1
|
Williamson A, Jashek-Ahmed F, Hardman J, Paleri V. Functional and quality-of-life outcomes following salvage surgery for recurrent squamous cell carcinoma of the head and neck: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:4597-4618. [PMID: 37329358 DOI: 10.1007/s00405-023-08056-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Recurrent head and neck squamous cell carcinomas (HNSCC) are frequently managed with salvage surgery, but the impact these operations have on function and quality-of-life (QoL) is understudied. This review aimed to provide a quantitative and qualitative assessment of the functional and QoL effects of salvage surgical procedures. METHODS Systematic review and meta-analysis were conducted of studies reporting QoL and function following salvage HNSCC resections. RESULTS The search identified 415 articles and 34 were selected for inclusion. Pooled random effects analysis revealed long-term feeding and tracheostomy tube rates of 18% and 7%. Pooled long-term feeding tube rates in open oral and oropharyngeal, transoral robotic, total and partial laryngectomy surgeries were 41%, 25%, 11% and 4%. Eight studies used validated QoL questionnaires. CONCLUSIONS Functional and QoL outcomes from salvage surgery are acceptable, but appear to be worse following open procedures. Prospective studies measuring changes over time are needed to assess these procedures impact on patient well-being.
Collapse
Affiliation(s)
- Andrew Williamson
- International Centre for Recurrent Head and Neck Cancer (IReC), Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK.
- Institute for Cancer Research, London, UK.
| | - Farizeh Jashek-Ahmed
- International Centre for Recurrent Head and Neck Cancer (IReC), Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - John Hardman
- International Centre for Recurrent Head and Neck Cancer (IReC), Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK
- Institute for Cancer Research, London, UK
| | - Vinidh Paleri
- International Centre for Recurrent Head and Neck Cancer (IReC), Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK
- Institute for Cancer Research, London, UK
| |
Collapse
|
2
|
Salvage carbon dioxide transoral laser microsurgery for laryngeal cancer after (chemo)radiotherapy: a European Laryngological Society consensus statement. Eur Arch Otorhinolaryngol 2021; 278:4373-4381. [PMID: 34226992 PMCID: PMC8486708 DOI: 10.1007/s00405-021-06957-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/23/2021] [Indexed: 12/11/2022]
Abstract
Purpose To provide expert opinion and consensus on salvage carbon dioxide transoral laser microsurgery (CO2 TOLMS) for recurrent laryngeal squamous cell carcinoma (LSCC) after (chemo)radiotherapy [(C)RT]. Methods Expert members of the European Laryngological Society (ELS) Cancer and Dysplasia Committee were selected to create a dedicated panel on salvage CO2 TOLMS for LSCC. A series of statements regarding the critical aspects of decision-making were drafted, circulated, and modified or excluded in accordance with the Delphi process. Results The expert panel reached full consensus on 19 statements through a total of three sequential evaluation rounds. These statements were focused on different aspects of salvage CO2 TOLMS, with particular attention on preoperative diagnostic work-up, treatment indications, postoperative management, complications, functional outcomes, and follow-up. Conclusion Management of recurrent LSCC after (C)RT is challenging and is based on the need to find a balance between oncologic and functional outcomes. Salvage CO2 TOLMS is a minimally invasive approach that can be applied to selected patients with strict and careful indications. Herein, a series of statements based on an ELS expert consensus aimed at guiding the main aspects of CO2 TOLMS for LSCC in the salvage setting is presented.
Collapse
|
3
|
Vander Poorten V, Meulemans J, Beitler JJ, Piazza C, Kowalski LP, Mäkitie AA, Paleri V, Rinaldo A, Robbins KT, Rodrigo JP, Silver CE, Sjögren EV, Strojan P, Takes RP, Ferlito A. Salvage surgery for residual or recurrent laryngeal squamous cell carcinoma after (Chemo)radiotherapy: Oncological outcomes and prognostic factors. Eur J Surg Oncol 2021; 47:2711-2721. [PMID: 34059377 DOI: 10.1016/j.ejso.2021.05.035] [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: 02/19/2021] [Revised: 04/26/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022] Open
Abstract
Nonsurgical primary treatment of early and advanced laryngeal squamous cell carcinoma, employing radiotherapy with or without chemotherapy, is considered a standard of care in many centers throughout the world. When patients have persistent or recurrent disease after non-surgical treatment, salvage surgery is frequently the only remaining potentially curative treatment. Depending on the extent of the residual/recurrent disease, different surgical salvage options are at the surgeon's disposal. In selected cases with limited local disease, salvage transoral laser microsurgery, transoral robotic surgery and open partial laryngectomies can be employed to achieve cure while preserving laryngeal function. For more advanced cases total laryngectomy is necessary. Identifying situations with unacceptable results from surgical salvage may guide future therapies.
Collapse
Affiliation(s)
- Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
| | - Jeroen Meulemans
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Otolaryngology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil; Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki, University Hospital, FI-00029, HUS Helsinki, Finland
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, The Institute of Cancer Research, Brompton Road, London, UK
| | | | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Elisabeth V Sjögren
- Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
4
|
The investigation of salvage endoscopic laryngopharyngeal surgery after chemoradiotherapy. Wideochir Inne Tech Maloinwazyjne 2020; 15:511-518. [PMID: 32904634 PMCID: PMC7457200 DOI: 10.5114/wiitm.2020.94518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Endoscopic laryngopharyngeal surgery (ELPS) is an effective treatment for early-stage oropharyngeal and hypopharyngeal cancers. Since 2007, we have performed ELPS on 14 patients with early-stage cancer who had undergone radiation therapy (salvage ELPS). We discuss the beneficial effects and issues with salvage ELPS compared with those of fresh patients since we experienced some severe complications, such as ruptured pseudoaneurysm with salvage ELPS. Aim To our knowledge, the efficacy and safety of ELPS following radiation therapy have not yet been evaluated, and several unknown factors exist. An evaluation was performed for assessing whether ELPS following radiation therapy is safe, similar to findings in fresh cases previously reported by us, and whether this treatment method can be efficacious. Material and methods We studied the cases of 14 patients who had undergone salvage ELPS after radiation therapy for head and neck cancer at Akita University Hospital between 2007 and 2018. Results The rate of recurrence of head and neck cancer at different sites after salvage ELPS was 48.9% at 2 years. Furthermore, deformation of the pharyngolarynx made it extremely difficult to perform surgery. We also experienced extremely severe complications of ruptured pseudoaneurysms. Conclusions If salvage ELPS is performed after radiation therapy, patients should be followed up on an outpatient basis to monitor the onset of subsequent cancers. Complications may become severe; therefore, postoperative management should be performed cautiously. In particular, vulnerable sites, such as the piriform sinus, may not be indicated for surgery. At this stage, the expectation is that patients need to be methodically selected.
Collapse
|
5
|
Horwich P, Rigby MH, MacKay C, Melong J, Williams B, Bullock M, Hart R, Trites J, Taylor SM. Laryngeal recurrence sites in patients previously treated with transoral laser microsurgery for squamous cell carcinoma. J Otolaryngol Head Neck Surg 2018; 47:14. [PMID: 29433567 PMCID: PMC5810005 DOI: 10.1186/s40463-018-0266-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The laryngeal framework provides a natural barrier preventing tumour spread to extralaryngeal structures. Transoral laser microsurgery (TLM) for laryngeal squamous cell carcinoma (SCC) may violate these boundaries, altering the pathways of tumor spread for potential recurrences. Our project objective is to describe laryngeal SCC recurrence patterns and overall survival in patients requiring total laryngectomy (TL) after TLM. METHODS Patients undergoing TLM for laryngeal SCC requiring salvage TL were identified from a prospective CO2 laser database containing all patients undergoing TLM for head and neck malignancies at the QEII Health Sciences Center in Halifax, Nova Scotia between March 2002 - May 2014. Surgical pathology reports were analyzed for tumor characteristics, extent of recurrence and invasion of local structures. Kaplan-Meier analyses were performed to evaluate overall survival, disease specific survival (DSS) and locoregional control. RESULTS Fifteen patients were identified from the database as receiving salvage TL for recurrent disease after initial TLM resection for laryngeal SCC. Final pathology reports demonstrated that 67% (10/15) of patients had thyroid cartilage involvement while 53% (9/15) of patients had cricoid cartilage involvement on salvage TL pathology. 33% (5/15) of patients had perineural invasion and 27% (4/15) had lymphovascular invasion. Mean and median follow-up times were 36.7 months and 26.8 months respectively (range 3.9-112.6). The Kaplan-Meier estimate for overall survival at 36 months was 40% post TL with a standard error (SE) of 13.6%. DSS was 47% (SE 14.2%), and locoregional control was 55% (SE 14.5%) post TL. CONCLUSIONS Laryngeal recurrence sites following TLM seem to be consistent with historical data at known laryngeal sites of vulnerability. Treatment with TLM does not predispose patients to a lower rate of locoregional control and overall survival after total laryngectomy and salvage outcomes are consistent with literature values.
Collapse
Affiliation(s)
- P Horwich
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada.
| | - M H Rigby
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada
| | - C MacKay
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada
| | - J Melong
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada
| | - B Williams
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada
| | - M Bullock
- Department of Pathology, Division of Anatomical Pathology, Queen Elizabeth II Health Science Centre and Dalhousie University, Halifax, NS, Canada
| | - R Hart
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada
| | - J Trites
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada
| | - S M Taylor
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada
| |
Collapse
|
6
|
Weiss BG, Bertlich M, Canis M, Ihler F. Transoral laser microsurgery or total laryngectomy for recurrent squamous cell carcinoma of the larynx: Retrospective analysis of 199 cases. Head Neck 2017; 39:1166-1176. [DOI: 10.1002/hed.24737] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/29/2016] [Indexed: 12/25/2022] Open
Affiliation(s)
- Bernhard G. Weiss
- Department of Otorhinolaryngology, University Medical Center Göttingen; Georg-August University Göttingen; Robert-Koch-Straße 40 Göttingen Germany
| | - Mattis Bertlich
- Department of Otorhinolaryngology, University Medical Center Göttingen; Georg-August University Göttingen; Robert-Koch-Straße 40 Göttingen Germany
| | - Martin Canis
- Department of Otorhinolaryngology, University Medical Center Göttingen; Georg-August University Göttingen; Robert-Koch-Straße 40 Göttingen Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, University Medical Center Göttingen; Georg-August University Göttingen; Robert-Koch-Straße 40 Göttingen Germany
| |
Collapse
|
7
|
Meulemans J, Delaere P, Nuyts S, Clement P, Hermans R, Vander Poorten V. Salvage Transoral Laser Microsurgery for Radiorecurrent Laryngeal Cancer: Indications, Limits, and Outcomes. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017; 5:83-91. [PMID: 28367362 PMCID: PMC5357496 DOI: 10.1007/s40136-017-0143-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review The aim of this report is to identify relevant literature reports on salvage transoral laser microsurgery (TLM); to consider its oncologic and functional outcomes, as well as reported complications; and to address indications and limitations of salvage TLM. Findings The weighted average of local control after first salvage TLM was 57%. Repeated TLM procedures for second or third recurrences were required in up to 41% of cases, resulting in a weighted average of local control with TLM alone of 67%. The rate of definite laryngeal preservation was 73%. The ultimate local control rate, including cases that required total laryngectomy, was 90%. The overall complication rate after salvage TLM was 14%. Summary Salvage TLM of radiorecurrent laryngeal cancer yields excellent oncologic outcomes. Serious complications are scarce, hospitalization times are short, and functional outcomes in terms of voice and swallowing are favorable when compared to open conservation laryngeal surgery. The key to success is an optimal patient selection.
Collapse
Affiliation(s)
- J. Meulemans
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - P. Delaere
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - S. Nuyts
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Experimental Radiotherapy, KU Leuven, Leuven, Belgium
| | - P.M. Clement
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
- Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - R. Hermans
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - V. Vander Poorten
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| |
Collapse
|
8
|
Tomifuji M, Araki K, Yamashita T, Shiotani A. Salvage Transoral Videolaryngoscopic Surgery for radiorecurrent hypopharyngeal and supraglottic cancer. Auris Nasus Larynx 2016; 44:464-471. [PMID: 27856033 DOI: 10.1016/j.anl.2016.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/16/2016] [Accepted: 10/19/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the feasibility of Transoral Videolaryngoscopic Surgery (TOVS) for radiorecurrent supraglottic and hypopharyngeal cancer, and to compare survival and complications between primary and radiorecurrent cases. METHODS Twelve cases of salvage TOVS for radiorecurrent cancer and 53 cases of TOVS as an initial treatment (primary cases) were evaluated. Days to resume soft diet, Functional Outcomes of Swallowing Scale (FOSS), postoperative complications, epithelization days and survival outcomes were assessed by retrospective chart review. RESULTS FOSS score was significantly worse in salvage cases compared with primary cases. Bleeding and airway compromise was slightly greater in salvage cases than in primary cases; however, this was not statistically significant. Wound healing was significantly delayed in salvage cases compared with primary cases (P<0.001). In primary cases, wounds were re-epithelized within 60 days in 83% of patients and within 90 days in almost all patients, while in salvage cases 42% of patients required more than 90 days for wound healing. In salvage cases, the 5-year overall survival, disease specific survival rate, local control rate, and laryngeal preservation rate was 85.7%, 85.7%, 62.5%, and 78.0%, respectively, and 85.7%, 98.0%, 91.3%, and 97.8%, respectively, for primary cases. Local control rate was significantly better in primary cases than in salvage cases. CONCLUSION Salvage TOVS was feasible in highly selected cases. After serial transoral surgery, the final laryngeal preservation rate was satisfactory. Swallowing function in salvage cases tended to be worse than in primary cases, and a significantly longer time was required for wound healing.
Collapse
Affiliation(s)
- Masayuki Tomifuji
- National Defense Medical College, Department of Otolaryngology - Head and Neck Surgery, Saitama, Japan.
| | - Koji Araki
- National Defense Medical College, Department of Otolaryngology - Head and Neck Surgery, Saitama, Japan
| | - Taku Yamashita
- Kitasato University School of Medicine, Department of Otorhinolaryngology - Head and Neck Surgery, Kanagawa, Japan
| | - Akihiro Shiotani
- National Defense Medical College, Department of Otolaryngology - Head and Neck Surgery, Saitama, Japan
| |
Collapse
|
9
|
Jayaram SC, Muzaffar SJ, Ahmed I, Dhanda J, Paleri V, Mehanna H. Efficacy, outcomes, and complication rates of different surgical and nonsurgical treatment modalities for recurrent/residual oropharyngeal carcinoma: A systematic review and meta-analysis. Head Neck 2016; 38:1855-1861. [PMID: 27405247 DOI: 10.1002/hed.24531] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- Sharan Chakkyath Jayaram
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham; Birmingham West Midlands United Kingdom
| | - Sayed Jameel Muzaffar
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham; Birmingham West Midlands United Kingdom
| | - Ikhlaaq Ahmed
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham; Birmingham West Midlands United Kingdom
| | - Jagtar Dhanda
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham; Birmingham West Midlands United Kingdom
| | - Vinidh Paleri
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham; Birmingham West Midlands United Kingdom
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham; Birmingham West Midlands United Kingdom
| |
Collapse
|
10
|
Melong JC, Rigby MH, Bullock M, Hart RD, Trites JRB, Taylor SM. Transoral laser microsurgery for the treatment of oropharyngeal cancer: the Dalhousie University experience. J Otolaryngol Head Neck Surg 2015; 44:39. [PMID: 26419647 PMCID: PMC4589206 DOI: 10.1186/s40463-015-0093-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/17/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The optimal treatment strategy for oropharyngeal squamous cell carcinoma is highly debated. However, growing evidence supports the use of minimally invasive techniques, such as transoral laser microsurgery (TLM), as a first-line treatment modality for these carcinomas. The purpose of our study was to assess the efficacy and safety of TLM for the treatment of primary and recurrent oropharyngeal carcinomas. METHODS All patients with oropharyngeal carcinoma undergoing TLM at the QEII Health Sciences Centre in Halifax, Nova Scotia were identified within a prospective database monitoring TLM outcomes. Kaplan-Meier survival analysis was used to evaluate the following end points at 36 months: local control (LC), disease-specific survival (DSS), and disease-free survival (DFS). Safety endpoints included complications following surgery and long term morbidity related to TLM. RESULTS Between 2003 and 2014, 39 patients with oropharyngeal carcinoma underwent TLM resection. Twenty-eight (72%) patients had primary carcinoma, nine (23%) were radiation/chemoradiation (RT/CRT) failures, and two (5%) had second primaries following previous RT/CRT. Three patients had stage I disease, 8 stage II, 5 stage III, and 23 stage IV disease. HPV status was available for 26 patients, of which 23 (88%) had HPV positive disease. Kaplan-Meier estimates of 36-month LC, DSS, and DFS for primary oropharyngeal carcinomas were 85.5% (SE 10.6%), 85.7% (SE 13.2%) and 77.7% (SE 12.5%) respectively. Thirty-six-month outcomes for RT/CRT failures were 66.76% (SE 15.7%) for LC and 55.6% (SE 16.6%) for DSS and DFS. Three patients developed complications following surgery. CONCLUSIONS Observed 36-month efficacy and safety outcomes support the use of TLM for the treatment of primary and recurrent oropharyngeal carcinoma.
Collapse
Affiliation(s)
- Jonathan C Melong
- Division of Otolaryngology - Head and Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
| | - Matthew H Rigby
- Division of Otolaryngology - Head and Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
| | - Martin Bullock
- Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
| | - Robert D Hart
- Division of Otolaryngology - Head and Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
| | - Jonathan R B Trites
- Division of Otolaryngology - Head and Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
| | - S Mark Taylor
- Division of Otolaryngology - Head and Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
| |
Collapse
|
11
|
Postoperative photodynamic therapy as a new adjuvant treatment after robot-assisted salvage surgery of recurrent squamous cell carcinoma of the base of tongue. World J Surg Oncol 2015; 13:214. [PMID: 26179387 PMCID: PMC4503294 DOI: 10.1186/s12957-015-0630-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/16/2015] [Indexed: 11/18/2022] Open
Abstract
Background For patients who remain with involved resection margins after transoral robot-assisted salvage surgery (TORS) for recurrent squamous cell carcinoma (SCC) at the base of tongue (BOT) following primary (chemo)radiotherapy, further adjuvant treatment options are very limited. We want to report on our preliminary experience with a new adjuvant strategy using postoperative temoporfin-mediated photodynamic therapy for this indication. Methods Two patients with recurrent SCC after primary (chemo)radiotherapy of the BOT were treated with TORS, but unfortunately remained with involved resection margins on the postoperative pathology report. If left without additional treatment, these patients are prone to further recurrence. Temoporfin-mediated photodynamic therapy was used as a new adjuvant approach to treat the remaining microscopic disease at the resection margins. Results Good oncological and functional results were obtained in these patients, now treated for a recurrence, after a preceding full course of radiotherapy. Both are disease free at 42 and 24 months of follow-up and are able to speak, breathe, and eat normally. Conclusions In selected patients that have undergone salvage surgery with positive resection margins, postoperative temoporfin-mediated photodynamic therapy can result in a good oncological and functional outcome. Electronic supplementary material The online version of this article (doi:10.1186/s12957-015-0630-6) contains supplementary material, which is available to authorized users.
Collapse
|
12
|
Abstract
Transoral laser microsurgery (TLM) was pioneered in the early 1970s as an approach to treat laryngeal pathology with precision and minimal thermal damage to the vocal cords. Over the last four decades, TLM has become an integral part of the treatment paradigm for patients with laryngeal cancer. TLM is one of the primary treatment options for early-stage laryngeal tumors. However, in recent years, surgeons have begun to develop TLM into a more versatile approach which can be used to address advanced laryngeal tumors. Although functional outcomes following TLM for advanced laryngeal disease are scarce, survival outcomes appear to be comparable with those reported for organ preservation strategies employing external beam radiation therapy (EBRT) and chemotherapy. In addition, TLM plays an important role in the setting of recurrent laryngeal cancer following primary irradiation. TLM has been demonstrated to decrease the need for salvage total laryngectomy resulting in improved functionality while retaining comparable oncologic outcomes. The aim of this review is to elucidate the indications, techniques, and oncological outcomes of TLM for advanced laryngeal cancers.
Collapse
Affiliation(s)
- Vlad C. Sandulache
- Bobby R. Alford Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA and
| | - Michael E. Kupferman
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
- To whom correspondence should be addressed. E-mail:
| |
Collapse
|
13
|
Changing management of head and neck cancer. The Journal of Laryngology & Otology 2013; 127:951. [PMID: 24168923 DOI: 10.1017/s0022215113002405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|