K, Noronha V, Pai P, Laskar S, Patil A, Patil V, Menon N, Thiagarajan S, Chaturvedi P. Second opinion interpretations by specialty radiologists in head-and-neck oncology and their impact on clinical management: A retrospective observational study. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_36_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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6
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Thakur P, Dwivedi A, Brar R, Rathore D, Sancheti S, Sharma A, Singla A. A retrospective observational study to assess the accuracy of preoperative computed tomography scan for thyroid cartilage involvement and T-categorization in patients with carcinoma larynx undergoing total laryngectomy. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_104_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Aslıer M, Uçurum BE, Kaya HC, Coskun H. The prognostic value of thyroid gland invasion in locally advanced laryngeal cancers. Acta Otolaryngol 2021; 141:865-872. [PMID: 34406113 DOI: 10.1080/00016489.2021.1962013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Locally advanced laryngeal cancers can spread to the thyroid gland by direct invasion of cricothyroid membrane. The prevalence of thyroid gland invasion (TGI) and the predictive factors of TGI were well described in literature. However, the association of TGI with survival was undetermined yet. OBJECTIVES The aim of this study is to analyze the effects of TGI on survival rates in patients with locally advanced laryngeal cancer. MATERIALS AND METHODS Medical records of 91 patients who underwent total laryngectomy with thyroidectomy were retrospectively reviewed. Demographical, clinical, and histopathological characteristics of the patients were noted. Kaplan-Meier test was used for survival analysis. RESULTS Histopathology reports revealed the prevalence of TGI as 14.3% (13/91). Survival analyses showed that TGI did not affect recurrence free (p = .078) and overall (p = .080) survival rates. CONCLUSIONS Thyroid gland invasion is one of the characteristic features of locally aggressive laryngeal tumors. In this study, TGI is not a statistically significant prognostic factor that has impact on survival of the patients with locally advanced laryngeal cancer.
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Affiliation(s)
- Mustafa Aslıer
- Department of Otolaryngology – Head and Neck Surgery, Bursa Uludağ University School of Medicine, Bursa, Turkey
| | - Bahar Ezgi Uçurum
- Department of Otolaryngology – Head and Neck Surgery, Bursa Uludağ University School of Medicine, Bursa, Turkey
| | - Hilmi Cem Kaya
- Department of Otolaryngology – Head and Neck Surgery, Bursa Uludağ University School of Medicine, Bursa, Turkey
| | - Hakan Coskun
- Department of Otolaryngology – Head and Neck Surgery, Bursa Uludağ University School of Medicine, Bursa, Turkey
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8
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Indications and results of extended total laryngectomy with en-bloc resection of overlying cervical skin. Eur Arch Otorhinolaryngol 2019; 276:3179-3184. [PMID: 31346690 DOI: 10.1007/s00405-019-05573-8] [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: 03/16/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Extended total laryngectomy with en-bloc resection of overlying cervical skin (ETL) is indicated in cases with infiltration of the pre-laryngeal soft tissues. The present study analyses the surgical indications and the results of ETL in our hospital. METHODS Retrospective review of 38 patients treated with an ETL during the period 1988-2016. RESULTS The indications for ETL were the initial treatment of tumors with extralaryngeal extension (n = 16), salvage treatment after failure of partial surgery or radiotherapy (n = 17), and total laryngectomy in patients with infection or fibrosis of the skin over the larynx (n = 5). The surgical defect was reconstructed with local flaps in 3 cases, with pectoralis major flaps in 34 cases, and with an internal mammary artery perforator flap in one case. The rate of pharyngocutaneous fistula in the postoperative period was 16%. 5-year cancer-specific survival for patients treated with an ETL was 67.1%. The patients with positive margins and those operated as a salvage treatment after failure of previous treatments showed worse survival. CONCLUSIONS ETL offers acceptable oncological results for patients with tumors with extralaryngeal extension. Myocutaneous or myofascial pectoralis major flaps allow for adequate reconstruction of the surgical defect with a low rate of complications.
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9
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Bonomi MR, Blakaj A, Blakaj D. Organ preservation for advanced larynx cancer: A review of chemotherapy and radiation combination strategies. Oral Oncol 2018; 86:301-306. [PMID: 30409316 DOI: 10.1016/j.oraloncology.2018.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/26/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
The larynx is an organ of the upper aerodigestive tract that is involved in many critical functions such as breathing, speaking, and swallowing. As a result, both larynx cancer and its treatment may significantly affect quality of life. The management of laryngeal cancer has focused on improving survival while preserving the function of the organ. This manuscript focuses on the use of chemotherapy and radiation therapy as a non-surgical approach and potential organ preservation strategy for patients with advanced larynx cancer. We review the key clinical data on the following treatment courses: (1) induction chemotherapy followed by definitive radiation therapy, (2) concurrent chemotherapy and radiation, and (3) induction chemotherapy followed by concurrent chemo-radiation. We also review the clinical data on organ preservation for patients with hypopharynx cancers. Results from phase III studies suggest that patients with advanced T4 cancers have better outcomes with a primary surgical approach, while for patients with T2N+ and T3 tumors, definitive concurrent chemotherapy and radiation or induction chemotherapy followed by definitive radiation therapy are acceptable options. Choosing the optimal treatment strategy depends on patients' desires, tumor extent, and adequate follow-up to detect early recurrences in cases of larynx preservation treatments. To proceed with an organ preservation strategy, the patient should have a good pre-treatment larynx function, and there must be a high level of skill and cooperation among various disciplines.
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Affiliation(s)
- Marcelo R Bonomi
- The Ohio State University, Division of Medical Oncology, 320 West 10th Avenue, Columbus, OH 43210, USA.
| | - Adriana Blakaj
- Yale School of Medicine, Department of Therapeutic Radiology, 35 Park St., New Haven, CT 06519, USA
| | - Dukagjin Blakaj
- The Ohio State University, Department of Radiation Oncology, 320 West 10th Avenue, Columbus, OH 43210, USA
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10
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Decision making in advanced larynx cancer: An evidenced based review. Oral Oncol 2018; 86:195-199. [PMID: 30409301 DOI: 10.1016/j.oraloncology.2018.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/10/2018] [Accepted: 09/15/2018] [Indexed: 12/15/2022]
Abstract
Organ preservation versus total laryngectomy for advanced laryngeal cancer continues to be hotly debated. This review presents evidence-based decision making points for these patents.
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11
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Management of locally advanced T3-4 glottic laryngeal carcinomas. The Journal of Laryngology & Otology 2018; 132:642-650. [PMID: 29961434 DOI: 10.1017/s0022215118000993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess five-year local control and ultimate local control rates of patients treated for locally advanced T3-4 glottic carcinoma with surgery only, radiotherapy only, or surgery plus radiotherapy. Cancer-specific survival, overall survival and rates of malignancy development were also assessed. METHODS A retrospective review was conducted on patients from 1967 to 2015, with analysis of local control, ultimate local control, overall survival and cancer-specific survival performed using Kaplan-Meier and Cox regression. RESULTS Of 169 eligible patients, the majority (59 per cent) were treated with surgery plus radiotherapy, with laryngectomy being the most common surgical procedure. Local control and ultimate local control rates were higher with surgery only (94.1 per cent) and surgery plus radiotherapy (87.9 and 86.8 per cent respectively), compared to radiotherapy only (46.8 and 52.4 per cent) (both p < 0.001). Cancer-specific survival, overall survival and malignancy development did not differ between groups. CONCLUSION Surgery, with or without radiotherapy, offers significantly higher five-year local control and ultimate local control for patients with advanced glottic carcinoma, compared to radiotherapy only.
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12
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De Virgilio A, Greco A, Bussu F, Gallo A, Rosati D, Kim SH, Wang CC, Conte M, Pagliuca G, De Vincentiis M. Salvage total laryngectomy after conservation laryngeal surgery for recurrent laryngeal squamous cell carcinoma. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 36:373-380. [PMID: 27958597 PMCID: PMC5225792 DOI: 10.14639/0392-100x-749] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/09/2015] [Indexed: 11/23/2022]
Abstract
The aim of the present study was to evaluate the oncological efficacy of salvage total laryngectomy in patients who had previously undergone supracricoid partial laryngectomy or transoral laser microsurgery for treatment of laryngeal squamous cell carcinoma. We retrospectively reviewed the medical, surgical and pathological records of 35 patients who underwent salvage total laryngectomy after recurrence of laryngeal cancer (following supracricoid partial laryngectomy or transoral laser microsurgery). Kaplan-Meier survival curves as well as univariate and multivariate analyses of prognostic factors were performed. No statistically significant differences were seen comparing the supracricoid partial laryngectomy group with the transoral laser microsurgery group for overall survival and disease-specific survival at 3 years (OS = 38% vs. 52%, p = 0.16; DSS = 40% vs. 61%, p = 0.057) or locoregional control at 2 years (LRC = 40% vs. 54%, p = 0.056). A trend indicating worse survival and locoregional control for supracricoid partial laryngectomy patients emerged. Preservation of the osteocartilaginous frame in transoral laser microsurgery could hypothetically result in better salvageability of anterior recurrences with extralaryngeal spread.
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Affiliation(s)
- A De Virgilio
- Department of Sensory Organs, ENT Section, "Sapienza" University of Rome, Italy.,Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute, Rome, Italy
| | - A Greco
- Department of Sensory Organs, ENT Section, "Sapienza" University of Rome, Italy
| | - F Bussu
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Policlinico Agostino Gemelli, Rome, Italy
| | - A Gallo
- Department of Surgical Biotechnologies and Science, ENT Section, "Sapienza" University of Rome, Italy
| | - D Rosati
- Department of Sensory Organs, ENT Section, "Sapienza" University of Rome, Italy
| | - S-H Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - C-C Wang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - M Conte
- Department of Sensory Organs, ENT Section, "Sapienza" University of Rome, Italy
| | - G Pagliuca
- Department of Surgical Biotechnologies and Science, ENT Section, "Sapienza" University of Rome, Italy
| | - M De Vincentiis
- Department of Sensory Organs, ENT Section, "Sapienza" University of Rome, Italy
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Abstract
Answer questions and earn CME/CNE Laryngeal cancer remains one of the most common tumors of the respiratory tract. Fortunately, significant advancements have been made over the past decade in the treatment of laryngeal cancer. Although surgery has been the historical mainstay for localized disease and still is an integral part of treatment, nonsurgical options like radiation and systemic therapy have emerged as viable options. In addition, in the metastatic setting, novel agents are showing promise for this patient population. The care for patients with laryngeal cancer continues to evolve and truly requires a multidisciplinary team-based approach. Unique morbidities, such as loss of natural voice, respiration, and airway protection during swallowing, are observed with this disease and require special consideration. CA Cancer J Clin 2017;67:31-50. © 2016 American Cancer Society.
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Affiliation(s)
- Conor E Steuer
- Assistant Professor, Department of Hematology Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Mark El-Deiry
- Associate Professor, Department of Otolaryngology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Jason R Parks
- Resident, Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Kristin A Higgins
- Assistant Professor, Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Nabil F Saba
- Professor and Director of the Head and Neck Medical Oncology Program, Department of Hematology Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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14
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Is there a role for PET/CT parameters to differentiate thyroid cartilage invasion from penetration? Eur J Radiol 2016; 85:319-23. [PMID: 26781136 DOI: 10.1016/j.ejrad.2015.11.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 11/26/2015] [Accepted: 11/30/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Assessment of thyroid cartilage invasion (tumor extension through inner cortex) and thyroid cartilage penetration (tumor involving both the inner and outer cortices of thyroid cartilage) may be challenging with CT (Computed Tomography) and MR imaging (Magnetic Resonance Imaging). Positron Emission Tomography/Computed Tomography (PET/CT) is a non invasive imaging modality that provides both anatomic and metabolic information. Quantitative data obtained from PET/CT, also known as PET/CT parameters, include maximum, mean or peak standardized uptake values (SUVmax, SUVmean, SUVpeak), metabolic tumor volume (MTV), total lesion glycolysis (TLG), standardized added metabolic activity (SAM) and normalized standardized added metabolic activity (NSAM). Our aim was to examine if FDG PET/CT parameters could differentiate thyroid cartilage invasion from penetration. METHODS 50 patients who underwent PET/CT before laryngectomy for squamous cell carcinoma of the larynx, had SUVmax, SUVmean, SUVpeak, TLG, MTV, SAM and NSAM calculated on a dedicated workstation. Univariate and multivariate analysis was performed. ROC analysis was used to determine the ability of PET/CT parameters to predict pathologically proven thyroid cartilage invasion or penetration. RESULTS Of the 50 patients, 50% (25/50 patients) had history of prior radiation therapy. Among the previously irradiated group, 24% had thyroid cartilage invasion and penetration. 8% of the patients in this group had thyroid cartilage invasion only. Among the non-irradiated group, 76% had thyroid cartilage invasion and penetration, 8% had thyroid cartilage invasion without penetration. ROC analysis revealed that none of the PET/CT parameters had enough power to predict thyroid cartilage penetration, but TLG, MTV and SAM had enough power to predict thyroid cartilage invasion in non-irradiated patients. TLG, MTV, SAM and NSAM had enough power to predict thyroid cartilage invasion and penetration in irradiated group. CONCLUSION TLG, MTV and SAM have enough power to predict thyroid cartilage invasion and penetration in irradiated patients. PET/CT parameters do not have enough potential to differentiate thyroid cartilage invasion from penetration.
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15
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Gorphe P, Ben Lakhdar A, Tao Y, Breuskin I, Janot F, Temam S. Evidence‐based management of the thyroid gland during a total laryngectomy. Laryngoscope 2015; 125:2317-22. [DOI: 10.1002/lary.25417] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/10/2022]
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Cohen JT, Gil Z, Binenbaum Y, Na'ara S, Amit M. An orthotopic mouse model of laryngeal squamous cell carcinoma. Ann Otol Rhinol Laryngol 2014; 124:143-7. [PMID: 25204712 DOI: 10.1177/0003489414549575] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to create a reliable and reproducible orthotopic mouse model of laryngeal malignancy that recapitulates its biologic behavior, local invasiveness, and spread as seen in patients. METHODS Via direct laryngoscopy, human squamous cell carcinoma line FaDu (ATCC HTB-43) was implanted in the larynx (supraglottis and glottis) in nu/nu mice (n = 31). Animals were monitored with direct laryngoscopy and ultrasound for tumor growth and survival. Specimens of larynxes, neck lymphatics, livers, and lungs were removed for histopathologic evaluation to assess tumor extension, thyroid cartilage invasion, and nodal spread. RESULTS Thirty-one successful direct laryngoscopies were performed. Supraglottic and glottic tumor uptake was 100% and 25%, respectively. Median survival for the animals with supraglottic tumors was 35 days. Histopathologic evaluation revealed pre-epiglottic extension, paraglottic extension, thyroid cartilage invasion, and lymph node metastasis. CONCLUSION We describe the first orthotopic model for laryngeal cancer. Our model faithfully recapitulates the phenotype and malignant behavior that reproduces its natural biologic behavior as seen in laryngeal cancer patients. This model offers an opportunity to identify and specifically target therapy for larynx squamous cell carcinoma.
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Affiliation(s)
- Jacob T Cohen
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ziv Gil
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel The Laboratory for Applied Cancer Research, Clinical Research Center at Rambam, Rambam Health Care Campus, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Yoav Binenbaum
- The Laboratory for Applied Cancer Research, Clinical Research Center at Rambam, Rambam Health Care Campus, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Shorook Na'ara
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel The Laboratory for Applied Cancer Research, Clinical Research Center at Rambam, Rambam Health Care Campus, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Moran Amit
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel The Laboratory for Applied Cancer Research, Clinical Research Center at Rambam, Rambam Health Care Campus, The Technion, Israel Institute of Technology, Haifa, Israel
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Clinical implication of computed tomography findings in patients with locally advanced squamous cell carcinoma of the larynx and hypopharynx. Eur Arch Otorhinolaryngol 2014; 272:2939-45. [PMID: 25149290 DOI: 10.1007/s00405-014-3249-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
Abstract
Accurate tumor staging including involvement of laryngeal cartilage is important to treatment planning. Clinicians rely on imaging findings and determine initial laryngectomy for T4-stage cancer with functionless larynx or extralaryngeal spread (ELS). We examined the accuracy and prognostic value of preoperative CT findings for tumor staging in patients with locally advanced laryngeal and hypopharyngeal cancer. Ninety-four consecutive patients with clinically T3-T4-stage squamous cell carcinoma of the larynx or hypopharynx who underwent curative resection of primary tumor were reviewed. Preoperative CT findings were interpreted by a radiologist without pathologic information. Pathologic findings were used as the gold standard for correlating radiographic findings. CT imaging identified 23 (72%) of 32 cases of pathologically documented thyroid cartilage penetration and 24 (73%) of 33 cases of pathologically documented ELS. The positive predictive values for thyroid cartilage penetration and ELS were 70 and 80%, respectively. Pretreatment CT imaging up-staged 6 of 46 pT3 cases and all of 8 pT2 cases, while it down-staged 7 of 40 pT4 cases. The accuracy for clinical staging by CT imaging was 78%. Subglottic extension of the CT image was an independent variable for predicting thyroid cartilage penetration and ELS (P = 0.014). Thyroid cartilage penetration with or without ELS on CT scans is significantly associated with unfavorable DFS outcome of patients (P = 0.020). CT imaging is suboptimal in diagnosing TCP or ELS of advanced laryngeal cancer, but may be useful to predict patient survival by identifying clinically TCP.
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Kroll T, Sharma SJ, Dreyer T, Grams A, Klussmann JP, Obert M, Wittekindt C. Contrast-agent enhancement in ex vivo flat-panel computed tomography of locally advanced laryngeal cancer. Acta Otolaryngol 2013; 133:1311-6. [PMID: 23919668 DOI: 10.3109/00016489.2013.823240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Visualization of cartilage invasion in ex vivo laryngectomy specimens was improved by flat-panel volumetric computed tomography (fpvCT) after diffusion of contrast agents. A prospective study to assess the specificity and sensitivity of this new method is warranted. OBJECTIVES Cartilage invasion is a criterion for staging laryngeal squamous cell carcinoma. Contrast-enhanced CT is routinely used for assessing cartilage invasion. However, the sensitivities and specificities given for this method in the literature vary, and there is a need for improvement of this staging method. The objective of our pilot study was to determine cartilage invasion with fpvCT after contrast agent diffusion. METHODS Three patients underwent preoperative CT and total laryngectomy. The excised larynges were immediately scanned with an fpvCT scanner, without contrast enhancement. Additional fpvCT scans were performed after incubation of the larynges in one of three different contrast agents for 24 and 48 h. The results from presurgical conventional scans, fpvCT scans, and histological examination - as the gold standard - were compared. RESULTS We demonstrated the feasibility of ex vivo contrast enhancement of laryngeal tissues by diffusion, with a subsequent increase in contrast enhancement and improved visualization of cartilage invasion in fpvCT scans. Histology confirmed the fpvCT results.
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Mitchell HK, Garas G, Mazarakis N, McGlashan J. Extramedullary relapse of multiple myeloma in the thyroid cartilage. BMJ Case Rep 2013; 2013:bcr-2013-200689. [PMID: 23997087 DOI: 10.1136/bcr-2013-200689] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Multiple myeloma involving the thyroid cartilage is a very uncommon disease entity. Only 10 cases have been reported in the international literature to date and as such it constitutes a rare and challenging diagnosis to make. We report the case of a 63-year-old man with a background of malignant melanoma and multiple myeloma both of which were in remission at the time of presentation. The patient presented with hoarseness and a large neck mass that turned out to be an extramedullary deposit of his previously treated multiple myeloma indicating disease relapse. The differential diagnosis of a mass in the thyroid cartilage is discussed. Despite its rarity, this diagnosis should be considered even in patients with no history of multiple myeloma, as it can arise de-novo in the thyroid cartilage (extramedullary plasmacytoma). The importance of the multidisciplinary team (MDT) approach as well as recent advances in treatment are also discussed.
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Affiliation(s)
- Hannah Katherine Mitchell
- Department of Otorhinolaryngology and Head & Neck Surgery, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK.
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Han MW, Kim SA, Cho KJ, Lee JH, Lim HK, Roh JL, Choi SH, Kim SY, Nam SY. Diagnostic accuracy of computed tomography findings for patients undergoing salvage total laryngectomy. Acta Otolaryngol 2013; 133:620-5. [PMID: 23448356 DOI: 10.3109/00016489.2012.761352] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Computed tomography (CT) imaging has clear limitations for the diagnosis of cartilage invasion or tumor spread in recurrent laryngeal cancer. Alternative methods of pretreatment assessment are needed for recurrent laryngeal cancer. OBJECTIVES The diagnosis and staging of recurrent laryngeal cancer, previously treated by radiation therapy (RT), remains challenging. Practically, surgeons need to depend on imaging to predict which patients will have a chance for conservation salvage laryngectomy. The purpose of the present study was to determine the accuracy of preoperative CT performed for recurrent laryngeal carcinoma evaluation following RT. METHODS This retrospective review identified 32 patients who underwent salvage total laryngectomy after RT from 1998 to 2010. For our radiologic classification of the thyroid cartilage, we analyzed the conditions as normal, sclerosis, invasion, penetration, and extralaryngeal spread and categorized the state of the arytenoids and cricoid into three possible conditions: normal, sclerosis, and destruction. Radiographic findings were correlated with pathology findings. RESULTS Sensitivity and specificity for the detection of the thyroid cartilage infiltration were 57% and 94%, 50% and 89% for the cricoid cartilage, and 33% and 76% for arytenoid cartilage, respectively. The accuracy of recurrent tumor classification was 59.4%. Three carcinomas were over-staged and 10 were under-staged.
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Affiliation(s)
- Myung Woul Han
- Department of Otolaryngology, Ulsan University Hospital, Ulsan, Republic of Korea
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