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Avdulla CS, Mastronikolis NS, Tachirai N, Leotsinidis M, Jelastopulu E. Survival Analysis of Elderly Patients With Laryngeal Cancer After Total Laryngectomy: A Retrospective Cohort Study. Cureus 2024; 16:e60792. [PMID: 38903270 PMCID: PMC11189274 DOI: 10.7759/cureus.60792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Objective This study investigates the overall survival (OS) of elderly patients who underwent total laryngectomy for laryngeal cancer (LC) and examines the impact of tumor-node-metastasis (TNM) staging on survival rates. Methods A retrospective cohort study utilized data from the Otorhinolaryngology Clinic at the University Hospital of Patras, including 75 elderly patients (>65 years) who underwent total laryngectomy for LC between 2000 and 2015. Survival analysis was performed using the Kaplan-Meier estimator, with comparisons made using the Log-rank test. Statistical significance was defined as the p-value being less than or equal to 0.05. Results Over the 16-year period, new LC cases were predominantly male (97.3%) with a mean age of 73.88 years (range: 65-89 years). Most patients were smokers (96%) and alcohol users (54.7%). Histologically, 18.7% of tumors were classified as poorly differentiated, 65.3% as moderately differentiated and 16% as well differentiated. Post-surgical TNM staging indicated 10.7% stage II, 37.3% stage III and 52% stage IV, primarily located in the glottis (62.7%) and followed by supraglottis (34.7%). All patients underwent total laryngectomy, with 69.3% and 37.3% receiving neck dissection and adjuvant therapy (chemotherapy or radiotherapy), respectively. During follow-up, 39 patients died, with 74.3% due to disease-related causes. Five-year OS rates were 44.6%, with variations by stage (stage II: 62.5%, stage III: 55.8%, stage IV: 32.4%; p=0.039) and age (65-75 years: 51.7%, >75 years: 34.7%; p=0.039). Conclusions TNM staging of the laryngeal cancer significantly influences the overall survival of elderly patients undergoing total laryngectomy for LC. Early diagnosis of the disease is crucial for patient survival.
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Affiliation(s)
| | | | - Ntaniela Tachirai
- Department of Public Health Policy, University of West Attica, Athens, GRC
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2
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Grošelj A, Tancer I, Jerman A, Paučič J, Pušnik L. Pharyngeal reconstruction after total laryngectomy with sliding epiglottis: technical aspects with retrospective review. Front Oncol 2024; 13:1284266. [PMID: 38260857 PMCID: PMC10801030 DOI: 10.3389/fonc.2023.1284266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Several techniques have been employed for defect reconstruction after total laryngectomy, among others sliding epiglottoplasty. As there is a paucity of data on sliding epiglottoplasty after total laryngectomy, this study aimed to present this reconstruction technique in detail with the retrospective analysis of the patients. Methods We retrospectively reviewed single-center medical records of patients who underwent pharyngeal reconstruction after total laryngectomy between 2007-2013, with a follow-up to 2020. The study included patients who had total laryngectomy performed followed by a primary closure or sliding epiglottoplasty. The patients were divided according to the pharyngeal reconstruction technique: sliding epiglottis (n = 38) and primary closure (n = 120). Results The baseline characteristics of patients, TNM stages, and previous treatment strategies did not differ significantly between the sliding epiglottis and primary closure group. The postoperative complication rates, including the pharyngocutaneous fistulae formation and strictures were comparable between the analyzed groups; however, a slightly higher incidence of pharyngocutaneus fistulae was noted within the patients after sliding epiglottoplasty. Overall 3-year survival of patients who underwent the epiglottoplasty and primary closure group were 73.7% vs. 57.5%, respectively. Conclusions Sliding epiglottoplasty is considered a safe reconstruction technique. Although slightly better outcomes were noted within the epiglottoplasty group, it is still considered inferior to the primary closure. This technique ought to be considered in meticulously selected patients in whom primary closure is not feasible, epiglottis with nearby structures is spared from disease, and when the distal flaps are less appropriate or contraindicated.
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Affiliation(s)
- Aleš Grošelj
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Otorhinolaryngology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Anže Jerman
- Department of Maxillofacial and Oral Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Jošt Paučič
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Luka Pušnik
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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3
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Arboleda LPA, Neves AB, Kohler HF, Vartanian JG, Candelária LM, Borges MF, Fernandes GA, de Carvalho GB, Kowalski LP, Brennan P, Santos‐Silva AR, Curado MP. Overview of glottic laryngeal cancer treatment recommendation changes in the NCCN guidelines from 2011 to 2022. Cancer Rep (Hoboken) 2023; 6:e1837. [PMID: 37288471 PMCID: PMC10432469 DOI: 10.1002/cnr2.1837] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The treatment of glottic cancer remains challenging, especially with regard to morbidity reduction and larynx preservation rates. The National Comprehensive Cancer Network (NCCN) has published guidelines to aid decision-making about this treatment according to the tumor site, clinical stage, and patient medical status. AIM The present review was conducted to identify changes in the NCCN guidelines for glottic cancer treatment made between 2011 and 2022 and to describe the published evidence concerning glottic cancer treatment and oncological outcomes in the same time period. METHODS AND RESULTS Clinical practice guidelines for head and neck cancer published from 2011 up to 2022 were obtained from the NCCN website (www.NCCN.org). Data on glottic cancer treatment recommendations were extracted, and descriptive analysis was performed. In addition, a review of literature registered in the PubMed database was performed to obtain data on glottic cancer management protocols and treatment outcomes from randomized controlled trials, systematic reviews, and meta-analyses published from 2011 to 2022. In total, 24 NCCN guidelines and updates and 68 relevant studies included in the PubMed database were identified. The main guideline changes made pertained to surgical and systemic therapies, the consideration of adverse features, and new options for the treatment of metastatic disease at initial presentation. Early-stage glottic cancer received the most research attention, with transoral endoscopic laser surgery and radiotherapy assessed and compared as the main treatment modalities. Reported associations between treatment types and survival rates for this stage of glottic cancer appear to be similar, but functional outcomes can be highly compromised. CONCLUSION NCCN panel members provide updated recommendations based on currently accepted treatment approaches for glottic cancer, constantly reviewing new surgical and non-surgical techniques. The guidelines support decision-making about glottic cancer treatment that should be individualized and prioritize patients' quality of life, functionality, and preferences.
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Affiliation(s)
| | | | - Hugo Fontan Kohler
- Head and Neck Surgery and Otorhinolaryngology DepartmentA.C. Camargo Cancer CenterSão PauloBrazil
| | - José Guilherme Vartanian
- Head and Neck Surgery and Otorhinolaryngology DepartmentA.C. Camargo Cancer CenterSão PauloBrazil
| | | | - Matheus Ferraz Borges
- Group of Epidemiology and Statistics on CancerA.C. Camargo Cancer CenterSão PauloSPBrazil
| | | | | | - Luiz Paulo Kowalski
- Head and Neck Surgery and Otorhinolaryngology DepartmentA.C. Camargo Cancer CenterSão PauloBrazil
- Head and Neck Surgery Department, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Paul Brennan
- International Agency for Research on CancerGenomic Epidemiology BranchLyonFrance
| | | | - Maria Paula Curado
- Group of Epidemiology and Statistics on CancerA.C. Camargo Cancer CenterSão PauloSPBrazil
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4
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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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5
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Shaikh N, Morrow V, Stokes C, Chung J, Fancy T, Turner MT, Stokes WA. Factors Associated With a Prolonged Diagnosis-to-Treatment Interval in Laryngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2022; 166:1092-1098. [PMID: 35380886 DOI: 10.1177/01945998221090115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Evaluate factors associated with treatment delays and their effect on survival in laryngeal squamous cell carcinoma. STUDY DESIGN Retrospective cohort study. SETTING National Cancer Database. METHODS Patients receiving primary radiation or surgery for laryngeal squamous cell carcinoma were included from 2004 to 2017. The primary outcomes were the diagnosis-to-treatment interval (DTI) and 5-year survival. Variables of prolonged DTI (>30 days) were assessed via logistic regression models. Survival was then assessed through Cox proportional hazards models. Candidate variables for both outcomes included age, sex, race, ethnicity, distance to treatment facility, insurance coverage, treatment facility type, TNM T stage, nodal status, and DTI (in models estimating survival). RESULTS An overall 136,203 patients with laryngeal cancer were identified, from which 51,747 remained after exclusions were applied: 18,499 received primary surgery and 33,248 received primary radiation. Being a member of a racial or ethnic minority, advanced age, female sex, ≥30 miles from treatment facility, lack of insurance, treatment at an academic cancer center, and primary radiation were associated with a prolonged DTI. However, in spite of a faster DTI, treatment at a community cancer center was independently associated with higher mortality (hazard ratio, 1.2; P < .0001). CONCLUSIONS Despite being associated with prolonged DTI, receiving treatment at a high-volume academic facility was associated with significantly improved survival. Our results indicate that improved referral pathways or outreach may help improve survival in laryngeal cancer, especially in high-risk populations.
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Affiliation(s)
- Noah Shaikh
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - Vincent Morrow
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Cara Stokes
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Jeffson Chung
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - Tanya Fancy
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - Meghan T Turner
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - William A Stokes
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
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6
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Heng Y, Xu C, Lin H, Zhu X, Zhou L, Zhang M, Wu C, Tao L. Management of clinically n
ode‐negative
glottic squamous cell carcinoma patients according to r
isk‐scoring
model for occult lymph node metastases. Laryngoscope Investig Otolaryngol 2022; 7:715-722. [PMID: 35734062 PMCID: PMC9195031 DOI: 10.1002/lio2.762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Yu Heng
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
| | - Chengzhi Xu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
| | - Hanqing Lin
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
| | - Xiaoke Zhu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
| | - Liang Zhou
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
| | - Ming Zhang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
| | - Chunping Wu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
| | - Lei Tao
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
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7
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Yang Z, Wang J, Chen C, Sun P, Yu Y. Effect of Programmed Death-Ligand 1 in Cancer-Associated Fibroblasts on Advanced Laryngeal Squamous Cell Carcinoma. Technol Cancer Res Treat 2021; 20:15330338211046432. [PMID: 34632870 PMCID: PMC8504221 DOI: 10.1177/15330338211046432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to explore the effect of programmed death-ligand 1 (PD-L1) in
cancer-associated fibroblasts (CAFs) on advanced laryngeal squamous cell
carcinoma (LSCC). The expression of PD-L1 in advanced LSCC tumor tissues was
observed in 83 patients with LSCC by immunofluorescence microscopy and compared
with that in normal laryngeal mucosa. The CAFs of LSCC and normal fibroblasts
(NFs) were isolated, cultured, purified, and examined by fluorescence. The
expression of PD-L1 in purified CAFs and NFs was measured by flow cytometry. The
expression of PD-L1 in CAFs was downregulated through small interferring RNA
(siRNA) transfection. The proliferation and migration capacities of CAFs were
observed using proliferation and scratch tests, respectively. The proliferation
of HEP-2 cells and T cells was measured after cocultured with CAFs. The
secretion of interleukins IL-2 and IL-10 was detected using enzyme-linked immuno
sorbent assay (ELISA). PD-L1 was expressed in 62 of 83 cases of the advanced
LSCC tumor tissues. Also, CAFs expressed more PD-L1 compared with NFs. The
proliferation and migration capacities of CAFs were significantly lower after
transfection with PD-L1-siRNA. The proliferation rate of HEP-2 cells cocultured
with CAFs decreased in PD-L1-siRNA-transfected cells. However, the proliferation
rate of T cells increased in transfected cells. The ELISA results showed that
the secretion of IL-2 increased and that of IL-10 decreased in
PD-L1-siRNA-transfected cells. The expression of PD-L1 in CAFs of advanced LSCC
was higher than that in NFs. The downregulation of PD-L1 reduced the
proliferation and migration of CAFs and HEP-2 cells but enhanced the
proliferation and pro-inflammatory function of T cells in the coculture
experiment.
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Affiliation(s)
- Zhendong Yang
- Department of Otolaryngology, 74566The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Otolaryngology, Suzhou Ninth Hospital affiliated to Soochow University, Suzhou, China
| | - Jinxin Wang
- Department of Otolaryngology, 74566The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chun Chen
- Department of Otolaryngology, 74566The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Peng Sun
- Department of Otolaryngology, 74566The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yafeng Yu
- Department of Otolaryngology, 74566The First Affiliated Hospital of Soochow University, Suzhou, China
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8
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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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Abstract
Cancer stem cells play a fundamental role in the growth, metastasis, recurrence, and chemoresistance of cancers of various origins; therefore, targeting these cells may prospectively help to eradicate cancer cells from patients. In this study, the effect of tetrandrine on the proliferation of CD133-positive (CD133) Hep-2 cells was examined to characterize its potential for targeting cancer stem cells in laryngeal cancer.The stem cell population of Hep-2 cells was isolated by magnetic-activated cell sorting against CD133, treated with different concentrations of tetrandrine, and assessed for cell cycle progression, proliferation, and migration. The mechanism of tetrandrine inhibition was also investigated.Our in vitro assay indicated that 20 μg/ml tetrandrine significantly inhibited the viability of CD133 Hep-2 cells (P < 0.01). Further cell cycle profiling showed a nearly 50% reduction of the S-phase cells after tetrandrine treatment, suggesting that tetrandrine inhibited DNA synthesis as well as cell proliferation. At the molecular level, tetrandrine induced downregulation of Bcl-2 and simultaneous upregulation of Bax and caspase-3 as well as enhanced cell apoptosis.Our results demonstrated that tetrandrine inhibited the cell viability and proliferation of CD133 Hep-2 cells by reducing the number of cells in the S-phase of the cell cycle and enhancing cell apoptosis.
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10
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Martinez-Monedero R, Danielian A, Angajala V, Dinalo JE, Kezirian EJ. Methodological Quality of Systematic Reviews and Meta-analyses Published in High-Impact Otolaryngology Journals. Otolaryngol Head Neck Surg 2020; 163:892-905. [PMID: 32450783 DOI: 10.1177/0194599820924621] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the methodological quality of intervention-focused systematic reviews (SRs) and meta-analyses (MAs) published in high-impact otolaryngology journals. DATA SOURCES Ovid Medline, Embase, and Cochrane Library. REVIEW METHODS A comprehensive search was performed for SR and MA citations from 2012 to 2017 in the 10 highest impact factor otolaryngology journals. Abstracts were screened to identify published manuscripts in which the authors indicated clearly that they were performing an SR or MA. Applying a modified typology of reviews, 4 reviewers characterized the review type as SR, MA, or another review type. A simplified version of the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2) tool was used to assess the reporting and methodological quality of the SRs and MAs that were focused on interventions. RESULTS Search and abstract screening generated 499 manuscripts that identified themselves as performing an SR or MA. A substantial number (85/499, 17%) were review types other than SRs or MAs, including 34 (7%) that were literature reviews. In total, 236 SRs and MAs focused on interventions. Over 50% of these SRs and MAs had weaknesses in at least 3 of the 16 items in the AMSTAR 2, and over 40% had weaknesses in at least 2 of the 7 critical domains. Ninety-nine percent of SRs and MAs provided critically low confidence in the results of the reviews. CONCLUSION Intervention-focused SRs and MAs published in high-impact otolaryngology journals have important methodological limitations that diminish confidence in the results of these reviews.
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Affiliation(s)
- Rodrigo Martinez-Monedero
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
| | - Arman Danielian
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Varun Angajala
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Jennifer E Dinalo
- Health Sciences Libraries, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Eric J Kezirian
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
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11
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Danstrup C, Andersen M. Tonic-clonic seizures as first symptom of a disseminated supraglottic laryngeal cancer. BMJ Case Rep 2020; 13:13/3/e233584. [PMID: 32205383 DOI: 10.1136/bcr-2019-233584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 60-year-old man was found unconscious at work, without any signs of trauma. At the site, he presented with tonic-clonic seizures, central facial palsy and eye deviation. A CT scan of the cerebrum did not find bleeding or thrombosis, but contrast enhancement at the superior sagittal sinus and pathological cervical lymph nodes. The MRI demonstrated multiple intracerebral metastases, while a supplementary fluoro-deoxy-glucose positron emission tomography scan revealed metastatic lesions above and below the diaphragm, without signs of a primary tumour. An ear, nose and throat examination found a small supraglottic tumour and cervical lymph node metastases. Following a multidisciplinary team discussion, biopsies from the duodenal mucosa and an inguinal lymph node were performed, showing squamous cell carcinoma with its origin in the head and neck. The patient was diagnosed with a T1N2cM1 supraglottic laryngeal cancer, receiving palliative whole brain radiation therapy but died 11 weeks after the debut of symptoms.
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Affiliation(s)
- Christian Danstrup
- Department of Otorhinolaryngology - Head and Neck surgery, Aalborg Universitetshospital, Aalborg, Denmark
| | - Maria Andersen
- Department of Clinical Oncology, Aalborg Universitetshospital, Aalborg, Denmark
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12
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Fullmer T, Wilde DC, Shi JW, Wagner T, Skinner H, Eicher SA, Sandulache VC, Hernandez DJ. Demographic and Tumor Characteristic Impact on Laryngeal Cancer Outcomes in a Minority Underserved Patient Population. Otolaryngol Head Neck Surg 2020; 162:888-896. [PMID: 32093532 DOI: 10.1177/0194599820907064] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Advanced laryngeal squamous cell carcinoma remains associated with approximately 50% mortality at 5 years. Delivery of multimodality treatment remains critical to maximizing survival for this disease, but achieving this at a national level remains a difficult undertaking, particularly in under- and uninsured patients as well as minority patients. We sought to evaluate laryngeal cancer treatment delivery and clinical outcomes in a predominantly minority and underserved cohort of largely under- and uninsured patients in a county hospital. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care county hospital in Houston, Texas. SUBJECTS AND METHODS Patients (N = 210) with a new diagnosis of laryngeal squamous cell carcinoma treated between 2005 and 2015 were included in a retrospective analysis of patient demographics, tumor and treatment characteristics, and oncologic outcomes. RESULTS The majority of patients presented with advanced disease (T4 = 43%, N>0 = 45%). Treatment selection was compliant with National Comprehensive Cancer Network guidelines in 81% of cases, but 76% of patients who required adjuvant radiotherapy were unable to start it within 6 weeks postsurgery. Overall survival and disease-free survival were 52% and 63% for the entire cohort, respectively. Supraglottic subsite and nodal metastases were significantly associated with decreased overall survival and disease-free survival. Race/ethnicity and insurance status were not associated with worse oncologic outcomes. CONCLUSION Under- and uninsured patients often present with advanced laryngeal cancer. Oncologic outcomes in this cohort of patients is similar to that of other published series. Moreover, tumor characteristics rather than demographic variables drive oncologic outcomes for the predominantly minority and underserved patients seeking care in our tertiary care county hospital.
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Affiliation(s)
- Tanner Fullmer
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - David C Wilde
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Justin W Shi
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Timothy Wagner
- Department of Radiation Oncology, UT Health San Antonio, San Antonio, Texas, USA
| | - Heath Skinner
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Susan A Eicher
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - David J Hernandez
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
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Tsushima N, Hayashi R, Shinozaki T, Tomioka T, Okano W, Ikeda M. The role of elective neck dissection for cT4aN0 glottic squamous cell carcinoma. Jpn J Clin Oncol 2019; 49:525-528. [PMID: 30839065 DOI: 10.1093/jjco/hyz022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/29/2019] [Accepted: 02/10/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The indication for elective neck dissection for patients with clinically T4aN0 (cT4aN0) glottic cancer is not established. The objective of this study was to evaluate the role of elective neck dissection for patients with cT4aN0 glottic cancer. METHODS We assessed patients with cT4aN0 laryngeal squamous cell carcinoma who underwent total laryngectomy between 1998 and 2014 and conducted a retrospective analysis. We considered occult neck metastasis positive when confirmed by histological analysis. When patients with late neck metastases did not undergo therapeutic neck dissection, the presence of occult neck metastasis was judged on the basis of computed tomography. The validity of elective neck dissection for patients with cT4aN0 glottic cancer was assessed from comparisons the rates of occult neck metastases of supraglottic and subglottic cancers, which are generally recommended for elective neck dissection. The distribution of occult neck metastases in glottic cancer is described according to nodal levels. RESULTS The rate of occult neck metastasis of cT4aN0 laryngeal cancer was 36% (14/39). There were no significant differences among the rates of glottic 7/21 (33%), supraglottic 3/8 (38%) and subglottic 4/10 (40%) cancers. Patients with glottic cancer did not have bilateral Level IIB and ipsilateral Level IV metastasis. One patient had contralateral Level IV metastasis. The metastases rates of ipsilateral Levels IIA, III, and VI were >10%. CONCLUSIONS We think that elective neck dissection is valid for cT4aN0 glottic cancer. Ipsilateral Levels IIA, III and VI should be dissected. The omission of neck dissection for bilateral Levels IIB and IV can be considered when there is a need to avoid complications.
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Affiliation(s)
- Nayuta Tsushima
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Ryuichi Hayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Toshifumi Tomioka
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Wataru Okano
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Masakazu Ikeda
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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14
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Lien CF, Wang CC, Hwang TZ, Liu CF, Lin BS, Weng HH, Liu CY. Comparison between open partial laryngectomy with tube-free tracheostomy and total laryngectomy for hypopharyngeal cancer with cartilage invasion. Oncol Lett 2018; 16:4961-4969. [PMID: 30250561 PMCID: PMC6144867 DOI: 10.3892/ol.2018.9298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 11/03/2017] [Indexed: 12/01/2022] Open
Abstract
The present study aimed to identify a feasible treatment strategy for hypopharyngeal cancer (HPC) with non-extensive invasion of the thyroid and/or cricoid cartilage. Between June 2008 and December 2014, patients with previously untreated HPC invading cartilage who had received either open partial laryngectomy (OPL) with tube-free tracheostomy or total laryngectomy (TL) with permanent tracheostomy and an artificial larynx (pneumatic tube) were retrospectively reviewed. The patients with extensive cartilage invasion and those with inoperable or T4b disease were excluded for OPL. Outcomes and quality of life were compared between the two treatment modalities. A total of 44 patients were included. The survival rates, complications, and Dysphagia Score were compared between the two treatment modalities. The outcome of the Voice Handicap Index (P=0.032), understandability of speech (P<0.001), normalcy of diet (P=0.041), senses (P=0.006), speech (P<0.001) and social contact (P=0.004) were significantly improved in the group receiving OPL compared with the group receiving TL. Therefore, OPL with tube-free tracheostomy may be a feasible option to treat patients with HPC with non-extensive invasion of the thyroid and/or cricoid cartilage.
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Affiliation(s)
- Ching-Feng Lien
- Department of Otolaryngology, Head and Neck Surgery, E-DA Hospital of I-Shou University, Kaohsiung 82445, Taiwan, R.O.C.,Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 71150, Taiwan, R.O.C
| | - Chih-Chun Wang
- Department of Otolaryngology, Head and Neck Surgery, E-DA Hospital of I-Shou University, Kaohsiung 82445, Taiwan, R.O.C
| | - Tzer-Zen Hwang
- Department of Otolaryngology, Head and Neck Surgery, E-DA Hospital of I-Shou University, Kaohsiung 82445, Taiwan, R.O.C
| | - Ching-Feng Liu
- Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan 71101, Taiwan, R.O.C
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 71150, Taiwan, R.O.C
| | - Hsu-Huei Weng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan, R.O.C.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C
| | - Chih-Yi Liu
- Department of Nursing, E-DA Hospital of I-Shou University, Kaohsiung 82445, Taiwan, R.O.C
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15
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Zhang C, Zhu M, Chen D, Chen S, Zheng H. Organ preservation surgery for patients with T4a laryngeal cancer. Eur Arch Otorhinolaryngol 2018; 275:1601-1606. [PMID: 29610957 DOI: 10.1007/s00405-018-4952-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Surgical preservation of laryngeal function is very challenging in patients with advanced SCCL, especially those of stage T4a. The purpose of this study was to assess the feasibility of organ preservation surgery for patients with T4a squamous cell carcinoma of the larynx (SCCL). METHODS We enrolled 32 patients with T4a SCCL and performed organ preservation surgery on them. Surgical details and perioperative morbidity were described, functional and oncologic outcomes were also evaluated. RESULTS All patients underwent supracricoid subtotal laryngectomy with unilateral or bilateral neck dissection, restoring laryngeal function via direct anastomosis of the cricoid cartilage and tongue base. The patients recovered well and exhibited relatively acceptable survival duration, with a 5-year overall survival rate of 62.5%. Most patients commenced oral intake within 2 weeks, and aspiration was commonly observed. Subjective functional outcomes indicated a relatively acceptable swallowing function and voice quality. CONCLUSION Our retrospective analysis of 32 patients with T4a SCCL showed that successful organ preservation surgery is safe and reliable, and associated with a relatively acceptable disease-free survival, normal swallowing function, and acceptable voice quality. More patients with T4a SCCL who wish to preserve the larynx should be considered for organ preservation surgery.
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Affiliation(s)
- Caiyun Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Minhui Zhu
- Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Donghui Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Shicai Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
| | - Hongliang Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
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16
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Forastiere AA, Ismaila N, Lewin JS, Nathan CA, Adelstein DJ, Eisbruch A, Fass G, Fisher SG, Laurie SA, Le QT, O'Malley B, Mendenhall WM, Patel S, Pfister DG, Provenzano AF, Weber R, Weinstein GS, Wolf GT. Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2017; 36:1143-1169. [PMID: 29172863 DOI: 10.1200/jco.2017.75.7385] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To update the guideline recommendations on the use of larynx-preservation strategies in the treatment of laryngeal cancer. Methods An Expert Panel updated the systematic review of the literature for the period from January 2005 to May 2017. Results The panel confirmed that the use of a larynx-preservation approach for appropriately selected patients does not compromise survival. No larynx-preservation approach offered a survival advantage compared with total laryngectomy and adjuvant therapy as indicated. Changes were supported for the use of endoscopic surgical resection in patients with limited disease (T1, T2) and for initial total laryngectomy in patients with T4a disease or with severe pretreatment laryngeal dysfunction. New recommendations for positron emission tomography imaging for the evaluation of regional nodes after treatment and best measures for evaluating voice and swallowing function were added. Recommendations Patients with T1, T2 laryngeal cancer should be treated initially with intent to preserve the larynx by using endoscopic resection or radiation therapy, with either leading to similar outcomes. For patients with locally advanced (T3, T4) disease, organ-preservation surgery, combined chemotherapy and radiation, or radiation alone offer the potential for larynx preservation without compromising overall survival. For selected patients with extensive T3 or large T4a lesions and/or poor pretreatment laryngeal function, better survival rates and quality of life may be achieved with total laryngectomy. Patients with clinically involved regional cervical nodes (N+) who have a complete clinical and radiologic imaging response after chemoradiation do not require elective neck dissection. All patients should undergo a pretreatment baseline assessment of voice and swallowing function and receive counseling with regard to the potential impact of treatment options on voice, swallowing, and quality of life. Additional information is available at www.asco.org/head-neck-cancer-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Arlene A Forastiere
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Nofisat Ismaila
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Jan S Lewin
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Cherie Ann Nathan
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - David J Adelstein
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Avraham Eisbruch
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Gail Fass
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Susan G Fisher
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Scott A Laurie
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Quynh-Thu Le
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Bernard O'Malley
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - William M Mendenhall
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Snehal Patel
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - David G Pfister
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Anthony F Provenzano
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Randy Weber
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Gregory S Weinstein
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Gregory T Wolf
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
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17
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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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Brandstorp-Boesen J, Sørum Falk R, Boysen M, Brøndbo K. Impact of stage, management and recurrence on survival rates in laryngeal cancer. PLoS One 2017; 12:e0179371. [PMID: 28708883 PMCID: PMC5510803 DOI: 10.1371/journal.pone.0179371] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/30/2017] [Indexed: 02/06/2023] Open
Abstract
A retrospective, longitudinal study of 1,616 patients with primary laryngeal squamous cell carcinoma (LSCC) at a single center in Norway during 1983–2010 was undertaken to investigate overall survival, disease specific survival, disease-free survival, prognostic factors for overall survival, and impact of recurrence among all-stage laryngeal cancer patients over 15 years' follow-up. The prognostic impact of gender, age, smoking/alcohol, subsite, tumour, node and metastasis staging, period and modality of treatment were evaluated using Kaplan-Meier and Cox proportional hazard analyses. The importance of recurrence on survival was assessed based on case fatality rates. Five-year overall survival was 56.8%, 64.0% and 38.8%, and disease-specific survival was 80.2%, 87% and 61.6%, respectively, for the entire cohort and for glottic and supraglottic LSCC. Old age, advanced-stage LSCC and supraglottic cancer were associated with lower overall survival. The risk of disease-specific death plateaued after five years and varied significantly by subsite. Multivariate analysis of glottic LSCC revealed that surgical treatment improved overall survival, whereas old age, alcohol, T3-T4 status, positive N-status and no treatment were associated with worse survival. In supraglottic LSCC, age, alcohol, and positive N-status had a significant impact on overall survival by multivariate analysis. Five-year overall survival and disease-specific survival among patients with recurrent disease were 34% and 52%, respectively. In conclusion, marked difference in overall survival between glottic and supraglottic LSCC underline the importance of subsite-specific survival analysis. T-status and primary surgical management is essential only for glottic LSCC, emphasizing the importance of correct disease classification. Inferior outcomes in supraglottic LSCC are associated with old age, positive N-status, and improved follow-up routines are necessary. Primary tumor control is essential since recurrence impairs survival considerably in all subsites. The potential benefit of a primary surgical approach towards T3 LSCC awaits further investigation.
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Affiliation(s)
- Jesper Brandstorp-Boesen
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
- Department of Otorhinolaryngology, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- * E-mail:
| | - Ragnhild Sørum Falk
- Oslo Centre for Biostatistics and Epidemiology, Research Support Service, Oslo University Hospital, Oslo, Norway
| | - Morten Boysen
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
- Department of Otorhinolaryngology, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Kjell Brøndbo
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
- Department of Otorhinolaryngology, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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Mañós M, Giralt J, Rueda A, Cabrera J, Martinez-Trufero J, Marruecos J, Lopez-Pousa A, Rodrigo J, Castelo B, Martínez-Galán J, Arias F, Chaves M, Herranz J, Arrazubi V, Baste N, Castro A, Mesía R. Multidisciplinary management of head and neck cancer: First expert consensus using Delphi methodology from the Spanish Society for Head and Neck Cancer (part 1). Oral Oncol 2017; 70:58-64. [DOI: 10.1016/j.oraloncology.2017.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/31/2017] [Accepted: 04/08/2017] [Indexed: 01/15/2023]
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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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22
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Wick CC, Rezaee RP, Wang T, Garcia-Jarchow AM, Zender CA, Gibson M, Yao M, Lavertu P. Use of concurrent chemoradiation in advanced staged (T4) laryngeal cancer. Am J Otolaryngol 2017; 38:72-76. [PMID: 27838151 DOI: 10.1016/j.amjoto.2016.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
Abstract
HYPOTHESIS Patients with advanced laryngeal cancer sometimes desire organ preservation protocols even if it portends a worse outcome. BACKGROUND To assess outcomes of patients with T4 laryngeal cancer treated with chemoradiation therapy. METHODS Case series with chart review at a tertiary university hospital. Twenty-four patients with T4 laryngeal cancer all declined total laryngectomy with adjuvant radiation as the primary treatment modality and alternatively received concurrent chemoradiation therapy. The primary outcome was overall survival. Secondary outcomes were rates of tracheotomy dependence, gastric tube dependence, and need for salvage laryngectomy. RESULTS All patients had T4 laryngeal disease, 71% had cartilage invasion and 59% had regional metastasis to the neck. Kaplan-Meier analysis determined 2-year and 5-year overall survival to be 64% and 59% respectively. The locoregional recurrence rate was 25%. The distant metastasis rate was 21%. The rate of salvage laryngectomy was 17%, which occurred at a mean of 56.5months after the original diagnosis. The rate of tracheotomy dependence was 33% while gastric tube dependence was 25%. CONCLUSION Advanced T4 laryngeal cancer, particularly with cartilage invasion, remains a surgical disease best treated with total laryngectomy and adjuvant radiation. This data may help guide patients and practitioners considering concurrent chemoradiation therapy for definitive treatment of advanced laryngeal cancer.
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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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24
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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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25
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Choi YS, Park SG, Song EK, Cho SH, Park MR, Park KU, Lee KH, Song IC, Lee HJ, Jo DY, Kim S, Yun HJ. Comparison of the therapeutic effects of total laryngectomy and a larynx-preservation approach in patients with T4a laryngeal cancer and thyroid cartilage invasion: A multicenter retrospective review. Head Neck 2016; 38:1271-7. [PMID: 27043228 DOI: 10.1002/hed.24438] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 01/24/2016] [Accepted: 01/31/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In T4a laryngeal cancer with thyroid cartilage invasion, no optimal frontline treatment has yet been defined in controlled trials. METHODS We reviewed data from 89 patients with T4a laryngeal cancer featuring thyroid cartilage invasion who were treated initially with either total laryngectomy (n = 53) or a larynx-preservation strategy (n = 36). RESULTS The median progression-free survival (PFS) of the total laryngectomy group had not been attained at the time of analysis and was thus significantly longer than that of the larynx-preservation group (8.7 months). The median overall survival (OS) of patients who underwent total laryngectomy was 87.2 months, significantly longer than that of the larynx-preservation group (31.3 months). The survival benefit of primary surgery compared to a larynx-preservation strategy was more striking in patients of lower N classifications. CONCLUSION Total laryngectomy may be a better therapeutic option to treat T4a laryngeal cancer featuring thyroid cartilage invasion, especially in patients exhibiting limited nodal involvement (N0/N1). © 2016 Wiley Periodicals, Inc. Head Neck, 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38:1271-1277, 2016.
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Affiliation(s)
- Yoon Seok Choi
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Sang Gon Park
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea
| | - Eun-Kee Song
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Sang-Hee Cho
- Department of Internal Medicine, Chonnam National University Medical School, Hwasoon, Republic of Korea
| | - Moo-Rim Park
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Keon Uk Park
- Department of Internal Medicine, Keimyung University College of Medicine, Daegu, Republic of Korea
| | - Ki-Hyeong Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Ik-Chan Song
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Hyo Jin Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Deog-Yeon Jo
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Samyong Kim
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Hwan-Jung Yun
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
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Gorphe P, Matias M, Moya-Plana A, Tabarino F, Blanchard P, Tao Y, Janot F, Temam S. Results and Survival of Locally Advanced AJCC 7th Edition T4a Laryngeal Squamous Cell Carcinoma Treated with Primary Total Laryngectomy and Postoperative Radiotherapy. Ann Surg Oncol 2016; 23:2596-601. [DOI: 10.1245/s10434-016-5217-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Indexed: 11/18/2022]
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Khoueir N, Matar N, Farah C, Francis E, Tabchy B, Haddad A. Survival of T4aN0 and T3N+ laryngeal cancer patients: a retrospective institutional study and systematic review. Am J Otolaryngol 2015; 36:755-62. [PMID: 26545467 DOI: 10.1016/j.amjoto.2015.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 07/11/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We aim to assess the correlation of tumor and nodal staging to survival in pT3N+ and T4aN0 laryngeal cancer with subgroup analysis within stage IVa (pT4N0 and pT3N2). STUDY DESIGN Retrospective cohort study with systematic review of the literature. SETTING Hotel Dieu de France University Hospital (tertiary referral center). SUBJECTS AND METHODS Laryngeal cancer patients' registries were reviewed from 1998 to 2012 selecting pT3N+ and pT4aN0 patients treated by primary total layngectomy. Overall survivals were compared using Log rank and Kaplan-Meier analysis. A systematic review was performed by 2 reviewers including all the articles reporting the outcome of these categories of patients. Online databases, including PubMed and EMBASE, were used. Reference sections of identified studies were examined for additional articles. RESULTS Thirteen T3N+ patients and 19 T4aN0 patients treated by primary total laryngectomy were included. Five-year overall survival for T3N+, T3N2 and T4aN0 was respectively 33%, 32.1% and 73.7%. Due to the small sample, the difference was not significant. The systematic review revealed three articles reporting overall survival outcome for the T4N0 group and 6 articles for the T3N+. At 5years, the survival ranged from 62.5% to 73% in T4N0 and from 32.2% to 77% in T3N+. CONCLUSION In advanced stage laryngeal cancer, T4aN0 tends toward a better survival than T3N+ especially when compared to T3N2 although they are grouped in the same TNM stage IVa.
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Forastiere AA, Weber RS, Trotti A. Organ Preservation for Advanced Larynx Cancer: Issues and Outcomes. J Clin Oncol 2015; 33:3262-8. [PMID: 26351339 DOI: 10.1200/jco.2015.61.2978] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To provide a review of the clinical data, controversies, and limitations that underpin current recommendations for approaches to larynx preservation for locally advanced larynx cancer requiring total laryngectomy. METHODS The key findings from pivotal randomized controlled trials are discussed, including quality of life, late effects, and function assessments. Trials investigating taxane inclusion in induction chemotherapy and trials of epidermal growth factor receptor inhibition for radiosensitization are put into perspective for larynx cancer. Controversies in the management of T4 primaries and the opportunities for conservation laryngeal surgery are reviewed. RESULTS There are data from clinical trials to support induction chemotherapy, followed by radiotherapy (preferred approach in Europe) and concomitant cisplatin plus radiotherapy (preferred in North America) for nonsurgical preservation of the larynx. Treatment intensification by a sequential approach of induction, followed by concomitant treatment, is investigational. Transoral laryngeal microsurgery and transoral robotic partial laryngectomy have application in selected patients. CONCLUSION The management of locally advanced larynx cancer is challenging and requires an experienced multidisciplinary team for initial evaluation, response assessment, and support during and after treatment to achieve optimal function, quality of life, and overall survival. Patient expectations, in addition to tumor extent, pretreatment laryngeal function, and coexisting chronic disease, are critical factors in selecting surgical or nonsurgical primary treatment.
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Affiliation(s)
- Arlene A Forastiere
- Arlene A. Forastiere, Johns Hopkins University and Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Randal S. Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; and Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
| | - Randal S Weber
- Arlene A. Forastiere, Johns Hopkins University and Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Randal S. Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; and Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Andy Trotti
- Arlene A. Forastiere, Johns Hopkins University and Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Randal S. Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; and Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Laryngeal preservation in ENT oncology. Retrospective series of 246 patients managed in the Caen University Hospital and François Baclesse Cancer Care Center between 1998 and 2008. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:129-34. [PMID: 25838235 DOI: 10.1016/j.anorl.2015.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES A 10-year retrospective study investigated factors for survival and laryngeal preservation in advanced laryngeal, hypopharyngeal or epilaryngeal neoplasia. MATERIAL AND METHOD Two hundred and forty-six patients with advanced cancer of the larynx (17.48%), hypopharynx (48.78%) or epilarynx (33.74%) undergoing primary organ-sparing treatment were included from 1998 to 2008. Treatment comprised chemotherapy followed by radiation therapy for 92.68% of patients, isolated radiation therapy for 1.6% and concomitant or sequential radiation-chemotherapy for 5.7%. General health status, history and tumor status were recorded. Factors influencing survival were analyzed by Kaplan-Meier estimator, log-rank test and Cox models. RESULTS Median overall survival of the population was 2.3 years and median laryngeal preservation 0.99 years in male patients and 2 years in female patients. Survival correlated significantly with body mass index (BMI; P=0.0004), WHO performance status (P=0.0064), alcohol consumption (P=0.0004) and cessation (P<0.0001) and also T stage (P=0.0038), initial laryngeal mobility (P=0.0002) and post-chemotherapy assessment (P<0.0001). Survival with functional larynx correlated with baseline BMI at first consultation (P=0.016), baseline WHO grade (P=0.0005), laryngeal mobility (P<0.0001), T staging (P=0.0009), and T and/or N chemotherapy response to a classical organ preservation protocol (P<0.0001). CONCLUSION Over and above established criteria, the present study highlighted the importance of general health and nutritional status during treatment.
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Zhang S, Guo Y, Zhang C, Gao W, Wen S, Huangfu H, Wang B. Primary laryngeal cancer-derived miR-193b induces interleukin-10-expression monocytes. Cancer Invest 2014; 33:29-33. [PMID: 25517434 DOI: 10.3109/07357907.2014.988344] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The pathogenesis of laryngeal cancer (LC) is unclear. Published data indicate that micro RNAs (miRNA) play an important role in the pathogenesis of cancer. This study aims to elucidate the role of miR-193b in the tumor tolerance of LC. High levels of miR-193b were detected in LC cells as well as in the culture supernatant. Interleukin (IL)-10-expressing Mos were detected in the LC tissue-derived single cells. Treating naïve Mos with a miR-193b induced expression of IL-10 in the Mos. Culturing the IL-10(+) Mos with effector CD8(+) T cells resulted in the suppression of CD8(+) T-cell activities.
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Affiliation(s)
- Sen Zhang
- Department of Otolaryngology, Head & Neck Surgery, the First Hospital, Shanxi Medical University, Taiyuan, Shanxi, China,1
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Abstract
Cumulative findings from many research groups have identified new signaling mechanisms associated with head and neck cancers. We summarize these findings, including discussion of aberrant NOTCH, PI3K, STAT3, immune recognition, oxidative pathway, and regulation of cell cycle and cell death. The genomic landscape of head and neck cancers has been shown to differ depending on human papillomavirus (HPV) status. We discuss studies examining the integration of HPV into genomic regions, as well as the epigenetic alterations that occur in response to HPV infection, and how these may help reveal new biomarker and treatment predictors. The characterization of premalignant lesions is also highlighted, as is evidence indicating that the surgical removal of these lesions is associated with better clinical outcomes. Current surgical methods are also discussed, including several less aggressive approaches such as minimal invasive robotic surgery. While much remains to be done in the fight against head and neck cancer, continued integration of basic research with new treatment options will likely lead to more effective therapeutic strategies directed against this disease.
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Affiliation(s)
- Xaralabos Varelas
- Department of Biochemistry, Boston University School of Medicine, Boston, Massachusetts
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