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Dietz A, Stöhr M, Zebralla V, Pirlich M, Wiegand S, Nicolay NH. [Surgical Treatment of Hypopharyngeal Carcinoma, Neck Dissection and Adjuvant Postoperative Therapy of Oropharyngeal and Hypopharyngeal Cancer: Recommendations of the current S3 Guideline - Part II]. Laryngorhinootologie 2024; 103:734-753. [PMID: 39353451 DOI: 10.1055/a-2223-4098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
Part II of the S3 guideline report deals with the surgical treatment of hypopharyngeal carcinoma, neck dissection for oropharyngeal and hypopharyngeal carcinomas and adjuvant therapy options. Primary surgical therapy ± adjuvant radio- or radiochemotherapy and primary radio- or radiochemotherapy are established as primary therapies for local-regional hypopharyngeal carcinomas. Direct randomized comparisons of both basic therapeutic procedures were never conducted. Available registry data show a worse prognosis of hypopharyngeal carcinoma compared to oropharyngeal carcinomas in all locoregional tumor stages, regardless of the treatment method. For T1N0-T2N0 squamous cell carcinoma of the hypopharynx, there are no relevant differences in overall survival and locoregional relapse rate between primary surgical and primary non-surgical treatment. Primary surgical therapy ± adjuvant radiotherapy or radiochemotherapy and primary radiotherapy or radiochemotherapy are established as primary therapies for advanced but locoregionally limited hypopharyngeal carcinomas. Neck dissection is an integral part of the primary surgical treatment of oropharyngeal and hypopharyngeal cancer. There are only a few randomized studies on non-surgical organ preservation for advanced hypopharyngeal cancer as an alternative to pharyngolaryngectomy, but these have led to the recommendation of alternative concepts in the new guideline. The indication and implementation of postoperative adjuvant radiotherapy and radiochemotherapy for hypopharyngeal carcinoma do not differ from those for HPV/p16-negative and -positive oropharyngeal carcinoma.
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Affiliation(s)
- Andreas Dietz
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Plastische Operationen, Universität Leipzig, Leipzig, Germany
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Grant DG, Salassa JR, Hinni ML, Pearson BW, Hayden RE, Perry WC. Transoral laser microsurgery for carcinoma of the supraglottic larynx. Otolaryngol Head Neck Surg 2016; 136:900-6. [PMID: 17547977 DOI: 10.1016/j.otohns.2006.12.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Accepted: 12/13/2006] [Indexed: 11/23/2022]
Abstract
Objectives The study goal was to report the oncologic outcomes of transoral laser microsurgery (TLM) in the treatment of squamous cell carcinoma of the supraglottic larynx. Study Design and Setting A two-center prospective case series analysis. Results Thirty-eight patients underwent TLM for previously untreated carcinoma of the supraglottic larynx between 1997 and 2005. Pathological T stages were T1 in 8 (21%), T2 in 14 (37%), T3 in 8 (21%), and T4 in 8 (21%). Twenty-six patients (68%) had neck dissections. Thirteen patients (34%) received adjuvant radiotherapy. The mean follow-up for all patients was 31 months. The 2-year Kaplan-Meier estimates for local control were 97%; locore-gional control, 94%; disease-specific survival, 80%; and overall survival, 85%. The overall functional laryngeal preservation rate was 79% (19 of 24). Conclusions TLM is a safe and effective treatment for cancer of the supraglottic larynx Significance TLM is an emerging strategy in the management of laryngeal cancer. © 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.
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Affiliation(s)
- David G Grant
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, FL 32224, USA.
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Vilaseca I, Blanch JL, Berenguer J, Grau JJ, Verger E, Muxí Á, Bernal-Sprekelsen M. Transoral laser microsurgery for locally advanced (T3-T4a) supraglottic squamous cell carcinoma: Sixteen years of experience. Head Neck 2016; 38:1050-7. [DOI: 10.1002/hed.24408] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 01/01/2023] Open
Affiliation(s)
- Isabel Vilaseca
- Department of ORL-HNS; Hospital Clínic; Barcelona Spain
- ENT Surgical Oncology Section; Hospital Clínic; Barcelona Spain
- University of Barcelona Medical School; Barcelona Spain
| | - José Luis Blanch
- Department of ORL-HNS; Hospital Clínic; Barcelona Spain
- ENT Surgical Oncology Section; Hospital Clínic; Barcelona Spain
| | - Joan Berenguer
- Neuroradiology Section, Department of Radiology; Hospital Clínic; Barcelona Spain
| | - Juan José Grau
- Department of Medical Oncology; Hospital Clínic; Barcelona Spain
- University of Barcelona Medical School; Barcelona Spain
| | - Eugenia Verger
- Department of Radiation Oncology; Hospital Clínic; Barcelona Spain
| | - África Muxí
- Department of Nuclear Medicine; Hospital Clínic; Barcelona Spain
| | - Manuel Bernal-Sprekelsen
- Department of ORL-HNS; Hospital Clínic; Barcelona Spain
- University of Barcelona Medical School; Barcelona Spain
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Ali M, Babaiah M, Raut B. Study of inter-fraction movements of tongue during radiation therapy in cases of tongue malignancy using volumetric cone beam computed tomography (CBCT) imaging. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2015. [DOI: 10.14319/ijcto.34.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Patel SH, Munson ND, Grant DG, Buskirk SJ, Hinni ML, Perry WC, Foote RL, McNeil RB, Halyard MY. Relapse patterns after transoral laser microsurgery and postoperative irradiation for squamous cell carcinomas of the tonsil and tongue base. Ann Otol Rhinol Laryngol 2014; 123:32-9. [PMID: 24574421 DOI: 10.1177/0003489414521383] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES We evaluated relapse patterns after transoral laser microsurgery (TLM) in squamous cell carcinoma (SCC) of the tonsil and tongue base and evaluated the indications for adjuvant irradiation. METHODS Between December 1, 1996, and December 31, 2005, 79 patients with previously untreated SCC of the tonsil or tongue base underwent TLM with or without neck dissection. Thirty-eight patients (48%) underwent postoperative irradiation (median, 62 Gy) to the primary site and the neck. Analysis of relapse patterns was performed on the basis of adverse risk factors and the presence or absence of adjuvant irradiation. RESULTS The median follow-up for living patients was 47 months (range, 10 to 107 months), and patients were monitored for at least 2 years or until recurrence or death. Local, regional, and distant treatment failures numbered 4, 6, and 4 for surgery alone (n = 41) and 0, 2, and 6 for adjuvant irradiation (n = 38), respectively. Patients with high-risk features (extracapsular extension or at least 2 adverse factors) had locoregional control rates at 2 or more years of 66% and 94% for TLM alone and TLM plus adjuvant irradiation, respectively. CONCLUSIONS Adjuvant irradiation after TLM resection of oropharyngeal SCC with intermediate- or high-risk features improves locoregional control compared with TLM alone.
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Affiliation(s)
- Samir H Patel
- Departments of Radiation Oncology (Patel, Halyard), Mayo Clinic, Scottsdale, Arizona
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Abstract
The Institute of Medicine has emphasized the roles of multidisciplinary treatment planning, evidence-based clinical practice guidelines, and regionalization of healthcare in optimizing the quality of cancer care. We discuss these critical elements as they pertain to head and neck cancer care.
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Affiliation(s)
- Carol M Lewis
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA.
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Patel SH, Hinni ML, Hayden RE, Wong WW, Dueck AC, Zarka MA, Curtis KK, Halyard MY. Transoral laser microsurgery followed by radiation therapy for oropharyngeal tumors: the Mayo Clinic Arizona experience. Head Neck 2013; 36:220-5. [PMID: 23529906 DOI: 10.1002/hed.23279] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to report the treatment outcomes of patients with advanced oropharyngeal cancer treated with transoral laser microsurgery (TLM) followed by radiation therapy (RT) at Mayo Clinic in Arizona. METHODS A retrospective study of 80 patients treated from January 1, 2000 to November 7, 2011 was performed. All patients had stage III/IV oropharyngeal tumors and underwent TLM with neck dissection. Adjuvant RT was then given. Thirty-seven patients received concurrent adjuvant chemotherapy. The primary outcome was locoregional control. RESULTS Median follow-up was 47.3 months (range, 9.7-139.2 months). The 3-year locoregional control, recurrence-free survival, and overall survival rates were 98.6% (95% confidence interval [CI], 91% to 100%), 91.1% (95% CI, 81% to 96%), and 93.7% (95% CI, 84% to 98%), respectively. There were a total of 5 treatment failures, 1 regional and 4 distant. Twenty-six patients underwent neck only RT with exclusion of the primary site. CONCLUSION TLM followed by RT for advanced oropharyngeal cancer results in excellent locoregional control rates.
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Affiliation(s)
- Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
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Arens C. Transoral treatment strategies for head and neck tumors. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc05. [PMID: 23320057 PMCID: PMC3544208 DOI: 10.3205/cto000087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The introduction of transoral endoscopic surgery has initiated a fundamental change in the treatment of head and neck cancer. The endoscopic approach minimizes the intraoperative trauma. Due to the lower burden for the patient and the savings potential these methods have gained wide acceptance. These transoral accesses routes allow experienced surgeons to reduce the morbidity of surgical resection with no deterioration of oncologic results. This suggests a further extension of the indication spectrum and a high growth potential for these techniques and equipment in the coming years. For selected patients with selected tumors the minimally invasive transoral surgery offers improved oncological and functional results. In the present paper, different surgical access routes are presented and their indications discussed.
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Affiliation(s)
- Christoph Arens
- Clinic for Ear, Nose and Throat Medicine, University Hospital Magdeburg, Germany
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Caicedo-Granados E, Beswick DM, Christopoulos A, Cunningham DE, Razfar A, Ohr JP, Heron DE, Ferris RL. Oncologic and Functional Outcomes of Partial Laryngeal Surgery for Intermediate-Stage Laryngeal Cancer. Otolaryngol Head Neck Surg 2012; 148:235-42. [DOI: 10.1177/0194599812466367] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To evaluate the oncologic and functional outcomes of partial laryngeal surgery (PLS) using transoral laser microsurgery (TLM) and supracricoid laryngectomy (SCL) in patients with intermediate-stage laryngeal squamous cell carcinoma (LSCC). Study Design Historical cohort study. Setting Single tertiary care center. Subjects and Methods Retrospective review of oncologic and functional outcomes in intermediate-stage (T2-3/N0-1, stage II and III) LSCC patients who underwent TLM or SCL from 1998 to 2010. Results Sixty patients were included, of whom 28 (47%) underwent TLM and 32 (53%) underwent SCL. For the entire cohort, 2- and 5-year probabilities were 86.2% (95% confidence interval [CI], 73.0%-93.2%) and 72.9% (95% CI, 52.4%-85.6%), respectively, for overall survival (OS) and 79.3% (95% CI, 65.6%-88.0%) and 62.4% (95% CI, 41.9%-77.4%), respectively, for recurrence-free survival (RFS). There was no difference between the TLM and SCL cohorts in OS ( P = .542) or RFS ( P = .483). More than 75% of patients avoided adjuvant therapy. Communication Scale and Functional Outcome Swallowing Scale scores at median follow-up of 33 months were 2 or better in 97% and 91% of patients, respectively, reflecting functional voice and swallowing postoperatively. Eighty-eight percent of patients retained a functional larynx. Conclusion PLS provides excellent oncologic and functional outcomes for intermediate-stage LSCC and should be considered an alternative to chemoradiation or total laryngectomy in selected patients.
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Affiliation(s)
- Emiro Caicedo-Granados
- Department of Otolaryngology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Daniel M. Beswick
- Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Apostolos Christopoulos
- Division of Otorhinolaryngology, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Diana E. Cunningham
- Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - Ali Razfar
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - James P. Ohr
- Department of Hematology/Oncology, Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - Dwight E. Heron
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - Robert L. Ferris
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA
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Jerjes W, Hamdoon Z, Hopper C. CO2 lasers in the management of potentially malignant and malignant oral disorders. HEAD & NECK ONCOLOGY 2012; 4:17. [PMID: 22546534 PMCID: PMC3448505 DOI: 10.1186/1758-3284-4-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 04/30/2012] [Indexed: 11/10/2022]
Abstract
The CO2 laser was invented in 1963 by Kumar Patel. Since the early 1970s, CO2 laser has proved to be an effective method of treatment for patients with several types of oral lesions, including early squamous cell carcinoma. Laser surgery of oral premalignant disorders is an effective tool in a complete management strategy which includes careful clinical follow-up, patient education to eliminate risk factors, reporting and biopsying of suspicious lesions and any other significant lesions. However, in a number of patients, recurrence and progression to malignancy remains a risk. CO2 laser resection has become the preferred treatment for small oral and oropharyngeal carcinomas. Laser resection does not require reconstructive surgery. There is minimal scarring and thus, optimum functional results can be expected. New and improved applications of laser surgery in the treatment of oral and maxillofacial/head and neck disorders are being explored. As more surgeons become experienced in the use of lasers and as our knowledge of the capabilities and advantages of this tool expands, lasers may play a significant role in the management of different pathologies.
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Affiliation(s)
- Waseem Jerjes
- Department of Surgery, Dijla University College, Baghdad, Iraq.
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Rich JT, Liu J, Haughey BH. Swallowing function after transoral laser microsurgery (TLM) ± adjuvant therapy for advanced-stage oropharyngeal cancer. Laryngoscope 2011; 121:2381-90. [PMID: 21882203 PMCID: PMC4201117 DOI: 10.1002/lary.21406] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Accepted: 09/27/2010] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To perform a longitudinal description of swallowing function following transoral laser microsurgery (TLM) ± adjuvant therapy for advanced-stage oropharyngeal cancer (OPC) and identify prognostic factors associated with swallowing performance. STUDY DESIGN Retrospective analysis and longitudinal descriptive study of swallowing outcomes. METHODS Patients treated with TLM for AJCC stage III-IV OPC at Washington University from 1996 to 2008 were included. A search of medical records and direct patient contact were performed to obtain swallowing function at multiple time points. Persistently poor swallowing at 2 year after surgery was the primary outcome measure. Two year swallowing outcomes stratified by tumor site and T stage are presented. RESULTS One hundred eighteen patients met criteria for the study (median follow-up 53.9 months). There were 44 T1's, 41 T2's, 23 T3's and 10 T4's. Forty seven percent received radiotherapy and 41% received chemoradiotherapy. Ninety-eight percent underwent neck dissection. Patients tolerated TLM well with 82% enjoying good swallowing at 1 month after surgery. During adjuvant therapy, at 3 months, good swallowing dropped to 55%. At 1 and 2 years after TLM, 89% and 88% of patients had good swallowing function, respectively. At 2 years, 9 patients had persistently poor swallowing function. 93% of patients with T1 through T3 enjoyed good swallowing at 2 years. T4 base of tongue disease was associated with persistently poor swallowing function in multivariate analyses (P = 0.0023), with 40% having good swallowing at 2 years. Preexisting comorbidities and conversion to an open procedure were associated with delayed return of swallowing function, but not with persistently poor swallowing. Seven patients developed late-onset swallowing dysfunction. CONCLUSIONS Treatment of advanced stage OPC with TLM ± adjuvant therapy results in excellent swallowing outcomes for patients with either T1 to T3 tonsil or T1 to T3 base of tongue resections. A detailed, longitudinal swallowing profile is presented to assist in preoperative counseling.
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Affiliation(s)
- Jason T. Rich
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jingxia Liu
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bruce H. Haughey
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Ding H, Mora R, Gao J, Sumer BD. Characterization and optimization of mTHPP nanoparticles for photodynamic therapy of head and neck cancer. Otolaryngol Head Neck Surg 2011; 145:612-7. [PMID: 21727244 DOI: 10.1177/0194599811412449] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To characterize the properties of polymeric micelles containing different loading percentages of mTHPP, a photosensitizer for photodynamic therapy (PDT), with respect to fluorescence, singlet oxygen ((1)O(2)) yield, and in vitro cytotoxicity in head and neck cancer cells. STUDY DESIGN Laboratory study. SETTING Polymer chemistry laboratory. SUBJECTS AND METHODS Absorption and emission spectroscopy was used to characterize the mTHPP-loaded micelles. The (1)O(2) yield was measured to determine the efficiency of reactive oxygen species (ROS) generation. In vitro studies were conducted using the HN5 cells and confirmed with H2009 cells to determine the photodynamic efficacy. DNA assay and confocal microscopy was used to measure intracellular fluorescence. RESULTS The mTHPP micelles demonstrated the highest fluorescence intensity at 0.5% loading. The (1)O(2) generation of the micelles in solution peaked at 2% loading. Phototoxicity and dark toxicity experiments in HN5 and H2009 cells demonstrated that the best therapeutic index was achieved with the 2% loaded micelles with 100% cell cytotoxicity at a micelle concentration of 10 µg/mL and less than 10% dark cytotoxicity. In comparison, 10% loaded micelles demonstrated 100% cell cytotoxicity at a concentration of 20 µg/mL under both light and dark conditions. Confocal microscopy demonstrated increasing intracellular fluorescence with higher loading. CONCLUSIONS The 2% mTHPP-loaded micelles generated greater (1)O(2), and 0.5% loading led to the most efficient generation of fluorescence in solution. Higher mTHPP loading density led to increased cellular fluorescence and dark cytotoxicity. Overall, 2% mTHPP-loaded micelles provided the optimal composition for photodynamic therapy with the largest therapeutic window.
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Affiliation(s)
- Huiying Ding
- Department of Pharmacology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390, USA
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Minimally invasive techniques for head and neck malignancies: current indications, outcomes and future directions. Eur Arch Otorhinolaryngol 2011; 268:1249-57. [PMID: 21562814 DOI: 10.1007/s00405-011-1620-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 04/12/2011] [Indexed: 01/25/2023]
Abstract
The trend toward minimally invasive surgery, appropriately applied, has evolved over the past three decades to encompass all fields of surgery, including curative intent cancer surgery of the head and neck. Proper patient and tumor selection are fundamental to optimizing oncological and functional outcomes in such a personalized approach to cancer treatment. Training, experience, and appropriate technological equipment are prerequisites for any type of minimally invasive surgery. The aim of this review was to provide an overview of currently available techniques and the evidence justifying their use. Much evidence is in favor of routine use of transoral laser resection, transoral robot-assisted surgery, transnasal endoscopic resection, sentinel node biopsy, and endoscopic neck surgery for selected malignant tumors, by experienced surgical teams. Technological advances will enhance the scope of this type of surgery in the future and physicians need to be aware of the current applications and trends.
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Suárez C, Rodrigo JP, Silver CE, Hartl DM, Takes RP, Rinaldo A, Strojan P, Ferlito A. Laser surgery for early to moderately advanced glottic, supraglottic, and hypopharyngeal cancers. Head Neck 2011; 34:1028-35. [PMID: 21500310 DOI: 10.1002/hed.21766] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Current practice standards for the treatment of early to moderately advanced laryngeal and hypopharyngeal cancer demand both achievement of cure and preservation of laryngeal structure and function to the greatest extent possible. The oncologic and functional results of transoral laser microsurgery (TLM) for early glottic cancer appear to be comparable to those of radiotherapy, with a higher rate of laryngeal preservation and a lower cost. TLM for early and moderately advanced supraglottic and hypopharyngeal cancers offers similar results with regard to survival and local control to those obtained with open surgical approaches. In addition, functional results of TLM are superior to those of open approaches because tracheotomies are usually avoided, rehabilitation of swallowing is faster, and hospital stay is shorter. TLM, when applicable, has become the preferred modality for surgical treatment of most early to moderately advanced cancers of the larynx and selected tumors of the hypopharynx.
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Affiliation(s)
- Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
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Haughey BH, Hinni ML, Salassa JR, Hayden RE, Grant DG, Rich JT, Milov S, Lewis JS, Krishna M. Transoral laser microsurgery as primary treatment for advanced-stage oropharyngeal cancer: A united states multicenter study. Head Neck 2011; 33:1683-94. [PMID: 21284056 DOI: 10.1002/hed.21669] [Citation(s) in RCA: 264] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 09/24/2010] [Accepted: 10/04/2010] [Indexed: 11/10/2022] Open
Affiliation(s)
- Bruce H Haughey
- Department of Otolaryngology-Head and Neck Surgery Washington University School of Medicine, St. Louis, Missouri, USA.
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Jerjes W, Upile T, Hamdoon Z, Mosse CA, Akram S, Hopper C. Prospective evaluation of outcome after transoral CO(2) laser resection of T1/T2 oral squamous cell carcinoma. ACTA ACUST UNITED AC 2011; 112:180-7. [PMID: 21232996 DOI: 10.1016/j.tripleo.2010.09.078] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 09/03/2010] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Oral cancer is the sixth most common cancer in the world. The incidence of oral squamous cell carcinoma (OSCC) continues to be high, if not increasing. This prospective study assessed the oncological outcomes following transoral CO(2) laser resection of T1/T2 N0 OSCC. Patients' 3-year disease-specific survival and disease-free survival were evaluated. MATERIAL AND METHODS The patients' data included a range of clinical, operative, and histopathological variables related to the status of the surgical margins. Data collection also included recurrence, cause of death, date of death, and last clinic review. Ninety patients (64 males and 26 females) participated in this study. Their mean age at the first diagnosis of OSCC was 63.5 years. Two thirds of the patients were Caucasians. Usually patients present with an ulcer of the tongue, floor of mouth, or buccal mucosa. Current and ex-smokers represented 82.2% of the cohort, whereas current and ex-drinkers were 78.9%. Comorbidities included history of oral lichen planus, oral submucous fibrosis, immunodeficiency, oral dysplasia, or OSCC. Clinically, 81 patients had T1N0 disease and 9 had T2N0 disease. RESULTS Pathologic analysis revealed that nearly half of the patients had moderately differentiated OSCC, 18 moderately to poorly differentiated, and 19 poorly differentiated carcinoma. Study of the tumor margins was carried out and showed a mean of 5.7-mm depth of invasion; tumor clearance was primarily achieved in 73 patients. Recurrence was identified in 11 (12%) patients. The mean age of first diagnosis of the recurrence group was 76.4 years. The most common clinical presentation in the recurrence group was an ulcer involving the tongue or buccal mucosa; most commonly were identified in current or ex-smokers or drinkers. Recurrence was associated with clinical N-stage disease. The surgical margins in this group were also evaluated following relaser excision or surgical excision ± neck dissection. Follow-up resulted in a 3-year survival of 86.7%. Twelve patients died: 9 from noncancer-related causes, 2 from locoregional disease spread, and 1 from distant metastasis to the lungs. CONCLUSIONS Squamous cell carcinoma of the oral cavity has a poor overall prognosis with a high tendency to recur at the primary site and extend to involve the locoregional lymph nodes. The overall results of this study suggest that CO(2) laser is a comparable modality to other traditional interventions (surgery) in the management of low-risk (T1/T2) tumors of the oral cavity.
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Affiliation(s)
- Waseem Jerjes
- University College London Hospitals Head, Neck Centre, London, UK.
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Chu PY, Lee TL, Chang SY. Impact and management of airway obstruction in patients with squamous cell carcinoma of the larynx. Head Neck 2011; 33:98-102. [DOI: 10.1002/hed.21401] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Lee S, Thiele C. Factors associated with free flap complications after head and neck reconstruction and the molecular basis of fibrotic tissue rearrangement in preirradiated soft tissue. J Oral Maxillofac Surg 2010; 68:2169-78. [PMID: 20605307 DOI: 10.1016/j.joms.2009.08.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Accepted: 08/24/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Several factors are associated with free flap complications in head and neck reconstruction after radiotherapy. The present study aimed to identify the correlation between irradiation and the healing of wounds after microvascular free flap transfer and to clarify the molecular mechanisms for the differences in healing between irradiated and nonirradiated patients. PATIENTS AND METHODS A retrospective study of 81 cases of microvascular free flap transfer was conducted. Tissue samples were obtained from 3 different regions of the patients (nonirradiated oral mucosa, irradiated skin, and nonirradiated skin). Expression of transforming growth factor-beta(1) was monitored by immunohistochemistry and immunoblot analysis. The levels of matrix metalloproteinase-1 and tissue inhibitor of matrix metalloproteinase-1 were investigated qualitatively and quantitatively. RESULTS Multivariate analysis revealed that only preoperative irradiation was a significant predictor of free flap complications (P = .006), with a 4 times greater risk (odds ratio 4.141). It was also shown that patients with an advanced tumor stage and those who had received chemotherapy after radiotherapy were twice as likely to develop free flap complications. Transforming growth factor-beta(1) was overexpressed in free flaps for as long as 6 months after radiotherapy. It was remarkably observed in the granulation tissue in the preirradiated skin. Moreover, extracellular matrix remodeling regulated by transforming growth factor-beta(1) was detected with decreased matrix metalloproteinase-1 and increased TIMP-1 expression in the irradiated skin. CONCLUSION The healing of surgical wounds created by microvascular free flap transfer correlated negatively with preoperative radiotherapy. Extracellular matrix remodeling was also detectable in the free flap for up to 6 months after radiotherapy completion.
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Affiliation(s)
- Sooyeon Lee
- Department of Oral and Craniomaxillofacial Surgery/Plastic Surgery, University of Jena, Jena, Thueringen, Germany.
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Abstract
Early detection of upper aerodigestive tract cancer improves prognosis. The primary care physician plays an important role in early detection of these cancers. Most upper aerodigestive tract cancers are squamous cell carcinomas that are linked to tobacco, alcohol, or human papillomavirus exposure. These cancers produce nonspecific symptoms; thus, any persistent oral cavity lesion or neck mass or other unexplainable ear, nose, and throat symptoms should prompt an evaluation for malignancy. Although overall survival has not improved, nonsurgical treatment approaches have led to higher rates of organ preservation and rehabilitation after treatment has improved the quality of life of survivors.
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Affiliation(s)
- Emily Crozier
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9035, USA
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Mueller CK, Thorwarth MW, Schultze-Mosgau S. Angiogenic Gene-Modified Fibroblasts for Induction of Localized Angiogenesis. J Surg Res 2010; 160:340-8. [DOI: 10.1016/j.jss.2008.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 11/23/2008] [Accepted: 12/03/2008] [Indexed: 11/17/2022]
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Petruzzelli GJ. Transoral laser microsurgery: applications in head and neck oncology. Expert Rev Med Devices 2010; 6:599-602. [PMID: 19911870 DOI: 10.1586/erd.09.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Surgery for Laryngopharyngeal SCC in the Era of Organ Preservation. Clin Exp Otorhinolaryngol 2009; 2:159-63. [PMID: 20072688 PMCID: PMC2804089 DOI: 10.3342/ceo.2009.2.4.159] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/18/2009] [Indexed: 11/09/2022] Open
Abstract
Over the past decades, randomized clinical trials have assessed and validated the concept of larynx preservation. This new concept has obviously modified the treatment algorithm for laryngopharyngeal squamous cell carcinoma. However surgery for larynx and hypopharynx cancer remains indicated in many cases. Initial partial surgery is indicated for early diseases. This surgery may be performed endoscopically or openly. The results are excellent in terms of local control and function. Transoral robotic surgery is under evaluation. Initial radical surgery is indicated for advanced diseases in case of very infiltrative tumor, in case of cartilage destruction or when tolerance and/or compliance to chemotherapy-based approached is questionable. Larynx preservation is to be discussed between these two situations. In randomized trials evaluating the different larynx preservation strategies, a substantial number of larynxes could be preserved without compromising disease control or survival. The best approach in terms of quality of function preservation, overall acute and late toxicity, disease control and survival is still a matter of clinical research. It must be stressed that salvage surgery is a definite part of these larynx preservation protocols in order to maintain the ultimate disease control. This discussion underscored the need of a multidisciplinary decision making and the need of a coordinated clinical research.
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Larynx Preservation Clinical Trial Design: Key Issues and Recommendations—A Consensus Panel Summary: In Regard to Lefebvre et al., for the Larynx Preservation Consensus Panel (Int J Radiat Oncol Biol Phys 2009;73:1293–1303). Int J Radiat Oncol Biol Phys 2009; 75:633; author reply 633-4. [DOI: 10.1016/j.ijrobp.2009.05.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 05/06/2009] [Indexed: 11/17/2022]
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Gillespie MB, Rubinchik S, Hoel B, Sutkowski N. Human papillomavirus and oropharyngeal cancer: what you need to know in 2009. Curr Treat Options Oncol 2009; 10:296-307. [PMID: 19768554 DOI: 10.1007/s11864-009-0113-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 09/03/2009] [Indexed: 01/30/2023]
Abstract
OPINION STATEMENT Oropharyngeal cancer has demonstrated a steady increase in incidence over the past 20 years in contrast to declining numbers of head and neck squamous cell carcinoma (HNSCC) overall. Recent evidence has found that high-risk strains of human papillomavirus (HPV) are the likely cause of the changing epidemiology of oropharyngeal cancer. HPV-associated oropharyngeal cancer has a molecular, epidemiological, and clinical profile that is distinct from non-HPV HNSCC. Clinicians managing oropharyngeal HNSCC need to be aware of differences in the HPV HNSCC population which may impact treatment outcomes. Testing of HNSCC tumor tissue for HPV using validated and precise techniques should be performed when feasible.
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Affiliation(s)
- M Boyd Gillespie
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue MSC 550, Charleston, SC 29425-5500, USA,
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Organ function and quality of life after transoral laser microsurgery and adjuvant radiotherapy for locally advanced laryngeal cancer. Strahlenther Onkol 2009; 185:303-9. [PMID: 19440669 DOI: 10.1007/s00066-009-1967-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 10/31/2008] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Transoral laser microsurgery (TLM) and adjuvant radiotherapy are an established therapy regimen for locally advanced laryngeal cancer at our institution. Aim of the present study was to assess value of quality of life (QoL) data with special regard to organ function under consideration of treatment efficacy in patients with locally advanced laryngeal cancer treated with larynx-preserving TLM and adjuvant radiotherapy. PATIENTS AND METHODS From 1994 to 2006, 39 patients (ten UICC stage III, 29 UICC stage IVA/B) with locally advanced laryngeal carcinomas were treated with TLM and adjuvant radiotherapy. Data concerning treatment efficacy, QoL (using the VHI [Voice Handicap Index], the EORTC QLQ-C30 and QLQ-H&N35 questionnaires) and organ function (respiration, deglutition, voice quality) were obtained for ten patients still alive after long-term follow-up. Correlations were determined using the Spearman rank test. RESULTS After a median follow-up of 80.8 months, the 5-year overall survival rate was 46.8% and the locoregional control rate 76.5%, respectively. The larynx preservation rate was 89.7% for all patients and 100% for patients still alive after follow-up. Despite some verifiable problems in respiration, speech and swallowing, patients showed a subjectively good QoL. CONCLUSION TLM and adjuvant radiotherapy is a curative option for patients with locally advanced laryngeal cancer and an alternative to radical surgery. Even if functional deficits are unavoidable in the treatment of locally advanced laryngeal carcinomas, larynx preservation is associated with a subjectively good QoL.
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Dental therapy before and after radiotherapy--an evaluation on patients with head and neck malignancies. Clin Oral Investig 2008; 13:157-64. [PMID: 18925418 PMCID: PMC3085778 DOI: 10.1007/s00784-008-0229-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2008] [Accepted: 09/22/2008] [Indexed: 11/06/2022]
Abstract
The present investigation evaluates the dental care situation of patients with head and neck cancer before and after radiotherapy. The situations of these patients in 1993 and 2005 were compared to detect similarities, differences and developments. In the years 1993 and 2005, 37 and 36 patients, respectively, with head and neck cancer treated by the local departments of otorhinolaryngology and of radiotherapy were examined consecutively according to their aftercare appointments. Time points of radiotherapy treatment of the patients evaluated in 1993 varied from 1984 to 1993. The patients evaluated in 2005 had received radiotherapy between 1998 and 2005. Therefore the applied radiotherapeutic regimen differed not only between the two groups of patients, but also within each group. The information for these investigations was provided anonymously. It was evaluated with descriptive statistics. The evaluation of the data shows distinct differences with respect to preventive and therapeutic dental care measures. In 2005, 35 out of 36 patients (97.2%) had a dental consultation before radiotherapy (1993, 65%). All 27 dentate patients (100%) obtained a splint for fluoride application (1993, none). 29% fewer edentulous patients were seen than in 1993. The number of teeth destroyed decreased from 19.2% (1993) to 7.8% in 2005. Mycoses due to Candida spp. and chronic failures in wound healing were rare (5.5%). In the course of the 12 years, prophylactic measures, such as the application of splints for fluoride treatment, were intensified. However, concepts for the dental care of patients undergoing radiotherapy, especially following the radiation, should be widened to avoid ruined teeth and long delayed wound healings.
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Jäckel MC, Ambrosch P, Christiansen H, Martin A, Steiner W. Value of postoperative radiotherapy in patients with pathologic N1 neck disease. Head Neck 2008; 30:875-82. [DOI: 10.1002/hed.20794] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Jäckel MC, Martin A, Steiner W. Twenty-five years experience with laser surgery for head and neck tumors. Eur Arch Otorhinolaryngol 2007; 264:577-85. [PMID: 17447079 DOI: 10.1007/s00405-007-0280-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 02/14/2007] [Indexed: 11/29/2022]
Abstract
During the last 25 years, the treatment of tumors arising in the upper aerodigestive tract has changed fundamentally. Whereas surgery in the 1970s aimed at radical block resection and defect repair from outside, the establishment of transoral laser microsurgery marked a new era of organ- and function-preserving therapy. An international symposium, held on 10 and 11 June 2005 in Göttingen, was dedicated to a critical review and assessment of the current role of laser surgery for the treatment of head and neck cancer. Experts from five continents presented their experiences and scientific results and had an intensive exchange with participants from different countries. The topics of the symposium were focused on the surgical principles of laser resection, the oncological and functional results in comparison with traditional therapy, the difficulties and limits of laser surgery in distinct anatomical regions and on the role of radiotherapy. This report summarizes the most important results and statements and gives an overview of actual developments. The names and addresses of the participants mentioned in this report are appended below.
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Yao M, Epstein JB, Modi BJ, Pytynia KB, Mundt AJ, Feldman LE. Current surgical treatment of squamous cell carcinoma of the head and neck. Oral Oncol 2007; 43:213-23. [PMID: 16978911 DOI: 10.1016/j.oraloncology.2006.04.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 04/26/2006] [Indexed: 11/27/2022]
Abstract
Historically treatment of head and neck cancers involved surgical resection followed by radiation therapy for advanced tumors. Concurrent chemoradiation therapies have shown equal survival to surgical resection with better preservation of function. However, concurrent therapy does entail significant morbidity, and recent advances have been used to minimize that morbidity. Newer tumor specific medical therapies are anticipated to be less toxic while maintaining a high degree of efficacy. For resectable cancer, transoral laser microsurgery is a new trend in surgery for complete resection of tumors with preservation of function. Advanced reconstructive techniques that allow free transfer of soft tissue and bone from all over the body improve the functional and aesthetic outcomes following major ablative surgery. With successful surgical reconstruction, dental and prosthetic rehabilitation choices are enhanced. Advances in rehabilitation of speech following removal of the larynx have improved the quality of life post-laryngectomy patients. With these newer therapies and methods of reconstruction, each patient needs to be carefully evaluated to maximize the possibility of cure and level of function, and minimize the morbidity associated with treatment. Combined chemotherapy and radiation protocols are associated with increased acute and chronic toxicities that may affect the quality of life due to the impact upon oral disease and oral function. Oral care providers must be aware of advances in cancer management and implications for patient care to effectively care for these patients.
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Affiliation(s)
- Mike Yao
- University of Illinois at Chicago, Department of Otolaryngology, 1855 W. Taylor Street, M/C 648, Chicago, IL 60612, United States.
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Cengiz M, Ozyar E, Genc M. In regards to: Adjuvant radiotherapy after transoral laser microsurgery for advanced squamous cell carcinoma of the head and neck by Pradier et al. (Int J Radiat Oncol Biol Phys 2005;63:1368-1377). Int J Radiat Oncol Biol Phys 2006; 65:955; author reply 955-6. [PMID: 16751078 DOI: 10.1016/j.ijrobp.2006.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Accepted: 02/24/2006] [Indexed: 11/18/2022]
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Christiansen H, Hermann RM, Martin A, Florez R, Kahler E, Nitsche M, Hille A, Steiner W, Hess CF, Pradier O. Long-term follow-up after transoral laser microsurgery and adjuvant radiotherapy for advanced recurrent squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2006; 65:1067-74. [PMID: 16750331 DOI: 10.1016/j.ijrobp.2006.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 02/02/2006] [Accepted: 03/09/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy of adjuvant radiotherapy after transoral laser microsurgery for advanced recurrent head-and-neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS Between 1988 and 2000, 37 patients with advanced local recurrences (23 local and 14 locoregional recurrences) of HNSCC without distant metastases were treated in curative intent with organ-preserving transoral laser microsurgery and adjuvant radiotherapy (before 1994 split-course radiotherapy with carboplatinum, after 1994 conventional radiotherapy). Initial therapy of the primary (8.1% oral cavity, 35.1% oropharynx, 13.5% hypopharynx, and 43.3% larynx) before relapse was organ-preserving transoral laser microsurgery without any adjuvant therapy. RESULTS After a median follow-up of 124 months, the 5-year overall survival rate was 21.3%, the loco-regional control rate 48.3%, respectively. In multivariate analysis, stage of original primary tumor (Stage I/II vs. Stage III/IV), and patient age (<58 years vs. >or=58 years) showed statistically significant impact on prognosis. In laryngeal cancer, larynx preservation rate after treatment for recurrent tumor was 50% during follow-up. CONCLUSION Our data show that organ-preserving transoral laser microsurgery followed by adjuvant radiotherapy is a curative option for patients who have advanced recurrence after transoral laser surgery and is an alternative to radical treatment.
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Affiliation(s)
- Hans Christiansen
- Department of Radiotherapy, University of Göttingen, Göttingen, Germany, and Départmentde Cancérologie, Hôpital Morvan, Centre Hospitalier Universitaire de Brest, France.
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