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Arboleda LPA, de Carvalho GB, Santos-Silva AR, Fernandes GA, Vartanian JG, Conway DI, Virani S, Brennan P, Kowalski LP, Curado MP. Squamous Cell Carcinoma of the Oral Cavity, Oropharynx, and Larynx: A Scoping Review of Treatment Guidelines Worldwide. Cancers (Basel) 2023; 15:4405. [PMID: 37686681 PMCID: PMC10486835 DOI: 10.3390/cancers15174405] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Head and neck cancer (HNC) treatments have been based on single or multimodal therapies with surgery, radiotherapy (RT), chemotherapy, and immunotherapy. However, treatment recommendations among countries may differ due to technological/human resources and usual local practices. This scoping review aims to identify, compare, and map the clinical practice guidelines (CPGs) for treating squamous cell carcinoma (SCC) of the oral cavity, oropharynx, and larynx worldwide. A search strategy on global CPGs for HNC was performed by using five electronic databases and grey literature. CPGs were selected for inclusion using EndNote-20 and Rayyan online software. No language or publication date restrictions were applied. The results were analyzed descriptively considering the most updated CPG version. In total, 25 CPGs covering the head and neck region (10), the larynx (7), the oral cavity (5), and the oropharynx (3), were found in 13 geographical regions, and 19 were developed by medical societies from 1996 to 2023. Surgery and RT remain the main modalities for early-stage HNC, with surgery preferred in low-resource countries, and RT in selected cases, especially in the larynx/oropharynx aiming to achieve a cure with organ preservation. Human papillomavirus infection for oropharyngeal SCC is not tested in some Asian countries and there is still no consensus to treat p16-positive cases differently from p16-negative. Recommendations for larynx preservation vary according to facilities in each country, however, individualized choice is emphasized. Inequality across countries/continents is evident, with a similar pattern of recommendations among developed as well as developing ones. No CPGs were found in Latin America as well as Oceania countries, where the incidence of HNC is high and limitations of access to treatment may be encountered.
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Affiliation(s)
| | - Genival Barbosa de Carvalho
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C.Camargo Cancer Center, Sao Paulo 01508-020, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, Brazil
| | - Gisele Aparecida Fernandes
- Group of Epidemiology and Statistics on Cancer, A.C.Camargo Cancer Center, Rua Tagua, 440, Liberdade, Sao Paulo CEP 01508-020, Brazil
| | - Jose Guilherme Vartanian
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C.Camargo Cancer Center, Sao Paulo 01508-020, Brazil
| | - David I. Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow G2 3JZ, UK
| | - Shama Virani
- Genomic Epidemiology Group, International Agency for Research on Cancer (IARC/WHO), G2 3JZ Lyon, France
| | - Paul Brennan
- Genomic Epidemiology Group, International Agency for Research on Cancer (IARC/WHO), G2 3JZ Lyon, France
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C.Camargo Cancer Center, Sao Paulo 01508-020, Brazil
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo 05403-000, Brazil
| | - Maria Paula Curado
- Group of Epidemiology and Statistics on Cancer, A.C.Camargo Cancer Center, Rua Tagua, 440, Liberdade, Sao Paulo CEP 01508-020, Brazil
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2
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Schicho A, Habicher W, Wendl C, Stroszczynski C, Strotzer Q, Dollinger M, Schreyer AG, Schleder S. Clinical Value of Diffusion-Weighted Whole-Body Imaging with Background Body Signal Suppression (DWIBS) for Staging of Patients with Suspected Head and Neck Cancer. Tomography 2022; 8:2522-2532. [PMID: 36287809 PMCID: PMC9607011 DOI: 10.3390/tomography8050210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 11/20/2022] Open
Abstract
(1) Background: To determine the importance of diffusion-weighted whole-body MRI with background body signal suppression (DWIBS) in the staging process of patients with suspected head and neck carcinomas. (2) Methods: A total of 30 patients (24 male, 6 female) with a median age of 67 years with clinically suspected head and neck carcinoma with pathologic cervical nodal swelling in ultrasound underwent the staging procedure with computed tomography (CT) and whole-body MRI including DWIBS. (3) Results: In a total of 9 patients, abnormalities in the routine work-up of pretherapeutic staging were found. Five cases of either secondary cancer or distant metastases were only visible in DWIBS, while being missed on CT. One diagnosis was only detectable in CT and not in DWIBS, whereas three diagnoses were recognizable in both modalities. (4) Conclusions: DWIBS in addition to a standard neck MRI in cervical lymphadenopathy suspicious for head and neck cancer yielded additional clinically relevant diagnoses in 17% of cases that would have been missed by current staging routine procedures. DWIBS offered a negative predictive value of 98.78% for ruling out distant metastases or secondary malignancies.
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Affiliation(s)
- Andreas Schicho
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany
- Correspondence:
| | - Werner Habicher
- Department of Othorhinolaryngology, Merciful Brothers Hospital St. Elisabeth, 94315 Straubing, Germany
| | - Christina Wendl
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany
| | | | - Quirin Strotzer
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Marco Dollinger
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Andreas G. Schreyer
- Department of Diagnostic and Interventional Radiology, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, 14770 Neuruppin, Germany
| | - Stephan Schleder
- Department of Diagnostic and Interventional Radiology, Merciful Brothers Hospital St. Elisabeth, 94315 Straubing, Germany
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3
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Dyckhoff G, Warta R, Herold-Mende C, Plinkert PK, Ramroth H. [Larynx preservation: recommendations for decision-making in T3 laryngeal cancer patients]. HNO 2022; 70:581-587. [PMID: 35575826 PMCID: PMC9329161 DOI: 10.1007/s00106-022-01177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND By today's standard, the optimal treatment of every individual tumor patient is discussed and determined in an interdisciplinary tumor board. According to the new S3 guidelines, larger volume T3 laryngeal cancers which are no longer safely resectable with larynx-sparing surgery are ideal candidates for a larynx preservation approach using primary chemoradiation (pCRT). So far, no clear criteria have been defined under what circumstances primary radiotherapy alone (pRT) might be acceptable in case chemotherapy (CT) is prohibited or in what cases, even in T3, upfront total laryngectomy with risk-adapted adjuvant treatment (TL±a[C]RT) should be recommended. METHOD The literature was searched for parameters chosen as criteria for an inclusion in the surgical rather than the conservative arm in non-randomized LP studies or which proved to be significant prognostic markers after conservative treatment. Development of a counselling tool for therapeutic decision making. RESULTS Significant prognostic markers were tumor volume (< 3.5 ccm/< 6 ccm vs. 6-12 ccm vs. > 12 ccm), presence and kind of vocal cord fixation (none vs. Succo I/II vs. Succo III/IV), extent of cartilage infiltration (none vs. minimal vs. multiple/gross), nodal status (N0‑1 vs. N2-3), and laryngeal dysfunction (pretreatment necessity of feeding tube or tracheostomy). CONCLUSION For T3 laryngeal cancers, pRT could be acceptable when the tumor volume is < 3.5 ccm for glottic and < 6 ccm for supraglottic tumors and there are no further risk factors. pCRT can be regarded as the standard for LP for tumors between 6 ccm and 12 ccm, vocal cord fixation Succo pattern I/II, only minimal cartilage infiltration and a high nodal burden. For tumor > 12 ccm, vocal cord fixation Succo pattern III/IV, gross or multiple cartilage infiltration or clinically relevant laryngeal dysfunction, upfront TL±a[C]RT should be considered.
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Affiliation(s)
- Gerhard Dyckhoff
- Universitäts-Hals-Nasen-Ohrenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - Rolf Warta
- Universitäts-Hals-Nasen-Ohrenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.,Neurochirurgische Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - Christel Herold-Mende
- Universitäts-Hals-Nasen-Ohrenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.,Neurochirurgische Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - Peter K Plinkert
- Universitäts-Hals-Nasen-Ohrenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Heribert Ramroth
- Heidelberger Institut für Global Health, Universität Heidelberg, Heidelberg, Deutschland
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Chemoradiotherapy but Not Radiotherapy Alone for Larynx Preservation in T3. Considerations from a German Observational Cohort Study. Cancers (Basel) 2021; 13:cancers13143435. [PMID: 34298650 PMCID: PMC8306673 DOI: 10.3390/cancers13143435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/13/2021] [Accepted: 07/02/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary For advanced laryngeal carcinoma, primary radiotherapy with or without chemotherapy (pCRT or pRT) is used as an alternative to total laryngectomy (TL) to preserve a functional larynx. For advanced laryngeal cancer (T4), poorer survival has been reported after nonsurgical treatment. Is there a need to fear worse survival in moderately advanced tumors (T3)? The outcomes after pRT, pCRT, or surgery were evaluated in 121 patients with T3 laryngeal cancers. pCRT and TL with risk-adopted adjuvant (chemo)radiotherapy (TL ± a(C)RT) yielded results without a significant survival difference. However, after pRT alone, survival was significantly poorer than after TL ± a(C)RT. Thus, according to our data and supported by the literature, pCRT instead of pRT alone is recommended for T3 laryngeal cancers. According to the literature, this recommendation also applies to bulky tumors (6–12 mm), vocal cord fixation, at least minimal cartilage infiltration, and advanced N stage. TL ± a(C)RT instead of larynx preservation should be considered if any of these factors is present and chemotherapy is prohibited; in cases with a tumor volume > 12 mm, severe forms of vocal cord fixation or cartilage infiltration; or when the patient needs a feeding tube or a tracheotomy before the onset of therapy. Abstract For advanced laryngeal cancers, after randomized prospective larynx preservation studies, nonsurgical therapy has been applied on a large scale as an alternative to laryngectomy. For T4 laryngeal cancer, poorer survival has been reported after nonsurgical treatment. Is there a need to fear worse survival also in T3 tumors? The outcomes of 121 T3 cancers treated with pCRT, pRT alone, or surgery were evaluated in an observational cohort study in Germany. In a multivariate Cox regression of the T3 subgroup, no survival difference was noted between pCRT and total laryngectomy with risk-adopted adjuvant (chemo)radiotherapy (TL ± a(C)RT) (HR 1.20; 95%-CI: 0.57–2.53; p = 0.63). However, survival was significantly worse after pRT alone than after TL ± a(C)RT (HR 4.40; 95%-CI: 1.72–11.28, p = 0.002). A literature search shows that in cases of unfavorable prognostic markers (bulky tumors of 6–12 ccm, vocal cord fixation, minimal cartilage infiltration, or N2–3), pCRT instead of pRT is indicated. In cases of pretreatment dysphagia or aspiration requiring a feeding tube or tracheostomy, gross or multiple cartilage infiltration, or tumor volume > 12 ccm, outcomes after pCRT were significantly worse than those after TL. In these cases, and in cases where pCRT is indicated but the patient is not suitable for the addition of chemotherapy, upfront total laryngectomy with stage-appropriate aRT is recommended even in T3 laryngeal cancers.
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van der Kamp MF, van Dijk BAC, Plaat BEC, van der Laan BFAM, Halmos GB. To what extent has the last two decades seen significant progress in the management of older patients with head and neck cancer? Eur J Surg Oncol 2021; 47:1398-1405. [PMID: 33648773 DOI: 10.1016/j.ejso.2021.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Life expectancy is rising and consequently also the number of older patients with head and neck cancer. Different treatment regimens are often applied for older patients. The aim of this study is to investigate how treatment patterns and survival rates have changed over the past 20 years in older patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS Patient and tumour characteristics, treatment and 5-year survival data from the Netherlands Cancer Registry of patients aged ≥60 years diagnosed with HNSCC in 1990-1995 and 2010-2015 were compared using chi-square test and relative survival analysis. RESULTS Data of 14,114 patients were analyzed. Oral cavity cancer treatment did not change over time, while survival improved from 54% to 58% (p = 0.03). Oropharyngeal and hypopharyngeal cancer treatment shifted towards non-surgical, with survival improving from 31% to 51% (p < 0.01) and 26% to 34% (p < 0.01), respectively. Laryngeal cancer treatment changed towards surgery in stage I and non-surgical treatment in stage III and IV disease. Survival in laryngeal cancer stage I remained stable and favorable at a relative survival rate of around 90%. Survival non-significantly changed from 54% to 49% for stage III disease and from 37% to 33% for disease. CONCLUSION Relative survival increased for all head and neck cancer sites in older patients, except for laryngeal cancer. For oropharyngeal, hypopharyngeal and advanced laryngeal cancer, a shift towards non-surgical treatment modalities was observed.
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Affiliation(s)
- Martine F van der Kamp
- University of Groningen, University Medical Centre Groningen, Department of Otorhinolaryngology, Head & Neck Surgery, Groningen, the Netherlands.
| | - Boukje A C van Dijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; University of Groningen, University Medical Centre Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Boudewijn E C Plaat
- University of Groningen, University Medical Centre Groningen, Department of Otorhinolaryngology, Head & Neck Surgery, Groningen, the Netherlands
| | - Bernard F A M van der Laan
- University of Groningen, University Medical Centre Groningen, Department of Otorhinolaryngology, Head & Neck Surgery, Groningen, the Netherlands
| | - Gyorgy B Halmos
- University of Groningen, University Medical Centre Groningen, Department of Otorhinolaryngology, Head & Neck Surgery, Groningen, the Netherlands
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Graff P, Blanchard P, Thariat J, Racadot S, Lapeyre M. [Post-treatment follow-up of head and neck cancer patients]. Cancer Radiother 2019; 23:576-580. [PMID: 31422000 DOI: 10.1016/j.canrad.2019.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 06/26/2019] [Indexed: 12/13/2022]
Abstract
Post-therapeutic follow-up of patients with head and neck cancer involves numerous professionals. The radiation oncologist should play an active role in this process. His oncological knowledge and technical expertise position him as a cornerstone for the detection of recurrences from the treated tumor, the research of second primary cancers and the screening of potential side-effects induced by the different treatments administered. To improve the benefits/costs ratio and allow good patient-compliance, follow-up programs should be built through close collaboration between the different contributors and planned according to a feasible schedule. Paraclinical exams must be arranged to respond to accurate objectives. Patient-education is essential to ensure the patient's full understanding and active participation. Finally, the transfer of the long-term follow-up of cancer survivors from specialists to primary care physicians is relevant but would require a prospective evaluation of its efficiency for this specific population.
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Affiliation(s)
- P Graff
- Département de radiothérapie, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France.
| | - P Blanchard
- Département de radiothérapie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - S Racadot
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
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Perlow HK, Ramey SJ, Cassidy V, Kwon D, Farnia B, Nicolli E, Samuels MA, Freedman L, Elsayyad N, Yechieli R, Samuels SE. Disparities in adherence to head and neck cancer follow-up guidelines. Laryngoscope 2018; 129:2303-2308. [PMID: 30582620 DOI: 10.1002/lary.27676] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES In this study, we aim to determine the frequency of adherence to National Comprehensive Cancer Network follow-up guidelines in a population of head and neck cancer patients who received curative treatment. We will also assess the impact of race, ethnicity, socioeconomic status, and treatment setting on utilization of follow-up care. METHODS This study included patients with biopsy-proven, nonmetastatic oropharyngeal or laryngeal cancer treated with radiotherapy between January 1, 2014, and June 30, 2016, at a safety-net hospital or adjacent private academic hospital. Components of follow-up care analyzed included an appointment with a surgeon or radiation oncologist within 3 months and posttreatment imaging of the primary site within 6 months. Univariable and multivariable analyses were conducted using a logistic regression model to estimate odds ratios and corresponding 95% confidence intervals. RESULTS Two hundred and thirty-four patients were included in this study. Of those, 88.8% received posttreatment imaging of the primary site within 6 months; 88.5% attended a follow-up appointment with a radiation oncologist within 3 months; and 71.1% of patients attended a follow-up appointment with a surgeon within 3 months. On multivariable analysis, private academic hospital treatment versus safety-net hospital treatment was associated with increased utilization of both surgical and radiation oncology follow-up. Non-Hispanic black (NHB) patients, Hispanic patients, and those with a low socioeconomic status were also less likely to receive follow-up. CONCLUSION Safety-net hospital treatment, socioeconomic status, Hispanic ethnicity, and NHB race were associated with decreased follow-up service utilization. Quality improvement initiatives are needed to reduce these disparities. LEVEL OF EVIDENCE 2b Laryngoscope, 129:2303-2308, 2019.
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Affiliation(s)
| | - Stephen J Ramey
- Sylvester Comprehensive Cancer Center, Miami, Florida, U.S.A.,Department of Radiation Oncology, Jackson Memorial Hospital, Miami, Florida, U.S.A
| | | | - Deukwoo Kwon
- Sylvester Comprehensive Cancer Center, Miami, Florida, U.S.A.,Department of Radiation Oncology, University of Miami, Miami, Florida, U.S.A
| | - Benjamin Farnia
- Sylvester Comprehensive Cancer Center, Miami, Florida, U.S.A.,Department of Radiation Oncology, Jackson Memorial Hospital, Miami, Florida, U.S.A
| | - Elizabeth Nicolli
- Sylvester Comprehensive Cancer Center, Miami, Florida, U.S.A.,Department of Otolaryngology, Miami, Florida, U.S.A
| | - Michael A Samuels
- Sylvester Comprehensive Cancer Center, Miami, Florida, U.S.A.,Department of Radiation Oncology, University of Miami, Miami, Florida, U.S.A
| | - Laura Freedman
- Sylvester Comprehensive Cancer Center, Miami, Florida, U.S.A.,Department of Radiation Oncology, University of Miami, Miami, Florida, U.S.A
| | - Nagy Elsayyad
- Sylvester Comprehensive Cancer Center, Miami, Florida, U.S.A.,Department of Radiation Oncology, University of Miami, Miami, Florida, U.S.A
| | - Raphael Yechieli
- Sylvester Comprehensive Cancer Center, Miami, Florida, U.S.A.,Department of Radiation Oncology, University of Miami, Miami, Florida, U.S.A
| | - Stuart E Samuels
- Sylvester Comprehensive Cancer Center, Miami, Florida, U.S.A.,Department of Radiation Oncology, University of Miami, Miami, Florida, U.S.A
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Abstract
PURPOSE OF REVIEW Treatment options for early laryngeal cancer are well established with good local control and 5-year survival. The commonest treatments are radiotherapy or transoral laser microsurgery (TLM). There are advantages and disadvantages of the different modalities, but debate continues regarding the voice outcomes posttreatment. This review will focus on early glottic carcinoma and voice outcomes following the different treatments. RECENT FINDINGS TLM and radiotherapy are both likely to affect voice quality, but the extent of voice change depends on different factors. These factors can be divided into patient, tumour and treatment factors. Recent meta-analyses data show similar voice outcomes for either modality in the treatment of early glottic carcinoma. However, larger tumours and those involving the anterior commissure are associated with worse voice outcomes. SUMMARY There are various considerations for the patient and clinician before deciding on the preferred treatment for early glottic carcinoma. Although both TLM and radiotherapy will affect voice outcomes, the recent meta-analyses show similar voice outcomes for either modality in the treatment of early glottic carcinoma. There are numerous variables in the published studies hindering direct comparisons. These include heterogeneous patient groups, different treatment standardization and methods of voice analysis.
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Halmos GB, Bras L, Siesling S, van der Laan BFAM, Langendijk JA, van Dijk BAC. Age-specific incidence and treatment patterns of head and neck cancer in the Netherlands-A cohort study. Clin Otolaryngol 2017; 43:317-324. [PMID: 28950049 DOI: 10.1111/coa.12991] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To explore the incidence and treatment pattern of head and neck cancer in different age groups. DESIGN Cohort study. SETTING Netherlands Cancer Registry. PARTICIPANTS All new primary head and neck cancer cases diagnosed between 2010 and 2014 were included and categorised into different age groups. MAIN OUTCOME MEASURES Tumour site, stage, treatment modality, location of diagnosis and treatment. RESULTS The study population was composed of 11 558 tumours. Oral cancer was the most common primary site (31%), followed by laryngeal (25%) and oropharyngeal cancer (22%). Ninety-six per cent of the entire study population was diagnosed and/or treated in a certified head and neck oncology centre which was lower in the 80+ population (92%). Multimodality treatment was less frequently applied with increasing age (eg oral cavity: 17% in 80+ vs 34% in 60-; P < .001). The percentage of patients not receiving tumour-directed treatment increased with age (eg oropharyngeal cancer: 25% in 80+ vs 6% in 80-; P < .001). CONCLUSIONS This study confirms that less multimodal and tumour-directed treatment is applied with the increasing age of head and neck cancer patients.
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Affiliation(s)
- G B Halmos
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - L Bras
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences (Damage and Repair in Cancer Development and Cancer Treatment), University of Groningen, Groningen, The Netherlands
| | - S Siesling
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Health Technology and Services Research, MIRA Institute for Technical Medicine and Biomedical Technology, University of Twente, Enschede, The Netherlands
| | - B F A M van der Laan
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B A C van Dijk
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Janssens GO, Langendijk JA, Terhaard CH, Doornaert PA, van den Ende P, de Jong MA, Takes RP, Span PN, Kaanders JH. Quality-of-life after radiotherapy for advanced laryngeal cancer: Results of a phase III trial of the Dutch Head and Neck Society. Radiother Oncol 2016; 119:213-20. [PMID: 27165613 DOI: 10.1016/j.radonc.2016.02.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 02/23/2016] [Accepted: 02/26/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND/PURPOSE To report on health-related quality-of-life (HRQoL) of patients with laryngeal cancer, treated in a randomized trial comparing accelerated radiotherapy with carbogen and nicotinamide (ARCON) against accelerated radiotherapy alone (AR). MATERIAL/METHODS HRQoL was assessed using the HRQoL Questionnaire-C30 (QLQ-C30) and the Head & Neck cancer module (QLQ-H&N35) at baseline, at completion of radiotherapy and at 6, 12, and 24months post-baseline. RESULTS From 269/345 patients (AR: 136/174; ARCON: 133/171) data on HRQoL were available for analysis. Moderate to severe clinical impact of the treatment was observed for nearly all items of the QLQ-C30 and QLQ-H&N35 between baseline and end-of-treatment. At 6months, scores returned to baseline level with exception of dry mouth, sticky saliva, and taste/smell. No difference between AR and ARCON was observed. At 2years from baseline, the percentage of patients reporting moderate to severe complaints of dry mouth, sticky saliva, or changes in taste/smell was 30%, 22% and 18%, respectively, while the majority of patients had no or few complaints of swallowing (79%) or speech (64%). CONCLUSIONS With accelerated radiotherapy, high local tumor control was obtained while maintaining good speech and swallowing function. Long-term dry mouth, sticky saliva and changes in taste/smell are limited to one quarter of patients. (ClinicalTrials.gov number, NCT00147732).
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Affiliation(s)
- Geert O Janssens
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands.
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Chris H Terhaard
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - Patricia A Doornaert
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Piet van den Ende
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Centre, The Netherlands
| | - Martin A de Jong
- Department of Clinical Oncology, Leiden University Medical Centre, The Netherlands
| | - Robert P Takes
- Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Paul N Span
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Johannes H Kaanders
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Blatt S, Ziebart T, Krüger M, Pabst AM. Diagnosing oral squamous cell carcinoma: How much imaging do we really need? A review of the current literature. J Craniomaxillofac Surg 2016; 44:538-49. [DOI: 10.1016/j.jcms.2016.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/28/2016] [Accepted: 02/04/2016] [Indexed: 12/11/2022] Open
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Timmermans AJ, Lange CAH, de Bois JA, van Werkhoven E, Hamming-Vrieze O, Hilgers FJM, van den Brekel MWM. Tumor volume as a prognostic factor for local control and overall survival in advanced larynx cancer. Laryngoscope 2015; 126:E60-7. [DOI: 10.1002/lary.25567] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/02/2015] [Accepted: 07/20/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Adriana J. Timmermans
- Department of Head and Neck Oncology and Surgery; Netherlands Cancer Institute; Amsterdam the Netherlands
| | | | - Josien A. de Bois
- Department of Radiation Oncology; Netherlands Cancer Institute; Amsterdam the Netherlands
| | - Erik van Werkhoven
- Biometrics Department; Netherlands Cancer Institute; Amsterdam the Netherlands
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology; Netherlands Cancer Institute; Amsterdam the Netherlands
| | - Frans J. M. Hilgers
- Department of Head and Neck Oncology and Surgery; Netherlands Cancer Institute; Amsterdam the Netherlands
- Institute of Phonetic Sciences/Amsterdam Center for Language and Communication, University of Amsterdam; Amsterdam the Netherlands
| | - Michiel W. M. van den Brekel
- Department of Head and Neck Oncology and Surgery; Netherlands Cancer Institute; Amsterdam the Netherlands
- Institute of Phonetic Sciences/Amsterdam Center for Language and Communication, University of Amsterdam; Amsterdam the Netherlands
- Department of Oral and Maxillofacial Surgery; Academic Medical Center; Amsterdam the Netherlands
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Timmermans AJ, van Dijk BAC, Overbeek LIH, van Velthuysen MLF, van Tinteren H, Hilgers FJM, van den Brekel MWM. Trends in treatment and survival for advanced laryngeal cancer: A 20-year population-based study in The Netherlands. Head Neck 2015; 38 Suppl 1:E1247-55. [DOI: 10.1002/hed.24200] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 05/19/2015] [Accepted: 07/07/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Adriana J. Timmermans
- Department of Head and Neck Oncology and Surgery; The Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Boukje A. C. van Dijk
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research; Utrecht The Netherlands
- University of Groningen, University Medical Centre Groningen, Department of Epidemiology; Groningen The Netherlands
| | - Lucy I. H. Overbeek
- PALGA (the Dutch nationwide network and registry of histopathology and cytopathology); Houten The Netherlands
| | - Marie-Louise F. van Velthuysen
- PALGA (the Dutch nationwide network and registry of histopathology and cytopathology); Houten The Netherlands
- Department of Pathology; the Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Harm van Tinteren
- Biometrics Department; the Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Frans J. M. Hilgers
- Department of Head and Neck Oncology and Surgery; The Netherlands Cancer Institute; Amsterdam The Netherlands
- Institute of Phonetic Sciences, University of Amsterdam; Amsterdam The Netherlands
- Department of Oral and Maxillofacial Surgery; Academic Medical Center; Amsterdam The Netherlands
| | - Michiel W. M. van den Brekel
- Department of Head and Neck Oncology and Surgery; The Netherlands Cancer Institute; Amsterdam The Netherlands
- Institute of Phonetic Sciences, University of Amsterdam; Amsterdam The Netherlands
- Department of Oral and Maxillofacial Surgery; Academic Medical Center; Amsterdam The Netherlands
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Marioni G, Ottaviano G, Lionello M, Fasanaro E, Staffieri C, Giacomelli L, Gattazzo S, Staffieri A, Blandamura S. A panel of biomarkers for predicting response to postoperative RT for laryngeal cancer? Am J Otolaryngol 2014; 35:771-8. [PMID: 25064017 DOI: 10.1016/j.amjoto.2014.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 06/10/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Postoperative radiotherapy (PORT) improves locoregional control and survival rates for patients with advanced laryngeal carcinoma (LSCC), but reported outcomes after PORT for LSCC vary considerably. Predictive markers (including biomarkers) are needed for LSCC to orient the choice of the most appropriate adjuvant therapy for individual patients. The aim of this study was to identify a panel of LSCC tissue markers (considering EGFR, mTOR, survivin, Bcl-2, angiogenin, endoglin [CD105], nm23-H1) capable of pinpointing patients at higher risk of recurrence among 33 LSCC cases treated with PORT. METHODS/RESULTS Univariate analysis found 4 biomarkers (mTOR, nuclear survivin, CD105, non-nuclear nm23-H1) significantly associated with LSCC recurrence. A collinearity emerged between mTOR and CD105 expressions. The predictive role of two different panels (panel 1: mTOR, nuclear survivin, non-nuclear nm23-H1; panel 2: CD105, nuclear survivin, non-nuclear nm23-H1) was considered. According to the Hosmer and Lemeshow scale, panel 1 demonstrated an outstanding discriminatory power (AUC 0.903) in predicting LSCC recurrence after PORT. Panel 2 had an excellent discriminatory power too (AUC 0.899). CONCLUSIONS Both panels of biomarkers showed an important discriminatory power in pinpointing patients at higher risk of recurrence after PORT for LSCC who could reasonably benefit from adjuvant postoperative chemo-RT.
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Timmermans AJ, de Gooijer CJ, Hamming-Vrieze O, Hilgers FJM, van den Brekel MWM. T3-T4 laryngeal cancer in The Netherlands Cancer Institute; 10-year results of the consistent application of an organ-preserving/-sacrificing protocol. Head Neck 2014; 37:1495-503. [PMID: 24891221 DOI: 10.1002/hed.23789] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 03/18/2014] [Accepted: 05/28/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Both organ-preserving concurrent (chemo)radiotherapy ((C)RT) and organ-sacrificing surgery (total laryngectomy) are used for treatment of advanced laryngeal cancer. The purpose of this study was to present the assessment of our treatment protocol for T3 (C)RT and T4 disease (total laryngectomy + postoperative RT). METHODS We conducted a retrospective cohort study in 182 consecutive patients (1999-2008). The primary outcome was overall survival (OS) in relation to stage and treatment. RESULTS One hundred two patients received RT (82.4% T3), 20 patients CRT (60.0% T3), and 60 patients total laryngectomy + RT (91.7% T4). Five-year OS: T3 52%, T4 48%, for RT 50%, for CRT 43%, and for total laryngectomy + RT 52%. Five-year laryngectomy-free interval was 72% after RT, and 83% after CRT. CONCLUSION There were no differences in survival according to T classification or treatment modality. Because the majority of T3 laryngeal cancers were treated with (C)RT and the majority of T4 with total laryngectomy + RT, this gives food for thought on whether the present protocol for T3 laryngeal cancer is optimal.
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Affiliation(s)
- Adriana J Timmermans
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Cornedine J de Gooijer
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frans J M Hilgers
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Institute of Phonetic Sciences, University of Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Institute of Phonetic Sciences, University of Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Levy A, Blanchard P, Temam S, Maison MM, Janot F, Mirghani H, Bidault F, Guigay J, Lusinchi A, Bourhis J, Daly-Schveitzer N, Tao Y. Squamous cell carcinoma of the larynx with subglottic extension: is larynx preservation possible? Strahlenther Onkol 2014; 190:654-60. [PMID: 24589921 DOI: 10.1007/s00066-014-0647-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/28/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Squamous cell carcinoma of larynx with subglottic extension (sSCC) is a rare location described to carry a poor prognosis. The aim of this study was to analyze outcomes and feasibility of larynx preservation in sSCC patients. PATIENTS AND METHODS Between 1996 and 2012, 197 patients with sSCC were treated at our institution and included in the analysis. Stage III-IV tumors accounted for 76%. Patients received surgery (62%), radiotherapy (RT) (18%), or induction chemotherapy (CT) (20%) as front-line therapy. RESULTS The 5-year actuarial overall survival (OS), locoregional control (LRC), and distant control rate were 59% (95% CI 51-68), 83% (95% CI 77-89), and 88% (95% CI 83-93), respectively, with a median follow-up of 54.4 months. There was no difference in OS and LRC according to front-line treatments or between primary subglottic cancer and glottosupraglottic cancers with subglottic extension. In the multivariate analysis, age > 60 years and positive N stage were the only predictors for OS (HR 2, 95% CI 1.2-3.6; HR1.9, 95% CI 1-3.5, respectively). A lower LRC was observed for T3 patients receiving a larynx preservation protocol as compared with those receiving a front-line surgery (HR 14.1, 95% CI 2.5-136.7; p = 0.02); however, no difference of ultimate LRC was observed according to the first therapy when including T3 patients who underwent salvage laryngectomy (p = 0.6). In patients receiving a larynx preservation protocol, the 5-year larynx-preservation rate was 55% (95% CI 43-68), with 36% in T3 patients. The 5-year larynx preservation rate was 81% (95% CI 65-96) and 35% (95% CI 20-51) for patients who received RT or induction CT as a front-line treatment, respectively. CONCLUSION Outcomes of sSCC are comparable with other laryngeal cancers when managed with modern therapeutic options. Larynx-preservation protocols could be a suitable option in T1-T2 (RT or chemo-RT) and selected T3 sSCC patients (induction CT).
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Affiliation(s)
- A Levy
- Department of Radiotherapy, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
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Marioni G, Blandamura S, Lionello M, Giacomelli L, Lovato A, Favaretto N, Breda S, Tealdo G, Guzzardo V, Ottaviano G, Staffieri A. Indications for postoperative radiotherapy in laryngeal carcinoma: A panel of tumor tissue markers for predicting locoregional recurrence in surgically treated carcinoma. A pilot study. Head Neck 2013; 36:1534-40. [DOI: 10.1002/hed.23493] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 06/17/2013] [Accepted: 08/23/2013] [Indexed: 12/19/2022] Open
Affiliation(s)
- Gino Marioni
- Department of Neurosciences, Otolaryngology Section; University of Padova; Padova Italy
| | | | - Marco Lionello
- Department of Neurosciences, Otolaryngology Section; University of Padova; Padova Italy
| | | | - Andrea Lovato
- Department of Neurosciences, Otolaryngology Section; University of Padova; Padova Italy
| | - Niccolò Favaretto
- Department of Neurosciences, Otolaryngology Section; University of Padova; Padova Italy
| | - Stefano Breda
- Department of Neurosciences, Otolaryngology Section; University of Padova; Padova Italy
| | - Giulia Tealdo
- Department of Neurosciences, Otolaryngology Section; University of Padova; Padova Italy
| | | | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section; University of Padova; Padova Italy
| | - Alberto Staffieri
- Department of Neurosciences, Otolaryngology Section; University of Padova; Padova Italy
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Practice of laryngectomy rehabilitation interventions: a perspective from Europe/the Netherlands. Curr Opin Otolaryngol Head Neck Surg 2013; 21:230-8. [PMID: 23572017 DOI: 10.1097/moo.0b013e3283610060] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Total laryngectomy rehabilitation (TLR) in Europe is not uniform, with quite some differences in approach and infrastructure between various countries. In, for example, the Netherlands, Switzerland, Scandinavia, and more recently also in the UK, head and neck cancer (HNC) treatment and rehabilitation shows a high level of centralization in dedicated HNC centres. In other European countries, the level of centralization is lower, with more patients treated in low-volume hospitals. This article focusses on the situation in the Netherlands and, where applicable, will discuss the regional variations in Europe. RECENT FINDINGS Prosthetic surgical voice restoration (PSVR) presently is the method of choice in Europe, and use of oesophageal and electrolarynx voice has moved to the background. In most European countries (except the UK and Ireland), PSVR is physician driven, with an indispensable role for speech-language pathologists and increasingly for oncology nurses. Indwelling voice prostheses are mostly preferred, also because these devices can be implanted at the time of trachea-oesophageal puncture. Pulmonary rehabilitation is achieved with heat and moisture exchangers, which, based on extensive clinical and basic physiology research, are considered an obligatory therapy measure. In addition to PSVR, also issues such as smoking cessation, dysphagia/swallowing rehabilitation, and olfaction/taste rehabilitation are discussed. Especially, the latter has shown great progress over the last decade and is another example of increasing implementation of evidence-based practice in TLR. SUMMARY TLR has shown considerable progress over the last decades, and through the intensified collaboration between all clinicians involved, significantly has improved vocal, pulmonary, and olfactory rehabilitation after total laryngectomy.
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Lévy A, Blanchard P, Janot F, Temam S, Bourhis J, Daly-Schveitzer N, Tao Y. [Results of definitive radiotherapy for squamous cell carcinomas of the larynx patients with subglottic extension]. Cancer Radiother 2013; 18:1-6. [PMID: 24309002 DOI: 10.1016/j.canrad.2013.06.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 06/10/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Squamous cell carcinoma of larynx with subglottic extension is a rare location described to carry a poor prognosis. The aim of this study was to analyze outcomes and feasibility of definitive radiotherapy in patients with squamous cell carcinoma. PATIENTS AND METHODS Between 1998 and 2012, 56 patients with squamous cell carcinoma were treated at our institution and included in the analysis. Patients received definitive radiotherapy/chemoradiotherapy alone (63%) or after induction chemotherapy (37%) at our institute. RESULTS The 5-year actuarial overall survival, progression-free survival and specific survival were 64% (CI 95%: 48-90), 45% (CI 95%: 28-61), 88% (CI 95%: 78-98), respectively, with median follow-up of 74 months. The 5-year locoregional control was 69% (CI 95%: 56-83) and the 5-year distant control was 95% (CI 95%: 89-100). There was no difference in overall survival and locoregional control according to front-line treatments or between primary subglottic cancer and glotto-supraglottic cancers with subglottic extension. In the multivariate analysis, performance status of at least 1 and positive N stage were the only predictors for overall survival (hazard ratio [HR] [CI 95%]: 6.5 [1.3-34; P=0.03] and 11 [1.6-75; P=0.02], respectively). No difference of locoregional control was observed according to the first received therapy. The univariate analysis retrieved that T3-T4 patients had a lower locoregional control (HR: 3.1; CI 95%: 1.1-9.2, P=0.04), but no prognostic factor was retrieved in the multivariate analysis. In patients receiving a larynx preservation protocol, 5-year larynx preservation rate was 88% (CI 95%: 78-98), and 58% in T3 patients. The 5-year larynx preservation rate was 91% (CI 95%: 79-100) and 83% (CI 95%: 66-100) for patients who received radiotherapy/chemoradiotherapy or induction chemotherapy as a front-line treatment, respectively. CONCLUSION This analysis suggests that the results for squamous cell carcinoma patients treated with radiotherapy/chemoradiotherapy are comparable to those obtained for other laryngeal tumors. This thus suggests the feasibility of laryngeal preservation protocols for infringement subglottic for selected cases. Further studies are needed to clarify these preliminary data.
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Affiliation(s)
- A Lévy
- Service d'oncologie-radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - P Blanchard
- Service d'oncologie-radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - F Janot
- Département de chirurgie ORL, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - S Temam
- Département de chirurgie ORL, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - J Bourhis
- Service d'oncologie-radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Service d'oncologie-radiothérapie, Lausanne, Suisse
| | - N Daly-Schveitzer
- Service d'oncologie-radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Y Tao
- Service d'oncologie-radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
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Oemus D, Inhestern J, Schmalenberg H, Schultze-Mosgau S, Mentzel HJ, Guntinas-Lichius O. Prognostic value of tumor volumetry data of routine imaging data in a head and neck cancer registry. Eur Arch Otorhinolaryngol 2013; 271:2531-7. [DOI: 10.1007/s00405-013-2800-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 10/28/2013] [Indexed: 12/24/2022]
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Wolff KD, Follmann M, Nast A. The diagnosis and treatment of oral cavity cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:829-35. [PMID: 23248713 DOI: 10.3238/arztebl.2012.0829] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 10/04/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND About 10,000 persons are diagnosed as having carcinoma of the oral cavity or the throat in Germany every year. Squamous-cell carcinoma accounts for 95% of cases. METHODS We systematically reviewed the pertinent literature on predefined key questions about these tumors (which were agreed upon by a consensus of the investigators), concerning imaging, the removal of cervical lymph nodes, and resection of the primary tumor. RESULTS 246 clinical trials were selected for review on the basis of 3014 abstracts. There was only one randomized, controlled trial (evidence level 1-); the remaining trials reached evidence levels 2++ to 3. Patients with mucosal changes of an unclear nature persisting for more than two weeks should be examined by a specialist without delay. The diagnosis is made by computed tomography or magnetic resonance imaging along with biopsy and a standardized histopathological examination. Occult metastases are present in 20% to 40% of cases. Advanced disease (stages T3 and T4) should be treated by surgery followed by radiotherapy, with or without chemotherapy. 20% of the patients overall go on to have a recurrence, usually within 2 to 3 years of the initial treatment. The 5-year survival rate is somewhat above 50%. Depending on the radicality of surgery and radiotherapy, there may be functional deficits, osteoradionecrosis, and xerostomia. The rate of loss of implants in irradiated bone is about 10% in 3 years. CONCLUSION The interdisciplinary planning and implementation of treatment, based on the patient's individual constellation of findings and personal wishes, are prerequisites for therapeutic success. Reconstructive measures, particularly microsurgical ones, have proven their usefulness and are an established component of surgical treatment.
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Affiliation(s)
- Klaus-Dietrich Wolff
- Clinic and Policlinic for Oro-Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany.
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Digonnet A, Hamoir M, Andry G, Haigentz M, Takes RP, Silver CE, Hartl DM, Strojan P, Rinaldo A, de Bree R, Dietz A, Grégoire V, Paleri V, Langendijk JA, Vander Poorten V, Hinni ML, Rodrigo JP, Suárez C, Mendenhall WM, Werner JA, Genden EM, Ferlito A. Post-therapeutic surveillance strategies in head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 2012; 270:1569-80. [DOI: 10.1007/s00405-012-2172-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 08/15/2012] [Indexed: 12/17/2022]
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Tong CC, Au KH, Ngan RKC, Cheung FY, Chow SM, Fu YT, Au JSK, Law SCK. Definitive radiotherapy for early stage glottic cancer by 6 MV photons. HEAD & NECK ONCOLOGY 2012; 4:23. [PMID: 22607730 PMCID: PMC3448507 DOI: 10.1186/1758-3284-4-23] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 04/29/2012] [Indexed: 11/24/2022]
Abstract
Purpose To evaluate the clinical outcome of early glottic cancer (GC) treated by primary radiotherapy (RT) with 6 MV photons. Methods and materials We retrospectively reviewed the medical records of 695 consecutive patients with T1N0 and T2N0 GC treated between 1983 and 2005 by RT in our institution. Clinical outcome in terms of local control (LC), overall survival (OS) and cause- specific survival (CSS) rate were evaluated. Results The median follow-up time was 10.5 years. The 10-year actuarial LC rates were as follows: T1A, 91%; T1B, 87%; T2, 77%. The 10-year OS were as follows: T1, 74.2%; T2, 70.7%. The 10-year CSS were as follows: T1, 97.7%; T2, 97.1%. Poorly differentiated histology and tumor biologically effective dose < 65 Gy15 were adverse factors in both LC of T1 and T2 disease. Involvement of anterior commissure was an adverse factor in both LC and CSS of T1 disease. Subglottic extension was associated with poor LC in T2 disease whereas hemoglobin <13.0 was associated with poor LC and CSS of T2 disease. Conclusion Primary RT remains an option among the various standard treatments for early GC. Clinical treatment outcome by 6MV photons is similar and comparable to historic data of Cobalt-60 and 2 MV photons.
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Affiliation(s)
- Chi-Chung Tong
- Department of Clinical Oncology, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China.
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van Gogh CD, Verdonck-de Leeuw IM, Langendijk JA, Kuik DJ, Mahieu HF. Long-Term Efficacy of Voice Therapy in Patients With Voice Problems After Treatment of Early Glottic Cancer. J Voice 2012; 26:398-401. [DOI: 10.1016/j.jvoice.2011.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Accepted: 06/13/2011] [Indexed: 10/17/2022]
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Impact and relationship of anterior commissure and time-dose factor on the local control of T1N0 glottic cancer treated by 6 MV photons. Radiat Oncol 2011; 6:53. [PMID: 21600025 PMCID: PMC3124409 DOI: 10.1186/1748-717x-6-53] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 05/21/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate prognostic factors that may influence local control (LC) of T1N0 glottic cancer treated by primary radiotherapy (RT) with 6 MV photons. METHODS We retrospectively reviewed the medical records of 433 consecutive patients with T1N0 glottic cancer treated between 1983 and 2005 by RT in our institution. All patients were treated with 6 MV photons. One hundred and seventy seven (41%) patients received 52.5 Gy in 23 fractions with 2.5 Gy/fraction, and 256 (59%) patients received 66 Gy in 33 fractions with 2 Gy/fraction. RESULTS The median follow-up time was 10.5 years. The 10-year LC rates were 91% and 87% for T1a and T1b respectively. Multivariate analysis showed LC rate was adversely affected by poorly differentiated histology (Hazard Ratio [HR]: 7.5, p = 0.035); involvement of anterior commissure (HR: 2.34, p = 0.011); fraction size of 2.0 Gy (HR: 2.17, p = 0.035) and tumor biologically effective dose (BED) < 65 Gy15 (HR: 3.38, p = 0.017). CONCLUSIONS The negative impact of anterior commissure involvement could be overcome by delivering a higher tumor BED through using fraction size of > 2.0 Gy. We recommend that fraction size > 2.0 Gy should be utilized, for radiation schedules with five daily fractions each week.
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van Kalkeren TA, van der Houwen EB, Duits MAE, Hilgers FJ, Hebe A, Mostafa BE, Lawson G, Martinez Z, Woisard V, Marioni G, Ruske D, Schultz P, Post WJ, Verkerke BJ, van der Laan BFAM. Worldwide, multicenter study of peristomal geometry and morphology in laryngectomees and its clinical effects. Head Neck 2011; 33:1184-90. [PMID: 21448981 DOI: 10.1002/hed.21595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 06/28/2010] [Accepted: 07/29/2010] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to improve attachment of automatic tracheostoma valves, the knowledge on tracheostoma geometry, and its clinical influences preferred. This article investigates whether the number of removed trachea rings, incision of the sternocleidomastoid muscles, neck dissection, reconstruction, time after operation, and age have any effect on the (peri)stomal geometry of the patient. METHODS (Peri)stomas of 191 patients from 10 institutes worldwide were photographed, measured, and compared. RESULTS Paired comparisons between the number of trachea rings removed showed significant differences in horizontal and vertical trachea-opening diameters, but failed to demonstrate an effect in the depth of the stoma. T tests did not demonstrate significant differences in peristomal geometry between the sternocleidomastoid-cleaved and non-cleaved group. CONCLUSION The number of removed tracheal rings during laryngectomy does not seem to influence stoma depth. However, this study does not demonstrate that cleaving the sternocleidomastoid muscle (SCM) at the time of a laryngectomy will result in a geometrically flatter stoma.
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Affiliation(s)
- Tjouwke A van Kalkeren
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Majdak-Paredes EJ, Goon P, Bardsley AF. ‘An approach to complex tracheostomal complications’ by CJ Baldwin and MI Liddington-comment. J Plast Reconstr Aesthet Surg 2009; 62:418-20. [DOI: 10.1016/j.bjps.2008.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 06/11/2008] [Indexed: 10/21/2022]
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Ritoe SC, Verbeek ALM, Krabbe PFM, Kaanders JHAM, van den Hoogen FJA, Marres HAM. Screening for local and regional cancer recurrence in patients curatively treated for laryngeal cancer: definition of a high-risk group and estimation of the lead time. Head Neck 2007; 29:431-8. [PMID: 17120311 DOI: 10.1002/hed.20534] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND All patients treated for laryngeal cancer are offered the same follow-up schedule to detect asymptomatic locoregional recurrences. In this study, we evaluated the prognostic profile of patients for cancer recurrence and estimated the lead time. METHODS A cohort study was performed between 1990 and 1995. Cox proportional hazards model was used to analyze the prognostic factors. The effect of altering the follow-up for asymptomatic recurrence detection was determined after estimating the lead time. RESULTS The variables cT classification, smoking, and histologic grade proved to be prognostic factors. The risk of locoregional failure was 15% in the low-risk group versus 29% in the high-risk group. The estimated lead time was 2 to 4 weeks. CONCLUSION Risk profiles for locoregional relapse were defined. Intensifying the follow-up schedule is not advisable because the lead time is very short. An excessively high number of routine visits would have to be performed to increase the detection rate for asymptomatic recurrences.
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Affiliation(s)
- Savitri C Ritoe
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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de Bree R, van der Putten L, Hoekstra OS, Kuik DJ, Uyl-de Groot CA, van Tinteren H, Leemans CR, Boers M. A randomized trial of PET scanning to improve diagnostic yield of direct laryngoscopy in patients with suspicion of recurrent laryngeal carcinoma after radiotherapy. Contemp Clin Trials 2007; 28:705-12. [PMID: 17459783 DOI: 10.1016/j.cct.2007.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Revised: 03/12/2007] [Accepted: 03/15/2007] [Indexed: 11/18/2022]
Abstract
The RELAPS study (REcurrent LAryngeal carcinoma PET Study) was designed to determine whether FDG-PET is of value in the selection of patients for direct laryngoscopy under general anesthesia in patients with suspicion of recurrent laryngeal carcinoma after radiotherapy. In a randomized controlled clinical trial the current diagnostic practice, i.e. all patients undergo direct laryngoscopy, will be compared to a strategy in which FDG-PET selects the patients for laryngoscopy. All eight head and neck cancer centers of the Dutch Head and Neck Oncology Cooperative Group NWHHT will participate in this multicenter trial. The study population consists of patients with clinical suspicion of recurrent T2-T4 laryngeal carcinoma after radiotherapy (without obvious signs of tumor) in whom a direct laryngoscopy under general anesthesia with taking of biopsies is indicated by the local physician. The primary efficacy endpoint is the difference in the number of futile indications for direct laryngoscopy between the conventional diagnostic arm and the FDG-PET based diagnostic arm. An indication for laryngoscopy is classified as futile if this laryngoscopy was negative and no recurrence was diagnosed within 6 months follow-up (gold standard). The FDG-PET based strategy may increase the risk of missing recurrent tumor compared to current practice. Safety endpoints include survival and morbidity due to laryngoscopy with taking of biopsies. Survival rates of both groups will have to be collected outside the time frame of the funded trial. Resectability of recurrent tumor and tumor negative surgical margins after total laryngectomy will be used as proxy endpoints. The trial will also compare quality of life and direct medical costs between both arms.
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Affiliation(s)
- Remco de Bree
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Braam PM, Raaijmakers CPJ, Terhaard CHJ. Cranial location of level II lymph nodes in laryngeal cancer: Implications for elective nodal target volume delineation. Int J Radiat Oncol Biol Phys 2007; 67:462-8. [PMID: 17236968 DOI: 10.1016/j.ijrobp.2006.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 10/04/2006] [Accepted: 10/04/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To analyze the cranial distribution of level II lymph nodes in patients with laryngeal cancer to optimize the elective radiation nodal target volume delineation. METHODS AND MATERIALS The most cranially located metastatic lymph node was delineated in 67 diagnostic CT data sets. The minimum distance from the base of the skull (BOS) to the lymph node was determined. RESULTS A total of 98 lymph nodes were delineated including 62 ipsilateral and 36 contralateral lymph nodes. The mean ipsilateral and contralateral distance from the top of the most cranial metastatic lymph node to the BOS was 36 mm (range, -9-120; standard deviation [SD], 17.9) and 35 mm (range, 14-78; SD 15.0), respectively. Only 5% and 12% of the ipsilateral and 3% and 9% of the contralateral metastatic lymph nodes were located within 15 mm and 20 mm below the BOS, respectively. No significant differences were found between patients with only ipsilateral metastatic lymph nodes and patients with bilateral metastatic lymph nodes. Between tumors that do cross the midline and those that do not, no significant difference was found in the distance of the most cranial lymph node to the BOS and the occurrence ipsilateral or contralateral. CONCLUSIONS Setting the cranial border of the nodal target volume 1.5 cm below the base of the skull covers 95% of the lymph nodes and should be considered in elective nodal irradiation for laryngeal cancer. Bilateral neck irradiation is mandatory, including patients with unilateral laryngeal cancer, when elective irradiation is advised.
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Affiliation(s)
- Pètra M Braam
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
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Ritoe SC, de Vegt F, Scheike IM, Krabbe PFM, Kaanders JHAM, van den Hoogen FJA, Verbeek ALM, Marres HAM. Effect of routine follow-up after treatment for laryngeal cancer on life expectancy and mortality. Cancer 2007; 109:239-47. [PMID: 17154185 DOI: 10.1002/cncr.22401] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Routine follow-up is offered to all patients with laryngeal cancer who are treated with curative intent. Although time and resources are devoted to surveillance, the effect of asymptomatic recurrence detection is not well understood. For this study, the authors evaluated the effect that routine follow-up may have on life expectancy and disease-specific mortality rate for patients with laryngeal cancer. METHODS Using a Markov model, a cohort simulation was performed on 4 hypothetical age groups of patients with laryngeal cancer. Three different follow-up strategies were compared-the current schedule, no follow-up, and the perfect follow-up-in which all recurrences were detected asymptomatically. Sensitivity analyses were performed to study the impact of variations in the transition rates on life expectancy. RESULTS Compared with no follow-up, the current schedule showed a gain in life expectancy with a range from 0.3 years to 1.5 years that decreased with advancing age. Abolishing the current follow-up schedule raised the disease-specific mortality rate; the increase ranged from 2.8% to 5.9%. Variations of +/-25% in the transition rates produced only a modest effect on life expectancy. CONCLUSIONS A small reduction in life expectancy was observed when follow-up was withheld from the majority of patients. Disease-specific mortality rates rose when no follow-up was provided. These rates probably were overestimated. A simplified version of the current follow-up protocol may be implemented.
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Affiliation(s)
- Savitri C Ritoe
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Ritoe SC, Bergman H, Krabbe PFM, Kaanders JHAM, van den Hoogen FJA, Verbeek ALM, Marres HAM. Cancer recurrence after total laryngectomy: treatment options, survival, and complications. Head Neck 2006; 28:383-8. [PMID: 16287138 DOI: 10.1002/hed.20350] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A follow-up schedule to detect asymptomatic cancer recurrence is offered to all patients with laryngeal cancer. In this study, the therapeutic options, prognosis, and morbidity of patients with total laryngectomy, who were found to have cancer recurrence during this follow-up schedule were determined. METHODS Patients who had undergone a total laryngectomy between January 1, 1990, and January 1, 2000, and had cancer recurrence were included. Data from this group were analyzed retrospectively. RESULTS The prognosis was poor after the development of cancer recurrence. Curative therapy could only be offered to 27.5% of these patients. Only 5% of the patients were disease free at the end of the study period. Many patients with cancer recurrence needed interventions. A large proportion of them had complications. CONCLUSIONS The follow-up schedule offered to patients after total laryngectomy should put greater emphasis on care than on early detection of cancer recurrence.
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Affiliation(s)
- Savitri C Ritoe
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Marioni G, Marchese-Ragona R, Cartei G, Marchese F, Staffieri A. Current opinion in diagnosis and treatment of laryngeal carcinoma. Cancer Treat Rev 2006; 32:504-15. [PMID: 16920269 DOI: 10.1016/j.ctrv.2006.07.002] [Citation(s) in RCA: 199] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 06/28/2006] [Accepted: 07/03/2006] [Indexed: 11/28/2022]
Abstract
Laryngeal carcinoma is the 11th commonest form of cancer in men world-wide, with 121,000 new cases in 1985. More than 95% of all laryngeal malignancies are squamous cell carcinomas. Treatment indications in cancer of the larynx are often controversial, since there are few comparative studies of different available therapeutic approaches. Surgery and radiotherapy are both widely used, and the choice between these two procedures is the most common therapeutic decision which has to be taken. Laryngeal function preservation has gained more and more weight in the last decades and chemotherapy is also a significant component of several curative approaches. In the last decades, several organ-preserving surgical techniques have become available and consequently total laryngectomy results less applied. Regardless of the treatment modality, Tis, T1, T2 laryngeal carcinomas have an 80-90% probability of cure, whereas for more advanced tumours this is approximately 60%. The most effective approach to laryngeal cancer remains prevention and early diagnosis when this cancer is curable with function preserving treatments.
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Affiliation(s)
- Gino Marioni
- Department of Medical and Surgical Specialties, Section of Otolaryngology, University of Padova, Via Giustiniani 2, 35100 Padua, Italy.
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van Agthoven M, Heule-Dieleman HAG, Knegt PP, Kaanders JHAM, Baatenburg de Jong RJ, Kremer B, Leemans CR, Marres HAM, Manni JJ, Langendijk JA, Levendag PC, Tjho-Heslinga RE, de Jong JMA, de Boer MF, Uyl-de Groot CA. Compliance and efficiency before and after implementation of a clinical practice guideline for laryngeal carcinomas. Eur Arch Otorhinolaryngol 2006; 263:729-37. [PMID: 16699832 DOI: 10.1007/s00405-006-0062-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Accepted: 09/13/2005] [Indexed: 10/24/2022]
Abstract
We evaluated whether the implementation of a nationwide clinical practice guideline for diagnosis, treatment and follow-up of laryngeal carcinomas led to changes in hospital costs, balanced against clinical changes observed following the guideline's implementation. Charts of 822 patients with larynx carcinoma (459 treated before the introduction of the guideline and 363 thereafter) in five hospitals were retrospectively investigated. In all phases, no differences in total hospital costs were observed after the guideline's implementation. Total mean costs were Euro 3,207 (95%CI 3,091-3,395) for diagnosis, Euro 3,169 (2,153-4,182), Euro 5,026 (3,996-6,057), Euro 6,458 (5,579-7,337), Euro 8,037 (7,469-8,606), Euro 12,765 (10,763-14,769), Euro 19,227 (16,848-21,605) for treatment of dysplasia, carcinoma in situ, T1, T2, T3 and T4 carcinoma, respectively, and Euro 1,856 (1,491-2,220) for 1 year disease-free follow-up. In an earlier study, we observed several positive changes after the guideline's implementation. Balanced against the equal costs before and after the guideline's implementation, we conclude that the efficiency of the care process improved.
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Affiliation(s)
- Michel van Agthoven
- Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus MC, University Medical Centre Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
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van Gogh CDL, Verdonck-de Leeuw IM, Boon-Kamma BA, Rinkel RNPM, de Bruin MD, Langendijk JA, Kuik DJ, Mahieu HF. The efficacy of voice therapy in patients after treatment for early glottic carcinoma. Cancer 2006; 106:95-105. [PMID: 16323175 DOI: 10.1002/cncr.21578] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND After treatment for early glottic carcinoma, a considerable number of patients end up with voice problems that interfere with daily life activities. The objective of this randomized and controlled study was to assess the efficacy of voice therapy in these patients. METHODS Of 177 patients, 6-120 months after treatment for early glottic carcinoma, 70 patients (40%) suffered from voice impairment based on a 5-item screening questionnaire. Approximately 60% of those 70 patients were not interested in participating in the current study. Twenty-three patients who were willing to participate were assigned randomly either to a voice therapy group (n = 12 patients) or to a control group (n = 11 patients). Multidimensional voice analyses (the self-reported Voice Handicap Index [VHI], acoustic and perceptual voice quality analysis, videolaryngostroboscopy, and the Voice Range Profile) were conducted twice: before and after voice therapy or with 3 months in between for the control group. RESULTS Statistical analyses of the difference in scores (postmeasurement minus premeasurement) showed significant voice improvement after voice therapy on the total VHI score, percent jitter, and noise-to-harmonics ratio in the voice signal and on the perceptual rating of vocal fry. CONCLUSIONS Voice therapy proved to be effective in patients who had voice problems after treatment for early glottic carcinoma. Improvement not only was noticed by the patients (VHI) but also was confirmed by objective voice parameters.
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Affiliation(s)
- Christine D L van Gogh
- Department of Otorhinolaryngology, Head and Neck Surgery, Vrije Universitet Medical Center, Amsterdam, The Netherlands
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Brouwer J, Bree R, Hoekstra OS, Langendijk JA, Castelijns JA, Leemans CR. Screening for distant metastases in patients with head and neck cancer: what is the current clinical practice? Clin Otolaryngol 2005; 30:438-43. [PMID: 16232248 DOI: 10.1111/j.1365-2273.2005.01068.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The detection of distant metastases during screening influences the choice of treatment in patients with head and neck squamous cell carcinoma (HNSCC). There is no consensus on the diagnostic technique that has to be used nor on the subgroup of HNSCC patients that may benefit from screening. DESIGN Questionnaire on current practice concerning the diagnostic work-up in HNSCC patients for screening for distant metastases. PARTICIPANTS Investigators in the 12 otolaryngology / head and neck and seven oromaxillofacial departments treating head and neck cancer in the Netherlands. RESULTS The response rate was 100%. Indications for screening were cervical lymph node metastases (63%), mutilating surgery (58%), locoregional recurrence (47%), advanced T-stage (32%), second primary tumour (21%). Diagnostic techniques routinely used for screening besides chest X-ray were chest CT (84%), liver ultrasound (53%), liver CT (16%) and bone scintigraphy (42%). Forty-two per cent of the clinicians were not satisfied with the current methods of screening. CONCLUSION This survey shows a substantial variation in indications and diagnostic techniques used for screening for distant metastases between the major institutions treating head and neck cancer in the Netherlands. There is a need for guidelines for screening for distant metastases in patients with head and neck cancer.
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Affiliation(s)
- J Brouwer
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Ten Hallers EJO, Marres HAM, Rakhorst G, Hagen R, Staffieri A, Van Der Laan BFAM, Van Der Houwen EB, Verkerke GJ. Difficulties in the fixation of prostheses for voice rehabilitation after laryngectomy. Acta Otolaryngol 2005; 125:804-13. [PMID: 16158525 DOI: 10.1080/00016480510031506] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In most patients with advanced or recurrent laryngeal or hypopharyngeal cancer, total laryngectomy is indicated. This means the loss of three main functions: phonation; respiration; and the prevention of aspiration during deglutition. Laryngectomy patients have various options to restore phonation: an oesophageal voice; an electrolaryngeal voice; or a tracheo-oesophageal voice. In the last case a silicone rubber shunt valve is placed in the tracheo-oesophageal wall and phonation is generated when exhaled air is forced through the oesophagus and neopharynx. This method is widely applied in Western Europe. In this paper we review the literature on fixation problems with shunt valves, tracheostoma valves and heat and moisture exchange (HME) filters. Tracheo-oesophageal speech without a valve is not considered. Despite 22 years of experience with the implantation of tracheo-esophageal shunt valves and many improvements in the design, problems still remain, such as biofilm formation with subsequent leakage through the valve, the need for frequent and inconvenient replacements, fistula enlargement leading to leakage around the device and reduced fixation, and infections. The high cost of shunt valves is a drawback to their use worldwide. To enable hands-free speech, different types of tracheostoma valve have been developed. These valves are fixed to the skin or to the tracheostoma by means of an intra-tracheal device. An HME filter is used to protect the airway and maintain physiological balance. Such devices are only suitable for a selected group of patients as fixation to the skin or trachea can be a major problem. Speaking and coughing cause pressure increases, which often result in mucous leakage and disconnection of the valve and/or HME filter. Recommendations are made for future improvements in fixation techniques.
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Affiliation(s)
- E J O Ten Hallers
- Department of BioMedical Engineering, Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands.
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van Gogh CDL, Verdonck-de Leeuw IM, Boon-Kamma BA, Langendijk JA, Kuik DJ, Mahieu HF. A screening questionnaire for voice problems after treatment of early glottic cancer. Int J Radiat Oncol Biol Phys 2005; 62:700-5. [PMID: 15936548 DOI: 10.1016/j.ijrobp.2004.10.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2004] [Revised: 10/20/2004] [Accepted: 10/22/2004] [Indexed: 11/23/2022]
Abstract
PURPOSE After treatment for early glottic cancer, a considerable number of patients end up with voice problems interfering with daily life activities. A 5-item screening questionnaire was designed for detection of voice impairment. The purpose of this study is to assess psychometric properties of this questionnaire in clinical practice. METHODS AND MATERIALS The questionnaire was completed by 110 controls without voice complaints and 177 patients after radiotherapy or laser surgery for early glottic cancer. RESULTS Based on normative data of the controls, a score of 5 or less on at least 1 of the 5 questions was considered to state overall voice impairment. Reliability of the questionnaire proved to be good. Voice impairment was reported in 44% of the patients treated with radiotherapy vs. 29% of the patients treated with endoscopic laser surgery. CONCLUSIONS The questionnaire proved to be a reliable, valid, and feasible method to detect voice impairment in daily life. The questionnaire is easy to fill in, and interpretation is straightforward. It is useful for both radiation oncologists and otorhinolaryngologists in their follow-up of patients treated for early glottic cancer.
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Affiliation(s)
- Christine D L van Gogh
- Department of Otorhinolaryngology, Head and Neck Surgery, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
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Zuur JK, Muller SH, de Jongh FHC, van Zandwijk N, Hilgers FJM. The physiological rationale of heat and moisture exchangers in post-laryngectomy pulmonary rehabilitation: a review. Eur Arch Otorhinolaryngol 2005; 263:1-8. [PMID: 16001247 DOI: 10.1007/s00405-005-0969-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 06/09/2005] [Indexed: 11/28/2022]
Abstract
Total laryngectomy results in a permanent disconnection of the upper and lower airways and inevitably leads to chronic pulmonary complaints like frequent involuntary coughing, increased sputum production and repeated daily forced expectoration to clean the airway. Heat and moisture exchangers (HMEs), applied in an attempt to compensate for the lost functions of the upper respiratory tract, have been found to diminish these symptoms and improve the quality of life significantly. An HME has three physical properties that might be responsible for these improvements. First, its heat and moisture exchanging capacity improves intra-airway preservation of heat and water. Since the condensation and evaporation of moisture are accompanied by the release and uptake of thermal energy, these parameters are inseparable. Secondly, the HME's resistance may reduce dynamic airway compression, thereby improving ventilation. Thirdly, to some extent, an HME might filter out particles, thereby cleaning inspiratory breathing air. This article summarizes our present knowledge of changes in respiratory physiology after total laryngectomy and the influence of the HME by reviewing the physiological impact of these three physical properties separately for in vitro and in vivo data.
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Affiliation(s)
- J K Zuur
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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van Agthoven M, Heule-Dieleman HAG, de Boer MF, Kaanders JHAM, Baatenburg de Jong RJ, Kremer B, Leemans CR, Marres HAM, Manni JJ, Langendijk JA, Levendag PC, Tjho-Heslinga RE, de Jong JMA, Uyl-de Groot CA, Knegt PP. Evaluating adherence to the Dutch guideline for diagnosis, treatment and follow-up of laryngeal carcinomas. Radiother Oncol 2005; 74:337-44. [PMID: 15763316 DOI: 10.1016/j.radonc.2005.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2004] [Revised: 12/14/2004] [Accepted: 01/19/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE An evidence-based clinical practice guideline for laryngeal carcinomas was introduced in the Netherlands late 1999. The objective of this guideline was to ensure uniformity in the diagnosis, treatment, and follow-up. We retrospectively evaluated whether clinical practice changed according to the recommendations of this guideline and whether it succeeded in its aim. MATERIAL AND METHODS In five out of eight Dutch university hospitals, chart data of 459 patients treated before the guideline introduction were compared to data of 363 patients treated after the guideline introduction. RESULTS Patient and tumour characteristics were comparable among both groups. In general, the guideline recommendations were properly complied with. The patients treated before the guideline introduction were actually also for a large part already treated according to the guideline's recommendations. After its introduction, several changes according to the guideline were observed: increased rates of reassessment of biopsy samples taken in local hospitals, psychological screening (although still only performed in 10.5% of patients), application of accelerated radiotherapy schedules, clinical trial treatments, function-preserving treatments, and decreased rates of total laryngectomy, and annual chest X-rays during follow-up. CONCLUSIONS Although a causal relationship cannot be established in this kind of observational studies, several positive changes were observed after the introduction of the guideline, and therefore the guideline seems to have contributed to more uniformity. The largest changes were seen for the guideline recommendations based on the highest levels of evidence.
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Affiliation(s)
- Michel van Agthoven
- Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus MC, University Medical Centre, PO Box 1738, 3000 DR Rotterdam, The Netherlands
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