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Kouka M, Beckmann L, Bitter T, Kaftan H, Böger D, Büntzel J, Müller A, Hoffmann K, Podzimek J, Pietschmann K, Ernst T, Guntinas-Lichius O. Oncological and functional outcome after laryngectomy for laryngeal and hypopharyngeal cancer: a population-based analysis in Germany from 2001 to 2020. Sci Rep 2024; 14:7761. [PMID: 38565603 PMCID: PMC10987613 DOI: 10.1038/s41598-024-58423-x] [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: 01/13/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
Prognostic factors for overall survival (OS), percutaneous endoscopic gastrostomy (PEG) dependency, and long-term speech rehabilitation via voice prosthesis (VP) after laryngectomy for laryngeal or hypopharyngeal cancer were investigated in a retrospective population-based study in Thuringia, Germany. A total of 617 patients (68.7% larynx; hypopharynx; 31.3%; 93.7% men; median age 62 years; 66.0% stage IV) from 2001 to 2020 were included. Kaplan-Meier and Cox multivariable regression analyses were performed. 23.7% of patients received a PEG. 74.7% received a VP. Median OS was 131 months. Independent factors for lower OS were stage IV (compared to stage II; hazard ratio [HR] = 3.455; confidence interval [CI] 1.395-8.556) and laryngectomy for a recurrent disease (HR = 1.550; CI 1.078-2.228). Median time to PEG removal was 7 months. Prior partial surgery before laryngectomy showed a tendency for independent association for later PEG removal (HR = 1.959; CI 0.921-4.167). Postoperative aspiration needing treatment was an independent risk factor (HR = 2.679; CI 1.001-7.167) for later definitive VP removal. Laryngectomy continuously plays an important role in a curative daily routine treatment setting of advanced laryngeal or hypopharyngeal cancer in Germany. Long-term dependency on nutrition via PEG is an important issue, whereas use of VP is a stable long-term measure for voice rehabilitation.
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Affiliation(s)
- Mussab Kouka
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Louise Beckmann
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Thomas Bitter
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Holger Kaftan
- Department of Otorhinolaryngology, Helios-Klinikum Erfurt, Erfurt, Germany
| | - Daniel Böger
- Department of Otorhinolaryngology, SRH Zentralklinikum Suhl, Suhl, Germany
| | - Jens Büntzel
- Department of Otorhinolaryngology, Suedharzklinikum Nordhausen, Nordhausen, Germany
| | - Andreas Müller
- Department of Otorhinolaryngology, SRH Wald-Klinikum Gera, Gera, Germany
| | - Kerstin Hoffmann
- Department of Otorhinolaryngology, Sophien-Hufeland-Klinikum, Weimar, Germany
| | - Jiri Podzimek
- Department of Otorhinolaryngology, Klinikum Bad Salzungen, Bad Salzungen, Germany
| | - Klaus Pietschmann
- Department of Radiation Oncology, Jena University Hospital, Jena, Germany
| | - Thomas Ernst
- University Tumor Center, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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Migliorelli A, Caranti A, Ferrarini L, Meccariello G, Cammaroto G, Ciorba A, Vicini C, Pelucchi S, Bianchini C. Oncological features and outcomes of laryngeal cancer surgery: a multicentric study. Minerva Surg 2024; 79:140-146. [PMID: 38264873 DOI: 10.23736/s2724-5691.23.09950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Laryngeal cancer (LC) is among of the most frequent head and neck cancers, associated to a high social impact and mortality. Unfortunately, the current treatment outcomes of LC are often scant, with different factors affecting patient's prognosis (i.e., advanced age, advanced disease stage, lymph node involvement, tumor pathological features, type of intervention). The aims of the present study were: 1) to evaluate the epidemiological and clinical features of patients affected by LC; and 2) to focus on tumor risk factors affecting patient's overall survival (OS) and recurrences. METHODS A retrospective analysis of all patients affected by LC and surgically treated at two different hospital settings has been performed. RESULTS Two hundred twenty-five patients were enrolled in the present study; of these 189 were males (84%) and 36 (16%) were females. The most frequently performed surgery was total laryngectomy. Thirty-two (14.2%) patients experienced local recurrence, while 15 patients (6.6%) had regional recurrence and 15 distant metastases. Multivariate analysis showed that locoregional recurrence was associated to the occurrence of distant metastases (P=0.002, HR=25,35). Analyzing OS, the only statistically significant factor that correlated with an increased risk of mortality (P<0.015, HR=2,45) was locoregional recurrence. CONCLUSIONS The present study confirms the literature data about age and sex distribution of LC, about tumors localization, lymph nodes metastasis and distant metastasis incidence and OS rate, based on T and N stage. Interestingly, within this series, the presence of locoregional recurrence or distant metastasis is related to a worst prognosis and a lower overall survival rate.
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Affiliation(s)
- Andrea Migliorelli
- ENT and Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, Ferrara, Italy
| | - Alberto Caranti
- ENT and Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, Ferrara, Italy
| | - Luca Ferrarini
- ENT and Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, Ferrara, Italy
| | - Giuseppe Meccariello
- ENT Unit, Morgagni Pierantoni Hospital, AUSL Romagna, Forlì, Forlì-Cesena, Italy
| | - Giovanni Cammaroto
- ENT Unit, Morgagni Pierantoni Hospital, AUSL Romagna, Forlì, Forlì-Cesena, Italy
| | - Andrea Ciorba
- ENT and Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, Ferrara, Italy -
| | - Claudio Vicini
- ENT Unit, Morgagni Pierantoni Hospital, AUSL Romagna, Forlì, Forlì-Cesena, Italy
| | - Stefano Pelucchi
- ENT and Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, Ferrara, Italy
| | - Chiara Bianchini
- ENT and Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, Ferrara, Italy
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Rao KN, Pai PS, Dange P, Kowalski LP, Strojan P, Mäkitie AA, Guntinas-Lichius O, Robbins KT, Rodrigo JP, Eisbruch A, Takes RP, de Bree R, Coca-Pelaz A, Piazza C, Chiesa-Estomba C, López F, Saba NF, Rinaldo A, Ferlito A. Survival Outcomes in T3 Laryngeal Cancers: Primary Total Laryngectomy vs. Concurrent Chemoradiation or Radiation Therapy-A Meta-Analysis. Biomedicines 2023; 11:2128. [PMID: 37626625 PMCID: PMC10452463 DOI: 10.3390/biomedicines11082128] [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: 07/04/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The management of cT3 laryngeal cancers remains controversial, with studies recommending surgical or non-surgical approaches. Despite the many papers that have been published on the subject, there is a lack of studies showing which treatment has better results in terms of survival. OBJECTIVE To determine the difference in survival outcomes following total laryngectomy (TL), concurrent chemoradiation (CRT) or radiation therapy (RT) alone in T3 laryngeal cancers. METHODS Search of PubMed, Scopus, and Google Scholar databases from 1995 to 2023 employing specific keywords and Boolean operators to retrieve relevant articles. Statistical analysis was conducted using a random-effects model, and heterogeneity was evaluated using the Q-test and I2 statistic. Funnel plot asymmetry was assessed using rank correlation and regression tests. RESULTS The qualitative data synthesis comprised 10,940 patients from 16 included studies. TL was performed in 2149 (19.4%), CRT in 6723 (61.5%), RT in 295 (2.7%), while non-surgical treatment was not specified in 1773 (16.2%) patients. The pooled 2-year overall survival (OS) rates were TL = 73%, CRT = 74.7%, RT = 57.9%, 3-year OS rates were TL = 64.3%, CRT = 62.9%, RT = 52.4%, and 5-year OS rates were TL = 54.2%, CRT = 52.7%, RT = 40.8%. There was a significant heterogeneity in the included studies. There was no statistically significant difference in 2-year OS (logOR= -0.88 (95% confidence interval (CI): -1.99 to 0.23), p = 0.12), 3-year OS (logOR = -0.6 (95% CI: -1.34 to 0.15), p = 0.11), and 5-year OS (logOR = -0.54 (95% CI: -1.29 to 0.21), p = 0.16) between TL and CRT. Instead, there was significant difference in 2-year OS (logOR= -1.2383 (95% CI: -2.1679 to -0.3087), p = 0.009), 3-year OS (-1.1262 (95% CI: -1.6166 to -0.6358), p < 0.001), and 5-year OS (-0.99 (95% CI: -1.44 to -0.53)), p < 0.001) between TL and RT alone. CONCLUSIONS AND SIGNIFICANCE TL followed with adjuvant (chemo)radiation on indication and CRT with salvage surgery in reserve appear to have similar OS outcomes. Both resulted in better OS outcomes compared to RT alone in the treatment of T3 laryngeal cancers. If patients are unfit for chemotherapy, making CRT impossible, surgery may become the choice of treatment.
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Affiliation(s)
- Karthik Nagaraja Rao
- Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur 492099, India;
| | - Prathamesh S. Pai
- Department of Head Neck Surgery, Tata Memorial Hospital, Mumbai 400012, India;
| | - Prajwal Dange
- Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur 492099, India;
| | - Luiz P. Kowalski
- Department of Head and Neck Surgery and Otorhinolaringology, A.C. Camargo Cancer Center, São Paulo 01509, Brazil;
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Faculty of Medicine, SI-10000 Ljubljana, Slovenia;
| | - Antti A. Mäkitie
- Research Program in Systems Oncology, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland;
| | | | - K. Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University, Carbondale, IL 62901, USA;
| | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-Instituto de Salud del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (J.P.R.); (A.C.-P.); (F.L.)
- IUOPA, University of Oviedo, 33006 Oviedo, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medicine, Ann Arbor, MI 48109, USA;
| | - Robert P. Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-Instituto de Salud del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (J.P.R.); (A.C.-P.); (F.L.)
- IUOPA, University of Oviedo, 33006 Oviedo, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Cesare Piazza
- Otorhinolaryngology—Head and Neck Surgery, ASST Spedali Civili di Brescia, School of Medicine, University of Brescia, 25121 Brescia, Italy;
| | - Carlos Chiesa-Estomba
- Otorhinolaryngology—Head & Neck Surgery, Donostia University Hospital, 20014 Donostia, Spain;
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias-Instituto de Salud del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (J.P.R.); (A.C.-P.); (F.L.)
- IUOPA, University of Oviedo, 33006 Oviedo, Spain
- CIBERONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Nabil F. Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA;
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy;
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4
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Han C, Khan NI, Mady LJ. Prognosis. Otolaryngol Clin North Am 2023; 56:389-402. [PMID: 37030950 DOI: 10.1016/j.otc.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Prognosis is defined as the likely outcome or course of a disease and is the result of a complex interplay between patient and tumor factors. Unfortunately, the prognosis of patients with laryngeal cancer has not changed significantly over the past several decades. However, as our understanding of these patient and tumor factors becomes more nuanced and the resulting treatment options become more precise, there is the potential to improve the prognosis for these patients.
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Bradley PJ. Peristomal recurrence following primary total laryngectomy: the enigma of the central compartment neck lymph nodes. Curr Opin Otolaryngol Head Neck Surg 2023; 31:94-104. [PMID: 36730566 DOI: 10.1097/moo.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW The practice of primary total laryngectomy (TL) for advanced laryngo-hypopharyngeal cancer has significantly declined in the developed countries. The treatment options most frequently adopted have changed from open surgery to transoral laser or robotic approaches or nonsurgical (bio-chemo-) radiotherapy. Primary TL remains the treatment of choice in the developing world where healthcare resources are limited, especially for the treatment of cancer. RECENT FINDINGS Peristomal recurrence (PSR) is quite a serious complication, with an incidence of 6.6% from the published literature (mainly concerning the developed world), most diagnosed within 2 years, and associated with >80% mortality. The major risk factors include pretreatment tracheostomy, specific primary tumor subsites, positive surgical margins, and presence of nodal metastasis. The treatment options are limited and most success has been observed with surgery, especially when PSR is diagnosed at an early-stage, which is uncommon. Treatment of advanced-stage disease is usually palliative. Reduction and/or prevention of the known risk factors for PSR remain the goal when performing TL. In particular, central compartment (para- and pretracheal) lymph nodes dissection in case of large tumors with extra-laryngeal and/or subglottic extension or pretreatment tracheotomy plays a paramount role in PSR prevention. SUMMARY Research is required to conclude the formulation of guidelines for proper dissection of the central compartment (level VI) lymph nodes as indicated either prophylactically or therapeutically during TL for preventing PSR.
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Affiliation(s)
- Patrick J Bradley
- Department Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK
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6
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McDermott JD, Amini A, Molina E, Stokes WA, Karam SD. Treatment outcomes and cost comparisons for older adults with T4 laryngeal squamous cell cancer. Head Neck 2023; 45:664-674. [PMID: 36563300 PMCID: PMC10626713 DOI: 10.1002/hed.27284] [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: 05/12/2021] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To evaluate treatment modalities of T4 larynx cancer in older adults using SEER-Medicare. METHODS The database was queried for patients aged 66 and older with nonmetastatic T4 laryngeal squamous cell cancer from 2006 to 2015. Treatment modalities compared were surgery plus chemoradiation (SCR), surgery plus radiation (SR), chemoradiation (CR), surgery (S), and radiation (R). Multivariate analysis and Kaplan-Meier methods were used to explore the relationship of treatment modality and survival. Total cancer-related costs were calculated. RESULTS A total of 438 patients met inclusion criteria. Patients receiving CR or SR had similar CSS to SCR (HR 1.36 and HR 1.24, respectively). Those receiving S (HR 2.00) or R (HR 2.41) had significantly worse CSS. Similar findings were observed for OS. Cancer care-related costs were not significantly different but highest in SCR ($162215) and lowest in R ($121421). CONCLUSION Older patients with T4 larynx cancer had similar survival rates when treated with CR, SR, and SCR. Average total health care costs were not significantly different between modalities. Patients not eligible for triple-modality could consider these other treatment options.
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Affiliation(s)
- Jessica D McDermott
- Department of Medical Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope, Duarte, California, USA
| | - Elizabeth Molina
- Department of Health Systems, Management, and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - William A Stokes
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
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7
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Lee MY, Belfiglio M, Zeng J, Fleming CW, Koyfman S, Joshi NP, Lamarre E, Prendes B, Scharpf J, Lorenz RR, Woody NM, Adelstein DJ, Geiger JL, Chute DJ, Ku JA. Primary Total Laryngectomy versus Organ Preservation for Locally Advanced T3/T4a Laryngeal Cancer. Laryngoscope 2022; 133:1122-1131. [PMID: 35754153 DOI: 10.1002/lary.30254] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/11/2022] [Accepted: 05/31/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Organ preservation (OP) treatment for advanced laryngeal cancer has increased compared to primary total laryngectomy. Our study compares oncologic and functional outcomes between these approaches. STUDY DESIGN Retrospective cohort study. SETTING Single tertiary care institution. METHODS Retrospective review of patients receiving primary total laryngectomy or OP for laryngeal cancer between 1/1/2000 and 12/31/2018. RESULTS A total of 118 patients received primary total laryngectomy and 119 received OP. Overall survival was similar between total laryngectomy and OP. When stratified by T stage, disease-free survival was worse among T3 patients receiving OP versus total laryngectomy. In T3 patients, 28 OP patients experienced local recurrence (28.9%) compared to 3 total laryngectomy patients (7.1%; p < 0.01). In total, 20 OP patients with local recurrence received salvage surgery. These patients had similar overall survival to patients who underwent initial total laryngectomy (TL). About 14 OP patients with local recurrence did not receive salvage surgery. About 89 (75.4%) TL patients achieved normal diet as compared to 64 (53.8%) OP patients (p < 0.001). In TL patients, 106 (89.8%) received primary or secondary tracheoesophageal-prosthesis, 82 (77.4%) of whom achieved completely understandable speech. CONCLUSIONS There was no difference in survival by treatment in T4 patients, possibly because of strict patient selection. However, disease-free survival was worse in T3 patients receiving OP, likely due to a high local recurrence rate. Approximately 40% of patients with local recurrence were not eligible for salvage laryngectomy. TL patients had comparable swallowing and speech outcomes with OP patients. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Maxwell Y Lee
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Mario Belfiglio
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Johnathan Zeng
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Christopher W Fleming
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Shlomo Koyfman
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Nikhil P Joshi
- Department of Radiation Oncology, Rush University Medical Center, Cleveland, Ohio, USA
| | - Eric Lamarre
- Head and Neck Cancer Program, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Brandon Prendes
- Head and Neck Cancer Program, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Joseph Scharpf
- Head and Neck Cancer Program, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Robert R Lorenz
- Head and Neck Cancer Program, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Neil M Woody
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - David J Adelstein
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Jessica L Geiger
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Deborah J Chute
- Department of Pathology, Cleveland Clinic Pathology and Laboratory Medicine Institute, Cleveland, Ohio, USA
| | - Jamie A Ku
- Head and Neck Cancer Program, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
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Abstract
Could primary chemoradiotherapy (pCRT) possibly be viewed as an alternative standard therapy to upfront total laryngectomy (TL)? According to the new German S3 guideline, despite higher rates of local recurrence, there would be no survival disadvantage and salvage surgery would be a curative option. In several large database studies and case series, statistically significant survival disadvantages of more than 30% between pCRT and TL have been reported for T4 laryngeal cancer. According to the literature, the success rate of salvage TL for T4 laryngeal cancer is only about 25-50%. Larynx preservation (LP) studies which could qualify the recommendation of pCRT as an alternative standard therapy to TL in T4 carcinomas should 1) evaluate T4a cancers within the T4 category; 2) perform subgroup analysis of laryngeal and hypopharyngeal cancers; 3) be sufficiently highly powered; 4) provide long-term outcomes of at least 5 years; 5) with oncological and 6) functional outcomes (duration of the need for tracheostomy and/or feeding tube dependency; necessity and success of salvage laryngectomies). 7) Specification of the criteria of the respective T4 classification (invasion through the outer cortex of the cartilage, or infiltration of which extralaryngeal structures) and 8) evaluation of pretreatment laryngeal function (at least: tracheostomy, feeding tube dependency). Collection of all the aforementioned data of T4 patients treated with pCRT in a large prospective observational cohort study in German-speaking countries is suggested. In case of rejection of TL by T4 laryngeal cancer patients, differentiation between primary spontaneous reluctance and a definitive, carefully considered decision is important. This distinction should be achieved by sensitive discussions. Not only oncological but also functional outcome probabilities should be included in the overall decision-making process.
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9
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Dyckhoff G, Warta R, Herold-Mende C, Plinkert PK, Ramroth H. [Larynx preservation: recommendations for decision-making in T3 laryngeal cancer patients]. HNO 2022; 70:581-587. [PMID: 35575826 PMCID: PMC9329161 DOI: 10.1007/s00106-022-01177-7] [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] [Accepted: 03/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND By today's standard, the optimal treatment of every individual tumor patient is discussed and determined in an interdisciplinary tumor board. According to the new S3 guidelines, larger volume T3 laryngeal cancers which are no longer safely resectable with larynx-sparing surgery are ideal candidates for a larynx preservation approach using primary chemoradiation (pCRT). So far, no clear criteria have been defined under what circumstances primary radiotherapy alone (pRT) might be acceptable in case chemotherapy (CT) is prohibited or in what cases, even in T3, upfront total laryngectomy with risk-adapted adjuvant treatment (TL±a[C]RT) should be recommended. METHOD The literature was searched for parameters chosen as criteria for an inclusion in the surgical rather than the conservative arm in non-randomized LP studies or which proved to be significant prognostic markers after conservative treatment. Development of a counselling tool for therapeutic decision making. RESULTS Significant prognostic markers were tumor volume (< 3.5 ccm/< 6 ccm vs. 6-12 ccm vs. > 12 ccm), presence and kind of vocal cord fixation (none vs. Succo I/II vs. Succo III/IV), extent of cartilage infiltration (none vs. minimal vs. multiple/gross), nodal status (N0‑1 vs. N2-3), and laryngeal dysfunction (pretreatment necessity of feeding tube or tracheostomy). CONCLUSION For T3 laryngeal cancers, pRT could be acceptable when the tumor volume is < 3.5 ccm for glottic and < 6 ccm for supraglottic tumors and there are no further risk factors. pCRT can be regarded as the standard for LP for tumors between 6 ccm and 12 ccm, vocal cord fixation Succo pattern I/II, only minimal cartilage infiltration and a high nodal burden. For tumor > 12 ccm, vocal cord fixation Succo pattern III/IV, gross or multiple cartilage infiltration or clinically relevant laryngeal dysfunction, upfront TL±a[C]RT should be considered.
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Affiliation(s)
- Gerhard Dyckhoff
- Universitäts-Hals-Nasen-Ohrenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - Rolf Warta
- Universitäts-Hals-Nasen-Ohrenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.,Neurochirurgische Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - Christel Herold-Mende
- Universitäts-Hals-Nasen-Ohrenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.,Neurochirurgische Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - Peter K Plinkert
- Universitäts-Hals-Nasen-Ohrenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Heribert Ramroth
- Heidelberger Institut für Global Health, Universität Heidelberg, Heidelberg, Deutschland
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10
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Morse E, Lohia S, Dooley LM, Gupta P, Roman BR. Travel distance is associated with stage at presentation and laryngectomy rates among patients with laryngeal cancer. J Surg Oncol 2021; 124:1272-1283. [PMID: 34390494 DOI: 10.1002/jso.26643] [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: 03/14/2021] [Revised: 07/18/2021] [Accepted: 08/03/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The impact of travel distance on stage at presentation and management strategies of laryngeal squamous cell carcinoma (SCC) is unknown. We investigated this relationship. METHODS Retrospective review of patients with laryngeal SCC in the National Cancer Data Base from 2004 to 2016. Multivariate analysis determined relationships between travel distance, sociodemographic, geographic, and hospital factors. Logistic regression determined the influence of travel distance on T-stage and overall stage at presentation, and receipt of total laryngectomy. RESULTS Sixty thousand four hundred and thirty-nine patients were divided into groups based on distance to treatment: short (<12.5 miles); intermediate (12.5-49.9 miles); and long (>50 miles). Increased travel was associated with T4-stage (intermediate vs. short OR 1.11, CI 1.04-1.18, p = 0.001; long vs. short OR 1.5, CI 1.36-1.65, p < 0.001), and total laryngectomy (intermediate vs. short OR 1.40, CI 1.3-1.5, p ≤ 0.001; long vs. short OR 2.52, CI 2.28-2.79, p ≤ 0.001). In T4 disease, total laryngectomy was associated with improved survival compared to nonsurgical treatment (HR 0.75, CI 0.70-0.80, p < 0.001) regardless of travel distance. CONCLUSION Longer travel distance to care is associated with increased stage at presentation, rate of laryngectomy, and improved survival in advanced laryngeal SCC. Health policy efforts should be directed towards improving early access to diagnosis and care.
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Affiliation(s)
- Elliot Morse
- Department of Otolaryngology, Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Shivangi Lohia
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan, USA
| | - Laura M Dooley
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan, USA
| | - Piyush Gupta
- Department of Otolaryngology, University of Missouri, Columbia, Missouri, USA
| | - Benjamin R Roman
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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11
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Chemoradiotherapy but Not Radiotherapy Alone for Larynx Preservation in T3. Considerations from a German Observational Cohort Study. Cancers (Basel) 2021; 13:cancers13143435. [PMID: 34298650 PMCID: PMC8306673 DOI: 10.3390/cancers13143435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/13/2021] [Accepted: 07/02/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary For advanced laryngeal carcinoma, primary radiotherapy with or without chemotherapy (pCRT or pRT) is used as an alternative to total laryngectomy (TL) to preserve a functional larynx. For advanced laryngeal cancer (T4), poorer survival has been reported after nonsurgical treatment. Is there a need to fear worse survival in moderately advanced tumors (T3)? The outcomes after pRT, pCRT, or surgery were evaluated in 121 patients with T3 laryngeal cancers. pCRT and TL with risk-adopted adjuvant (chemo)radiotherapy (TL ± a(C)RT) yielded results without a significant survival difference. However, after pRT alone, survival was significantly poorer than after TL ± a(C)RT. Thus, according to our data and supported by the literature, pCRT instead of pRT alone is recommended for T3 laryngeal cancers. According to the literature, this recommendation also applies to bulky tumors (6–12 mm), vocal cord fixation, at least minimal cartilage infiltration, and advanced N stage. TL ± a(C)RT instead of larynx preservation should be considered if any of these factors is present and chemotherapy is prohibited; in cases with a tumor volume > 12 mm, severe forms of vocal cord fixation or cartilage infiltration; or when the patient needs a feeding tube or a tracheotomy before the onset of therapy. Abstract For advanced laryngeal cancers, after randomized prospective larynx preservation studies, nonsurgical therapy has been applied on a large scale as an alternative to laryngectomy. For T4 laryngeal cancer, poorer survival has been reported after nonsurgical treatment. Is there a need to fear worse survival also in T3 tumors? The outcomes of 121 T3 cancers treated with pCRT, pRT alone, or surgery were evaluated in an observational cohort study in Germany. In a multivariate Cox regression of the T3 subgroup, no survival difference was noted between pCRT and total laryngectomy with risk-adopted adjuvant (chemo)radiotherapy (TL ± a(C)RT) (HR 1.20; 95%-CI: 0.57–2.53; p = 0.63). However, survival was significantly worse after pRT alone than after TL ± a(C)RT (HR 4.40; 95%-CI: 1.72–11.28, p = 0.002). A literature search shows that in cases of unfavorable prognostic markers (bulky tumors of 6–12 ccm, vocal cord fixation, minimal cartilage infiltration, or N2–3), pCRT instead of pRT is indicated. In cases of pretreatment dysphagia or aspiration requiring a feeding tube or tracheostomy, gross or multiple cartilage infiltration, or tumor volume > 12 ccm, outcomes after pCRT were significantly worse than those after TL. In these cases, and in cases where pCRT is indicated but the patient is not suitable for the addition of chemotherapy, upfront total laryngectomy with stage-appropriate aRT is recommended even in T3 laryngeal cancers.
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12
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Comparison of treatment modalities for selected advanced laryngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2021; 279:361-371. [PMID: 33864482 DOI: 10.1007/s00405-021-06780-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/22/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE The authors aimed to clarify the optimal treatment strategy and the indication of different treatments in managing advanced laryngeal squamous cell carcinoma (LSCC). METHODS A total of 9700 patients with advanced (T3-4aN0-3M0) LSCC who treated with (1) surgery alone, (2) surgery plus adjuvant radiation with or without chemotherapy (aCRT/RT), or (3) definitive CRT/RT was retrieved from the SEER database. The propensity score matching (PSM) was applied to balance confounding factors. Kaplan-Meier method and Cox proportional hazards regression were used to comparing the overall survival (OS) of patients. RESULTS After optimal matching, 907 patients were screened from each treatment cohort. Kaplan-Meier and multivariate analyses presented that patients treated with surgery plus aCRT/CT had significantly longer OS than those treated with either surgery alone or CRT/RT, even after PSM. However, significant interactions were tested in treatment effects in stratified analyses of the primary subsite, T stage, N stage, and insurance status (PInteraction < 0.05 for all). Specifically, surgery plus aCRT/CT significantly improved the OS of patients with supraglottic, T4a, and N + tumors (P < 0.001 for all), while three treatment modalities achieved equal OS rates for patients with glottic, T3, and N0 tumors (P > 0.05 for all). Besides, supraglottic tumors presented a poorer prognosis than glottic subsite. CONCLUSION Current study suggests that surgery with aCRT/RT is the preferred initial therapy for patients with T4a tumors, whereas patients with T3 tumors could be treated with either surgery (followed by aCRT/RT if it presents N +) or definitive CRT/RT for achieving laryngeal preservation. More-intense treatment should be emphasized for advanced supraglottic cancer.
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13
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Zarei M, Mirzaee M, Alizadeh H, Jahani Y. Investigation of the affective factors on the survival rate of patients with laryngeal cancer using Cox proportional hazards and Lin -Ying's additive hazards models. Med J Islam Repub Iran 2021; 35:16. [PMID: 33996667 PMCID: PMC8111620 DOI: 10.47176/mjiri.35.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Determining the factors affecting survival and appropriate treatment methods leads to improving the survival rate and quality of life in cancer patients; therefore this study was aimed to determine the effective factors on the survival rate of patients with Laryngeal cancer in Kerman city, Iran.
Methods: This retrospective cohort study included 370 patients with Laryngeal cancer who referred to the hospitals of Kerman city, Iran during 2008 to 2018. Data were analyzed using Cox Proportional Hazards and Lin-Ying’s Additive Hazards models. Data analysis was done using SAS software version 9.4. The P-value of less than 0.05 was considered as statistically significant.
Results: The mean age at the time of diagnosis was 58.16±10.60 years. About 92% of the patients were men. The patient’s 1, 3, 5, 7 and 10-years of overall survival rates were equal to 82.38%, 60.68%, 55.98%, 49.83%, and 30.91%, respectively. Age at the diagnosis (p=0.001), radiotherapy (p=0.001), chemotherapy (p=0.015), surgery (p=0.031), and smoking (p=0.001) were found to have significant effect on the patient’s survival rate in the Cox model. These variables were significant in the Lin-Ying model too.
Conclusion: Treatment is an important factor in controlling the disease and survival of cancer patients, and choosing the best treatment depends on the condition of the patient and the disease level.
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Affiliation(s)
- Masoud Zarei
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Moghaddameh Mirzaee
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hosniyeh Alizadeh
- Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Yunes Jahani
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
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14
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van der Kamp MF, van Dijk BAC, Plaat BEC, van der Laan BFAM, Halmos GB. To what extent has the last two decades seen significant progress in the management of older patients with head and neck cancer? Eur J Surg Oncol 2021; 47:1398-1405. [PMID: 33648773 DOI: 10.1016/j.ejso.2021.01.014] [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: 10/09/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Life expectancy is rising and consequently also the number of older patients with head and neck cancer. Different treatment regimens are often applied for older patients. The aim of this study is to investigate how treatment patterns and survival rates have changed over the past 20 years in older patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS Patient and tumour characteristics, treatment and 5-year survival data from the Netherlands Cancer Registry of patients aged ≥60 years diagnosed with HNSCC in 1990-1995 and 2010-2015 were compared using chi-square test and relative survival analysis. RESULTS Data of 14,114 patients were analyzed. Oral cavity cancer treatment did not change over time, while survival improved from 54% to 58% (p = 0.03). Oropharyngeal and hypopharyngeal cancer treatment shifted towards non-surgical, with survival improving from 31% to 51% (p < 0.01) and 26% to 34% (p < 0.01), respectively. Laryngeal cancer treatment changed towards surgery in stage I and non-surgical treatment in stage III and IV disease. Survival in laryngeal cancer stage I remained stable and favorable at a relative survival rate of around 90%. Survival non-significantly changed from 54% to 49% for stage III disease and from 37% to 33% for disease. CONCLUSION Relative survival increased for all head and neck cancer sites in older patients, except for laryngeal cancer. For oropharyngeal, hypopharyngeal and advanced laryngeal cancer, a shift towards non-surgical treatment modalities was observed.
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Affiliation(s)
- Martine F van der Kamp
- University of Groningen, University Medical Centre Groningen, Department of Otorhinolaryngology, Head & Neck Surgery, Groningen, the Netherlands.
| | - Boukje A C van Dijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; University of Groningen, University Medical Centre Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Boudewijn E C Plaat
- University of Groningen, University Medical Centre Groningen, Department of Otorhinolaryngology, Head & Neck Surgery, Groningen, the Netherlands
| | - Bernard F A M van der Laan
- University of Groningen, University Medical Centre Groningen, Department of Otorhinolaryngology, Head & Neck Surgery, Groningen, the Netherlands
| | - Gyorgy B Halmos
- University of Groningen, University Medical Centre Groningen, Department of Otorhinolaryngology, Head & Neck Surgery, Groningen, the Netherlands
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15
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Beck AJCC, Retèl VP, Bunting G, Sethi RKV, Deschler DG, van den Brekel MWM, van Harten WH. Cost-effectiveness analysis of using the heat and moisture exchangers compared with alternative stoma covers in laryngectomy rehabilitation: US perspective. Head Neck 2020; 42:3720-3734. [PMID: 32885527 DOI: 10.1002/hed.26442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 07/14/2020] [Accepted: 08/14/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND This study aims to evaluate the cost-effectiveness of using heat and moisture exchangers (HMEs) vs alternative stoma covers (ASCs) following laryngectomy in the United States. METHODS A cost-effectiveness and budget impact analysis were conducted including uncertainty analyses using real-world survey data with pulmonary events and productivity loss. RESULTS HME use was more effective and less costly compared with ASCs. Quality-adjusted life years were slightly higher for HME-users. Total costs per patient (lifetime) were $59 362 (HME) and $102 416 (ASC). Pulmonary events and productivity loss occurred more frequently in the ASC-users. Annual budget savings were up to $40 183 593. Costs per pulmonary event averted were $3770. CONCLUSIONS HME utilization in laryngectomy patients was cost-effective. Reimbursement of HME devices is thus recommended. Utilities may be underestimated due to the generic utility instrument used and sample size. Therefore, we recommend development of a disease-specific utility tool to incorporate in future analyses.
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Affiliation(s)
- Ann-Jean C C Beck
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Valesca P Retèl
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Glenn Bunting
- Department of Otolaryngology-Head and Neck Oncology and Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Rosh K V Sethi
- Department of Otolaryngology-Head and Neck Oncology and Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Oncology and Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
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16
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Arends CR, Petersen JF, van der Noort V, Timmermans AJ, Leemans CR, de Bree R, van den Brekel MW, Stuiver MM. Optimizing Survival Predictions of Hypopharynx Cancer: Development of a Clinical Prediction Model. Laryngoscope 2020; 130:2166-2172. [PMID: 31693181 PMCID: PMC7496756 DOI: 10.1002/lary.28345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/26/2019] [Accepted: 09/12/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To develop and validate a clinical prediction model (CPM) for survival in hypopharynx cancer, thereby aiming to improve individualized estimations of survival. METHODS Retrospective cohort study of hypopharynx cancer patients. We randomly split the cohort into a derivation and validation dataset. The model was fitted on the derivation dataset and validated on the validation dataset. We used a Cox's proportional hazard model and least absolute shrinkage and selection operator (LASSO) selection. Performance (discrimination and calibration) of the CPM was tested. RESULTS The final model consisted of gender, subsite, TNM classification, Adult Comorbidity Evaluation-27 score (ACE27), body mass index (BMI), hemoglobin, albumin, and leukocyte count. Of these, TNM classification, ACE27, BMI, hemoglobin, and albumin had independent significant associations with survival. The C Statistic was 0.62 after validation. The model could significantly identify clinical risk groups. CONCLUSIONS ACE27, BMI, hemoglobin, and albumin are independent predictors of overall survival. The identification of high-risk patients can be used in the counseling process and tailoring of treatment strategy or follow-up. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2166-2172, 2020.
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Affiliation(s)
- Coralie R. Arends
- Department of Head and Neck Oncology and SurgeryThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Japke F. Petersen
- Department of Head and Neck Oncology and SurgeryThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | | | - Adriana J. Timmermans
- Department of Head and Neck Oncology and SurgeryThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Department of Head and Neck Oncology and SurgeryAmsterdam UMCAmsterdamThe Netherlands
| | - C. René Leemans
- Department of Head and Neck Oncology and SurgeryAmsterdam UMCAmsterdamThe Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical OncologyUniversity Medical Center UtrechtThe Netherlands
| | - Michiel W.M. van den Brekel
- Department of Head and Neck Oncology and SurgeryThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Institute of Phonetic SciencesAmsterdam Center of Language and Communication, University of AmsterdamAmsterdamThe Netherlands
- Department of Oral and Maxillofacial SurgeryAcademic Medical CenterAmsterdamThe Netherlands
| | - Martijn M. Stuiver
- Department of Head and Neck Oncology and SurgeryThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Department of Clinical Epidemiology, Biostatistics, and BioinformaticsAmsterdam UMCAmsterdamThe Netherlands
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17
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Beck AJCC, van Harten WH, van den Brekel MWM, Navran A, Retèl VP. Cost-Effectiveness of Surgery Versus Organ Preservation in Advanced Laryngeal Cancer. Laryngoscope 2020; 131:E509-E517. [PMID: 32776557 DOI: 10.1002/lary.28954] [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: 03/27/2020] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 12/09/2022]
Abstract
OBJECTIVE Treatment decision-making for patients with laryngeal cancer consists of a complex trade-off between survival and quality of life. For decision makers on coverage and guidelines, costs come in addition to this equation. Our aim was to perform a cost-effectiveness analysis of surgery (laryngectomy with or without radiotherapy) versus organ preservation (OP: radiotherapy, chemo- and/or bioradiation) in advanced laryngeal cancer patients from a healthcare perspective. METHODS A cost-effectiveness analysis was conducted using a Markov model. For each modality, data on survival and quality-adjusted life years (QALYs) were sourced from relevant articles in agreement with experts, and national benchmark cost prices were included regarding treatment, follow-up, adverse events, and rehabilitation. RESULTS Total QALYs of the surgical approach (6.59) were substantially higher compared to the OP approach (5.44). Total lifetime costs were higher for the surgical approach compared to the OP approach, namely €95,881 versus €47,233. The surgical approach was therefore more effective and more costly compared to OP, resulting in an incremental cost-effectiveness ratio of €42,383/QALY. CONCLUSION Based on current literature, surgical treatment was cost-effective compared to OP in advanced laryngeal cancer within most willingness-to-pay thresholds. The study provides information on the survival adjusted for quality of life in combination with costs of two different approaches for advanced laryngeal cancer, relevant for patients, physicians, and policy makers. As financial toxicity is a relevant aspect in this population, collection of real-world data on country-specific costs and utilities is strongly recommended to enable further generalization. LEVEL OF EVIDENCE N/A. Laryngoscope, 131:E509-E517, 2021.
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Affiliation(s)
- Ann-Jean C C Beck
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands.,Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (AUMC), Amsterdam, The Netherlands
| | - Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Valesca P Retèl
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
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18
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Survival prediction and treatment strategies for patients with advanced laryngeal carcinoma: a population-based study. Int J Clin Oncol 2020; 25:1483-1491. [PMID: 32462387 DOI: 10.1007/s10147-020-01688-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study aimed at exploring high-risk factors associated with survival outcomes in patients with advanced primary laryngeal carcinoma and at developing and validating a survival-predicting model to help to select the appropriate treatment for each patient. METHODS Data of patients with advanced primary laryngeal cancer in 2003-2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. High-risk factors were identified and integrated to build a nomogram, which was internally validated using bootstrap and externally validated with a patient cohort from China. The impact of various treatments was examined on model-defined high-, moderate- and low-risk patient groups, respectively. RESULTS A total of 6070 patients were analyzed. Patients' age, gender, tumor T stage, N stage, and differentiation grade were recognized and integrated into the model. The concordance index of this model (0.602) was significantly higher than that of the TNM staging system (0.547). The calibration curve showed a good agreement between model-predicted and actual survival outcomes. Patients were categorized into three different subgroups with incremental risks of overall mortality. The roles of three treatment strategies in these subgroups are varied. CONCLUSION In this large SEER-based study, we established a practical model to predict overall survival for patients with advanced primary laryngeal cancer. For patients identified as high-risk and moderate-risk, surgery plus adjuvant therapy is recommended, while for patients in the low-risk group, surgery alone plus regular re-examination is recommended as the primary treatment strategy.
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19
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Repova B, Zabrodsky M, Plzak J, Kalfert D, Matousek J, Betka J. Text-to-speech synthesis as an alternative communication means after total laryngectomy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:192-197. [PMID: 32367081 DOI: 10.5507/bp.2020.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/06/2020] [Indexed: 11/23/2022] Open
Abstract
AIMS Total laryngectomy still plays an essential part in the treatment of laryngeal cancer and loss of voice is the most feared consequence of the surgery. Commonly used rehabilitation methods include esophageal voice, electrolarynx, and implantation of voice prosthesis. In this paper we focus on a new perspective of vocal rehabilitation utilizing alternative and augmentative communication (AAC) methods. METHODS AND PATIENTS 61 consecutive patients treated by means of total laryngectomy with or w/o voice prosthesis implantation were included in the study. All were offered voice banking and personalized speech synthesis (PSS). They had to voluntarily express their willingness to participate and to prove the ability to use modern electronic communication devices. RESULTS Of 30 patients fulfilling the study criteria, only 18 completed voice recording sufficient for voice reconstruction and synthesis. Eventually, only 7 patients started to use this AAC technology during the early postoperative period. The frequency and total usage time of the device gradually decreased. Currently, only 6 patients are active users of the technology. CONCLUSION The influence of communication with the surrounding world on the quality of life of patients after total laryngectomy is unquestionable. The possibility of using the spoken word with the patient's personalized voice is an indisputable advantage. Such a form of voice rehabilitation should be offered to all patients who are deemed eligible.
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Affiliation(s)
- Barbora Repova
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol
| | - Michal Zabrodsky
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol
| | - Jan Plzak
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol
| | - David Kalfert
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol
| | - Jindrich Matousek
- Department of Cybernetics, University of West Bohemia in Pilsen, Pilsen, Czech Republic
| | - Jan Betka
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol
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20
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van der Heijden M, Essers PBM, de Jong MC, de Roest RH, Sanduleanu S, Verhagen CVM, Hamming-Vrieze O, Hoebers F, Lambin P, Bartelink H, Leemans CR, Verheij M, Brakenhoff RH, van den Brekel MWM, Vens C. Biological Determinants of Chemo-Radiotherapy Response in HPV-Negative Head and Neck Cancer: A Multicentric External Validation. Front Oncol 2020; 9:1470. [PMID: 31998639 PMCID: PMC6966332 DOI: 10.3389/fonc.2019.01470] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/09/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose: Tumor markers that are related to hypoxia, proliferation, DNA damage repair and stem cell-ness, have a prognostic value in advanced stage HNSCC patients when assessed individually. Here we aimed to evaluate and validate this in a multifactorial context and assess interrelation and the combined role of these biological factors in determining chemo-radiotherapy response in HPV-negative advanced HNSCC. Methods: RNA sequencing data of pre-treatment biopsy material from 197 HPV-negative advanced stage HNSCC patients treated with definitive chemoradiotherapy was analyzed. Biological parameter scores were assigned to patient samples using previously generated and described gene expression signatures. Locoregional control rates were used to assess the role of these biological parameters in radiation response and compared to distant metastasis data. Biological factors were ranked according to their clinical impact using bootstrapping methods and multivariate Cox regression analyses that included clinical variables. Multivariate Cox regression analyses comprising all biological variables were used to define their relative role among all factors when combined. Results: Only few biomarker scores correlate with each other, underscoring their independence. The different biological factors do not correlate or cluster, except for the two stem cell markers CD44 and SLC3A2 (r = 0.4, p < 0.001) and acute hypoxia prediction scores which correlated with T-cell infiltration score, CD8+ T cell abundance and proliferation scores (r = 0.52, 0.56, and 0.6, respectively with p < 0.001). Locoregional control association analyses revealed that chronic (Hazard Ratio (HR) = 3.9) and acute hypoxia (HR = 1.9), followed by stem cell-ness (CD44/SLC3A2; HR = 2.2/2.3), were the strongest and most robust determinants of radiation response. Furthermore, multivariable analysis, considering other biological and clinical factors, reveal a significant role for EGFR expression (HR = 2.9, p < 0.05) and T-cell infiltration (CD8+T-cells: HR = 2.2, p < 0.05; CD8+T-cells/Treg: HR = 2.6, p < 0.01) signatures in locoregional control of chemoradiotherapy-treated HNSCC. Conclusion: Tumor acute and chronic hypoxia, stem cell-ness, and CD8+ T-cell parameters are relevant and largely independent biological factors that together contribute to locoregional control. The combined analyses illustrate the additive value of multifactorial analyses and support a role for EGFR expression analysis and immune cell markers in addition to previously validated biomarkers. This external validation underscores the relevance of biological factors in determining chemoradiotherapy outcome in HNSCC.
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Affiliation(s)
- Martijn van der Heijden
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, Netherlands.,Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Paul B M Essers
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, Netherlands.,Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Monique C de Jong
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Reinout H de Roest
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology/Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Sebastian Sanduleanu
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Caroline V M Verhagen
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, Netherlands.,Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Olga Hamming-Vrieze
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Frank Hoebers
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Philippe Lambin
- The D-Lab and The M-Lab, Department of Precision Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Harry Bartelink
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - C René Leemans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology/Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Marcel Verheij
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, Netherlands.,Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands.,Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ruud H Brakenhoff
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology/Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Academic Medical Center, Amsterdam, Netherlands
| | - Conchita Vens
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, Netherlands.,Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
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21
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Plaat RE, van Dijk BAC, Muller Kobold AC, Steenbakkers RJHM, Links TP, van der Laan BFAM, Plaat BEC. Onset of hypothyroidism after total laryngectomy: Effects of thyroid gland surgery and preoperative and postoperative radiotherapy. Head Neck 2019; 42:636-644. [PMID: 31833166 PMCID: PMC7154538 DOI: 10.1002/hed.26048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 11/03/2019] [Accepted: 12/03/2019] [Indexed: 12/22/2022] Open
Abstract
Background To determine time of onset and risk of hypothyroidism after total laryngectomy (TL) with and without (hemi)thyroidectomy in relation to treatment regimen, that is, preoperative radiotherapy (RT‐TL), postoperative radiotherapy (TL‐RT), and postoperative re‐irradiation (RT‐TL‐RT). Methods Retrospective review of 128 patients treated by RT‐TL (51 patients), TL‐RT (55 patients), and RT‐TL‐RT (22 patients). Risk of hypothyroidism was determined by multivariable Cox regression analysis and euthyroid survival was calculated using Kaplan‐Meier method. Results Hypothyroidism developed in 69 (54%) patients. The median onset of hypothyroidism was later (P < .01) and the risk of hypothyroidism was lower (hazard ratio 0.49; P = .014) in the TL‐RT group compared to both other treatment regimens. Euthyroid survival did not differ between the treatment regimens. Two years euthyroid survival was 24% with and 61% without (hemi)thyroidectomy (P < .001). Conclusions Patients treated with TL‐RT have later onset of hypothyroidism. Higher risk for hypothyroidism is associated with salvage TL after radiotherapy and (hemi)thyroidectomy.
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Affiliation(s)
- Robert E Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Boukje A C van Dijk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiotherapy, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thera P Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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22
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Dulguerov P, Broglie MA, Henke G, Siano M, Putora PM, Simon C, Zwahlen D, Huber GF, Ballerini G, Beffa L, Giger R, Rothschild S, Negri SV, Elicin O. A Review of Controversial Issues in the Management of Head and Neck Cancer: A Swiss Multidisciplinary and Multi-Institutional Patterns of Care Study-Part 1 (Head and Neck Surgery). Front Oncol 2019; 9:1125. [PMID: 31709185 PMCID: PMC6822016 DOI: 10.3389/fonc.2019.01125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/09/2019] [Indexed: 11/23/2022] Open
Abstract
Background: The Head and Neck Cancer Working Group of Swiss Group for Clinical Cancer Research (SAKK) has investigated the level of consensus (LOC) and discrepancy in everyday practice of diagnosis and treatment in head and neck cancer. Materials and Methods: An online survey was iteratively generated with 10 Swiss university and teaching hospitals. LOC below 50% was defined as no agreement, while higher LOC were arbitrarily categorized as low (51-74%), moderate (75-84%), and high (≥85%). Results: Any LOC was achieved in 62% of topics (n = 60). High, moderate and low LOC were found in 18, 20, and 23%, respectively. Regarding Head and Neck Surgery, Radiation Oncology, Medical Oncology, and biomarkers, LOC was achieved in 50, 57, 83, and 43%, respectively. Conclusions: Consensus on clinical topics is rather low for surgeons and radiation oncologists. The questions discussed might highlight discrepancies, stimulate standardization of practice, and prioritize topics for future clinical research.
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Affiliation(s)
- Pavel Dulguerov
- Department of Otorhinolaryngology, Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Martina A. Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Guido Henke
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marco Siano
- Department of Medical Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Medical Oncology, Hôpital Riviera-Chablais, Vevey, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Simon
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Daniel Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Graubünden, Chur, Switzerland
- Department of Radiation Oncology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Gerhard F. Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Giorgio Ballerini
- Department of Radiation Oncology, Clinica Luganese SA, Lugano, Switzerland
| | - Lorenza Beffa
- Department of Radiation Oncology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sacha Rothschild
- Department of Medical Oncology, University Hospital of Basel, Basel, Switzerland
| | - Sandro V. Negri
- Department of Otorhinolaryngology, Lindenhofspital, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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23
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Willems SM, Abeln S, Feenstra KA, de Bree R, van der Poel EF, Baatenburg de Jong RJ, Heringa J, van den Brekel MWM. The potential use of big data in oncology. Oral Oncol 2019; 98:8-12. [PMID: 31521885 DOI: 10.1016/j.oraloncology.2019.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/31/2019] [Accepted: 09/06/2019] [Indexed: 12/16/2022]
Abstract
In this era of information technology, big data analysis is entering biomedical sciences. But what is big data, where do they come from and what can we do with it? In this commentary, the main sources of big data are explained, especially in (head and neck) oncology. It also touches upon the need to integrate various sources of clinical, pathological and quality-of-life data. It discusses some initiatives in linking of such datasets on a nation-wide scale in the Netherlands. Finally, it touches upon important issues regarding governance, FAIRness of data and the need to bring into place the necessary infrastructures needed to fully exploit the full potential of big data sets in head and neck cancer.
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Affiliation(s)
- Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Sanne Abeln
- Department of Computer Science, Faculty of Science, Vrije Universiteit, Amsterdam, the Netherlands
| | - K Anton Feenstra
- Department of Computer Science, Faculty of Science, Vrije Universiteit, Amsterdam, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Egge F van der Poel
- Department of Head and Neck Surgery, Erasmus Cancer Center, Erasmus MC, Rotterdam, the Netherlands
| | | | - Jaap Heringa
- Department of Computer Science, Faculty of Science, Vrije Universiteit, Amsterdam, the Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
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24
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T4 Laryngeal Cancer With Good Function: Should We Be Reluctant to Treat Without Surgery? Int J Radiat Oncol Biol Phys 2019; 102:1400-1403. [PMID: 31014779 DOI: 10.1016/j.ijrobp.2018.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/24/2018] [Accepted: 03/08/2018] [Indexed: 11/21/2022]
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25
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Subramaniam N, Balasubramanian D, Reddy R, Thankappan K, Iyer S. Organ Preservation Protocols in T4 Laryngeal Cancer: a Review of the Literature. Indian J Surg Oncol 2019; 10:149-155. [PMID: 30948891 DOI: 10.1007/s13193-018-0840-9] [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: 05/13/2018] [Accepted: 11/23/2018] [Indexed: 11/29/2022] Open
Abstract
Population-based studies indicate that chemoradiation has become the most popular treatment for advanced laryngeal cancers; however, by extrapolating trial results to the general population, several issues have emerged, such as reduced overall survival, non-functional laryngeal preservation, and poor response to treatment. Although included in these trials, T4 laryngeal and hypopharyngeal cancers with cartilage invasion formed a small percentage of these patients and questions over whether they were appropriately staged remain unanswered. Literature on the use of chemoradiation in this set of patients, including the challenges, treatment considerations, and factors predicting response to treatment and outcomes, was reviewed. Current evidence indicates that all patients of T4 laryngeal and hypopharyngeal cancer are not suitable candidates for organ preservation; this modality should be offered only to select patients with good performance status and access to rehabilitative care and regular follow-up in order to achieve good results.
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Affiliation(s)
- Narayana Subramaniam
- 1Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Deepak Balasubramanian
- 1Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Rithvik Reddy
- 2Department of Surgery, Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Krishnakumar Thankappan
- 1Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Subramania Iyer
- 1Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
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26
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Petersen JF, Pézier TF, van Dieren JM, van der Noort V, van Putten T, Bril SI, Janssen L, Dirven R, van den Brekel MW, de Bree R. Dilation after laryngectomy: Incidence, risk factors and complications. Oral Oncol 2019; 91:107-112. [DOI: 10.1016/j.oraloncology.2019.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/12/2019] [Accepted: 02/23/2019] [Indexed: 12/30/2022]
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27
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Ahmed OH, Roden DF, Ahmed YC, Wang B, Nathan CAO, Myssiorek D. Perioperative Management of Total Laryngectomy Patients: A Survey of American Head and Neck Society Surgeons. Ann Otol Rhinol Laryngol 2019; 128:534-540. [DOI: 10.1177/0003489419830118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Standards of care for total laryngectomy (TL) patients in the postoperative period have not been established. Perioperative care remains highly variable and perhaps primarily anecdotally based. The aim of this study was to survey members of the American Head and Neck Society to capture management practices in the perioperative care of TL patients. Methods: In this survey study, an electronic survey was distributed to the international attending physician body of the American Head and Neck Society. Forty-five-question electronic surveys were distributed. A total of 777 members were invited to respond, of whom 177 (22.8%) fully completed the survey. The survey elicited information on management preferences in the perioperative care of TL patients. Differences in management on the basis of irradiation status and pharyngeal repair (primary closure vs regional or free flap reconstruction) were ascertained. Main outcomes and measures were time to initiate oral feeding, perioperative antibiotic selection and duration, and estimated pharyngocutaneous fistula rates. These measures were stratified by patient type. Results: Most respondents completed head and neck fellowships (77.0%) and practice at academic tertiary centers (72.3%). Ampicillin/sulbactam was the most preferred perioperative antibiotic (43.2%-49.1% depending on patient type), followed by cefazolin and metronidazole in combination (32.0%-33.7%) and then clindamycin (10.8%-12.6%). Compared with nonirradiated patients, irradiated patients were significantly more likely to have longer durations of antibiotics ( P < .05), longer postoperative times to initiate oral feeding ( P < .05), and higher estimated fistula rates ( P < .05). Additionally, in nonirradiated patients, flap-repaired patients (vs primary repair) were significantly more likely to have longer durations of antibiotics (odds ratio, 1.29; 95% confidence interval, 1.13-1.48) and postoperative times to initiate oral feeding (odds ratio, 2.24; 95% confidence interval, 1.76-2.84). Conclusions: Perioperative management of TL patients is highly variable. Management of antibiotics and oral feeding are significantly affected by irradiation status and scope of pharyngeal repair. Further studies are needed to standardize perioperative care for this unique patient population.
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Affiliation(s)
- Omar H. Ahmed
- Department of Otolaryngology–Head and Neck Surgery, New York University, New York, NY, USA
| | - Dylan F. Roden
- Department of Otolaryngology–Head and Neck Surgery, New York University, New York, NY, USA
| | - Yasmina C. Ahmed
- Department of Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, New York, NY, USA
| | - Binhuan Wang
- Department of Population Health, Division of Biostatistics, New York University, New York, NY, USA
| | - Cherie-Ann O. Nathan
- Department of Otolaryngology–Head and Neck Surgery, Louisiana State University, Shreveport, LA, USA
| | - David Myssiorek
- Department of Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, New York, NY, USA
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28
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Petersen JF, Berlanga A, Stuiver MM, Hamming-Vrieze O, Hoebers F, Lambin P, van den Brekel MWM. Improving decision making in larynx cancer by developing a decision aid: A mixed methods approach. Laryngoscope 2019; 129:2733-2739. [PMID: 30663068 PMCID: PMC6899876 DOI: 10.1002/lary.27800] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/10/2018] [Accepted: 12/19/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Patients diagnosed with advanced larynx cancer face a decisional process in which they can choose between radiotherapy, chemoradiotherapy, or a total laryngectomy with adjuvant radiotherapy. Clinicians do not always agree on the best clinical treatment, making the decisional process for patients a complex problem. METHODS Guided by the International Patient Decision Aid (PDA) Standards, we followed three developmental phases for which we held semi-structured in-depth interviews with patients and physicians, thinking-out-loud sessions, and a study-specific questionnaire. Audio-recorded interviews were verbatim transcribed, thematically coded, and analyzed. Phase 1 consisted of an evaluation of the decisional needs and the regular counseling process; phase 2 tested the comprehensibility and usability of the PDA; and phase 3 beta tested the feasibility of the PDA. RESULTS Patients and doctors agreed on the need for development of a PDA. Major revisions were conducted after phase 1 to improve the readability and replace the majority of text with video animations. Patients and physicians considered the PDA to be a major improvement to the current counseling process. CONCLUSION This study describes the development of a comprehensible and easy-to-use online patient decision aid for advanced larynx cancer, which was found satisfactory by patients and physicians (available on www.treatmentchoice.info). The outcome of the interviews underscores the need for better patient counseling. The feasibility and satisfaction among newly diagnosed patients as well as doctors will need to be proven. To this end, we started a multicenter trial evaluating the PDA in clinical practice (ClinicalTrials.gov Identifier: NCT03292341). LEVEL OF EVIDENCE NA Laryngoscope, 129:2733-2739, 2019.
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Affiliation(s)
- Japke F Petersen
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Adriana Berlanga
- Department of Radiation Oncology (MAASTRO), Research Institute GROW, Maastricht University, Maastricht, The Netherlands
| | - Martijn M Stuiver
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Clinical Epidemiology Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Olga Hamming-Vrieze
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frank Hoebers
- Department of Radiation Oncology (MAASTRO), Research Institute GROW, Maastricht University, Maastricht, The Netherlands
| | - Philippe Lambin
- Department of Radiation Oncology (MAASTRO), Research Institute GROW, Maastricht University, Maastricht, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands.,Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands
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29
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Petersen JF, Lansaat L, Timmermans AJ, van der Noort V, Hilgers FJM, van den Brekel MWM. Postlaryngectomy prosthetic voice rehabilitation outcomes in a consecutive cohort of 232 patients over a 13-year period. Head Neck 2019; 41:623-631. [PMID: 30614644 PMCID: PMC6590326 DOI: 10.1002/hed.25364] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/22/2018] [Accepted: 05/17/2018] [Indexed: 11/09/2022] Open
Abstract
Background With the increasing necessity for total laryngectomy (TL) after prior (chemo)radiotherapy, prosthetic vocal rehabilitation outcomes might have changed. Methods Retrospective cohort study including all patients laryngectomized between 2000 and 2012 with a voice prosthesis (VP) in the Netherlands Cancer Institute. Results Median device lifetimes of the standard Provox2 and Vega VPs are 63 and 66 days, respectively, and for the problem‐solving ActiValve Light and Strong VPs 143 and 186 days, respectively. In multivariable analysis, salvage TL and TL for a dysfunctional larynx (compared to primary TL) were associated with a shorter device lifetime. Almost half of the patients (48%) experienced tracheoesophageal puncture tract‐related problems, and this concerned 12% of all VP replacements. Conclusions Compared to historical cohorts, device lifetimes of regular Provox2 and Vega voice prostheses have decreased. Complications are not occurring more frequently but affect more patients. Nevertheless, the clinical reliability and validity of prosthetic voice rehabilitation is still sound.
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Affiliation(s)
- Japke F Petersen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Liset Lansaat
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Adriana J Timmermans
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Frans J M Hilgers
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Institute of Phonetic Sciences-Amsterdam Center of Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Institute of Phonetic Sciences-Amsterdam Center of Language and Communication, University of Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
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30
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Karsten RT, Timmermans AJ, ten Cate J, Stuiver MM, van den Brekel MWM. Direct complications and routine ICU admission after total laryngectomy. Acta Otolaryngol 2018; 138:1128-1135. [PMID: 30686089 DOI: 10.1080/00016489.2018.1515497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the Netherlands Cancer Institute (NCI), patients are admitted to the Intensive Care Unit (ICU) after total laryngectomy (TL). AIMS/OBJECTIVES To assess direct complications and the need for ICU admission after TL. MATERIAL AND METHODS Patients who underwent a TL in the NCI were reviewed on the occurrence of an event requiring ICU treatment within the first 24 hours postoperatively. The predictive value of predetermined risk factors was assessed with multivariable logistic analysis. The optimal threshold of the risk score assigned by the resulting model was determined. RESULTS An event occurred in 25 of the 113 patients (22%) of which 72% included norepinephrine dependence. Risk analysis showed that patients with either CRT prior to TL or a procedure including pharynx reconstruction, or both, should be indicated for ICU stay. Applying the rule on this cohort, 57 patients (50%) would have been sent to the ward postoperatively of which seven (12%) developed an event requiring ICU treatment. CONCLUSIONS A substantial proportion of the patients developed an event within the first 24 hours after TL. Our risk stratification of patients based on the mentioned risk factors is insufficiently accurate. SIGNIFICANCE The study provides an overview of direct postoperative complications after TL.
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Affiliation(s)
- Rebecca Tosca Karsten
- Department of Head and Neck Surgery, Antoni van Leeuwenhoek Nederlands Kanker Instituut, Amsterdam, The Netherlands
| | | | - Julia ten Cate
- Department of Head and Neck Surgery, Antoni van Leeuwenhoek Nederlands Kanker Instituut, Amsterdam, The Netherlands
| | - Martijn Matthias Stuiver
- Department of Head and Neck Surgery, Antoni van Leeuwenhoek Nederlands Kanker Instituut, Amsterdam, The Netherlands
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31
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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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32
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Tang ZX, Gong JL, Wang YH, Li ZH, He Y, Liu YX, Zhou XH. Efficacy comparison between primary total laryngectomy and nonsurgical organ-preservation strategies in treatment of advanced stage laryngeal cancer: A meta-analysis. Medicine (Baltimore) 2018; 97:e10625. [PMID: 29794737 PMCID: PMC6392597 DOI: 10.1097/md.0000000000010625] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We aimed to provide a pooled analysis of controlled trials comparing long-term survival after primary laryngectomy and primary organ preservation methods in patients with T3-4 laryngeal cancer. METHODS We performed random-effects meta-analyses on overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), and locoregional control (LRC). RESULTS Fifteen studies met the selection criteria including 6288 patients (2696 patients who underwent primary laryngectomy and 3592 patients who underwent primary nonsurgical organ preservation therapy). There was a significant difference between the groups with respect to OS (HR 0.71, 95% CI 0.57-0.89, P = .003). However, a subgroup analysis found OS was not significantly worse for patients with T3 laryngeal cancer who received primary organ preservation compared with patients who underwent primary laryngectomy (HR 0.96, 95% CI 0.45-2.03, P = .91). There was no significant difference for DFS (HR 0.63, 95% CI 0.39-1.04, P = .07) in two groups. Patients with laryngeal cancer who underwent primary laryngectomy had a better DSS (HR 0.47, 95% CI 0.25-0.88, P = .02) and LRC (HR 0.56, 95% CI 0.390.80, P = .001) than patients who underwent primary nonsurgical organ preservation therapy. CONCLUSION Our results support total laryngectomy for patients with T4 laryngeal cancer and show that primary organ preservation for laryngeal cancer has no advantage and also did not decrease the rate of OS in patients with T3 laryngeal cancer when compared with primary total laryngectomy.
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33
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Vossen DM, Verhagen CVM, Verheij M, Wessels LFA, Vens C, van den Brekel MWM. Comparative genomic analysis of oral versus laryngeal and pharyngeal cancer. Oral Oncol 2018; 81:35-44. [PMID: 29884412 DOI: 10.1016/j.oraloncology.2018.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/28/2018] [Accepted: 04/07/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Locally advanced oral squamous cell carcinoma (OSCC) shows lower locoregional control and disease specific survival rates than laryngeal and pharyngeal squamous cell carcinoma (L/P-SCC) after definitive chemoradiotherapy treatment. Despite clinical factors, this can point towards a different tumor biology that could impact chemoradiotherapy response rates. This prompted us to compare the mutational profiles of OSCC with L/P-SCC. METHODS We performed target capture DNA sequencing on 111 HPV-negative HNSCC samples (NKI dataset), 55 oral and 56 laryngeal/pharyngeal, and identified somatic point mutations and copy number aberrations. We next expanded our analysis with 276 OSCC and 134 L/P-SCC sample data from The Cancer Genome Atlas (TCGA dataset). We focused our analyses on genes that are frequently mutated in HNSCC. RESULTS The mutational profiles of OSCC and L/P-SCC showed many similarities. However, OSCC was significantly enriched for CASP8 (NKI: 15% vs 0%; TCGA: 17% vs 2%) and HRAS (TCGA: 10% vs 1%) mutations. LAMA2 (TCGA: 5% vs 19%) and NSD1 (TCGA: 7% vs 25%) mutations were enriched in L/P-SCC. Overall, we find that OSCC had fewer somatic point mutations and copy number aberrations than L/P-SCC. Interestingly, L/P-SCC scored higher in mutational and genomic scar signatures associated with homologous recombination DNA repair defects. CONCLUSION Despite showing a similar mutational profile, our comparative genomic analysis revealed distinctive features in OSCC and L/P-SCC. Some of these genes and cellular processes are likely to affect the cellular response to radiation or cisplatin. Genomic characterizations may guide or enable personalized treatment in the future.
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Affiliation(s)
- David M Vossen
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Caroline V M Verhagen
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marcel Verheij
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lodewyk F A Wessels
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of EEMCS, Delft University of Technology, Delft, The Netherlands
| | - Conchita Vens
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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Kamal M, Ng SP, Eraj SA, Rock CD, Pham B, Messer JA, Garden AS, Morrison WH, Phan J, Frank SJ, El-Naggar AK, Johnson JM, Ginsberg LE, Ferrarotto R, Lewin JS, Hutcheson KA, Cardenas CE, Zafereo ME, Lai SY, Hessel AC, Weber RS, Gunn GB, Fuller CD, Mohamed ASR, Rosenthal DI. Three-dimensional imaging assessment of anatomic invasion and volumetric considerations for chemo/radiotherapy-based laryngeal preservation in T3 larynx cancer. Oral Oncol 2018; 79:1-8. [PMID: 29598944 PMCID: PMC5880303 DOI: 10.1016/j.oraloncology.2018.01.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/07/2018] [Accepted: 01/26/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To investigate the impact of 3-Diminsional (3D) tumor volume (TV) and extent of involvement of primary tumor on treatment outcomes in a large uniform cohort of T3 laryngeal carcinoma patients treated with nonsurgical laryngeal preservation strategies. MATERIALS AND METHODS The pretreatment contrast-enhanced computed tomography images of 90 patients with T3 laryngeal carcinoma were reviewed. Primary gross tumor volume (GTVp) was delineated to calculate the 3D TV and define the extent of invasion. Cartilage and soft tissue involvement was coded. The extent of invasion was dichotomized into non/limited invasion versus multiple invasion extension (MIE), and was subsequently correlated with survival outcomes. RESULTS The median TV was 6.6 cm3. Sixty-five patients had non/limited invasion, and 25 had MIE. Median follow-up for surviving patients was 52 months. The 5-year local control and overall survival rates for the whole cohort were 88% and 68%, respectively. There was no correlation between TV and survival outcomes. However, patients with non/limited invasion had better 5-year local control (LC) than those with MIE (95% vs 72%, p = .009) but did not have a significantly higher rate of overall survival (OS) (74% vs 67%, p = .327). In multivariate correlates of LC, MIE maintained statistical significance whereas baseline airway status showed a statistically significance trend with poor LC (p = .0087 and 0.06, respectively). Baseline good performance status was an independent predictor of improved OS (p = .03) in multivariate analysis. CONCLUSION The extent of primary tumor invasion is an independent prognostic factor of LC of the disease after definitive radiotherapy in T3 larynx cancer.
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Affiliation(s)
- Mona Kamal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sweet Ping Ng
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Salman A Eraj
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; School of Medicine, The University of Texas Health Science Center at Houston, McGovern School of Medicine, Houston, TX, USA
| | - Crosby D Rock
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; School of Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA
| | - Brian Pham
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jay A Messer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adel K El-Naggar
- Department of Pathology, Division of Pathology/Lab Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jason M Johnson
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lawrence E Ginsberg
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Renata Ferrarotto
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos E Cardenas
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C Hessel
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Cancer Biology Program, The University of Texas Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Cancer Biology Program, The University of Texas Graduate School of Biomedical Sciences, Houston, TX, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Petersen JF, Stuiver MM, Timmermans AJ, Chen A, Zhang H, O'Neill JP, Deady S, Vander Poorten V, Meulemans J, Wennerberg J, Skroder C, Day AT, Koch W, van den Brekel MWM. Development and external validation of a risk-prediction model to predict 5-year overall survival in advanced larynx cancer. Laryngoscope 2017; 128:1140-1145. [DOI: 10.1002/lary.26990] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/27/2017] [Accepted: 10/09/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Japke F. Petersen
- Department of Head and Neck Surgery and Oncology; the Netherlands Cancer Institute; Amsterdam the Netherlands
| | - Martijn M. Stuiver
- Department of Head and Neck Surgery and Oncology; the Netherlands Cancer Institute; Amsterdam the Netherlands
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics; Amsterdam Medical Center; Amsterdam the Netherlands
| | - Adriana J. Timmermans
- Department of Head and Neck Surgery and Oncology; the Netherlands Cancer Institute; Amsterdam the Netherlands
| | - Amy Chen
- Department of Otolaryngology-Head and Neck Surgery; Emory University; Atlanta Georgia U.S.A
| | - Hongzhen Zhang
- Department of Otolaryngology-Head and Neck Surgery; Emory University; Atlanta Georgia U.S.A
| | - James P. O'Neill
- Department of Head and Neck Surgery and Oncology; St. James Hospital; Dublin Ireland
| | | | - Vincent Vander Poorten
- Department of Oncology, Head and Neck Oncology Section; University Hospitals Leuven; Leuven Belgium
| | - Jeroen Meulemans
- Department of Oncology, Head and Neck Oncology Section; University Hospitals Leuven; Leuven Belgium
| | - Johan Wennerberg
- Department of ENT/Head and Neck Surgery; Lund University Hospital; Lund Sweden
| | - Carl Skroder
- Department of ENT/Head and Neck Surgery; Lund University Hospital; Lund Sweden
| | - Andrew T. Day
- Department of Head and Neck Surgery and Oncology; Johns Hopkins Medical Center; Baltimore Maryland U.S.A
| | - Wayne Koch
- Department of Head and Neck Surgery and Oncology; Johns Hopkins Medical Center; Baltimore Maryland U.S.A
| | - Michiel W. M. van den Brekel
- Department of Head and Neck Surgery and Oncology; the Netherlands Cancer Institute; Amsterdam the Netherlands
- Institute of Phonetic Sciences; University of Amsterdam; Amsterdam the Netherlands
- Department of Oral and Maxillofacial Surgery; Academic Medical Center; Amsterdam the Netherlands
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Halmos GB, Bras L, Siesling S, van der Laan BFAM, Langendijk JA, van Dijk BAC. Age-specific incidence and treatment patterns of head and neck cancer in the Netherlands-A cohort study. Clin Otolaryngol 2017; 43:317-324. [PMID: 28950049 DOI: 10.1111/coa.12991] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To explore the incidence and treatment pattern of head and neck cancer in different age groups. DESIGN Cohort study. SETTING Netherlands Cancer Registry. PARTICIPANTS All new primary head and neck cancer cases diagnosed between 2010 and 2014 were included and categorised into different age groups. MAIN OUTCOME MEASURES Tumour site, stage, treatment modality, location of diagnosis and treatment. RESULTS The study population was composed of 11 558 tumours. Oral cancer was the most common primary site (31%), followed by laryngeal (25%) and oropharyngeal cancer (22%). Ninety-six per cent of the entire study population was diagnosed and/or treated in a certified head and neck oncology centre which was lower in the 80+ population (92%). Multimodality treatment was less frequently applied with increasing age (eg oral cavity: 17% in 80+ vs 34% in 60-; P < .001). The percentage of patients not receiving tumour-directed treatment increased with age (eg oropharyngeal cancer: 25% in 80+ vs 6% in 80-; P < .001). CONCLUSIONS This study confirms that less multimodal and tumour-directed treatment is applied with the increasing age of head and neck cancer patients.
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Affiliation(s)
- G B Halmos
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - L Bras
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences (Damage and Repair in Cancer Development and Cancer Treatment), University of Groningen, Groningen, The Netherlands
| | - S Siesling
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Health Technology and Services Research, MIRA Institute for Technical Medicine and Biomedical Technology, University of Twente, Enschede, The Netherlands
| | - B F A M van der Laan
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B A C van Dijk
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Dyckhoff G, Plinkert PK, Ramroth H. A change in the study evaluation paradigm reveals that larynx preservation compromises survival in T4 laryngeal cancer patients. BMC Cancer 2017; 17:609. [PMID: 28863776 PMCID: PMC5580444 DOI: 10.1186/s12885-017-3608-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 08/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Larynx preservation (LP) is recommended for up to low-volume T4 laryngeal cancer as an evidence-based treatment option that does not compromise survival. However, a reevaluation of the current literature raises questions regarding whether there is indeed reliable evidence to support larynx preservation for T4 tumor patients. METHODS In an observational cohort study of 810 laryngeal cancer patients, we evaluated the outcomes of all T4 tumor patients treated with primary chemo-radiotherapy (CRT) or primary radiotherapy alone (RT) compared with upfront total laryngectomy followed by adjuvant (chemo)radiotherapy (TL + a[C]RT). Additionally, we reevaluated the studies that form the evidence base for the recommendation of LP for patients with up to T4 tumors (Pfister et al., J Clin Oncol 24:3693-704, 2006). RESULTS The evaluation of all 288 stage III and IV patients together did not show a significant difference in overall survival (OS) between CRT-LP and TL + a(C)RT (hazard ratio (HR) 1.23; 95% confidence interval (CI): 0.82-1.86; p = 0.31) using a multivariate proportional hazard model. However, a subgroup analysis of T4 tumor patients alone (N = 107; 13.9%) revealed significantly worse OS after CRT compared with TL + a(C)RT (HR 2.0; 95% CI: 1.04-3.7; p = 0.0369). A reevaluation of the subgroup of T4 patients in the 5 LP studies that led to the ASCO clinical practice guidelines revealed that only 21-45 T4 patients had differential data on survival outcome. These data, however, showed a markedly worse outcome for T4 patients after LP. CONCLUSIONS T4 laryngeal cancer patients who reject TL as a treatment option should be informed that their chance of organ preservation with primary conservative treatment is likely to result in a significantly worse outcome in terms of OS. Significant loss of survival in T4 patients after LP is also confirmed in recent literature.
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Affiliation(s)
- Gerhard Dyckhoff
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Heribert Ramroth
- Institute of Public Health, University of Heidelberg, INF 324, 69120, Heidelberg, Germany
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Laccourreye O, Bonfils P, Malinvaud D, Ménard M, Giraud P. Survival and laryngeal preservation tradeoff in advanced laryngeal cancer: From the otorhinolaryngology patient to the managing physician. Head Neck 2017; 39:1984-1989. [PMID: 28786181 DOI: 10.1002/hed.24833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/27/2017] [Accepted: 04/17/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to document the tradeoff between survival and laryngeal preservation in advanced-stage laryngeal cancer amenable to chemoradiation or total laryngectomy. METHODS We conducted a prospective analysis based on a questionnaire completed by 209 laryngeal cancer specialists and 269 volunteers from an otorhinolaryngology clinic. RESULTS Of the responders, 34.5% would not consider any decrease in survival to preserve their larynx. This percentage varied from 52% in otorhinolaryngologists to 27.3% in radiotherapists and 28.6% in volunteers (P < .001). Among the responders prepared to trade, the percentage of survival they were willing to trade to preserve their larynx varied from 5% to 100% (median 30%). On univariate analysis, 3 variables significantly affected this percentage: (1) the living status (single or not); (2) the existence of children; and (3) the study group (volunteers, radiation therapists, or otorhinolaryngologists) to whom the responders belong. CONCLUSION The significant variations noted should develop modes of practice that cater to this and stimulate further research in this field.
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Affiliation(s)
- Ollivier Laccourreye
- Department of Otorhinolaryngology - Head Neck Surgery, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Pierre Bonfils
- Department of Otorhinolaryngology - Head Neck Surgery, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - David Malinvaud
- Department of Otorhinolaryngology - Head Neck Surgery, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Madeleine Ménard
- Department of Otorhinolaryngology - Head Neck Surgery, Université Paris Descartes Sorbonne Paris Cité, Paris, France
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García Lorenzo J, Montoro Martínez V, Rigo Quera A, Codina Aroca A, López Vilas M, Quer Agustí M, León Vintró X. Modifications in the treatment of advanced laryngeal cancer throughout the last 30 years. Eur Arch Otorhinolaryngol 2017. [PMID: 28625009 DOI: 10.1007/s00405-017-4639-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In the last decades, the treatment schemes for patients with locally advanced laryngeal cancer have changed significantly. These changes may have an impact in the survival of these patients. Our objective is to review the treatments administered to patients with locally advanced larynx tumors during a period of 30 years in our institution and to evaluate the prognostic impact of the changes in treatment protocols. Retrospective analysis of a cohort of 830 consecutive patients with T3 or T4 laryngeal carcinomas diagnosed and treated between 1985 and 2014 with a minimum follow-up of 1.5 years. During the study period, we witnessed a reduction in surgery as the initial treatment, as well as a substitution of induction chemotherapy by chemoradiotherapy as an organ preservation strategy. For patients with T3 tumors, there were no differences in cancer-specific survival by type of treatment, while patients with T4 tumors treated surgically showed significantly better survival than those treated with preservation strategies. Patients treated in the last decade (2005-2014) showed worse cancer-specific survival than those treated in the previous decade (1995-2004). The multivariate analysis showed significant differences in cancer-specific survival for larger tumors, positive nodal extension, and treatment with radiotherapy alone. The main changes in the management of advanced laryngeal carcinomas are the implementation of organ preservation strategies that reduce the use of surgery and the progressive of chemoradiotherapy as a standard treatment. These changes may have had a negative impact in survival of these patients.
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Affiliation(s)
- Jacinto García Lorenzo
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, c/Mas Casanovas 90, 08041, Barcelona, Spain.
| | | | - Antonio Rigo Quera
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, c/Mas Casanovas 90, 08041, Barcelona, Spain
| | - Alberto Codina Aroca
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, c/Mas Casanovas 90, 08041, Barcelona, Spain
| | - Montserrat López Vilas
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, c/Mas Casanovas 90, 08041, Barcelona, Spain
| | - Miquel Quer Agustí
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, c/Mas Casanovas 90, 08041, Barcelona, Spain
| | - Xavier León Vintró
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, c/Mas Casanovas 90, 08041, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
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40
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Roux M, Dassonville O, Ettaiche M, Chamorey E, Poissonnet G, Bozec A. Primary total laryngectomy and pharyngolaryngectomy in T4 pharyngolaryngeal cancers: Oncologic and functional results and prognostic factors. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:151-154. [DOI: 10.1016/j.anorl.2016.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wolf GT, Bellile E, Eisbruch A, Urba S, Bradford CR, Peterson L, Prince ME, Teknos TN, Chepeha DB, Hogikyan ND, McLean SA, Moyer J, Taylor JMG, Worden FP. Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer. JAMA Otolaryngol Head Neck Surg 2017; 143:355-366. [PMID: 28152117 PMCID: PMC5439146 DOI: 10.1001/jamaoto.2016.3669] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Importance Use of chemoradiotherapy for advanced laryngeal cancer led to a major shift in treatment as an alternative to laryngectomy. Despite widespread adoption of chemoradiotherapy, survival rates have not improved and the original premise of matching neoadjuvant chemotherapy tumor response to determine subsequent treatment has not been followed. Objective To determine whether improved survival could be achieved by incorporating a single cycle of neoadjuvant chemotherapy to select patients with advanced disease for either laryngectomy or concurrent chemoradiotherapy. Design, Setting, and Participants An unselected cohort of 247 patients with laryngeal cancer in an academic institution between 2002 and 2012 was evaluated. Patients with limited disease (stages I and II) underwent endoscopic resection, radiotherapy, or chemoradiotherapy for deeply invasive T2 lesions. For patients with advanced disease (stages III and IV), neoadjuvant chemotherapy, concurrent chemoradiotherapy, or primary surgery was recommended. Overall survival (OS) and disease-specific survival (DSS) were analyzed. Median follow-up was 48 months. The study was conducted from January 1, 2002, to December 31, 2012; data analysis was completed December 1, 2015. Interventions Endoscopic resection, radiotherapy, chemoradiotherapy, neoadjuvant chemotherapy, concurrent chemoradiotherapy, and primary surgery. Main Outcomes and Measures Overall survival and DSS. Results Of the 247 patients, 191 (77.3%) were male; mean (SD) age was 59.6 (10.4) years. Of 94 patients with limited disease, 33 (35.1%) underwent endoscopic resection; 50 (53.2%), radiotherapy alone; and 11 (11.7%), chemoradiotherapy for deeply invasive T2 lesions. Of 153 patients with advanced disease, 71 (46.4%) received neoadjuvant chemotherapy; 50 (32.7%), concurrent chemoradiotherapy; and 32 (20.9%), surgery. Five-year OS and DSS was 75% (95% CI, 68%-81%) and 83% (95% CI, 77%-88%), respectively, for the entire cohort. The DSS was 92% (95% CI, 83%-97%) for patients with stage I or II and 78% (95% CI, 69%-84%) for patients with stage III or IV disease. For patients with advanced disease, 5-year OS and DSS ranged from 78% (95% CI, 55%-90%) and 91% (95% CI, 67%-98%), respectively, for surgery; to 76% (95% CI, 63%-85%) and 79% (95% CI, 67%-88%), respectively, for neoadjuvant bioselection; and to 61% (95% CI, 44%-75%) and 66% (95% CI, 48%-79%), respectively, for primary chemoradiotherapy. Propensity-adjusted, multivariable controlling for known prognostic factors DSS was significantly improved in the neoadjuvant group compared with the chemoradiotherapy group (hazard ratio [HR], 0.48; 95% CI, 0.29-0.80). Conclusions and Relevance Superior survival rates were achieved with a bioselective treatment approach using a single cycle of neoadjuvant chemotherapy. Good survival rates were also achieved in patients selected for primary surgery, and both neoadjuvant chemotherapy and primary surgery were better than survival rates with concurrent chemoradiotherapy, suggesting that the optimal individualized treatment approach for patients with advanced laryngeal cancer has not yet been defined.
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Affiliation(s)
- Gregory T. Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, 48109
| | - Emily Bellile
- Department of Biostatistics, University of Michigan Health System, Ann Arbor, MI, 48109
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI, 48109
| | - Susan Urba
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, 48109
| | - Carol R. Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, 48109
| | - Lisa Peterson
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, 48109
| | - Mark E. Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, 48109
| | - Theodoros N. Teknos
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH 43212
| | | | - Norman D. Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, 48109
| | - Scott A. McLean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, 48109
| | - Jeffery Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, 48109
| | - Jeremy MG Taylor
- Department of Biostatistics, University of Michigan Health System, Ann Arbor, MI, 48109
| | - Francis P. Worden
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, 48109
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de Ridder M, Balm AJM, Baatenburg de Jong RJ, Terhaard CHJ, Takes RP, Slingerland M, Dik E, Sedee RJE, de Visscher JGAM, Bouman H, Willems SM, Wouters MW, Smeele LE, van Dijk BAC. Variation in head and neck cancer care in the Netherlands: A retrospective cohort evaluation of incidence, treatment and outcome. Eur J Surg Oncol 2017; 43:1494-1502. [PMID: 28336186 DOI: 10.1016/j.ejso.2017.02.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/15/2017] [Accepted: 02/23/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To explore variation in numbers and treatment between hospitals that treat head and neck cancer (HNC) in the Netherlands. MATERIAL AND METHODS Patient, tumor and treatment characteristics were collected from the Netherlands Cancer Registry, while histopathological features were obtained by linkage to the national pathology record register PALGA. Inter-hospital variation in volume, stage, treatment, pathologically confirmed loco-regional recurrence and overall survival rate was evaluated by tumor site. RESULTS In total, 2094 newly diagnosed patients were included, ranging from 65 to 417 patients in participating hospitals treating HNC in 2008. Oral cavity cancer was mainly treated by surgery only, ranging from 46 to 82% per hospital, while the proportion of surgery with (chemo)radiotherapy ranged from 18 to 40%. Increasing age, male sex, and high stage were associated with a higher hazard of dying. In oropharynx cancer, the use of (chemo)radiotherapy varied from 31 to 82% between hospitals. We found an indication that higher volume was associated with a lower overall hazard of dying for the total group, but not by subsite. Low numbers, e.g. for salivary gland, nasopharynx, nasal cavity and paranasal sinus, did not permit all desired analyses. CONCLUSION This study revealed significant interhospital variation in numbers and treatment of especially oropharyngeal and oral cavity cancer. This study is limited because we had to rely on data recorded in the past for a different purpose. To understand whether this variation is unwanted, future research should be based on prospectively collected data, including detailed information on recurrences, additional case-mix information and cause of death.
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Affiliation(s)
- M de Ridder
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Head and Neck Surgery, Amsterdam, The Netherlands.
| | - A J M Balm
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Head and Neck Surgery, Amsterdam, The Netherlands; Academic Medical Center, Department of Maxillo-facial Surgery, Amsterdam, The Netherlands
| | | | - C H J Terhaard
- University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands
| | - R P Takes
- Radboud University Medical Center, Department of Otorhinolaryngology, Nijmegen, The Netherlands
| | - M Slingerland
- Leiden University Medical Center, Department of Medical Oncology, Leiden, The Netherlands
| | - E Dik
- Maastricht University Medical Center, Department of Cranio-maxillofacial Surgery Maastricht, The Netherlands
| | - R J E Sedee
- Medical Center Haaglanden, Department of Otorhinolaryngology, Den Haag, The Netherlands
| | - J G A M de Visscher
- Medical Center Leeuwarden, Department of Maxillo-facial Surgery, Leeuwarden, The Netherlands
| | - H Bouman
- Rijnstate Hospital, Department of Otorhinolaryngology, Arnhem, The Netherlands
| | - S M Willems
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Pathology, Amsterdam, The Netherlands; The Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands (PALGA), The Netherlands; University Medical Center Utrecht, Department of Pathology, Utrecht, The Netherlands
| | - M W Wouters
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Surgical Oncology, Amsterdam, The Netherlands
| | - L E Smeele
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Head and Neck Surgery, Amsterdam, The Netherlands; Academic Medical Center, Department of Maxillo-facial Surgery, Amsterdam, The Netherlands
| | - B A C van Dijk
- Comprehensive Cancer Organization The Netherlands (IKNL), Department of Research, Utrecht, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
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Crosetti E, Caracciolo A, Arrigoni G, Fantini M, Sprio AE, Berta GN, Succo G. Management of T4a Laryngeal Cancer. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017. [DOI: 10.1007/s40136-017-0142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gilbert JM, Gonzalez JA, Cheah LA, Ell SR, Green P, Moore RK, Holdsworth E. Restoring speech following total removal of the larynx by a learned transformation from sensor data to acoustics. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2017; 141:EL307. [PMID: 28372104 DOI: 10.1121/1.4978364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Total removal of the larynx may be required to treat laryngeal cancer: speech is lost. This article shows that it may be possible to restore speech by sensing movement of the remaining speech articulators and use machine learning algorithms to derive a transformation to convert this sensor data into an acoustic signal. The resulting "silent speech," which may be delivered in real time, is intelligible and sounds natural. The identity of the speaker is recognisable. The sensing technique involves attaching small, unobtrusive magnets to the lips and tongue and monitoring changes in the magnetic field induced by their movement.
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Affiliation(s)
- James M Gilbert
- School of Engineering, University of Hull, Kingston upon Hull, United Kingdom
| | - Jose A Gonzalez
- Department of Computer Science, University of Sheffield, Sheffield, United Kingdom
| | - Lam A Cheah
- School of Engineering, University of Hull, Kingston upon Hull, United Kingdom
| | - Stephen R Ell
- Hull and East Yorkshire Hospitals Trust, Castle Hill Hospital, Cottingham, United Kingdom
| | - Phil Green
- Department of Computer Science, University of Sheffield, Sheffield, United Kingdom ,
| | - Roger K Moore
- Department of Computer Science, University of Sheffield, Sheffield, United Kingdom ,
| | - Ed Holdsworth
- Practical Control Limited, Sheffield, United Kingdom
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Wiegand S. Evidence and evidence gaps of laryngeal cancer surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 15:Doc03. [PMID: 28025603 PMCID: PMC5169076 DOI: 10.3205/cto000130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Surgical treatment of laryngeal cancer has been established for decades. In addition to total laryngectomy, which was first performed in 1873, a large number or organ preservation surgical techniques, like open partial laryngectomy, transoral laser microsurgery, and transoral robotic surgery have been developed. Studies on laryngeal cancer surgery are mainly retrospective case series and cohort studies. The evolution of chemoradiation protocols and their analysis in prospective randomized trials have led to an increasing acceptance of non-surgical treatment procedures. In addition to an improvement of prognosis, in recent years the preservation of function and maintenance of life quality after primary therapy of laryngeal cancer has increasingly become the focus of therapy planning. Significant late toxicity after chemoradiation has been identified as an important issue. This leads to a reassessment of surgical concepts and initiation of studies on laryngeal cancer surgery which was additionally stimulated by the advent of transoral robotic surgery in the US. Improving the evidence base of laryngeal cancer surgery by successful establishment of surgical trials should be the future goal.
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Affiliation(s)
- Susanne Wiegand
- Department of Otolaryngology, Head & Neck Surgery, University Hospital of Leipzig, Germany
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46
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Predictive and prognostic factors for patients with locoregionally advanced laryngeal carcinoma treated with surgical multimodality protocol. Eur Arch Otorhinolaryngol 2016; 274:1701-1711. [DOI: 10.1007/s00405-016-4411-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/26/2016] [Indexed: 01/11/2023]
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47
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Organ preservation with chemoradiation in advanced laryngeal cancer: The problem of generalizing results from randomized controlled trials. Auris Nasus Larynx 2016; 44:18-25. [PMID: 27397024 DOI: 10.1016/j.anl.2016.06.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/23/2016] [Accepted: 06/06/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The primary goal of treatment in advanced laryngeal cancer is to achieve optimal oncologic outcomes while preserving function and quality of life. Combination of chemotherapy and radiation has been popularized as an alternative to surgery for patients facing total laryngectomy. However, survival analyses from large, population-based databases have not duplicated results reported from randomized trials. METHODS A comprehensive literature review was undertaken to try to better understand the reasons why results differ among randomized trials and population cohort studies. RESULTS A variety of reasons are discussed, including differences in patient staging, selection bias, complexity bias, inconsistent terminology, patient compliance and treatment expertise. CONCLUSIONS Personalized treatment considering all factors is critical for optimal outcomes. In general, evidence supports total laryngectomy for patients with T4 cancers. Definitive chemoradiotherapy strategies are acceptable alternatives for T3 cancers, provided that all resources for the administration of the treatment, follow-up and surgical salvage are available.
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48
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Schuler PJ, Hoffmann TK, Veit JA, Rotter N, Friedrich DT, Greve J, Scheithauer MO. Hybrid procedure for total laryngectomy with a flexible robot-assisted surgical system. Int J Med Robot 2016; 13. [PMID: 27196407 DOI: 10.1002/rcs.1749] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/11/2016] [Accepted: 04/14/2016] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Total laryngectomy is a standard procedure in head-and-neck surgery for the treatment of cancer patients. Recent clinical experiences have indicated a clinical benefit for patients undergoing transoral robot-assisted total laryngectomy (TORS-TL) with commercially available systems. Here, a new hybrid procedure for total laryngectomy is presented. METHODS TORS-TL was performed in human cadavers (n = 3) using a transoral-transcervical hybrid procedure. The transoral approach was performed with a robotic flexible robot-assisted surgical system (Flex®) and compatible flexible instruments. Transoral access and visualization of anatomical landmarks were studied in detail. RESULTS Total laryngectomy is feasible with a combined transoral-transcervical approach using the flexible robot-assisted surgical system. Transoral visualization of all anatomical structures is sufficient. The flexible design of the robot is advantageous for transoral surgery of the laryngeal structures. CONCLUSION Transoral robot assisted surgery has the potential to reduce morbidity, hospital time and fistula rates in a selected group of patients. Initial clinical studies and further development of supplemental tools are in progress. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Patrick J Schuler
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
| | - Thomas K Hoffmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
| | - Johannes A Veit
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
| | - Nicole Rotter
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
| | - Daniel T Friedrich
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
| | - Jens Greve
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
| | - Marc O Scheithauer
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
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Calkovsky V, Wallenfels P, Calkovska A, Hajtman A. Laryngeal Cancer: 12-Year Experience of a Single Center. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 911:9-16. [PMID: 27028881 DOI: 10.1007/5584_2015_201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Laryngeal cancer is about the twentieth most common cancer in the world and more than 150,000 new cases are diagnosed annually. The aim of the study was to evaluate the history, diagnostics, treatment outcomes, and prognosis in patients with laryngeal cancer in Northern Slovakia. We analyzed retrospectively 227 patients (207 males, 20 females) with laryngeal carcinoma treated in the period 2003-2014 at the Clinic of Otorhinolaryngology and Head and Neck Surgery of the Jessenius Faculty of Medicine and Martin University Hospital in Martin, Slovakia. The majority of patients were in the sixth (38.0 %) and seventh decade of life (30.8 %). Two hundred and seventeen patients (95.6 %) were smokers or ex-smokers. Sixty-six percent of patients were diagnosed with glottic or transglottic carcinoma, related probably to the anatomical structure of the larynx and exposure to inhalation pollutants. It is alarming that the majority of patients with malignant laryngeal disease were admitted to the hospital in advanced stages. In 151 (66.5 %) of patients, the extent of infiltration was T3 or T4, and 156 (68 %) patients were in disease stage III and IV. The incidence and mortality of laryngeal cancer suggest the need to intensify the prevention and to search for an early clinical stage of laryngeal cancer using a targeted screening.
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Affiliation(s)
- V Calkovsky
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Jessenius Faculty of Medicine, Comenius University and Martin University Hospital, 2 Kollarova St., 036 01, Martin, Slovakia.
| | - P Wallenfels
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Jessenius Faculty of Medicine, Comenius University and Martin University Hospital, 2 Kollarova St., 036 01, Martin, Slovakia
| | - A Calkovska
- Department of Physiology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia.,Biomedical Center Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - A Hajtman
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Jessenius Faculty of Medicine, Comenius University and Martin University Hospital, 2 Kollarova St., 036 01, Martin, Slovakia
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