1
|
Eker C, Surmelioglu O, Dagkiran M, Kaya O, Tanrisever I, Arpaci B, Kaya B, Yucel Karakaya SP, Onan E. Transoral laser microsurgery for T1 glottic cancer with anterior commissure: Identifying clinical and radiological variables that predict oncological outcome. Eur Arch Otorhinolaryngol 2024; 281:2597-2608. [PMID: 38424299 PMCID: PMC11023970 DOI: 10.1007/s00405-024-08513-3] [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: 11/13/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The involvement of the anterior commissure (AC) is regarded to be a risk factor for poor results after transoral laser microsurgery (TLM) for early glottic cancer. The objective of this study was to determine how AC-related clinical and radiological factors affected oncological outcomes in a cohort of patients with T1 stage early glottic carcinoma involving the anterior commissure who were treated with TLM with negative surgical margins. METHODS Retrospective analysis was performed on clinical, radiological, and follow-up data of patients consecutively treated with TLM at a tertiary academic center between November 2011 and August 2021 for T1 glottic squamous cell carcinoma involving the anterior commissure. Recurrence-free survival (RFS), local control with laser alone (LCL), laryngeal preservation (LP), and overall survival (OS) rates (Kaplan-Meier) were the primary outcome metrics. RESULTS In our series, 5-year OS probability was 75.1%, RFS was 64.8%, LCL was 73.8%, and LP was 83.4%. OS and RFS were higher in patients with early stages of AC pattern than in patients with advanced stage (p = 0.004, p = 0.034, respectively). Vertical extension ratio was found to be associated with OS and RFS (p = 0.023, p = 0.001, respectively), and thyroid cartilage interlaminar angle with LCL by multiple Cox regression analysis (p = 0.041). CONCLUSION TLM remains a valuable treatment option for AC involvement. AC3 type involvement and elevated vertical extension ratio were associated with negative prognosis. There have been signs that thyroid cartilage with a narrow angle increases recurrence. Alternative modalities should be kept in mind in the treatment decision of these cases.
Collapse
Affiliation(s)
- Caglar Eker
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey.
| | - Ozgur Surmelioglu
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Muhammed Dagkiran
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Omer Kaya
- Faculty of Medicine, Department of Radiology, Cukurova University, Adana, Turkey
| | - Ilda Tanrisever
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Burak Arpaci
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| | - Bedir Kaya
- Faculty of Medicine, Department of Radiology, Cukurova University, Adana, Turkey
| | | | - Elvan Onan
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey
| |
Collapse
|
2
|
Matos LL, Kowalski LP, Chaves ALF, de Oliveira TB, Marta GN, Curado MP, de Castro Junior G, Farias TP, Bardales GS, Cabrera MA, Capuzzo RDC, de Carvalho GB, Cernea CR, Dedivitis RA, Dias FL, Estefan AM, Falco AH, Ferraris GA, Gonzalez-Motta A, Gouveia AG, Jacinto AA, Kulcsar MAV, Leite AK, Lira RB, Mak MP, De Marchi P, de Mello ES, de Matos FCM, Montero PH, de Moraes ED, de Moraes FY, Morais DCR, Poenitz FM, Poitevin A, Riveros HO, Sanabria Á, Ticona-Castro M, Vartanian JG, Viani G, Vines EF, William Junior WN, Conway D, Virani S, Brennan P. Latin American Consensus on the Treatment of Head and Neck Cancer. JCO Glob Oncol 2024; 10:e2300343. [PMID: 38603656 DOI: 10.1200/go.23.00343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 04/13/2024] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.
Collapse
Affiliation(s)
- Leandro Luongo Matos
- Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | - Gilberto de Castro Junior
- Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Andrés Munyo Estefan
- Profesor Adjunto Catedra de Otorrinolaringologia del Hospital de Clínicas, Montevidéu, Uruguay
| | | | | | | | - Andre Guimarães Gouveia
- Juravinski Cancer Centre, Department of Oncology, Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | | | - Marco Aurelio Vamondes Kulcsar
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Ana Kober Leite
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Renan Bezerra Lira
- AC Camargo Cancer Center and Hospital Albert Einstein, São Paulo, Brazil
| | - Milena Perez Mak
- 3Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | | | | | | | - Pablo H Montero
- Department of Surgical Oncology and Head and Neck Surgery, Division of Surgery, P. Universidad Católica de Chile, Santiago, Chile
| | | | | | | | | | | | | | - Álvaro Sanabria
- 4Department of Surgery, Universidad de Antioquia, Hospital Alma Mater, Medellin, Colombia
| | - Miguel Ticona-Castro
- 5ESMO Member, Peruvian Society of Medical Oncology (S.P.O.M.) Member, La Molina, Peru
| | - José Guilherme Vartanian
- 6Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Gustavo Viani
- 7Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Eugenio F Vines
- Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | | | - Shama Virani
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| | - Paul Brennan
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| |
Collapse
|
3
|
Kienle LL, Schild LR, Böhm F, Grässlin R, Greve J, Hoffmann TK, Schuler PJ. A novel 3D-printed laryngoscope with integrated working channels for laryngeal surgery. Front Surg 2023; 10:906151. [PMID: 36998594 PMCID: PMC10043209 DOI: 10.3389/fsurg.2023.906151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
BackgroundFor the surgical treatment of early-stage laryngeal cancer, the use of transoral laser microsurgery (TLM) has emerged as the gold standard. However, this procedure requires a straight line of sight to the operating field. Therefore, the patient's neck needs to be brought into a hyperextended position. In a considerable number of patients, this is not possible due to anomalies in the cervical spine anatomy or soft tissue scarring, e.g., after radiation. In these cases, adequate visualization of relevant laryngeal structures cannot be ensured using a conventional rigid operating laryngoscope, which may negatively affect the outcome of these patients.MethodsWe present a system based on a 3D-printed prototype of a curved laryngoscope with three integrated working channels (sMAC). The curved profile of the sMAC-laryngoscope is specifically adapted to the nonlinear anatomy of the upper airway structures. The central working channel provides access for flexible video endoscope imaging of the operating field while the two remaining channels provide access for flexible instrumentation. In a user study (n = 11), visualization and reachability of relevant laryngeal landmarks as well as the feasibility of basic surgical procedures with the proposed system were examined in a patient simulator. In a second setup, the system was evaluated for its applicability in a human body donor.ResultsAll participants of the user study were able to visualize, reach and manipulate the relevant laryngeal landmarks. Reaching those took significantly less time in the second attempt compared to the first one (27.5 s ± 5.2 s vs. 39.7 s ± 16.5 s, p = 0.008) indicating a significant learning curve for handling the system. Instrument changes were performed quickly and reliably by all participants (10.9 s ± 1.7 s). All participants were able to bring the bimanual instruments into position for a vocal fold incision. Relevant laryngeal landmarks could be visualized and reached in the human body donor setup.ConclusionPossibly, the proposed system may develop into an alternative treatment option for patients with early-stage laryngeal cancer and restricted mobility of the cervical spine in the future. Further improvements of the system could include finer end effectors and a flexible instrument with a laser cutting tool.
Collapse
Affiliation(s)
- Linus L. Kienle
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Leon R. Schild
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Felix Böhm
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Rene Grässlin
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Thomas K. Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Patrick J. Schuler
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
- Correspondence: Patrick J. Schuler
| |
Collapse
|
4
|
Dai J, Qi G, Cao Y, Xu M, Wang S, Song H, Cai J, Li S, Wei J, Huai D. Effect of CO2 laser combined with low-temperature plasma radiofrequency ablation on the early glottic laryngeal carcinoma. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2023. [DOI: 10.1016/j.jrras.2022.100501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|
5
|
Ming W, Zuo J, Han J, Chen J. Establishment of prognostic nomogram for T1N0M0 glottic squamous cell carcinoma: an SEER database analysis. Eur Arch Otorhinolaryngol 2022; 280:2397-2410. [PMID: 36454384 DOI: 10.1007/s00405-022-07763-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES The study aimed to construct prognostic models for OS and CSS in patients with T1N0M0 glottic SCC. In addition, we used PSM to re-assess the effect of surgery alone and radiation alone. METHODS The Surveillance, Epidemiology, and End Results database was searched for patients with confirmed T1N0M0 glottic SCC. Patients with complete data were randomly divided into the training and the validation cohort (7:3), Cox-regression analysis was performed to identified significant predictors of OS and CSS. PSM was used to mimic randomized controlled the trials. Kaplan-Meier survival method and log-rank tests were utilized for survival analysis. RESULTS A total 1827 patients met the inclusion criteria. Survival analysis indicated that the patients who underwent the primary site surgery had a better OS (P = 0.002) and CSS (P = 0.008), compared with non-surgery patients. Cox-regression analysis proved that age, marital status, T1 stages, surgery, radiation, sequential treatments, and chemotherapy had significant effects on OS. While age, marital status, histologic grade, surgery, radiation, sequential treatments, and chemotherapy were substantially associated with CSS. Patients who received primary site surgery had a better OS and CSS, compared with non-surgical patients. Patients receiving radiation had a better CSS than non-radiation patients. However, patients who received sequential treatments or chemotherapy had a worse OS and CSS, compared with controlled groups. Predictive nomogram models were established to predict patients' prognosis with good consistency between the actual observation and the nomogram prediction. Before PSM, patients who underwent surgery alone had a better OS and CSS than those who received radiation alone. After PSM, patients receiving surgery still had a better OS than those receiving radiation. However, there were no statistically significant differences in CSS. CONCLUSIONS Nomogram models were developed to predict OS and CSS in patients with T1N0M0 glottic SCC. Primary site surgery could definitely increase OS and CSS, while radiation could significantly increase CSS. Using PSM, surgery alone could significantly enhance OS, as compared to radiation alone. Chemotherapy should not be recommended for early glottic carcinoma.
Collapse
Affiliation(s)
- Wei Ming
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Jingjing Zuo
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jibo Han
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jinhui Chen
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
6
|
Cristalli G, Vidiri A, Mercante G, Ferreli F, De Virgilio A, Donelli F, Davì L, Gasparin P, Cocco P, Giudici F, Boscolo Nata F. Radiological Findings in Laryngeal Anterior Commissure Invasion: CT Scan Highlights. Laryngoscope 2022; 132:2427-2433. [PMID: 35166380 DOI: 10.1002/lary.30060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Preoperative anterior commissure (AC) evaluation in glottic cancer is crucial for therapeutic decisions. Endoscopy is often inadequate to precisely detect the presence of cancer in the AC; thus, computed tomography (CT) scan could help. We investigated the relation between AC thickness on CT scan (in mm), AC involvement by cancer at histology, and radiologic signs of anterior paraglottic space (PGS) infiltration. STUDY DESIGN Retrospective observational study. METHODS An experienced radiologist retrospectively measured AC thickness and identified signs of anterior PGS infiltration on pretreatment contrast-enhanced CT scans of 80 patients with primary glottic cancer. The gold standard to define the presence of cancer in the AC was histology. The receiver operating characteristic (ROC) curves were used to determine the potential cut-off values of AC thickness (Youden index method) able to maximize both sensitivity and specificity in identifying the presence of cancer in the AC at histology and PGS infiltration on CT scan. RESULTS AC was significantly thicker in patients with cancer in the AC at histology (P < .001) and in patients with PGS infiltration on CT scan (P < .001). The cut-off values to discriminate the presence of cancer at histology and PGS infiltration on CT scan were 3.62 and 2.6 mm, respectively. We found a substantial agreement between anterior PGS infiltration on CT scan and the presence of cancer in the AC at histology (Cohen Kappa: P = .70). CONCLUSION AC thickness and radiologic signs of PGS infiltration on pretreatment CT scan could represent a method to predict the presence of cancer in the AC at histology. LEVEL OF EVIDENCE 4 Laryngoscope, 132:2427-2433, 2022.
Collapse
Affiliation(s)
- Giovanni Cristalli
- Otorhinolaryngology Unit, Ospedali Riuniti Padova Sud "Madre Teresa di Calcutta" Hospital, Monselice, Italy
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Filippo Donelli
- Radiology Unit, Ospedali Riuniti Padova Sud "Madre Teresa di Calcutta" Hospital, Monselice, Italy
| | - Luigi Davì
- Radiology Unit, Ospedali Riuniti Padova Sud "Madre Teresa di Calcutta" Hospital, Monselice, Italy
| | - Pierpaola Gasparin
- Pathological Anatomy Unit, Ospedali Riuniti Padova Sud "Madre Teresa di Calcutta" Hospital, Monselice, Italy
| | - Patrizia Cocco
- Pathological Anatomy Unit, Ospedali Riuniti Padova Sud "Madre Teresa di Calcutta" Hospital, Monselice, Italy
| | - Fabiola Giudici
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesca Boscolo Nata
- Otorhinolaryngology Unit, Ospedali Riuniti Padova Sud "Madre Teresa di Calcutta" Hospital, Monselice, Italy
| |
Collapse
|
7
|
Kim MS, Wu HG, Sung MW, Kwon TK. Long-term impact of smoking cessation on new glottic cancer events in patients with early glottic cancer. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:525-530. [PMID: 36654518 PMCID: PMC9853108 DOI: 10.14639/0392-100x-n1917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 06/13/2022] [Indexed: 01/18/2023]
Abstract
Objective Patients with early glottic cancer sometimes exhibit new glottic cancer events after 5 years. This study aimed to analyse the patterns and risk factors of new glottic cancer events in patients with early glottic cancer 5 years after initial treatment. Methods In total, 209 patients were included in this study. Age, sex, T stage, anterior commissure involvement, smoking pattern and treatment modality were retrospectively analysed. Results The median follow-up was 91 (range, 60-266) months. The median time for the occurrence of new glottic cancer events was 97 (range, 61-199) months. New glottic cancer events occurred 5 years after initial treatment in 16 (7.6%) patients, among whom 12 (75.0%) had new glottic cancer event lesions overlapping with initial lesions. Smoking cessation after treatment was significantly correlated with fewer new glottic cancer events after 5 years. Conclusions New glottic cancer events occurring 5 years after initial treatment in patients with early glottic cancer are not negligible. In particular, if smoking is continued after treatment, these patients can experience new glottic cancer events even after 5 years.
Collapse
Affiliation(s)
- Min-Su Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Gyeonggi-do, Republic of Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myung-Whun Sung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea,Correspondence Tack-Kyun Kwon Department of Otorhinolaryngology-Head-and-Neck Surgery, Seoul National University College of Medicine, Boramae Medical Center, Room No 11221, 11th floor, Hangbok Building, Boramae Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Republic of Korea E-mail:
| |
Collapse
|
8
|
Wang WL, Zheng HW, Zhang LH, Yu LS. Effect of treatment modality on the long-term survival of patients with early glottic squamous cancer: a retrospective cohort study based on the SEER database. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:440. [PMID: 35571433 PMCID: PMC9096410 DOI: 10.21037/atm-21-5288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/14/2022] [Indexed: 11/06/2022]
Abstract
Background The optimal treatment strategy for patients with early glottic (T1-2N0M0) squamous cancer remains unclear. Methods A retrospective population-based analysis was performed using the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was used to balance treatment arms, and Cox regression analysis was used to determine prognostic factors for survival. Kaplan-Meier analysis, log-rank tests, and competing risk analysis were used to compare survival outcomes between treatment modalities (surgery vs. radiotherapy). Results Among the 3,994 eligible patients in this study, surgery was associated with improved cancer-specific survival (CSS) and overall survival (OS) compared with radiotherapy (log-rank test, P<0.05). This survival trend favoring surgery was consistent in the T1a, well/moderately differentiated grade, male, and all age subgroups. However, after the baseline characteristics were balanced with PSM, the survival outcomes (CSS and OS) did not differ significantly between the surgery and radiotherapy groups. Interestingly, surgery was associated with a 39% reduced risk of cancer-related death compared with radiotherapy in patients aged ≥70 years (hazard ratio 0.61; 95% CI: 0.43-0.87; P=0.006). However, this survival trend favoring surgery was not observed in younger patients (age <70 years), T stage subgroups, male or female subgroups, or in any of the pathological grade subgroups. Conclusions In patients with early glottic squamous cell carcinoma undergoing surgery or radiotherapy, there is no sufficient evidence favoring one method over another in terms of survival. However, surgery is recommended in patients aged ≥70 years because, in this group, it was associated with improved survival outcomes compared with radiotherapy.
Collapse
Affiliation(s)
- Wen-Lun Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Hong-Wei Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Li-Hong Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Li-Sheng Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| |
Collapse
|
9
|
Li W, Zhang H, Ren L, Zou Y, Tian F, Ji X, Li Q, Wang W, Ma G, Xia S. Radiomics of dual-energy computed tomography for predicting progression-free survival in patients with early glottic cancer. Future Oncol 2022; 18:1873-1884. [PMID: 35293227 DOI: 10.2217/fon-2021-1125] [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: 11/21/2022] Open
Abstract
Aim: This study aimed to predict progression-free survival (PFS) in patients with early glottic cancer using radiomic features on dual-energy computed tomography iodine maps. Methods: Radiomic features were extracted from arterial and venous phase iodine maps, and radiomic risk scores were determined by univariate Cox proportional hazards regression analysis and least absolute shrinkage and selection operator regression with tenfold cross-validation. The Kaplan-Meier method was used to evaluate the association between radiomic risk scores and PFS. Results: Patients were stratified into low-risk and high-risk groups using radiomics, the PFS corresponding rates with statistical significance between the two groups. The high-risk group showed better survival, benefiting from laryngectomy. Conclusion: Radiomics could provide a promising biomarker for predicting the PFS of early glottic cancer patients.
Collapse
Affiliation(s)
- Wenfei Li
- Department of Radiology, The First Central Clinical School, Tianjin Medical University, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.,Department of Radiology, The First Hospital of Qinhuangdao, No. 258 Wenhua Road, Haigang District, Qinhuangdao, 066000, China
| | - Huanlei Zhang
- Department of Radiology, The First Central Clinical School, Tianjin Medical University, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Lei Ren
- Department of Radiology, The First Central Clinical School, Tianjin Medical University, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.,Department of Medical Imaging, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 88 Changling Road, Xiqing District, Tianjin, 300381, China
| | - Ying Zou
- Department of Medical Imaging, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 88 Changling Road, Xiqing District, Tianjin, 300381, China
| | - Fengyue Tian
- Department of Radiology, Affiliated Hospital of Nankai University (Tianjin No. 4 Hospital), No. 4 Weishan Road, Hexi District, Tianjin, 300222, China
| | - Xiaodong Ji
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Qing Li
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Wei Wang
- Department of Otolaryngology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Guolin Ma
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| |
Collapse
|
10
|
Zhou J, Wen Q, Wang H, Li B, Liu J, Hu J, Liu S, Zou J. Prognostic comparison of transoral laser microsurgery for early glottic cancer with or without anterior commissure involvement: A meta-analysis. Am J Otolaryngol 2021; 42:102787. [PMID: 33316724 DOI: 10.1016/j.amjoto.2020.102787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/10/2020] [Accepted: 10/18/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Transoral laser microsurgery (TLM) has gradually gained approval in the treatment of early glottic cancer. However, the oncological outcomes of TLM for glottic cancer with anterior commissure (AC) involvement are still a controversial topic. We aimed to systematically review the literature on glottic cancer (Tis-T2) with patients who received TLM as first choice therapy and to evaluate several prognostic outcomes in patients with or without AC involvement. METHODS A systematic literature retrieval was conducted in PubMed, Medline (Ovid) and Web of Science. Risk ratio (RR) between AC involvement (AC+) or without AC involvement (AC-) was assessed and 95% confidence interval(95%CI) was calculated, which was performed on RevMan 5.3. RESULTS A total of 20 literatures were included when comparing the local recurrence (LR) rate of patients with or without AC involvement, and the results suggested LR matters in group AC+ over group AC- (RR = 2.39, 95%CI = 1.99-2.86, p < 0.00001). The 5-year overall survival(5yOS) rate included 10 studies, and there was no significant difference between AC+ and AC- (RR = 0.98, 95%CI = 0.93-1.02, p = 0.35). The laryngeal preservation rate (LPR) of AC+ was lower than that of AC- (RR = 0.97, 95%CI = 0.94-1.00, p = 0.04). CONCLUSION The results indicate that the prognosis of early glottic cancer with AC involvement is more likely to have higher local recurrence and lower LPR but no statistical difference in 5yOS rate.
Collapse
|
11
|
Current indications for adjuvant treatment following transoral laser microsurgery of early and intermediate laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg 2021; 29:79-85. [PMID: 33664193 DOI: 10.1097/moo.0000000000000702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the information in the literature on the indications for adjuvant therapy after transoral laser microsurgery (TLM) for early/intermediate stage laryngeal cancer. RECENT FINDINGS A high rate of 'nonevaluable' margins after TLM significantly complicates decision-making concerning adjuvant therapy. However, consensus grows that second-look TLM in patients with multiple superficial and deep positive margins is more sensible than sending these patients systematically for adjuvant radiotherapy (RT). SUMMARY The classical adagium: 'Failure to achieve negative margins indicates need for adjuvant RT' does not translate automatically to patients with glottic cancer treated by TLM. Rather, specifically patients with multiple superficial positive margins and positive deep margins after TLM need careful judging what constitutes the best additional adjuvant treatment. Second-look resection is nowadays regarded as the preferred adjuvant treatment for many of these patients whereas RT is reserved for those in whom a second look TLM is judged unlikely to result in 'true negative margins.' Additionally, when the pathology of the re-resection reveals multiple foci of residual disease or suggests again a resection with positive margins, adjuvant postoperative RT is likely to result in a better local control. If this strict selection of patients for adjuvant RT is adhered to carefully, oncological and functional results will be optimal.
Collapse
|
12
|
Zhang Q, Chen X, He S, Li L. Application of a thyroid cartilage window technique for transoral resection of early glottic cancer involving the anterior commissure. Acta Otolaryngol 2021; 141:197-202. [PMID: 33118844 DOI: 10.1080/00016489.2020.1832254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Management of early stage glottic carcinoma involving the anterior commissure is challenging. AIMS/OBJECTIVES This study aimed to evaluate the efficacy of a thyroid cartilage window (TCW) technique for transoral laser resection of early glottic cancer with involvement of the anterior commissure. MATERIAL AND METHODS Twenty-one patient who underwent a TCW technique for transoral resection early glottic carcinoma involving the anterior commissure, were retrospectively analyzed. The technical nuances, organ preservation rate and voice outcomes, local and regional recurrence, and perioperative comorbidities, were assessed. RESULTS All 21 patients underwent a TCW technique for resection, both the organ preservation rate and negative margin achieved 100%. The local control rate achieved 100%, and the 5 years recurrence free survival was 90.5%. For two patients with subglottic involvement (9.5%), regional recurrence with confirmation of a positive pre-laryngeal lymph node was observed. Postoperative granuloma was detected in all 21 patients, 13 of whom spontaneously disappeared (61.9%); whereas the remaining 8 patients (38.1%) demonstrated a consistent presence of granuloma more than 12 weeks, and they accepted surgical extirpation of granuloma under surface anesthesia. The laryngeal web developed in all 21 patients, while no dyspnea and local recurrence were present. By comparison with preoperative baseline, postoperative self-assessment voice demonstrated a significant improvement (p = .01), while objective voice indices were not significantly altered (p > .05). CONCLUSIONS AND SIGNIFICANCE TCW technique is a valuable means for transoral resection of early glottic laryngeal cancer involving the anterior commissure, with acceptable voice quality and seemingly low comorbidities.
Collapse
Affiliation(s)
- Qingxiang Zhang
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Chen
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shuangba He
- Department of Otolaryngology-Head & Neck Surgery, Nanjing Tongren Hospital, Nanjing, China
| | - Lifeng Li
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
13
|
Cabrera-Sarmiento JA, Vázquez-Barro JC, González-Botas JH, Chiesa-Estomba C, Mayo-Yáñez M. T1b Glottic Tumor and Anterior Commissure Involvement: Is the Transoral CO 2 Laser Microsurgery a Safe Option? EAR, NOSE & THROAT JOURNAL 2020; 100:68S-72S. [PMID: 32627619 DOI: 10.1177/0145561320937238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Transoral CO2 laser therapy represents the treatment of choice for early-stage laryngeal tumors. The anterior commissure involvement (ACI) is related to a worse local control and a lower rates of organ preservation. The objective of this study is to analyze the differences in survival, local control, and organ preservation in T1b glottic patients according to the presence of ACI. METHODS Observational prospective study in pT1b treated with transoral CO2 laser between 2009 and 2014. RESULTS Forty patients (37 male and 3 female) with a mean age of 66.43 ± 8.16 years were recruited. Anterior commissure involvement was present in 70% of the patients. The 5-year specific cause survival was 91.66%, with 32.50% of local recurrences. Laryngeal preservation was 80%, being lower in the group with local recurrence (P < .000). The involvement of the anterior commissure does not influence the organ preservation (P = .548), the appearance of local recurrences (P = .391), or the survival (P = .33). CONCLUSIONS Transoral CO2 laser therapy is an effective and reproducible treatment for early-stage laryngeal tumors. The results obtained are similar to previous studies, although they present discrepancies in relation to the role of the ACI. Prospective randomized trials are required focusing also on the patients' quality of life and functional outcome in order to clarify the role of the ACI and the need to implement changes in its evaluation, staging, and evolution.
Collapse
Affiliation(s)
- Juan Antonio Cabrera-Sarmiento
- Otorhinolaryngology-Head and Neck Surgery Department, 16811Complexo Hospitalario Universitario A Coruña (CHUAC), Galicia, Spain
| | - Juan Carlos Vázquez-Barro
- Otorhinolaryngology-Head and Neck Surgery Department, 16811Complexo Hospitalario Universitario A Coruña (CHUAC), Galicia, Spain.,School of Educational Sciences and Speech Therapy, Universidade da Coruña (UDC), A Coruña, Galicia, Spain
| | - Jesús Herranz González-Botas
- Otorhinolaryngology-Head and Neck Surgery Department, 16811Complexo Hospitalario Universitario A Coruña (CHUAC), Galicia, Spain.,School of Medicine and Odontology, Universidade de Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain
| | - Carlos Chiesa-Estomba
- Otorhinolaryngology-Head and Neck Surgery Department, 16650Hospital Universitario Donostia, Euskadi, Spain
| | - Miguel Mayo-Yáñez
- Otorhinolaryngology-Head and Neck Surgery Department, 16811Complexo Hospitalario Universitario A Coruña (CHUAC), Galicia, Spain.,Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain
| |
Collapse
|
14
|
Lei L, Zhong D, Zou J, Wang H, Yang H, Zhao Y, Liu J, Cheng D, Wu F. Oncological outcomes of early stage glottic squamous cell carcinoma treated with transoral laser microsurgery. Am J Otolaryngol 2020; 41:102364. [PMID: 31924412 DOI: 10.1016/j.amjoto.2019.102364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 02/05/2023]
Abstract
MATERIALS AND METHODS The records of patients treated with TLM with previously untreated early stage glottic squamous cell carcinoma were reviewed. RESULTS A total of 201 patients were enrolled: 191 men (95.0%) and 10 women (4.98%). The anterior commissure (AC) was involved in 94 (47.8%) patients. The 3- and 5-year overall survival rates of all patients were 94.5% and 90.9%. The local recurrence rates were 30.8% in the AC involvement (AC+) group and 16.0% in the group without AC involvement (AC-). The mortality rates were 18.1% and 3.7% in the AC+ and AC- groups. The 3- and 5-year disease-free survival rates were lower in the AC+ group (89.1%, 82.5%) than that in AC- group (99.0%, 96.5%). Local recurrence rates were 25%, 22.7%, 23.4%, and 22.1% for Tis, T1a, T1b, and T2 lesions. The mortality rates were 0.0%, 4.6%, 12.8%, and 15.3%. Three- and 5-year disease-free survival rates did not differ significantly between the tumor stage subgroups. The mortality for patients with local recurrence was 22.2%, which was higher than that for those without recurrence. The organ preservation rate was 98.5%. PURPOSE This study was to assess the rates of oncological outcomes in patients with early stage glottic squamous cell carcinoma treated with transoral laser microsurgery (TLM). CONCLUSION AC involvement was a predictor of local recurrence, and its presence was associated with a reduced survival rate and increased mortality after TLM. TLM got high survival rate and low recurrence rate. The staging and oncological outcomes did not differ between tumor stage subgroups.
Collapse
Affiliation(s)
- Lei Lei
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Daling Zhong
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Jian Zou
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China.
| | - Haiyang Wang
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Hui Yang
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Yu Zhao
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Jun Liu
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Danni Cheng
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Fumei Wu
- The Department of Traditional Chinese Medicine Hospital, Section 2, Huayuan Road, Shuangliu District, Chengdu, Sichuan, China
| |
Collapse
|
15
|
Advantages of Transoral Endoscopic Diode Laser Microsurgery for the Treatment of Early-Stage Glottic Laryngeal Cancers. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.97928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
16
|
Osuch-Wójcikiewicz E, Rzepakowska A, Sobol M, Bruzgielewicz A, Niemczyk K. Oncological outcomes of CO 2 laser cordectomies for glottic squamous cell carcinoma with respect to anterior commissure involvement and margin status. Lasers Surg Med 2019; 51:874-881. [PMID: 31286558 DOI: 10.1002/lsm.23130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Controversial prognostic factors of primary CO2 laser cordectomy are anterior commissure involvement (ACI) and status of margin. STUDY DESIGN/MATERIALS AND METHODS Retrospective analysis of oncological outcomes in 102 patients with early glottic cancer undergoing laser cordectomy between 2013 and 2015. RESULTS The T stages distribution included: 72.6% T1a, 14.7% T1b, and 12.7% T2. The ACI was diagnosed in 26 patients. The primary cordectomy was radical in 72 patients. The 2- and 5-year disease free survival (DFS) for all patients were, respectively, 83.3% and 77.3%.The 2-year DFS rates for T1a, T1b, T2 were, respectively, 91.7%, 66.7%, and 53.9% and the differences were statistically significant (P < 0.001). The 2-year DFS rates according to the ACI and free anterior commissure tumors were, respectively, 65.4% and 89.2%, and the ACI indicated worse prognosis (P = 0.057). The 2-year DFS rates according to margins status were higher for patients with close or positive margins, who had second resection (88.9%) compared with those of negative margins (80.9%) (P = 0.340). Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Ewa Osuch-Wójcikiewicz
- Department of Otolaryngology, Medical University of Warsaw, Banacha Street 1a, Warsaw, 02-097, Poland
| | - Anna Rzepakowska
- Department of Otolaryngology, Medical University of Warsaw, Banacha Street 1a, Warsaw, 02-097, Poland
| | - Maria Sobol
- Department of Biophysics and Human Physiology, Medical University of Warsaw, Chałubińskiego Street 5, Warsaw, 02-004, Poland
| | - Antoni Bruzgielewicz
- Department of Otolaryngology, Medical University of Warsaw, Banacha Street 1a, Warsaw, 02-097, Poland
| | - Kazimierz Niemczyk
- Department of Otolaryngology, Medical University of Warsaw, Banacha Street 1a, Warsaw, 02-097, Poland
| |
Collapse
|