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Shelan M, Anschuetz L, Schubert A, Bojaxhiu B, Aebersold DM, Elicin O, Giger R. Superior loco-regional control after primary surgery compared to chemo-radiotherapy for advanced stage laryngeal cancer. Front Oncol 2023; 13:1132486. [PMID: 37593093 PMCID: PMC10431594 DOI: 10.3389/fonc.2023.1132486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/05/2023] [Indexed: 08/19/2023] Open
Abstract
Objective The optimal strategy to treat loco-regionally advanced squamous cell carcinoma of the larynx (LSCC) remains to be defined. The goal of this single institution retrospective study was to report on oncologic outcome of advanced LSCC treated with curative intent. Methods Patients diagnosed and treated for stage T3-T4a LSCC between 2001 and 2014 were retrospectively analyzed. Time-to-event endpoints were calculated beginning from the date of histologic diagnosis, which were analyzed with log-rank test and Cox proportional hazard models. Results The cohort was divided into two subgroups: primary radiotherapy with concomitant cisplatin (CRT) (n=30, 38%) and primary surgery (n=48, 62%). Median follow-up was 56 months. Locoregional control (LRC) for the primary surgery and CRT were 95% and 50% in 5 years, respectively (p<0.01). Progression free survival (PFS) for the primary surgery and CRT were 61% and 38% in 5 years, respectively (p=0.23). The overall survival (OS) after primary surgery and CRT in 5 years were 63% vs. 65%, respectively (p=0.93). The 5-years LRC was significantly superior after surgery compared to RT for cT3 primaries (100% vs 50%, p= 0.0022). No significant differences were observed in the remaining subgroups regarding cT stage and PFS or OS. Conclusion Our series demonstrated superior LRC after primary surgery followed by risk-adapted adjuvant (C)RT compared to primary CRT in cT3 LSCC, but no significant difference in PFS or OS in locally-advanced LSCC. The optimal patient selection criteria for the ideal treatment for loco-regionally advanced LSCC still needs to be defined.
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Affiliation(s)
- Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian Schubert
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beat Bojaxhiu
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel M. Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Lee DS, Lee JJ, Sinha P, Puram SV, Jackson RS, Adkins DR, Oppelt P, Brenneman R, Thorstad WL, Pipkorn P. Risk Factors for Functional Outcomes in Advanced Laryngeal Squamous Cell Carcinoma. Laryngoscope 2023; 133:594-600. [PMID: 35611799 PMCID: PMC9691786 DOI: 10.1002/lary.30166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/23/2022] [Accepted: 04/13/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Chemoradiation for patients with laryngeal squamous cell carcinoma (SCC) may achieve organ preservation, but appropriate patient selection remains unknown. This study investigates pre-treatment risk factors associated with functional and survival outcomes after radiation-based therapy in patients with advanced laryngeal SCC. METHODS A retrospective cohort study was performed on 75 adult patients with stage III or IV laryngeal SCC receiving definitive radiation-based therapy from 1997 to 2016 at a tertiary care center. Tracheostomy and gastrostomy dependence were the primary functional outcomes. Multivariable logistic regressions were performed to evaluate relationships between pre-treatment factors and tracheostomy and gastrostomy dependence. Time-to-event analyses were performed to determine risk factors associated with overall survival. RESULTS Among 75 patients included in the analysis, 30 (40%) patients were tracheostomy dependent and 31 (41%) were gastrostomy tube dependent. The median length of follow-up was 31 months (range = 1 to 142 months). Pre-treatment tracheostomy was a significant predictor of post-treatment tracheostomy (aOR = 13.9, 95% CI = 3.35 to 57.5) and moderate-severe comorbidity was a significant predictor of post-treatment gastrostomy dependence (aOR = 2.96, 95% CI = 1.04 to 8.43). The five-year overall survival was 51% (95% CI = 38 to 64%). Pre-treatment gastrostomy tube dependence was associated with an increased risk of death (aHR = 2.45, 95% CI = 1.09 to 5.53). CONCLUSIONS Baseline laryngeal functional status and overall health in advanced laryngeal SCC are associated with poor functional outcomes after radiation-based therapy, highlighting the importance of patient selection when deciding between surgical and non-surgical treatment plans. Laryngoscope, 133:594-600, 2023.
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Affiliation(s)
- David S. Lee
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jake J. Lee
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Parul Sinha
- Department of Otolaryngology – Head and Neck Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Sidharth V. Puram
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Douglas R. Adkins
- Department of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peter Oppelt
- Department of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Randall Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Wade L. Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Batchelor CJJ, Flukes SP. Tracheostomy dependence following "organ preservation" (chemo)radiation protocol for laryngeal and hypopharyngeal cancers. Head Neck 2022; 44:2779-2785. [PMID: 36121012 DOI: 10.1002/hed.27195] [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: 01/27/2022] [Revised: 08/15/2022] [Accepted: 08/31/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Patients receiving primary (chemo)radiotherapy for laryngeal or hypopharyngeal cancer risk developing severe laryngeal dysfunction and becoming tracheostomy dependent, detracting from the benefits of organ preservation. We aim to describe the airway outcomes for this cohort and identify risk factors for developing tracheostomy dependence. METHODS Patients with laryngeal or hypopharyngeal cancer who were recommended for and underwent primary (chemo)radiotherapy over a 6-year period were identified from a tertiary hospital Head and Neck cancer database. Patient, tumor, and treatment details were collected and analyzed. RESULTS Of 166 patients, 18.7% (N = 31) required tracheostomy insertion. Advanced tumor classification was the only significant predictor (p < 0.00001). Successful decannulation was observed in 12.9% (N = 4). Decannulation was observably less successful with advanced tumors, bilateral vocal cord immobility, tracheostomies inserted under emergency conditions. CONCLUSION We quantified tracheostomy insertion rates and dependence in patients undergoing "organ-preserving" (chemo)radiotherapy, to assist in the pre-treatment counseling of patients opting for this approach.
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Affiliation(s)
| | - Stephanie Patricia Flukes
- Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Perth, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
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Gong H, Wu J, Sun J, Hsueh CY, Wu C, Tao L, Wu H, Zhang M, Zhou J, Zhou L. Preoperative tracheotomy in the treatment of upper airway obstruction of patients with advanced stage supraglottic carcinoma. Am J Otolaryngol 2022; 43:103381. [PMID: 35339772 DOI: 10.1016/j.amjoto.2022.103381] [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: 07/01/2021] [Revised: 12/24/2021] [Accepted: 01/30/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Preoperative tracheotomy is an effective option that secures upper airway patency in laryngeal carcinoma patients suffering from upper airway obstruction, but the influence of this treatment on oncologic outcomes of laryngeal carcinoma remains controversial. The purpose of this study was to determine the impact of preoperative tracheotomy on overall survival in supraglottic carcinoma patients with tumor obstruction of the upper airway, and explore the potential causes. MATERIALS AND METHODS This retrospective study collected 243 consecutive patients with advanced stage supraglottic carcinoma from 2005 to 2010. Preoperative tracheotomy in the management of upper airway obstruction in patients with supraglottic carcinoma was analyzed. RESULTS The mean age was 60.9 years at diagnosis, with men accounting for 98.4% of all patients. Thirty nine (16.0%) patients presenting with tumor obstruction of the upper airway required preoperative tracheotomy. T4 stage patients had higher rate of tracheotomy than those of patients with T3 stage (36.8% vs 12.2%). Patients with upper airway obstruction presented with greater tumor area compared with patients without (13.7 cm2 vs 9.0 cm2). The optimal cutoff value of tumor area for tracheotomy and OS rate were both at 10 cm2. Supraglottic patients with upper airway obstruction receiving preoperative tracheotomy had poorer OS rate compared with patients without. T stage and tumor area were correlated with upper airway obstruction, and these two variables were independent predictors of OS rate in supraglottic carcinoma patients. CONCLUSIONS Advanced stage supraglottic carcinoma patients with upper airway obstruction undergoing preoperative tracheotomy experienced worse overall survival. Advanced T stage and greater tumor size were associated with upper airway obstruction, indicating that the negative influence of tumor obstruction on survival may be cause by these two preoperative variables. Therefore, preoperative tracheotomy acts only as an alternative procedure, and is not a prognostic agent.
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Barnes RK, Au J. Transtracheal jet ventilation in a general tertiary hospital: A 7-year audit. Anaesth Intensive Care 2021; 49:316-321. [PMID: 34348483 DOI: 10.1177/0310057x211002525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Airway management in patients presenting with severe airway obstruction can present a challenge to the anaesthetist, as conventional difficult airway pathways are often inappropriate. The use of a transtracheal jet cannula is an alternative means of airway securement, but lack of familiarity has limited its use in general tertiary hospitals. We report a retrospective audit of the use of transtracheal jet ventilation in a general tertiary healthcare centre over the past seven years, with a total of 50 patients with severe airway compromise undergoing pharyngolaryngeal surgery. Transtracheal jet ventilation was successful in 98% of patients, and was the definitive means of airway management in 43 cases. In six cases, the technique was a useful temporising measure while the airway was secured by other means. Minor complications occurred in 12% of patients. No major morbidities or mortalities were recorded. We conclude that transtracheal jet ventilation for high-risk pharyngolaryngeal surgery can be performed using a high frequency jet ventilator, with a high rate of success and only minor complications. Cannulation of the trachea below the cricothyroid membrane is feasible but more challenging. Low-flow apnoeic oxygenation through the transtracheal jet ventilation cannula maintains oxygenation during initial surgical airway manipulation.
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Affiliation(s)
- Richard K Barnes
- Department of Anaesthesia and Perioperative Medicine, Monash Health, Clayton, Australia
| | - Jonathan Au
- Department of Anaesthesia and Perioperative Medicine, Monash Health, Clayton, Australia
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North AS, Carson L, Sharp L, Patterson J, Hamilton DW. The unmet needs of patients with advanced incurable head and neck cancer and their carers: A systematic review and meta-ethnography of qualitative data. Eur J Cancer Care (Engl) 2021; 30:e13474. [PMID: 34086378 DOI: 10.1111/ecc.13474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/07/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Patients with advanced-stage head and neck cancers (HNC) endure a significant symptom burden and suffer greatly towards the end of their lives. Qualitative evidence can provide insight into how existing services meet their needs. We aimed to synthesise qualitative data from patients with advanced HNC and their carers to inform improvements to services and care. METHODS A systematic search was conducted in MEDLINE and EMBASE for studies containing qualitative data from patients with advanced HNC and their carers. An interpretive account was generated using the meta-ethnography methodology. RESULTS We identified 8 studies including 38 patients and 25 carers. Twenty-six themes were synthesised into five concepts: psychological impact and adjustment, physical limitations and deliverance of symptomatic care, communication and information needs from healthcare professionals, social support and dependence, and needs of the primary caregiver. We identified that patients had complex psychological needs, centred on uncertainty and fear of suffering. Patients desired full information and found poor communication highly distressing. There was a dearth of literature on the subjective impact of physical limitations. Patients became reliant on social networks, and those with lower quality relationships coped poorly. However, caregivers struggled to meet patients' complex needs, resulting in distress and isolation. CONCLUSIONS Patients with advanced HNCs have complex needs that are not met in current systems. Further qualitative work focusing on the physical and psychological impact of advanced HNC would be of value.
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Affiliation(s)
- Alexander S North
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.,Department of Otolaryngology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Luke Carson
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.,Department of Otolaryngology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Joanne Patterson
- Liverpool Head and Neck Centre, School of Health Sciences, University of Liverpool, Liverpool, UK
| | - David W Hamilton
- Department of Otolaryngology, Freeman Hospital, Newcastle Upon Tyne, UK
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Preoperative tracheotomy as reflection of tumor size impacting oncologic outcomes of patients with advanced stage glottic carcinoma. Eur Arch Otorhinolaryngol 2021; 278:4943-4950. [PMID: 33675419 DOI: 10.1007/s00405-021-06721-9] [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: 12/31/2020] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate the influence of preoperative tracheotomy on oncologic outcomes of advanced stage glottic carcinoma patients, and to explore the potential reason. METHODS We retrospectively analyzed 413 consecutive advanced stage glottic carcinoma patients from January 2005 to December 2010. The correlation of preoperative tracheotomy and potential impacting factor of tumor size involving tumor diameter and tumor area with overall survival (OS) and disease-free survival (DFS) was fully assessed. RESULTS Our cohort consisted of 302 (73.1%) patients with T3 and 111 (26.9%) patients with T4, and 98 (23.7%) patients received preoperative tracheotomy. The OS and DFS rates of patients receiving preoperative tracheotomy were worse than those without (5-year OS: 49.3% versus 69.8%; 5-year DFS: 45.3% versus 61.0%). The mean tumor diameter and tumor area of patients with preoperative tracheotomy were greater than those without (3.3 cm versus 2.4 cm, 8.9 cm2 versus 4.7 cm2). The optimal cutoff values of tumor diameter and tumor area for tracheotomy were 2.85 cm and 6.64 cm2. Tumor diameter and tumor area were correlated with tracheotomy intervention. Furthermore, when considering the potential effect of tumor area in multivariate model, we found that it was a significant factor in survival outcomes but variable of preoperative tracheotomy was not. CONCLUSION This study indicates that tumor size is correlated with preoperative tracheotomy, and tracheotomy intervention may be reflection from effect of great tumor size that is a true adverse factor influencing oncologic outcomes of advanced stage glottic carcinoma patients.
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Lane C, Rabbani R, Linton J, Taylor SM, Viallet N. Systematic review and meta-analysis of transoral laser microsurgery in hypopharyngeal carcinoma. Laryngoscope Investig Otolaryngol 2020; 5:66-73. [PMID: 32128432 PMCID: PMC7042655 DOI: 10.1002/lio2.351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/15/2019] [Accepted: 12/31/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transoral laser microsurgery has been suggested as an alternative treatment modality for hypopharyngeal carcinoma. The purpose of this study is to systematically review the oncologic and functional outcomes of patients with hypopharyngeal carcinoma when treated with primary transoral laser microsurgery. METHODS A comprehensive literature search was performed using PRISMA methodology on OVID MEDLINE and EMBASE. Meta-analysis was completed for oncological outcomes. RESULTS Six studies reported quality of life outcomes five reported oncologic outcomes. A median of 95% (range 0.83-0.98) patients achieving gastrostomy independence, a median of 3% (range 0%-6%) were tracheostomy dependent, and a median of 97% (Range 0.89-1.0) were able to preserve their larynx. Pooled five-year overall survival was 54% (CI, 0.50-0.58, I2 = 29%), pooled disease-specific survival was 72% (CI, 0.68-0.77, I2 = 46%), and pooled local control rate was 78% (CI, 0.72-0.85, I2 = 69%). CONCLUSION Systematic review supports improvements in functional outcomes and oncologic outcomes with transoral laser microsurgery.
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Affiliation(s)
- Ciaran Lane
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of ManitobaWinnipegCanada
| | - Rasheda Rabbani
- George & Fay Yee Center for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Janice Linton
- Neil John Maclean Health SciencesUniversity of Manitoba LibrariesWinnipegManitobaCanada
| | - S. Mark Taylor
- Division of Otolaryngology‐Head and Neck SurgeryDalhousie UniversityHalifax Regional MunicipalityNova ScotiaCanada
| | - Norbert Viallet
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of ManitobaWinnipegCanada
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Anschuetz L, Shelan M, Dematté M, Schubert AD, Giger R, Elicin O. Long-term functional outcome after laryngeal cancer treatment. Radiat Oncol 2019; 14:101. [PMID: 31186027 PMCID: PMC6558792 DOI: 10.1186/s13014-019-1299-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/16/2019] [Indexed: 12/23/2022] Open
Abstract
Background The functional outcome after the treatment of laryngeal cancer is tightly related to the quality of life of affected patients. The aim of this study is to describe the long-term morbidity and functional outcomes associated with the different treatment modalities for laryngeal cancer. Methods Retrospective chart review of 477 patients undergoing curatively intended treatment for laryngeal cancer at our tertiary referral center from 2001 to 2014: Details on patient and disease characteristics, diagnostics and treatment related functional outcomes were analyzed. Results With a median follow-up of 51 months, the crude rate of functional larynx preservation was 74.6%. Radiotherapy +/− chemotherapy was the dominant treatment modality (n = 359–75.3%), whereas 24.7% (n = 118) underwent primary surgery, with 58.5% (69) receiving adjuvant treatment. The 5-year laryngectomy-free survival was 57% (95% CI, 48–66%) after surgery vs. 69% (95% CI, 64–75%) after chemoradiotherapy (p < 0.01). In stage III-IVB, these rates were 26% (95% CI, 16–39%) vs. 47% (95% CI, 36–59%), respectively (p < 0.01). Aspiration occurred in 7%, tracheostomy was necessary in 19.8% and feeding tube placement in 25.4%. Feeding tube and tracheostomy necessity was higher in the initially surgically treated group. Primary surgery (HR: 1.67, 95% CI: 1.19–2.32; p < 0.01), stage III-IVB (HR: 4.07, 95% CI: 2.97–5.60; p < 0.01) and tumor recurrence (HR: 3.83, 95% CI: 2.79–5.28; p < 0.01) remained as adverse factors for laryngectomy-free survival. Conclusions Preserving the laryngeal function after cancer treatment is challenging. Advanced tumor stages, primary surgery and recurrence are related to a poor functional outcome. Therefore, the criteria for initial decision-making needs to be further refined. Electronic supplementary material The online version of this article (10.1186/s13014-019-1299-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lukas Anschuetz
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Marco Dematté
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.,Department of Otorhinolaryngology, Head & Neck Surgery, Head and Neck and Sensory Organs Department, Sant'Orsola-Malpighi Hospital, University of Bologna, 40138, Bologna, Italy
| | - Adrian D Schubert
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
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Organ-preservation (chemo)radiotherapy for T4 laryngeal and hypopharyngeal cancer: is the effort worth? Eur Arch Otorhinolaryngol 2018; 276:575-583. [PMID: 30564952 DOI: 10.1007/s00405-018-5241-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE We aimed to analyze the oncological and functional outcomes of chemoradiation for T4 laryngeal and hypopharyngeal cancer. METHODS Patients treated between 2008 and 2015 with chemoradiation (n = 39) were retrospectively analyzed for oncological and functional (laryngo-esophageal dysfunction-free survival, LED-FS) outcomes and compared with 32 consecutive patients treated primarily with total laryngectomy (TL). LED was scored as event in case of local failure, TL for any reason, persistent tracheotomy and/or feeding tube dependency 2 years after chemoradiation. RESULTS The 5-year local control (LC) rates in the chemoradiation and TL groups were 64 and 87%, respectively (p = 0.030). The disease-free survival was 54 and 59% (p = 0.810), and overall survival (OS) was 46 and 47% (p = 1.00). In the chemoradiation group, the 5-year cumulative incidence of LED-FS was 46%, but was significantly worse in patients with poor pre-treatment laryngeal function, compared to those without (20% and 74%, respectively, p = 0.001). Furthermore, patients with LED have significantly worse OS compared to those without (32% and 65%, respectively, p = 0.041). Multivariate analysis showed that primary treatment type is significantly predictive for LC, while tumor site and extra-capsular extension were predictive for OS. Poor pre-treatment laryngeal function is the only significant predictive factor for LED. CONCLUSIONS TL resulted in significantly better LC, as compared to chemoradiation in T4 laryngeal and hypopharyngeal cancer patients and the LED-FS is worse in patients with poor pre-treatment laryngeal function. These patients might benefit more from primary treatment with TL followed by radiotherapy. These issues should be taken into consideration, as patients are counseled about different primary treatment options.
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11
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Wang Q, Liu Y, Wu K, Zhao Y, Gao C, Tong B, Zhang M. Options of medical treatment and laryngeal function preservation in elderly patients with medial wall pyriform sinus cancer. Onco Targets Ther 2018; 11:7441-7446. [PMID: 30464497 PMCID: PMC6219120 DOI: 10.2147/ott.s171873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To retrospectively investigate the clinical efficacy and larynx preservation of two different treatments: radiotherapy followed by surgery (R+S) and surgery followed by radiotherapy (S+R), in elderly patients with medial wall pyriform sinus cancer. Materials and methods Medical records from 48 patients over 70 years old with medial wall pyriform sinus cancer who underwent different treatments between 2001 and 2010 were analyzed. Twenty-one patients underwent radiotherapy first followed by surgery (R+S), and the other 27 patients underwent surgery first followed by radiotherapy (S+R). A Kaplan–Meier method was used to calculate the survival rate. Results Overall 3-year and 5-year survival rates were 60.4% and 35.4%, respectively. The 5-year survival rates in R+S group and S+R group were 38.1% and 33.3%, respectively, without a statistically significant difference between the two groups (P>0.05). Also, comparisons of the decannulation rates (64.3% for R+S group vs 50.0% for S+R group) and postoperative complication rates (42.9% for R+S group vs 37.0% for S+R group) between the two groups of patients did not show obvious differences. However, the laryngeal preservation rates in R+S group and S+R group were 66.7% and 37.0%, respectively, with significantly statistical difference between the two groups (P<0.05). Conclusion Based on the data analysis of 48 patients, the survival rates of elderly patients who underwent R+S or S+R were comparable, but R+S treatment could improve the laryngeal preservation rate of patients. Further study on large-scale sample pool should be performed to confirm this conclusion.
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Affiliation(s)
- Qin Wang
- Department of Otolaryngology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China, .,Department of Otolaryngology, Hefei Second People's Hospital, Hefei, People's Republic of China
| | - Yehai Liu
- Department of Otolaryngology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China,
| | - Kaile Wu
- Department of Otolaryngology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China,
| | - Yi Zhao
- Department of Otolaryngology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China,
| | - Chaobing Gao
- Department of Otolaryngology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China,
| | - Busheng Tong
- Department of Otolaryngology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China,
| | - Ming Zhang
- Department of Anatomy, Anhui Medical University, Hefei, People's Republic of China.,Department of Anatomy, University of Otago, Dunedin, New Zealand
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Anschuetz L, Visini M, Shelan M, Elicin O, Giger R. Risk analysis for tracheostomy dependency in curatively treated laryngeal cancer with organ preservation. Head Neck 2018; 40:2469-2475. [DOI: 10.1002/hed.25373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/12/2018] [Accepted: 05/22/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
- Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital; Bern University Hospital, University of Bern; Bern Switzerland
| | - Miranda Visini
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital; Bern University Hospital, University of Bern; Bern Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital; Bern University Hospital, University of Bern; Bern Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital; Bern University Hospital, University of Bern; Bern Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital; Bern University Hospital, University of Bern; Bern Switzerland
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14
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Byrd SA, Xu MJ, Cass LM, Wehrmann DJ, Naunheim M, Christopher K, Dombrowski JJ, Walker RJ, Wirth L, Clark J, Busse P, Chan A, Deschler DG, Emerick K, Lin DT, Varvares MA. Oncologic and functional outcomes of pretreatment tracheotomy in advanced laryngeal squamous cell carcinoma: A multi-institutional analysis. Oral Oncol 2018; 78:171-176. [DOI: 10.1016/j.oraloncology.2018.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/13/2018] [Accepted: 01/23/2018] [Indexed: 11/15/2022]
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15
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Tamaki A, Miles BA, Lango M, Kowalski L, Zender CA. AHNS Series: Do you know your guidelines? Review of current knowledge on laryngeal cancer. Head Neck 2017; 40:170-181. [PMID: 29076227 DOI: 10.1002/hed.24862] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/22/2017] [Indexed: 11/07/2022] Open
Abstract
The following article is part of a series in an initiative by the American Head and Neck Society's Education Committee and will review clinical practice guidelines for head and neck oncology. The primary goal is to increase awareness of current best practices pertaining to head and neck surgery and oncology. This manuscript is a review of current knowledge in laryngeal cancer with a focus on anatomy, epidemiology, diagnosis, evaluation, and treatment.
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Affiliation(s)
- Akina Tamaki
- Ear, Nose, and Throat Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Brett A Miles
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Miriam Lango
- Department of Surgical Oncology, Division of Head and Neck Surgery, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Luiz Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, Sao Paulo, Brazil
| | - Chad A Zender
- Ear, Nose, and Throat Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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16
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Chiesa Estomba CM, Betances Reinoso FA, Martinez Villasmil V, González Cortés MJ, Santidrian Hidalgo C. Persistent Tracheostomy after Organ Preservation Protocol in Patients Treated for Larynx and Hypopharynx Cancer. Int Arch Otorhinolaryngol 2017; 21:377-381. [PMID: 29018502 PMCID: PMC5629076 DOI: 10.1055/s-0037-1601416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/05/2017] [Indexed: 01/07/2023] Open
Abstract
Introduction Squamous cell carcinoma of the larynx is currently the second most common malignancy of the airway after lung cancer, and hypopharyngeal cancer accounts for fewer than 5% of head and neck cancers. The nonsurgical options for patients with this disease are related to significant long-term toxicities and the need for persistent tracheostomy, which adversely affects the quality of life of these patients. Objective To evaluate the need for tracheostomy, and the influence of this in the overall and specific survival rates of patients diagnosed with all stages of laryngeal carcinoma treated by chemoradiotherapy. Methods A retrospective study of patients diagnosed with laryngeal carcinoma was performed according to the criteria of the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) 7th edition, in a tertiary hospital. Results A total of 21 patients were evaluated, 8 patients required a tracheotomy (31%) during the treatment protocol, 7 (35%) men and 1 (100%) women. According to subsite 4/4 patient with glottis cancer (p ≤ 0.001), 2/10 patients with supra glottis cancer and 2/7 patients with hypopharyngeal cancer. During follow up, just in 1 patient was possible to close the tracheostomy. Conclusion Persistent tracheostomy dependence after primary chemoradiation increases significantly the morbidity, and decreases the quality of life of those patients. Patients with glottis cancer are prone to need a tracheostomy, but no statistical difference regarding the oncological stage and the need for a tracheostomy were detected. A more thorough selection of the patients is needed to improve the quality of life and reduce permanent tracheostomy dependence.
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Affiliation(s)
- Carlos Miguel Chiesa Estomba
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Frank Alberto Betances Reinoso
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Virginia Martinez Villasmil
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Maria Jesus González Cortés
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Carmelo Santidrian Hidalgo
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
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17
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Wang Q, Liu Y, Hu G, Wang R, Zhao Y, Zhang M. The survival rate and larynx preservation in elderly cancer patients who received surgical operation: A retrospective cohort study. Int J Surg 2016; 36:342-346. [PMID: 27871805 DOI: 10.1016/j.ijsu.2016.11.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND To investigate the efficiency of surgical operation for patients over 70 years with hypopharyngeal cancer. MATERIALS AND METHODS A retrospective analysis of the medical records from 68 patients over 70 years-old with hypopharyngeal cancer who underwent different therapeutic regimen between 2000 and 2009 was conducted. 36 of 68 patients underwent larynx preservation. All patients were treated with surgical operation and adjuvant radiotherapy. A Kaplan-Meier method was employed to calculate the survival rate. RESULTS Overall 3 year-and 5 year-survival rates were 48.6% and 29.4% respectively. For patients who underwent larynx preservation, 5 year-survival rate was 30.5%, which was decreased compared to 3 year-survival rate (46.9%) However, 3 year- and 5 year-survival rates in patients without larynx preservation were 46.9% and 28.1% respectively, suggesting that no statistically significant difference of survival rates was found between patients with or without larynx preservation (P > 0.05). A majority of patients who receive larynx preservation exhibited normal breathing and eating abilities and could present an intelligible speech. 16 of 36 patients who preserved larynx and 14 of 32 patients who underwent laryngectomy showed postoperative complication. No significant difference was observed in these two treatments, indicating larynx preservation is not a factor for inducing complication. CONCLUSION This study provides evidence that the quality of life for elderly patients with hypopharyngeal cancer can be improved by optimizing the therapeutic regimen based on the physical condition of each patient.
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Affiliation(s)
- Qin Wang
- Otorhinolaryngology Head and Neck Surgery Department, The First Affiliated Hospital of Medical University of Anhui, Hefei, China; The Second People's Hospital of Hefei & Affiliated Hospital of Medical University of Anhui, Hefei, China
| | - Yehai Liu
- Otorhinolaryngology Head and Neck Surgery Department, The First Affiliated Hospital of Medical University of Anhui, Hefei, China.
| | - Guoqin Hu
- The Second People's Hospital of Hefei & Affiliated Hospital of Medical University of Anhui, Hefei, China
| | - Ruokun Wang
- Department of Radiology, The Second People's Hospital of Hefei & Affiliated Hospital of Medical University of Anhui, Hefei, China
| | - Yi Zhao
- Otorhinolaryngology Head and Neck Surgery Department, The First Affiliated Hospital of Medical University of Anhui, Hefei, China
| | - Ming Zhang
- Department of Anatomy, Medical University of Anhui, Hefei, China; Department of Anatomy, University of Otogo, New Zealand
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18
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Hurst NJ, Pereira LM, Dominello MM, Dyson G, Laszewski P, Robinette N, Lin HS, Yoo G, Sukari A, Kim H. Pretreatment computed tomographic gross tumor volume as predictor of persistence of tracheostomy and percutaneous endoscopic gastrostomy tube in patients undergoing larynx preservation. Head Neck 2016; 38:1455-8. [PMID: 27131223 DOI: 10.1002/hed.24458] [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: 10/29/2014] [Revised: 01/17/2016] [Accepted: 02/09/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Although larynx preservation affords patients improvements in laryngectomy-free survival, little has been reported regarding the functional outcomes after larynx preservation. The purpose of this study was to report the predictive value of pretreatment CT-gross tumor volume (GTV) for persistence of tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube in larynx preservation patients. METHODS Each patient had a CT scan before initiation of therapy and the GTV was contoured. RESULTS Using recursive partitioning analysis (RPA), threshold GTVs of 27.16 cc and 12 cc were identified for association of time with tracheostomy and PEG tube, respectively. Median (95% confidence interval [CI]) times above and below these thresholds were 1.84 (1.06-not reached [NR]) and 0.75 (0.63-1.26) years, respectively (p = .03) for time with tracheostomy and 1.75 (1.34-NR) and 0.84 (0.46-NR) years, respectively (p = 0.10) for time with PEG tube. CONCLUSION This study demonstrates that pretreatment CT-GTV is predictive of an approximately 2.5-fold and approximately 2-fold, respectively, increase in time with tracheostomy and PEG tube. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1458, 2016.
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Affiliation(s)
- Newton J Hurst
- Department of Radiation Oncology, Wayne State University, Detroit Medical Center, Karmanos Cancer Center, Detroit, Michigan.
| | - Lucio M Pereira
- Department of Otolaryngology, Wayne State University, Detroit Medical Center, Karmanos Cancer Center, Detroit, Michigan
| | - Michael M Dominello
- Department of Radiation Oncology, Wayne State University, Detroit Medical Center, Karmanos Cancer Center, Detroit, Michigan
| | - Gregory Dyson
- Department of Oncology, Wayne State University, Detroit Medical Center, Karmanos Cancer Center, Detroit, Michigan
| | - Pamela Laszewski
- Department of Radiation Oncology, Wayne State University, Detroit Medical Center, Karmanos Cancer Center, Detroit, Michigan
| | - Natasha Robinette
- Department of Radiology, Wayne State University, Detroit Medical Center, Karmanos Cancer Center, Detroit, Michigan
| | - Ho-Sheng Lin
- Department of Otolaryngology, Wayne State University, Detroit Medical Center, Karmanos Cancer Center, Detroit, Michigan
| | - George Yoo
- Department of Otolaryngology, Wayne State University, Detroit Medical Center, Karmanos Cancer Center, Detroit, Michigan
| | - Ammar Sukari
- Department of Oncology, Wayne State University, Detroit Medical Center, Karmanos Cancer Center, Detroit, Michigan
| | - Harold Kim
- Department of Radiation Oncology, Wayne State University, Detroit Medical Center, Karmanos Cancer Center, Detroit, Michigan
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19
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Jefferson GD, Wenig BL, Spiotto MT. Predictors and outcomes for chronic tracheostomy after chemoradiation for advanced laryngohypopharyngeal cancer. Laryngoscope 2015; 126:385-91. [DOI: 10.1002/lary.25585] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/17/2015] [Accepted: 07/28/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Gina D. Jefferson
- Department of Otolaryngology-Head and Neck Surgery; University of Illinois at Chicago; Chicago Illinois U.S.A
| | - Barry L. Wenig
- Department of Otolaryngology-Head and Neck Surgery; University of Illinois at Chicago; Chicago Illinois U.S.A
| | - Michael T. Spiotto
- Department of Radiation and Cellular Oncology; University of Chicago Medical Center; Chicago Illinois U.S.A
- Department of Radiation Oncology; University of Illinois Hospital and Health Sciences System; Chicago Illinois U.S.A
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