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Okubo M, Itonaga T, Saito T, Shiraishi S, Mikami R, Sakurada A, Sugahara S, Park J, Tokuuye K, Saito K. Predictive factors for local control of early glottic squamous cell carcinomas after definitive radiotherapy. Mol Clin Oncol 2020; 12:541-550. [PMID: 32337036 DOI: 10.3892/mco.2020.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/29/2020] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to retrospectively investigate the risk factors of local failure for T1 glottic carcinoma irradiated with a prescription dose of 66 Gy. Between July 2006 and December 2017, 64 patients with T1 glottic squamous cell carcinoma treated with 66 Gy/33 fractions were analyzed for risk factors of local failure. The sex, age, performance status, T stage, overall treatment time, anterior commissure involvement, smoking status during/after treatment, histological tumor grade and pretreatment hemoglobin level were investigated. The maximum, mean and minimum doses, and the homogeneity index for the glottic larynx were calculated for dosimetric risk factors of local failure. The median follow-up duration was 51 months. Local failure was observed in 6 patients (9.5%). Among all risk factors, only the minimum dose to the glottic larynx was found to be significantly associated with local failure (P=0.025). The 5-year local control rates for a minimum dose to the glottic larynx of <65 and ≥65 Gy were 79 and 95%, respectively, with a statistically significant difference (P=0.015). No patients exhibited grade ≥3 late adverse effects. The minimum dose to the glottic larynx was the only factor significantly associated with local failure. Thus, local control of T1 glottic carcinoma may improve with a minimum dose of ≥65 Gy to the glottic larynx. In conclusion, radiotherapy with a minimum prescription dose of ≥65 Gy to the glottic larynx appears to be safe and achieves a high local control rate for T1 glottic carcinoma.
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Affiliation(s)
- Mitsuru Okubo
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Tomohiro Itonaga
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Tatsuhiko Saito
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Sachika Shiraishi
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Ryuji Mikami
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Akira Sakurada
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Shinji Sugahara
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Jinho Park
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Koichi Tokuuye
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
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Lionello M, Bertolin A, Nardello E, Giacomelli L, Canal F, Rizzotto G, Marioni G, Lucioni M. Could the infiltration of the thyroarytenoid muscle define the pT2 glottic carcinoma? Head Neck 2019; 41:3639-3646. [PMID: 31385412 DOI: 10.1002/hed.25893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The involvement of the thyroarytenoid (TA) muscle by glottic cancer may be related to an impaired vocal cord mobility, which is classified as cT2 disease. The primary endpoint was to evaluate the prognostic significance of TA muscle involvement in early glottic cancer treated with transoral laser microsurgery (TLM). METHODS A review was conducted on a cohort of 209 patients consecutively treated with TLM for early glottic carcinoma. Univariate analysis was used to examine the prognostic meaning of clinical and pathological parameters. RESULTS The statistical analysis showed that TA muscle infiltration correlated significantly with a worse prognosis in terms of recurrence rate and disease-free survival, and this was confirmed even in the subcohort with pT1a glottic cancer. CONCLUSIONS Our preliminary findings suggest that it could be considered as a criterion for upstaging a glottic cancer from pT1 to pT2.
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Affiliation(s)
- Marco Lionello
- Otolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - Andy Bertolin
- Otolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - Ennio Nardello
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | | | - Fabio Canal
- Pathology Unit, Vittorio Veneto - Conegliano Hospital, Treviso, Italy
| | | | - Gino Marioni
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - Marco Lucioni
- Otolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
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Ding S, Huang J, Huang Z, Xu H, Guo W, Zhang Y. Variation in prognosis of early laryngeal carcinoma after different types of cordectomy with transoral laser microsurgery. Acta Otolaryngol 2018; 138:741-745. [PMID: 29504443 DOI: 10.1080/00016489.2018.1439592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The lack of standardized treatment is problematic in laser surgery for laryngeal cancer, and may result in an increased recurrence rate. This study analyzed the prognosis of early laryngeal carcinoma after different types of cordectomy with laser surgery. METHODS A cohort of 818 patients with stage Tis or T1 primary early glottic squamous cell carcinoma treated with CO2 laser surgery was retrospectively analyzed. RESULTS Of the 818 patients, According to the Kaplan-Meier method, the rate of 5-year overall survival was 92.8%, and the rates for 5-year disease-specific survival and 5-year locoregional control were 96.9% and 91.3%, respectively. Among the T1 patients, type II cordectomy with laser surgery had a significant impact on the 5-year locoregional control rate, but no obvious impact on the 5-year overall survival rate. CONCLUSIONS There must be sufficient depth and extent of excision in T1 patientsand in early carcinoma especially those with possible microinvasive carcinoma.
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Affiliation(s)
- Shuo Ding
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
| | - Junwei Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
| | - Zhigang Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
| | - Hongbo Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
| | - Wei Guo
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
| | - Yang Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
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Chu PY, Hsu YB, Lee TL, Fu S, Wang LM, Kao YC. Modified type III cordectomy to improve voice outcomes after transoral laser microsurgery for early glottic canser. Head Neck 2011; 34:1422-7. [PMID: 22052443 DOI: 10.1002/hed.21936] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 06/28/2011] [Accepted: 08/03/2011] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND We proposed a modified type III cordectomy for the treatment of early glottic cancer that removed the upper part of the vocalis muscle to improve glottic closure and voice outcomes. METHODS Twenty-two patients with early glottic cancer underwent type III cordectomy, including 9 classical (proposed by European Laryngological Society) and 13 modified resections. Multidimensional voice evaluations were performed. RESULTS Voice parameters including GRBAS (overall grade [G], roughness of the voice [R], breathiness [B], asthenicity [A], and strain [S]), jitter, shimmer, noise-to-harmonic ratio, maximum phonation time, voice handicap index-functional, physical, and total scores were better in modified resection. Eleven patients (85%) had complete glottic closure in modified resection and 3 (33%) in classical resection (p = .026). Only 2 patients had tumor recurrence, 1 (8%) in the modified resection and 1 (11%) in the classical resection group (p = 1.000). CONCLUSIONS Modified type III cordectomy proved to be an oncologically safe method. The voice outcomes were better than those in patients who underwent classical type III cordectomy.
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Affiliation(s)
- Pen-Yuan Chu
- Department of Otolaryngology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan.
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Alicandri-Ciufelli M, Molteni G, Mattioli F, Bergamini G, Tassi S, Monzani D, Presutti L, D'Angeli I, Izzo P, Izzo L. Horizontal glottectomy: is it an out-of-date procedure? Am J Otolaryngol 2011; 32:578-82. [PMID: 21306787 DOI: 10.1016/j.amjoto.2010.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 11/20/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the study is to illustrate our experience with horizontal glottectomy (HG), reviewing the indications and results of this uncommon partial laryngectomy. MATERIALS AND METHODS It is a retrospective study. We completed a chart review of patients who underwent partial laryngectomy between May 2003 and June 2010. Patients who underwent HG were included in the study. Data obtained were collected and analyzed. RESULTS Seven male patients were included in the study (mean age was 78 years; range, 69-88 years). In all cases, the TNM classification was pT1bN0M0 apart from one patient who had pT1N1M0. Three patients had a moderately differentiated neoplasm (G2), whereas 4 patients had a well-differentiated tumor (G1). Tracheotomy tube removal, oral feeding, and voice analysis have been evaluated and reported in the study. Mean follow-up was 16 months. CONCLUSIONS Horizontal glottectomy might be a worthwhile treatment option in selected patients nowadays. In older patients with anterior commissure involvement, this procedure guarantees adequate functional and good oncological results. This study may possibly help surgeons dealing with glottic cancer involving the anterior commissure because we believe that some patients could benefit from HG, even in this radiotherapy and transoral laser surgery "era."
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Okubo M, Nishimura Y, Shibata T, Nakamatsu K, Kanamori S, Tachibana I, Koike R, Nishikawa T, Mori K. Definitive radiation therapy for moderately advanced laryngeal cancer: effects of accelerated hyperfractionation. Jpn J Clin Oncol 2010; 40:944-8. [PMID: 20534687 DOI: 10.1093/jjco/hyq078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this retrospective study was to analyze the results of accelerated hyperfractionation for patients with moderately advanced (T2 and T3) laryngeal cancer. METHODS Between 1998 and 2007, 9 supraglottic carcinomas (6 T2N0M0, 2 T2N2M0, 1 T3N0M0), 30 glottic carcinomas (25 T2N0M0, 5 T3N0M0), and 1 T2N0M0 subglottic carcinoma were treated with definitive radiotherapy using accelerated hyperfractionation without concurrent chemotherapy. The dose-fractionation for 35 patients was 72.8 Gy/56 fractions/5.6 weeks, and that for four patients treated between 1998 and 2001 was 72 Gy/60 fractions/6 weeks. One patient who had been treated with steroid therapy for systemic lupus erythematosus was treated by 67.8 Gy/44 fractions/4.4 weeks. RESULTS The local control and overall survival probabilities at 5 years for supraglottic carcinomas were 75% and 86%, respectively. Those for glottic carcinomas were 80% and 92%, respectively. The 5-year local control probabilities for T2 and T3 tumors were 85% and 56%, respectively. This excellent local control rate especially for T2 laryngeal carcinomas may be attributable to the effect of accelerated hyperfractionation. No late toxicities of grade 2 or more was noted among the 39 patients treated with 72.8 Gy/56 fractions or 72 Gy/60 fractions. CONCLUSION Accelerated hyperfractionation of 72.8 Gy/56 fractions/5.6 weeks using 1.3 Gy/fraction seems a safe and effective dose-fractionation for patients with moderately advanced laryngeal carcinomas.
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Affiliation(s)
- Mitsuru Okubo
- Department of Radiology, Tokyo Medical University Hachioji Medical Center, 1663 Tatemachi, Hachioji city, Tokyo 193-0998, Japan.
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Silver CE, Beitler JJ, Shaha AR, Rinaldo A, Ferlito A. Current trends in initial management of laryngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 2009; 266:1333-52. [PMID: 19597837 DOI: 10.1007/s00405-009-1028-2] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 06/18/2009] [Indexed: 11/24/2022]
Affiliation(s)
- Carl E Silver
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Remacle M, Van Haverbeke C, Eckel H, Bradley P, Chevalier D, Djukic V, de Vicentiis M, Friedrich G, Olofsson J, Peretti G, Quer M, Werner J. Proposal for revision of the European Laryngological Society classification of endoscopic cordectomies. Eur Arch Otorhinolaryngol 2007; 264:499-504. [PMID: 17377801 DOI: 10.1007/s00405-007-0279-z] [Citation(s) in RCA: 216] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 12/11/2006] [Indexed: 11/29/2022]
Abstract
A classification of laryngeal endoscopic cordectomies, which included eight different types, was first proposed by the European Laryngological Society in 2000. The purpose of this proposal of classification was an attempt to reach better consensus amongst clinicians and agree on uniformity in reporting the extent and depth of resection of cordectomy procedures, to allow relevant comparisons within the literature when presenting/publishing the results of surgery, and to recommend the use of guidelines to allow for reproducibility amongst practicing laryngologists. A total of 24 article citations of this classification have been found through the science citation index, as well as 3 book chapters on larynx cancer surgery, confirming its acceptance. However, on reflection, and with the passage of time, lesions originating at the anterior commissure have not been clearly described and, for that reason, a new endoscopic cordectomy (type VI) for cancers of the anterior commissure, which have extended or not to one or both of the vocal folds, without infiltration of the thyroid cartilage is now being proposed by the European Laryngological Society Committee on Nomenclature to revise and complete the initially reported classification.
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Affiliation(s)
- Marc Remacle
- Department of Oto-rhino-laryngology, University Hospital of Louvain at Mont-Godinne, Yvoir, Belgium.
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Abstract
The length and quality of head and neck cancer survivorship continues to improve. Radiotherapy has been central to this process through advances in treatment technology, fractionation schemas, radiosensitizing chemotherapy, and surgical technique. The future of head and neck radiotherapy looks brighter still with progress in radiosensitizing biologic therapy, molecular characterization, functional imaging, and rehabilitative strategies fast approaching. Head and neck cancer, a disease once fraught with nihilism and failure, is evolving into a major success story of multidisciplinary solid tumor management. Continued dedication and work on the part of provider and patient alike will be required to make this promise a reality.
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Affiliation(s)
- D L Schwartz
- Department of Radiation Oncology, M.D. Anderson Cancer Center, Unit 97, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Akimoto T, Nonaka T, Kitamoto Y, Ishikawa H, Ninomiya H, Chikamatsu K, Furuya N, Hayakawa K, Mitsuhashi N, Nakano T. Radiation therapy for T2N0 laryngeal cancer: A retrospective analysis for the impact of concurrent chemotherapy on local control. Int J Radiat Oncol Biol Phys 2006; 64:995-1001. [PMID: 16406396 DOI: 10.1016/j.ijrobp.2005.10.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Revised: 10/09/2005] [Accepted: 10/11/2005] [Indexed: 11/29/2022]
Abstract
PURPOSE The impact of concurrent chemotherapy on the local control in patients with T2N0 laryngeal cancer who receive radiation therapy (RT) was evaluated. METHODS AND MATERIALS Sixty-three patients with T2N0 laryngeal cancer who were treated by definitive RT were analyzed. The primary site of the cancer was the glottis in 50 patients, the supraglottis in 9 patients, and the subglottis in 4 patients. Thirty-six patients were treated by RT alone and the remaining 27 patients received concurrent chemoradiotherapy (CRT). RESULTS Complete response (CR) was obtained in 92% of the patients who received RT alone and 100% of the patients who received CRT. Voice preservation in the group who received CRT (89%) was significantly higher than that in the group treated by RT alone (61%). The 5-year disease-free survival rates in those who received concurrent CRT was significantly superior to that in the patients who received RT alone, although no significant difference was seen in the cause-specific survival rate between the 2 groups. The multivariate analysis revealed that the treatment method (RT alone vs. CRT) was the most significant risk factor that predicted recurrence after RT. CONCLUSION Concurrent CRT had a positive impact on the local control of T2N0 laryngeal cancer.
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Affiliation(s)
- Tetsuo Akimoto
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
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Kadish SP. Can I treat this small larynx lesion with radiation alone? Update on the radiation management of early (T1 and T2) glottic cancer. Otolaryngol Clin North Am 2005; 38:1-9, vii. [PMID: 15649494 DOI: 10.1016/j.otc.2004.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article endeavors to explain the advantages and disadvantages of radiotherapy (RT) versus transoral laser excision (TLE)and to suggest when each modality may be employed for optimal treatment of patients with this heterogeneous group of tumors. It compares RT and TLE using the criteria of cure and local control rates, posttreatment voice quality, side effects and morbidity, cost,convenience, and salvage potential.
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Affiliation(s)
- Sidney P Kadish
- Department of Radiation Oncology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
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Abstract
Laryngeal cancers account for approximately 1.5% (1 approximately 2%) of the total cancers in Korea, and 30% of all head and neck cancers, not including thyroid cancer. Early laryngeal cancer is treated by operation, including transoral laser excision or radiotherapy. Advanced laryngeal cancer has been treated with mutilating operations, such as a total laryngectomy. However, a laryngeal preserving approach, which can improve the quality of life, has recently been tried with advanced laryngeal cancer.
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Affiliation(s)
- Youn Sang Shim
- Department of Otorhinolaryngology and Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea.
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Amdur RJ, Li JG, Liu C, Hinerman RW, Mendenhall WM. Unnecessary laryngeal irradiation in the IMRT era. Head Neck 2004; 26:257-63; discussion 263-4. [PMID: 14999801 DOI: 10.1002/hed.10379] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The purpose of this review is to address the issue of unnecessary irradiation of the normal larynx. METHODS We performed a literature review and dosimetry evaluation of intensity modulated radiotheraphy (IMRT) techniques. RESULTS Data suggest that matching conventional parallel opposed photon fields through adenopathy is a reasonable alternative to the common practice of unnecessarily irradiating the normal larynx to high doses. The dosimetry evaluation demonstrates that the laryngeal dose is much higher when the entire neck is included in the IMRT field as opposed to using a standard anterior low-neck field below the level of the thyroid notch. CONCLUSIONS Lateral opposed fields should not be extended to include the larynx to avoid matching fields through adenopathy. IMRT fields should not include the normal larynx when the laryngeal dose would be substantially lower with a technique that shields the larynx in an anterior low-neck field.
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Affiliation(s)
- Robert J Amdur
- Department of Radiation Oncology, University of Florida Health Science Center, P.O. Box 100385, Gainesville, Florida 32610-0385, USA.
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