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Prognostic impact of sarcopenia in patients with head and neck cancer treated with surgery or radiation: A meta-analysis. PLoS One 2021; 16:e0259288. [PMID: 34714876 PMCID: PMC8555817 DOI: 10.1371/journal.pone.0259288] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/15/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The objective of this study was to compare the prognostic impact of sarcopenia in patients with head and neck cancer (HNC) treated with surgery or radiation. METHODS We systematically searched electronic databases to identify articles reporting the impact of sarcopenia on the prognosis of patients with HNC. Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) were extracted and pooled. HR according to treatment modality were estimated using random-effects models. Statistical analyses were carried out using the Comprehensive Meta-Analysis software. RESULTS In total, 18 studies enrolling 3,233 patients were included. Sarcopenia was associated with poor OS in both surgery and radiotherapy groups (hazard ratio [HR] 2.50, 95% confidence interval [CI] 1.95-3.21; HR 1.63, 95% CI 1.40-1.90, respectively). The HR was significantly higher in the surgery group than in the radiotherapy group (p = 0.004), with similar results obtained for DFS (HR 2.59, 95% CI 1.56-4.31; HR 1.56, 95% CI 1.24-1.97 for the surgery and radiotherapy groups, respectively) and DSS (HR 2.96, 95% CI 0.73-11.95; HR 2.67, 95% CI 1.51-4.73 for the surgery and RT groups, respectively). CONCLUSIONS Sarcopenia was a poor prognostic factor for HNC, regardless of the treatment modality. However, the adverse effects of sarcopenia on survival were more prominent in the surgery group than in the radiotherapy group. Sarcopenia assessment is required for appropriate treatment decision-making.
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Ono T, Tanaka N, Chitose SI, Tanoue S, Kurita T, Sueyoshi S, Fukahori M, Miyata Y, Muraki K, Tsuji C, Ogo E, Hattori C, Sato K, Abe T, Umeno H. Comparative Treatment Outcome in T3N0 Glottic Cancer With and Without Vocal Fold Fixation Receiving Radiation Therapy and Concurrent Low-Dose Intra-Arterial Cisplatin Infusion. Ann Otol Rhinol Laryngol 2021; 131:897-904. [PMID: 34565187 DOI: 10.1177/00034894211047789] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Selective radiotherapy and concomitant intra-arterial cisplatin infusion (m-RADPLAT) with a lower cisplatin dosage have been performed for organ and function preservation in patients with locally advanced squamous cell carcinoma of the larynx (SCC-L), and results showing a lower rate of adverse events have been reported. This study evaluated the treatment outcomes of patients with T3N0 glottic SCC-L with or without vocal fold fixation (VFF) who were treated with m-RADPLAT. METHODS We retrospectively reviewed the data of 33 patients with T3N0 SCC-L who received m-RADPLAT. RESULTS The vocal fold in patients with VFF 3 months after completing m-RADPLAT resumed normal movement in 15 patients (83%) and persisted fixation in 3 (17%). The 3-year local control, laryngeal cancer-specific survival, and overall survival rates of patients with or without VFF were 88.9% and 86.7%, 94.1% and 93.3%, and 88.9% and 86.7%, respectively. Additionally, the 3-year freedom from laryngectomy, laryngectomy-free survival, and laryngo-esophageal dysfunction-free survival rates of patients with or without VFF were 94.4% and 86.7%, 88.9% and 73.3%, and 83.3% and 73.3%, respectively. Grade 3 or higher toxicities were observed in all patients: leukopenia in 4 patients (12%), neutropenia in 5 (15%), anemia in 2 (6%), thrombocytopenia in 3 (9%), and mucositis in 2 (6%). CONCLUSIONS This study demonstrated that m-RADPLAT yielded VFF improvement and a favorable survival while maintaining laryngeal function not only in patients with T3N0 glottic SCC-L without VFF but also in patients with VFF.
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Affiliation(s)
- Takeharu Ono
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Norimitsu Tanaka
- Department of Radiology, School of Medicine, Kurume University, Kurume, Japan
| | - Shun-Ichi Chitose
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Syuichi Tanoue
- Department of Radiology, School of Medicine, Kurume University, Kurume, Japan
| | - Takashi Kurita
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Shintarou Sueyoshi
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Mioko Fukahori
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Yusaku Miyata
- Department of Radiology, School of Medicine, Kurume University, Kurume, Japan
| | - Koichiro Muraki
- Department of Radiology, School of Medicine, Kurume University, Kurume, Japan
| | - Chiyoko Tsuji
- Department of Radiology, School of Medicine, Kurume University, Kurume, Japan
| | - Etsuyo Ogo
- Department of Radiology, School of Medicine, Kurume University, Kurume, Japan
| | - Chikayuki Hattori
- Department of Radiology, School of Medicine, Kurume University, Kurume, Japan
| | - Kiminobu Sato
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Toshi Abe
- Department of Radiology, School of Medicine, Kurume University, Kurume, Japan
| | - Hirohito Umeno
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kurume University, Kurume, Japan
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The Occurrence of Local Recidive in Patients with Planocellular Carcinoma of the Larynx. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020. [DOI: 10.2478/sjecr-2020-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Background/Aim. Early diagnosis and adequate surgical treatment are the key factors for the course of the laryngeal cancer of the head and neck and the outcome of the surgical treatment in these patients. The aim of the paper is to compare the characteristics of the surgically treated patients with the larynx carcinoma who developed recidivism to those who did not.
Material and methods. The study was done as a retrospective observational case-control study on a total of 90 patients with the laryngeal cancer who had been successfully operated on and whose cases had been followed over a period of at least five years after the surgery. After that, they were shorted into two groups based on the development of recidivism, and clinical characteristics of the patients with and without recidive disease were compared.
Results. 19 out of 90 patients developed recidivism. Maximum diameter of the tumour was significantly larger in patients without local recidivism. In patients without local recidivism, most common clinical stages were 3 and 4 (32.4%, 40.8%, respectively), whereas in patients with local recidivism stages 1 and 2 were the most common (47.7%, 26.3%, respectively). The average time to disease recurrence in the 19 patients who developed local recidive disease was 648.10 (384.67-911.54) days.
Conclusion. Pathohisto-logical analysis showed that samller the size of the tumour and lower T grade at the moment of surgery are precautionary factors for further monitoring of patients with laryngeal cancer.
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Evaluation of survival of patients with locally advanced head and neck cancer treated in a single center. Braz J Otorhinolaryngol 2019; 87:3-10. [PMID: 31395491 PMCID: PMC9422420 DOI: 10.1016/j.bjorl.2019.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/07/2019] [Accepted: 06/08/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Even with improved treatment outcomes with multimodality approaches, the question of what is the best initial treatment for locally advanced head and neck cancer still remains unanswered. Objective To review the overall survival of a large cohort of head and neck cancer, patients with locally advanced head and neck cancer treated in a single institution. Material and methods We studied a cohort of patients with locally advanced head and neck cancer treated in our institution in the last fifteen years. To gather a large sample of patients with adequate follow-up time, a cross-check between ours and Fundação Oncocentro de São Paulo databases were done. We included patients with head and neck cancer, clinical or pathological staging III or IV, treated with surgery followed by radiotherapy or surgery plus chemoradiation or radiotherapy alone or chemoradiation alone. Results 796 patients with locally advanced head and neck cancer were included, 88% male, 44% age >60 years and 76% stage IV. The tumor location was the oral cavity (34%), oropharynx (27%), hypopharynx (17%) and larynx (17%). The treatment groups were chemoradiation alone (39.7%), surgery plus chemoradiation (26.3%), surgery followed by radiotherapy (18.5%) and radiotherapy alone (15.5%). Comparing the clinical variables between the treatment groups significant differences in age and clinical stage were observed. With a median follow up of 7.5 years (1–16 years), for the entire cohort, the overall survival at 5 and 10 years was 34.8% and 28%. The overall survival at 5 and 10 years was 16.7% and 12.2% for radiotherapy alone, 38.8% and 26.3% for surgery followed by radiotherapy, 28% and 16.6% for chemoradiation alone, and 37.3% and 23.2% for surgery plus chemoradiation. The staging IV (p = 0.03) and radiotherapy alone (p = 0.05), had a worst survival in multivariate analysis. Surgical groups vs. chemoradiation alone had no significant difference for overall survival. Conclusion The present study is the largest cohort of locally advanced head and neck cancer of Brazilian patients to evaluate treatment outcomes. Although there were significant clinical differences between surgical and radiotherapy groups, surgery or chemoradiation alone as the initial treatment resulted in no significant difference in survival.
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Tangsriwong K, Jitreetat T. Clinical Predictors of Laryngeal Preservation Rate in Stage III-IV Laryngeal Cancer and Hypopharyngeal Cancer Patients Treated with Organ Preservation. Asian Pac J Cancer Prev 2019; 20:2051-2057. [PMID: 31350965 PMCID: PMC6745228 DOI: 10.31557/apjcp.2019.20.7.2051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose: To determine factors affecting laryngeal preservation rate in laryngeal and hypopharyngeal cancer patients
treated with organ preservation. Material and Methods: Retrospective study examining stage III to IV laryngeal and
hypopharyngeal cancer patients who have been treated with organ preservation. Conventional radiation must be applied
in all patients with minimum dose of 45 Gray. Weekly or triweekly chemotherapy can be adding during radiation. Salvage
surgery should be considered in residual disease or local recurrence. Kaplan-Meier was used for survival analysis and,
Log rank test and Cox proportional hazard test were used for uni and multivariate analysis. Results: From January
2010 to October 2014, there were 69 patients treated with laryngeal preservation and 53 patients received radiation
dose 61-70 Gray. After completing radiation, we found that 44 patients have no residual tumor within 6 months and
33 patients can preserve their functional larynx later with complete response (median follow up 6 mo, range 0-46.3
mo). The 1-year, 2-year and 3-year laryngeal preservation rate was 49%, 36 % and 32 % respectively. On univariate
analysis, lower nodal stage (p = 0.008), stage III disease (p = 0.046), tumor volume <10 ml (p = 0.005), no true vocal
cord involvement (p = 0.016), dose 61-70 Gray (p < 0.001) and no interruption of treatment (p = 0.017) have better
laryngeal preservation rates. ECOG performance status 2, higher nodal stage, stage IV, presence of true vocal cord
involvement, upper airway obstruction before/during radiation and radiation dose below 61-70 Gray had an effect on
worse overall survival when evaluated with univariate analysis statistical significance. Conclusion: For factors that
affected laryngeal preservation in our study were nodal stage, group stage, tumor volume, true vocal cord involvement,
radiation dose and treatment break time more than one week with statistical significance.
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Affiliation(s)
- Kanograt Tangsriwong
- Department of Radiation Oncology, Rajavithi Hospital, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
| | - Tastsanachart Jitreetat
- Department of Otolaryngology, Head and Neck Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
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Management of locally advanced T3-4 glottic laryngeal carcinomas. The Journal of Laryngology & Otology 2018; 132:642-650. [PMID: 29961434 DOI: 10.1017/s0022215118000993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess five-year local control and ultimate local control rates of patients treated for locally advanced T3-4 glottic carcinoma with surgery only, radiotherapy only, or surgery plus radiotherapy. Cancer-specific survival, overall survival and rates of malignancy development were also assessed. METHODS A retrospective review was conducted on patients from 1967 to 2015, with analysis of local control, ultimate local control, overall survival and cancer-specific survival performed using Kaplan-Meier and Cox regression. RESULTS Of 169 eligible patients, the majority (59 per cent) were treated with surgery plus radiotherapy, with laryngectomy being the most common surgical procedure. Local control and ultimate local control rates were higher with surgery only (94.1 per cent) and surgery plus radiotherapy (87.9 and 86.8 per cent respectively), compared to radiotherapy only (46.8 and 52.4 per cent) (both p < 0.001). Cancer-specific survival, overall survival and malignancy development did not differ between groups. CONCLUSION Surgery, with or without radiotherapy, offers significantly higher five-year local control and ultimate local control for patients with advanced glottic carcinoma, compared to radiotherapy only.
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Kim BH, Park SJ, Jeong WJ, Ahn SH. Comparison of Treatment Outcomes for T3 Glottic Squamous Cell Carcinoma: A Meta-Analysis. Clin Exp Otorhinolaryngol 2018; 11:1-8. [PMID: 29486540 PMCID: PMC5831661 DOI: 10.21053/ceo.2017.00717] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 11/22/2022] Open
Abstract
Objectives This study compared the survival outcomes, local control rate, and laryngeal preservation rate of various treatment strategies in the treatment of T3 squamous cell carcinoma of the glottis using proportional meta-analyses. Methods Twenty-five retrospective case-series studies were included in these analyses. Treatment strategies were classified as total laryngectomy (TL), open partial laryngectomy (PL), transoral laser microsurgery (TLM), chemo-radiation therapy (CRT), and radiation therapy (RT) alone. Results The overall survival rate and disease-specific survival rate among laryngeal preservation treatments did not differ from the overall survival rate of TL. However, the local control rate was lower with RT than TL and PL, and laryngeal preservation rates of TLM and CRT were higher than RT alone. Conclusion Consideration of preservation of laryngeal function is necessary when treating T3 glottic squamous cell carcinoma. PL, TLM, and, CRT are considered more appropriate initial laryngeal preservation strategies if available.
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Affiliation(s)
- Bo Hae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Sung Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
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Calvas OIJ, Ramos DM, Matos LL, Kulcsar MAV, Dedivitis RA, Brandão LG, Cernea CR. Oncological results of surgical treatment versus organ-function preservation in larynx and hypopharynx câncer. Rev Assoc Med Bras (1992) 2017; 63:1082-1089. [DOI: 10.1590/1806-9282.63.12.1082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/22/2017] [Indexed: 02/06/2023] Open
Abstract
Summary Introduction: Since the beginning of the 1990s, non-surgical radiochemotherapy treatment has become popular with the prospect of maintaining oncological results and preserving the organ in patients with advanced squamous cell carcinoma of the larynx and hypopharynx. However, subsequent studies demonstrated increased recurrence and mortality after the non-surgical treatment became popular. Objective: To compare the oncological results of surgical and non-surgical treatments of patients with larynx and hypopharynx cancer and to evaluate the variables associated with disease recurrence. Method: This is a retrospective cohort study of 134 patients undergoing surgical (total or partial laryngectomy) or non-surgical (isolated radiotherapy, chemotherapy or induction chemotherapy followed by radiotherapy and chemotherapy) treatment, with 62 patients in the surgical group and 72 in the non-surgical group. Results: Disease-free survival rates were higher in the surgical group (81.7% vs. 62.2%; p=0.028), especially in III/IV stages (p=0.018), locally advanced tumors T3 and T4a (p=0.021) and N0/N1 cases (p=0.005). The presence of cervical lymph nodes, especially N2/N3, was considered a risk factor for disease recurrence in both groups (HR=11.82; 95CI 3.42-40.88; p<0.0001). Patients not undergoing surgical treatment were 3.8 times more likely to develop recurrence (HR=3.76; 95CI 1.27-11.14; p=0.039). Conclusion: Patients with larynx or hypopharynx cancer non-surgically treated had a poorer disease-free survival, especially in cases with locally advanced tumors (T3 and T4a) and in which the neck was only slightly affected (N0/N1).
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Affiliation(s)
| | - Daniel Marin Ramos
- Instituto do Câncer do Estado de São Paulo, Brazil; Universidade de São Paulo, Brazil
| | - Leandro Luongo Matos
- Instituto do Câncer do Estado de São Paulo, Brazil; Universidade de São Paulo, Brazil
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Predictive and prognostic factors for patients with locoregionally advanced laryngeal carcinoma treated with surgical multimodality protocol. Eur Arch Otorhinolaryngol 2016; 274:1701-1711. [DOI: 10.1007/s00405-016-4411-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/26/2016] [Indexed: 01/11/2023]
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Li L, Yang J, Li X, Wang X, Ren Y, Fei J, Xi Y, Sun R, Ma J. (125)I Seed Permanent Implantation as a Palliative Treatment for Stage III and IV Hypopharyngeal Carcinoma. Clin Exp Otorhinolaryngol 2016; 9:185-91. [PMID: 27440132 PMCID: PMC4996106 DOI: 10.21053/ceo.2015.00213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 08/03/2015] [Accepted: 09/02/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the feasibility and safety of percutaneous (125)I seed permanent implantation for advanced hypopharyngeal carcinoma from toxicity, tumor response, and short-term outcome. METHODS (125)I seeds implant procedures were performed under computed tomography for 34 patients with advanced hypopharyngeal carcinoma. We observed the local control rate, overall survival, and acute or late toxicity rate. RESULTS In the 34 patients (stage III, n=6; stage IV, n=28), the sites of origin were pyriform sinus (n=29) and postcricoid area (n=5). All patients also received one to four cycles of chemotherapy after seed implantation. The post-plan showed that the actuarial D90 of (125)I seeds ranged from 90 to 158 Gy (median, 127 Gy). The mean follow-up was 12.3 months (range, 3.4 to 43.2 months). The local control was 2.1-31.0 months with a median of 17.7 months (95% confidence interval [CI], 13.4 to 22.0 months). The 1-, 2-, and 3-year local controls were 65.3%, 28.6%, and 9.5% respectively. Twelve patients (35%) died of local recurrence, fourteen patients (41%) died of distant metastases, and three patients (9%) died of recurrence and metastases at the same time. Five patients (15%) still survived to follow-up. At the time of analysis, the median survival time was 12.5 months (95% CI, 9.5 to 15.4 months). The 1-, 2-, and 3-year overall survival rates were 55.2%, 20.3%, and 10.9%, respectively. Five patients (15%) experienced grade 3 toxic events and nine patients (26%) have experienced grade 2 toxic events. CONCLUSION This review shows relatively low toxicity for interstitial (125)I seed implantation in the patients with advanced stage hypopharyngeal cancer. The high local control results suggest that (125)I seed brachytherapy implant as a salvage or palliative treatment for advanced hypopharyngeal carcinoma merit further investigation.
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Affiliation(s)
- Lei Li
- Head and Neck Tumor Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jie Yang
- Head and Neck Tumor Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaojiang Li
- Head and Neck Tumor Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoli Wang
- Radiation Therapy Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanxin Ren
- Head and Neck Tumor Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jimin Fei
- Head and Neck Tumor Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yan Xi
- Head and Neck Tumor Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ruimei Sun
- Head and Neck Tumor Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jing Ma
- Department of ENT, Kunming City Children's Hospital, Kunming, China
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Maurizi M, Almadori G, Plaudetti G, De Corso E, Galli J. Laser carbon dioxide cordectomy versus open surgery in the treatment of glottic carcinoma: Our results. Otolaryngol Head Neck Surg 2016; 132:857-61. [PMID: 15944555 DOI: 10.1016/j.otohns.2005.01.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE: To analyze oncologic results in patients with glottic cancers treated respectively, by laser CO2 or open surgery, taking into account specific-disease survival, rate of locoregional recurrences, and their salvageability. STUDY DESIGN: Retrospective study of 198 patients treated from January 1993 to June 2002 in the department of otorhinolaryngology at a Catholic university in Rome. METHODS: Glottic carcinoma were treated by laser CO2 cordectomy in 132 patients (group 1) and by open surgery in 66 patients (group 2). The statistical analysis was performed by Kaplan Meyer method, log rank test, and x 2 , test. RESULTS: The log-rank test points out significant differences between the 2 groups regarding specific-disease survival; no differences were found for disease-free survival. Within group 1, 16 patients developed local failure, which was retreated in 6 cases with laser surgery; in 9 (6.8%) with total laryngectomy, only 1 case was inoperable. In this group, 10 patients (62.5%) were salvaged. Within group 2, 18 patients developed local recurrences, which was retreated in 14 (21.21%) cases with total laryngectomy; the other 4 cases were not suitable for surgery. Of these 18, 8 patients (44.5%) were salvaged. CONCLUSIONS AND SIGNIFICANCE: Our results show significant differences between the 2 groups concerning the specific-disease survival and the salvageability of local recurrences. In fact, in group 1 we found a higher salvage rate and a lower incidence of total laryngectomy. As already suggested, laser therapy leaves the laryngeal cartilaginous framework intact, avoiding the spread of the tumor out of laryngeal organ and resulting in a more favorable oncologic outcome.
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Affiliation(s)
- Maurizio Maurizi
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
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Heaton CM, Al-Shwaiheen F, Liu CSJ, Yom SS, Ryan WR. Prognostic significance of hyoid bone invasion in advanced base of tongue carcinoma treated by chemoradiation. Clin Otolaryngol 2015; 40:260-5. [PMID: 25641627 DOI: 10.1111/coa.12367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the prognostic influence of hyoid bone invasion in advanced base of tongue squamous cell carcinoma treated with chemoradiation. METHODS We retrospectively reviewed pre-treatment imaging (CT/MRI) for the presence or absence of hyoid bone invasion in patients with advanced (clinical T3 or T4a stage) base of tongue squamous cell carcinoma treated with chemoradiation from January 2001 to January 2011. We compared patients with hyoid bone invasion to those without based on the following metrics: 1-, 2- and 5-year locoregional recurrence-free survival, disease-free survival, disease-specific survival and overall survival. RESULTS Eleven of thirty-seven patients had hyoid invasion present on pre-treatment imaging. Average follow-up was 45 months. Patients with hyoid bone invasion were found to have lower percentages in all survival metrics measured compared to patients without, respectively, with statistical significance achieved in the following: 2-year locoregional recurrence-free survival: 36.4% versus 86.4% (P = 0.006), 5-year locoregional recurrence-free survival: 12.5% versus 63.6% (P = 0.05), 2-year disease-free survival: 36.4% versus 77.3% (P = 0.05), 5-year disease-free survival: 12.5% versus 63.3% (P = 0.05) and the Kaplan-Meier curve for locoregional recurrence-free survival (P = 0.0075). CONCLUSIONS Hyoid bone invasion by base of tongue squamous cell carcinoma may indicate a poorer prognosis despite treatment. Hyoid bone invasion may be a possible indication for intensification of treatment and/or may indicate a necessity for increasing the degree of post-treatment surveillance monitoring and imaging.
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Affiliation(s)
- C M Heaton
- Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, CA, USA
| | - F Al-Shwaiheen
- School of Medicine, Graduate Program for Clinical Research, University of California - San Francisco, San Francisco, CA, USA
| | - C-S J Liu
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, CA, USA
| | - S S Yom
- Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, CA, USA.,Department of Radiation Oncology, University of California - San Francisco, San Francisco, CA, USA
| | - W R Ryan
- Division of Head and Neck Oncologic/Endocrine/Salivary Surgery, Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, CA, USA
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Connor KL, Pattle S, Kerr GR, Junor E. Treatment, comorbidity and survival in stage III laryngeal cancer. Head Neck 2014; 37:698-706. [PMID: 24596316 DOI: 10.1002/hed.23653] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/01/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was for us to identify factors associated with survival and laryngeal function in a contemporary, population-based study of stage III laryngeal carcinoma. METHODS Patients presenting to a tertiary center with stage III laryngeal carcinoma between 1999 and 2010 were included in the study. Kaplan-Meier and Cox proportional hazards analyses were utilized. RESULTS Of 137 patients receiving either surgery ± adjuvant therapy (SURG±Adj = 24.1%), chemoradiotherapy (CRT = 32.8%), or radiotherapy alone (RT = 36.5%), 5-year cause-specific survival (5-year CSS) was 81.0% and 2-year local relapse rate was 27.5%. RT had higher recurrence (p < .01), lower 5-year CSS (90.8% vs 87.8% vs 68.9%/SURG±Adj vs CRT vs RT/p = .0026) and lower overall survival (p = .001). Adjusting for excess of severe comorbidity in the RT group, there was no difference in 5-year CSS between treatment modality. CONCLUSION SURG±Adj and CRT had similar survival. Severe comorbidity was associated with selection bias to RT and reduced 5-year CSS. Comorbidity is a key prognostic variable and should be considered in the interpretation of treatment outcomes.
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Affiliation(s)
- Katie L Connor
- Department of Oncology, The Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland
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Karlsson TR, Al-Azzawe M, Aziz L, Hurman D, Finizia C. Survival outcome depending on different treatment strategies in advanced stages III and IV laryngeal cancers: an audit of data from two European centres. Eur Arch Otorhinolaryngol 2013; 271:547-54. [PMID: 23995705 DOI: 10.1007/s00405-013-2657-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 08/13/2013] [Indexed: 11/25/2022]
Abstract
In light of continued uncertainty regarding efficacy of treatment of Stages III and IV laryngeal tumours, this study aims to evaluate organ-preservation strategies, comprising radiotherapy and chemoradiotherapy versus surgical treatment (laryngectomy ± adjuvant treatment) by encompassing the long-established practice at two internationally acclaimed tertiary centres not previously presented in published literature. Retrospective review was conducted of non-randomised prospectively maintained Stages III and IV disease patient databases at two tertiary centres: Sahlgrenska University Hospital (SU) in Gothenburg, Sweden, and Aberdeen Royal Infirmary (ARI) in Aberdeen, Scotland. Primary outcome measures included 3-year overall, disease-specific survival and local control depending on treatment. A total of 176 patients were identified. Sixty-five patients (37 %) presented with Stage III tumours, of which 51 patients received organ-preserving treatment and 14 underwent total laryngectomy. The corresponding figures for the 111 patients (63 %) presenting with Stage IV disease were 42 and 69. Three-year overall and disease-specific survival for Stage III was 58 and 73 %, respectively. The corresponding figures for Stage IV disease were 42 and 53 %. The choice of treatment did not appear to significantly influence survival for Stage III (p = 0.56) or IV (p = 0.93) disease. The choice of treatment, whether organ preservation or surgery, does not seem to significantly influence the overall or disease-specific survival. Therefore, other factors such as quality of life and voice and efficacy of salvage treatments are perhaps more likely to indicate the preferred treatment options, but larger randomised trials are needed.
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Affiliation(s)
- Therese R Karlsson
- Department of Otorhinolaryngology, Head and Neck Surgery Sahlgrenska University Hospital, Gothenburg University, SE 413 45, Gothenburg, Sweden,
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Oksuz DC, Prestwich RJ, Carey B, Wilson S, Senocak MS, Choudhury A, Dyker K, Coyle C, Sen M. Recurrence patterns of locally advanced head and neck squamous cell carcinoma after 3D conformal (chemo)-radiotherapy. Radiat Oncol 2011; 6:54. [PMID: 21609453 PMCID: PMC3127781 DOI: 10.1186/1748-717x-6-54] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 05/24/2011] [Indexed: 01/22/2023] Open
Abstract
Background To establish recurrence patterns among locally advanced head and neck non-nasopharyngeal squamous cell carcinoma (HNSCC) patients treated with radical (chemo-) radiotherapy and to correlate the sites of loco-regional recurrence with radiotherapy doses and target volumes Method 151 locally advanced HNSCC patients were treated between 2004-2005 using radical three-dimensional conformal radiotherapy. Patients with prior surgery to the primary tumour site were excluded. The sites of locoregional relapses were correlated with radiotherapy plans by the radiologist and a planning dosimetrist. Results Median age was 59 years (range:34-89). 35 patients had stage III disease, 116 patients had stage IV A/B. 36 patients were treated with radiotherapy alone, 42 with induction chemotherapy, 63 with induction and concomitant chemoradiotherapy and 10 concomitant chemoradiotherapy. Median follow-up was 38 months (range 3-62). 3-year cause specific survival was 66.8%. 125 of 151 (82.8%) achieved a complete response to treatment. Amongst these 125 there were 20 local-regional recurrence, comprising 8 local, 5 regional and 7 simultaneous local and regional; synchronous distant metastases occurred in 7 of the 20. 9 patients developed distant metastases in the absence of locoregional failure. For the 14 local recurrences with planning data available, 12 were in-field, 1 was marginal, and 1 was out-of-field. Of the 11 regional failures with planning data available, 7 were in-field, 1 was marginal and 3 were out-of-field recurrences. Conclusion The majority of failures following non-surgical treatment for locally advanced HNSCC were loco-regional, within the radiotherapy target volume. Improving locoregional control remains a high priority.
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Liu XK, Zhang Q, Li Q, Liu WW, Li H, Zeng ZY, Guo ZM. Laryngeal framework reconstruction using titanium mesh in glottic cancer after frontolateral vertical partial laryngectomy. Laryngoscope 2011; 120:2197-202. [PMID: 20824791 DOI: 10.1002/lary.21103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate the feasibility and efficacy of laryngeal framework reconstruction using titanium mesh in patients with glottic cancer after frontolateral vertical partial laryngectomy. STUDY DESIGN Prospective study. METHODS Defect of laryngeal framework, caused by frontolateral vertical partial laryngectomy in nine patients with T2 or T3 squamous cell carcinoma of glottic, were reconstructed with titanium mesh from 2007 to 2009. Computed tomography (CT) and fiberscopic examinations were performed at two weeks and three months postoperatively. RESULTS No aspiration and laryngeal stenosis was observed in the nine patients. CT scanning showed that titanium mesh was fastened well without displacement and deformity and that there was no laryngeal stenosis. Fiberscopic inspection showed that the larynx lumen was maintained well without stricture, shrinkage, and necrosis. No titanium mesh was exposed to the larynx lumen. CONCLUSIONS Titanium mesh was a good alternative for reconstruction of the laryngeal framework. It provided adequate structural support to maintain airway patency.
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Affiliation(s)
- Xue-Kui Liu
- State Key Laboratory of Oncology in South China, Department of Head and Neck Surgery, Cancer Center, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
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Effects of tumour stage, comorbidity and therapy on survival of laryngeal cancer patients: a systematic review and a meta-analysis. Eur Arch Otorhinolaryngol 2010; 268:165-79. [DOI: 10.1007/s00405-010-1395-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 09/24/2010] [Indexed: 12/18/2022]
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Liu WS, Hsin CH, Chou YH, Liu JT, Wu MF, Tseng SW, Lee JK, Tseng HC, Wang TH, Su MC, Lee H. Long-term results of intensity-modulated radiotherapy concomitant with chemotherapy for hypopharyngeal carcinoma aimed at laryngeal preservation. BMC Cancer 2010; 10:102. [PMID: 20298550 PMCID: PMC3087314 DOI: 10.1186/1471-2407-10-102] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 03/18/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this retrospective study is to investigate laryngeal preservation and long-term treatment results in hypopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT) combined with chemotherapy. METHODS Twenty-seven patients with hypopharyngeal carcinoma (stage II-IV) were enrolled and underwent concurrent chemoradiotherapy. The chemotherapy regimens were monthly cisplatin and 5-fluorouracil for six patients and weekly cisplatin for 19 patients. All patients were treated with IMRT with simultaneous integrated boost technique. Acute and late toxicities were recorded based on CTCAE 3.0 (Common Terminology Criteria for Adverse Events). RESULTS The median follow-up time for survivors was 53.0 months (range 36-82 months). The initial complete response rate was 85.2%, with a laryngeal preservation rate of 63.0%. The 5-year functional laryngeal, local-regional control, disease-free and overall survival rates were 59.7%, 63.3%, 51.0% and 34.8%, respectively. The most common greater than or equal to grade 3 acute and late effects were dysphagia (63.0%, 17 of 27 patients) and laryngeal stricture (18.5%, 5 of 27 patients), respectively. Patients belonging to the high risk group showed significantly higher risk of tracheostomy compared to the low risk group (p = 0.014). CONCLUSIONS After long-term follow-up, our results confirmed that patients with hypopharyngeal carcinoma treated with IMRT concurrent with platinum-based chemotherapy attain high functional laryngeal and local-regional control survival rates. However, the late effect of laryngeal stricture remains a problem, particularly for high risk group patients.
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Affiliation(s)
- Wen-Shan Liu
- Departments of Radiation Oncology, Chung Shan Medical University Hospital, No 110, Sec 1, Chien-Kuo N Rd, Taichung 402, Taiwan
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Haugen H, Johansson KA, Ejnell H, Edström S, Mercke C. Accelerated radiotherapy for advanced laryngeal cancer. Acta Oncol 2009; 44:481-9. [PMID: 16118082 DOI: 10.1080/02841860510029950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to evaluate a single institution's outcome for patients with advanced laryngeal cancer treated with accelerated radiotherapy (RT). Fifty-eight patients with advanced laryngeal cancer (T3/T4N0/N + M0) were treated with curative intent with accelerated RT during the period 1990-1998. Patients received radiotherapy alone or with induction chemotherapy. The 5-year local control (LC) and loco-regional control (LRC) probabilities were both 49% for T3 and 75% for T4 tumors. The 5-year disease-free survival probability was 46% and 68% and overall survival probability was 30% and 39% for T3 and T4 tumors respectively. No significant statistical difference in outcome was found, either between T3 and T4 tumors, or between patients who received induction chemotherapy and those who did not. The treatment results for advanced laryngeal cancer at this institution were comparable to those reported in the literature. The results for T3 and T4 were similar. T4 classification alone should not be an exclusion criterion for larynx preservation. Overall survival was poor, partly because of a high incidence of deaths from intercurrent diseases.
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Affiliation(s)
- Hedda Haugen
- Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden
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Delaere P, Goeleven A, Poorten VV, Hermans R, Hierner R, Vranckx J. Organ preservation surgery for advanced unilateral glottic and subglottic cancer. Laryngoscope 2007; 117:1764-9. [PMID: 17713447 DOI: 10.1097/mlg.0b013e3181238397] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Functional surgery of unilateral T(2b) to T3 glottic cancer and cricoid chondrosarcoma is possible using the technique of tracheal autotransplantation. The objective of this paper is to report the functional and oncologic outcome of 24 consecutive patients treated with this technique between 2001 and 2007. METHODS Seventeen patients, of whom nine were previously irradiated, had unilateral glottic cancer with impaired mobility of the vocal fold. Clinical staging was T(2b) to (3)N(0). Seven patients had a chondrosarcoma of the cricoid cartilage. In a first operation, an extended hemilaryngectomy was performed, and a radial forearm flap, comprising a distal fascial and a proximal skin component, was transferred to the neck. The fascial paddle was wrapped around the upper 4-cm segment of cervical trachea, and the skin paddle was used for temporary closure of the extended hemilaryngectomy defect. The definitive reconstruction was performed after 2 to 3 months and consisted of removal of the skin paddle from the laryngeal defect and a transplantation of a patch of revascularized cervical trachea to reconstruct the laryngeal defect. RESULTS Swallowing and speech were restored after the first operation. The glottic and subglottic airway lumen was restored during the second operation. The tracheostomy could be closed in 20 patients. After a median follow-up period of 33 (range, 1-66) months or almost 3 years, 23 patients remained free of tumor recurrence. CONCLUSIONS Tracheal autotransplantation can be recommended as a functional treatment for selected T(2b) to T(3) glottic cancers and for unilateral chondrosarcomas of the cricoid cartilage. The technique is oncologically robust while resulting in good postoperative function.
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Affiliation(s)
- Pierre Delaere
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital K.U. Leuven, Leuven, Belgium.
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Hinerman RW, Mendenhall WM, Morris CG, Amdur RJ, Werning JW, Villaret DB. T3 and T4 true vocal cord squamous carcinomas treated with external beam irradiation: a single institution's 35-year experience. Am J Clin Oncol 2007; 30:181-5. [PMID: 17414468 DOI: 10.1097/01.coc.0000251368.57302.cc] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to report the outcomes after external-beam radiotherapy (RT) for selected T3 and T4 vocal cord squamous cell carcinomas. METHODS AND MATERIALS One hundred nine patients with previously untreated T3 and T4 squamous cell carcinomas of the glottic larynx were treated with curative intent in this Institutional Review Board-approved outcome study using continuous-course RT alone (106 patients) or followed by a planned neck dissection (3 patients) between September 1966 and June 2002. Patients selected for such treatment had relatively low-volume, unilateral disease. Patients were staged according to the recommendations of the American Joint Committee on Cancer (AJCC) as follows: T3N0, 68 patients (62%); T3N1, 14 patients (13%); T3N2B, 5 patients (5%); T4N0, 17 patients (16%); T4N1, 4 patients (4%); and T4N2B, 1 patient. RESULTS The 5-year outcomes after treatment were: local control for stage T3 and T4, 78% and 81%; locoregional control for AJCC stage III and IVa, 62% and 78%; distant metastasis-free survival for AJCC stage III and IVa, 97% and 100%; cause-specific survival for AJCC stage III and IVa, 84% and 87%; and overall survival for AJCC stage III and IVa, 52% and 67%, respectively. Severe complications occurred in 13 patients (12%). CONCLUSIONS The results of this retrospective study compare favorably with those published elsewhere in the literature for T3 and T4 vocal cord carcinomas. Local control and ultimate cure probabilities will hopefully improve further with the addition of concomitant chemotherapy to RT for larger tumors.
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Affiliation(s)
- Russell W Hinerman
- Department of Radiation Oncology at the University of Florida, Gainesville, Florida, USA.
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González-Botas JH, Vázquez Barro JC. [Epidermoid carcinoma larynx in stage IV]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007; 57:419-24. [PMID: 17184011 DOI: 10.1016/s0001-6519(06)78740-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the survival, loco-regional control, distant metastases and second primary in stage IV laryngeal carcinoma treated by surgery and radiotherapy. MATERIAL Retrospective study of 147 patients treated with surgery and radiotherapy with a 5 year minimun follow-up. RESULTS Overall and cause specific survival at 5 and 10 years was 42%, 35% and 49%, 45.8% respectively. Loco-regional control was 57.7 % and 54.7% at 5 and 10 years. Local recurrences presented in 25.7%, regional recurrences in 74.2%, and distant metastases 10.9%. Second primary tumors developed in 12% of the patients, 50% of the cases in the lungs. Factors related to survival are evaluated. CONCLUSIONS In our experience, surgery with postoperative radiotherapy in N+, controls 45% of stage IV laryngeal carcinoma. Regional recurrencies are the main cause of failure, more frequent in N+ patientes, present in the first 36 months after treatment.
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Abstract
OBJECTIVE This study reports the results of treatment for supraglottic laryngeal cancer with nine different treatment modalities with long-term follow-up. STUDY DESIGN Retrospective study of 653 patients with supraglottic laryngeal squamous cell cancer treated from April 1955 to January 1999. METHODS The study population included previously untreated patients with cancer of the supraglottic larynx treated with curative intent by one of nine treatment modalities and who were eligible for 5-year follow-up. The treatment modalities included subtotal supraglottic laryngectomy (SSL), SSL with neck dissection (SSL/ND), total laryngectomy (TL), TL/ND, radiation therapy (RT), SSL/RT, SSL/ND/RT, TL/RT, and TL/ND/RT. Multiple diagnostic, treatment, and follow-up parameters were studied using standard statistical analysis to determine significance. RESULTS None of the nine treatment modalities produced a survival advantage, either overall or within the stages. Overall disease specific survival (DSS) by treatment modality included SSL 88.9%, SSL/ND 75.8%, TL 83.3%, TL/ND 66.7%, RT 47.2%, SSL/RT 68.9%, SSL/ND/RT 68.1%, TL/RT 59.3%, and TL/ND/RT 46.7%. Improved DSS and cumulative disease specific survival rates were associated with patients under the age of 65 years (P = .0001), early stage disease, N0 disease (P = .0001), clear resection margins (P = .0094), and no recurrence (P = .0001). Posttreatment function showed that 90% of patients were functional in everyday life, 90.7% were eating satisfactorily, 91.4% were breathing naturally, and 83% of SSL patients, 85.7% of RT patients, and 52.8% of TL patients had "good" voices. Laryngeal preservation was accomplished in 86.1% of SSL patients and 72.7% of RT patients (P = .0190). CONCLUSIONS No treatment modality produced a survival advantage. Because SSL produced the best rate of laryngeal preservation, we recommend its use in treating the primary in eligible patients. The importance of clear resection margins is stressed. Patients with N+ disease should have the neck treated. Patients with N0 disease may be observed safely with no loss of survival advantage. Because of the pattern of recurrence and the high rates of distant metastasis and second primary cancers, follow-up for a period of not less than 8 years is recommended.
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Affiliation(s)
- Donald G Sessions
- Department of Otolaryngology-Head and Neck Surgery, and Head and Neck Tumor Research Project, Barnes-Jewish Hospital Foundation, St. Louis, MO 63110, U.S.A
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Spector GJ, Sessions DG, Lenox J, Newland D, Simpson J, Haughey BH. Management of Stage IV Glottic Carcinoma: Therapeutic Outcomes. Laryngoscope 2004; 114:1438-46. [PMID: 15280724 DOI: 10.1097/00005537-200408000-00024] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS The best therapeutic approach for the treatment of stage IV glottic carcinoma is controversial. STUDY DESIGN A retrospective study. METHODS A retrospective study of Tumor Research Project data was performed using patients with stage IV glottic squamous cell carcinoma treated with curative intent by five different treatment modalities from 1955 to 1998 at Washington University School of Medicine and Barnes-Jewish Hospital (St. Louis, MO). RESULTS Ninety-six patients with stage IV glottic carcinoma were treated by five modalities: total laryngectomy (TL) (n = 13), total laryngectomy with neck dissection (TL/ND) (n = 18), radiation therapy alone (RT) (n = 7) (median dose, 69.5 Gy), total laryngectomy combined with radiation therapy (TL/RT) (n = 10), and total laryngectomy and neck dissection combined with radiation therapy (TL/ND/RT) (n = 48). The overall 5-year observed survival (OS) rate was 39%, and the 5-year disease-specific survival (DSS) rate was 45%. The 5-year DSS rates for the individual treatment modalities included the following: TL, 58.3%; TL/ND, 42.9%; RT, 50.0%; TL/RT, 30.0%; and TL/ND/RT, 43.9%. There was no significant difference in DSS for any individual treatment modality (P =.759). The overall locoregional control rate was 69% (66 of 96). The overall recurrence rate was 39% with recurrence at the primary site and in the neck at 19% and 17%, respectively. Recurrence was not related to treatment modality. The 5-year DSS after treatment of locally recurrent cancer (salvage rate) was 30% (3 of 10) and for recurrent neck disease (28 of 67) was 42%. The incidence of delayed regional metastases was 28%; of distant metastasis, 12%; and of second primary cancers, 9%. There was no statistically significant difference in survival between node-negative (N0) necks initially treated (5-y DSS, 31%) versus N0 necks observed and later treated if necessary (5-y DSS, 44%) (P =.685). CONCLUSION The five treatment modalities had statistically similar survival, recurrence, and complication rates. The overall 5-year DSS for patients with stage IV glottic carcinoma was 45%, and the OS was 39%. The cumulative disease-specific survival (CDSS) was 0.4770 with a mean survival of 10.1 years and a median survival of 3.9 years. Patients younger than age 55 years had better survival (DSS) than patients 56 years of age or older (P =.0002). Patients with early T stage had better survival than patients with more advanced T stage (P =.04). Tumor recurrence at the primary site (P =.0001) and in the neck (P =.014) and distant metastasis (P =.0001) had a deleterious effect on survival. Tumor recurrence was not related to treatment modality. Patients with clear margins of resection had a statistically significant improved survival (DSS and CDSS) compared with patients with close or involved margins (P =.0001). Post-treatment quality of life was not significantly related to treatment modality. Patients whose N0 neck was treated with observation and appropriate treatment for subsequent neck disease had statistically similar survival compared with patients whose N0 neck was treated prophylactically at the time of treatment of the primary. A minimum of 7 years of follow-up is recommended for early identification of recurrent disease, second primary tumors, and distant metastasis. None of the standard treatment modalities currently employed has a statistical advantage regarding survival, recurrence, complications, or quality of life.
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Affiliation(s)
- Gershon J Spector
- Department of Otolaryngology--Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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Pfreundner L, Hoppe F, Willner J, Preisler V, Bratengeier K, Hagen R, Helms J, Flentje M. Induction chemotherapy with paclitaxel and cisplatin and CT-based 3D radiotherapy in patients with advanced laryngeal and hypopharyngeal carcinomas--a possibility for organ preservation. Radiother Oncol 2003; 68:163-70. [PMID: 12972311 DOI: 10.1016/s0167-8140(03)00076-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND To evaluate the effect of paclitaxel/cisplatin induction chemotherapy (ICHT) and CT-based radiotherapy (RT) on larynx preservation, tumor control, and survival in patients with larynx/hypopharynx carcinoma eligible for total laryngectomy (TL) or TL plus partial pharyngectomy (TLPP). PATIENTS AND METHODS Fifty patients eligible for TL or TLPP were enrolled onto a prospective study and treated with ICHT (200 mg/m(2) paclitaxel, 100 mg/m(2) cisplatin; day 1, 22). In patients with complete or partial tumor response RT (69.9 Gy in 5.5 weeks at the gross tumor, 50.4 Gy in the lymphatic drainage; single dose: 1.8 Gy, concomitant boost: 1.5 Gy) was applied. Non-responders had TL/TLPP and RT with total doses adapted to the radicality of tumor resection (56-70 Gy). RESULTS The response rate to ICHT was 88% (10% complete, 78% partial response). At a median follow-up period of 25 months the larynx preservation rate was 84%. The 2-year local-regional control rate was 91% and the 2-year overall survival rate was 72.3%. The 3-year estimate to survive with functional larynx is 60%. CONCLUSION In a large portion of patients eligible for TL or TLPP the larynx was preserved by paclitaxel/cisplatin ICHT and 3D RT.
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Affiliation(s)
- Leo Pfreundner
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str.11, 97080 Wuerzburg, Germany.
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Abstract
Definitive radiotherapy for T1 or T2 laryngeal carcinoma offers good local control and quality of voice. Recent clinical trials with hyperfractionated radiotherapy and concurrent chemoradiotherapy demonstrated improved rates of local control for advanced laryngeal cancer treated with primary radiotherapy and provides the opportunity for organ preservation. The use of amifostine and pilocarpine may prevent or ameliorate radiation-induced xerostomia. Recent advances in 3-D conformal radiotherapy and IMRT lead to a better dose distribution for sparing normal organs while treating target volumes with full dose.
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Affiliation(s)
- Ding-Jen Lee
- Division of Radiation Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, 401 North Broadway, Baltimore, MD 21231, USA.
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Johansen LV, Grau C, Overgaard J. Glottic carcinoma--patterns of failure and salvage treatment after curative radiotherapy in 861 consecutive patients. Radiother Oncol 2002; 63:257-67. [PMID: 12142089 DOI: 10.1016/s0167-8140(02)00118-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to evaluate the patterns of failure and the treatment of recurrences, in a series of primary irradiated patients with squamous cell carcinoma of the glottic larynx. MATERIALS AND METHODS Eight hundred and sixty-one consecutive patients were included in this study from 1963 to 1991, out of which 74 were females and 787 males. The stages were: I 56, II 26, III 15, and IV 3%. In 847 of 861 cases (98%) the primary treatment was delivered with curative intent, and out of these 834 patients received primary radical radiotherapy. RESULTS With a minimum follow up of 5 years, 274/861(32%) patients had persistent or recurrent disease; in 91% of these the persistent or recurrent disease was in the T-position, 15% in the N-position, and 5% developed distant metastases. Curative salvage attempt was possible in 207 patients, and 145 were subsequently controlled. A total of 718 (83%) patients obtained ultimate tumour control, 584 (68%) without a laryngectomy (134 of the controlled had a laryngectomy, 109 had a total laryngectomy and 25 had a partial laryngectomy). In the patients treated with curative intent, the overall 5-year local tumour control, loco-regional tumour control, disease specific survival rate and overall survival rate was 72, 70, 86 and 66%, respectively. For patients with small tumours the disease specific survival for T1a, T1b and T2 was 95, 93 and 83%, respectively. In the 718 patients cured for their glottic carcinoma, 204 new primary malignant tumours were detected. CONCLUSIONS The study shows that laryngeal glottic carcinoma can be effectively managed by primary radiotherapy and surgery salvage. The control is obtained with a high proportion of laryngeal preservation (68%). Recurrences treated with surgical salvage have a success rate of 70%. New primaries are a major problem.
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Affiliation(s)
- Lars Vendelbo Johansen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, DK-8000 Aarhus C, Denmark
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Couture C, Raybaud-Diogène H, Têtu B, Bairati I, Murry D, Allard J, Fortin A. p53 and Ki-67 as markers of radioresistance in head and neck carcinoma. Cancer 2002; 94:713-22. [PMID: 11857304 DOI: 10.1002/cncr.10232] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND p53 and Ki-67 are regarded as potential interesting predictors of radioresistance, although their exact influence awaits confirmation on a large cohort of uniformly treated patients. METHODS In a retrospective cohort of 304 patients with squamous cell carcinoma of the head and neck who were treated with radical radiotherapy, the expression levels of p53 and Ki-67 were assessed by immunohistochemistry. Local control and survival curves were generated for p53 and Ki-67 using the Kaplan-Meier method. The difference between curves was calculated in univariate and multivariate analyses. RESULTS The overexpression of p53 was associated with local treatment failure (P = 0.01) but not with survival (P = 0.09). In a Cox analysis, p53 overexpression remained an independent predictor of local failure, with a relative risk of local failure of 1.5 (P = 0.05). Low proliferation (Ki-67 < 20%) was a significant factor in local failure for patients with tumors of the oral cavity only (P = 0.01). Patients with both unfavorable immunohistochemical markers (p53 overexpression and low proliferation) had a 45% rate of local control compared with a 67% rate for all other combinations (P = 0.002). This association was even more significant in patients with T1-T2 lesions (45% vs. 77%; P = 0.0002). CONCLUSIONS The results support the role of p53 as an independent predictor of local failure in patients with squamous cell carcinoma of the head and neck who are treated by radical radiotherapy, suggesting that it may predict radioresistance. Combined with p53, Ki-67 may help in the better selection of patients for radiotherapy, especially for patients with early-stage tumors. Prospective studies are now needed to confirm these results and to define better the role of these markers in the management of patients with head and neck carcinoma.
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Nguyen-Tan PF, Le QT, Quivey JM, Singer M, Terris DJ, Goffinet DR, Fu KK. Treatment results and prognostic factors of advanced T3--4 laryngeal carcinoma: the University of California, San Francisco (UCSF) and Stanford University Hospital (SUH) experience. Int J Radiat Oncol Biol Phys 2001; 50:1172-80. [PMID: 11483326 DOI: 10.1016/s0360-3016(01)01538-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To review the UCSF-SUH experience in the treatment of advanced T3--4 laryngeal carcinoma and to evaluate the different factors affecting locoregional control and survival. METHODS AND MATERIALS We reviewed the records of 223 patients treated for T3--4 squamous cell carcinoma of the larynx between October 1, 1957, and December 1, 1999. There were 187 men and 36 women, with a median age of 60 years (range, 28--85 years). The primary site was glottic in 122 and supraglottic in 101 patients. We retrospectively staged the patients according to the 1997 AJCC staging system. One hundred and twenty-seven patients had T3 lesions, and 96 had T4 lesions; 132 had N0, 29 had N1, 45 had N2, and 17 had N3 disease. The overall stage was III in 93 and IV in 130 patients. Seventy-nine patients had cartilage involvement, and 144 did not. Surgery was the primary treatment modality in 161 patients, of which 134 had postoperative radiotherapy (RT), 11 had preoperative RT, 7 had surgery followed by RT and chemotherapy (CT), and 9 had surgery alone. Forty-one patients had RT alone, and 21 had CT with RT. Locoregional control (LRC) and overall survival (OS) were estimated using the Kaplan--Meier method. Log-rank statistics were employed to identify significant prognostic factors for OS and LRC. RESULTS The median follow-up was 41 months (range, 2--367 months) for all patients and 78 months (range, 6--332 months) for alive patients. The LRC rate was 69% at 5 years and 68% at 10 years. Eighty-four patients relapsed, of which 53 were locoregional failures. Significant prognostic factors for LRC on univariate analysis were primary site, N stage, overall stage, the lowest hemoglobin (Hgb) level during RT, and treatment modality. Favorable prognostic factors for LRC on multivariate analysis were lower N stage and primary surgery. The overall survival rate was 48% at 5 years and 34% at 10 years. Significant prognostic factors for OS on univariate analysis were: primary site, age, overall stage, T stage, N stage, lowest Hgb level during RT, and treatment modality. Favorable prognostic factors for OS on multivariate analysis were lower N stage and higher Hgb level during RT. CONCLUSION Lower N-stage was a favorable prognostic factor for LRC and OS. Hgb levels > or = 12.5 g/dL during RT was a favorable prognostic factor for OS. Surgery was a favorable prognostic factor for LRC but did not impact on OS. Correcting the Hbg level before and during treatment should be investigated in future clinical trials as a way of improving therapeutic outcome in patients with advanced laryngeal carcinomas.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- California/epidemiology
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Carcinoma, Squamous Cell/therapy
- Chemotherapy, Adjuvant/adverse effects
- Cisplatin/administration & dosage
- Cisplatin/adverse effects
- Combined Modality Therapy
- Disease-Free Survival
- Female
- Fluorouracil/administration & dosage
- Fluorouracil/adverse effects
- Follow-Up Studies
- Hemoglobins/analysis
- Humans
- Laryngeal Neoplasms/drug therapy
- Laryngeal Neoplasms/mortality
- Laryngeal Neoplasms/pathology
- Laryngeal Neoplasms/radiotherapy
- Laryngeal Neoplasms/surgery
- Laryngeal Neoplasms/therapy
- Laryngectomy/adverse effects
- Life Tables
- Male
- Middle Aged
- Neoplasm Staging
- Neoplasms, Second Primary/epidemiology
- Radiotherapy, Adjuvant/adverse effects
- Remission Induction
- Retrospective Studies
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- P F Nguyen-Tan
- Department of Radiation Oncology, University of California, San Francisco, CA, USA.
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30
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Abstract
Treatment of laryngeal and hypopharyngeal cancers often necessitates total laryngectomy. This article reviews approaches of curing patients with these diseases while preserving their larynx. Strategies include radiation alone, neoadjuvant chemotherapy with radiation for responders, or concurrent chemotherapy and radiation. Both retrospective experiences and randomized trials evaluating differing therapies in an effort to achieve voice preservation are reported and analyzed.
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Affiliation(s)
- A S Garden
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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31
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Rudat V, Wannenmacher M. Role of multimodal treatment in oropharynx, larynx, and hypopharynx cancer. SEMINARS IN SURGICAL ONCOLOGY 2001; 20:66-74. [PMID: 11291134 DOI: 10.1002/ssu.1018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Due to recent advances in radiation fractionation, radiochemotherapy, and conservative surgical techniques, the concept of multimodal therapy in head and neck cancer is currently changing. The recently published RTOG Phase III trial 9003, with 1,113 patients accrued, showed that hyperfractionation and accelerated fractionation with concomitant boost are more efficacious than standard fractionation for locally-advanced head and neck cancer. Acute, but not late, toxicity was also increased. Three meta-analyses have suggested that the impact of chemotherapy in head and neck cancer is small but is highly associated with the timing of therapy. Concomitant administration of radiation therapy and chemotherapy led to an absolute benefit in 5-year survival of about 10%. This finding has been further supported by recently published randomized prospective trials comparing concomitant radiochemotherapy with radiotherapy alone in advanced head and neck cancer. There is now clear evidence that radiochemotherapy provides a substantial and statistically significant improvement in survival and local-regional control, as compared to radiotherapy alone. Radiochemotherapy should be considered an accepted standard of care in cancers of the oropharynx, particularly for patients with locally-advanced disease who have a good performance status. Two randomized studies conducted by the Department of Veterans' Affairs and the EORTC, with a total of 534 patients accrued, showed that induction chemotherapy followed by radiotherapy of responders yields survival rates equal to those of total laryngectomy with postoperative radiotherapy. After 4 years, one-half to two-thirds of survivors of the chemotherapy arm retained a functional larynx. Larynx preservation using induction chemotherapy can now be regarded as feasible but still investigational. Current phase II studies show excellent larynx preservation rates using a primary concomitant radiochemotherapy with an altered fractionation regimen. More clinical and laboratory research is required to further evaluate the different treatment options of the multimodality concept, and to develop prognostic models that will allow individualization of the therapy.
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Affiliation(s)
- V Rudat
- Department of Radiation Oncology, University of Heidelberg, Germany.
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32
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Barbosa MM, Dias FL, Kligerman J, Faria TPD, Chagas MJ, Leôncio MDP. Radioterapia como tratamento exclusivo no câncer avançado da laringe. Rev Col Bras Cir 2000. [DOI: 10.1590/s0100-69912000000400004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Caracteristicamente os estágios avançados (III e IV) do câncer da laringe são tratados inicialmente por cirurgia, seguida de radioterapia complementar. Esta tem sido a combinação terapêutica que tem obtido os melhores resultados, com relação à maior sobrevida e ao maior tempo livre de doença, nestes pacientes. Porém, como freqüentemente a cirurgia a ser adotada nestes casos representa uma mutilação, perda da voz laríngea, nem sempre esta opção de tratamento é aceita pelos pacientes. Por outro lado, pacientes portadores de doença em estágio avançado podem encontrar-se com suas condições clínicas bastante comprometidas, o que impossibilita a realização de uma cirurgia de grande porte. A associação de quimioterapia e radioterapia tem tido pouca utilidade neste tipo de pacientes, pois geralmente apresentam estado clínico geral comprometido e não suportam a alta toxicidade dos esquemas terapêuticos empregados. Nestes casos a indicação de radioterapia exclusiva, como forma de tentar controlar a doença, tem sido a única arma terapêutica que nos resta, e cujos resultados sempre foram uma incógnita no nosso meio. Foram estudados 62 pacientes portadores de carcinoma epidermóide avançado (estágios III e IV) da laringe, tratados por radioterapia exclusiva, no Hospital do Câncer (INCa), durante os anos de 1992 e 1993. Foi realizado tratamento radioterápico com intenção curativa, sendo empregada a dose clássica de 50cGy em cinco semanas. Estes pacientes foram retrospectivamente analisados quanto à sobrevida, ao estágio da doença, à presença de linfonodos cervicais metastáticos, à idade e à necessidade de traqueostomia prévia. Além da constatação da total ineficácia da radioterapia no controle da doença laríngea estágio IV, detectou-se que a sobrevida de três anos igual a 54% para os pacientes do estágio III e a preservação da função da laringe em 2/3 dos pacientes, poderão representar, dependendo de estudos mais abrangentes, uma alternativa terapêutica para pacientes selecionados.
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