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Aydil U, Akmansu M, Gümüşay Ö, Eravcı FC, Bakkal FK, Yazıcı Ö, Kızıl Y, Zorlu ME, Yıldız R, Köybaşıoğlu A. Failure of Concurrent Chemoradiotherapy for Organ Preservation in Laryngeal Cancer: Survival Outcomes and Recurrence Patterns. EAR, NOSE & THROAT JOURNAL 2019; 98:E92-E96. [PMID: 30983390 DOI: 10.1177/0145561319839788] [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] [Indexed: 11/16/2022] Open
Abstract
Although definitive chemoradiation (CRT) has been used for locally advanced laryngeal cancer for more than 2 decades, studies focusing on CRT failures in advanced laryngeal cancer are scarce. In this study, we aimed to determine the failure patterns and the survival outcomes in the patients who had recurrence after concurrent CRT for laryngeal cancer. Clinical records of the patients who had definitive concurrent CRT for laryngeal cancer between 2001 and 2014 at a tertiary referral center were reviewed. The end points of the study were 1-, 2-, and 3-year overall survival (OS) and disease-specific survival (DSS).In our results, there were 48 failures and the mean time period from the first diagnosis of disease to the diagnosis of recurrence was 18.0 months (range 2-72; standard deviation: 15.6). The most common recurrence pattern was local recurrence in 21 (47.9%) patients followed by regional recurrence in 11 (22.9%) patients. The 1 and 3 years OS rates were 41.7%, and 19.2% for the entire cohort, and 64.5%, and 29.7% for the patients who had not systemic recurrence at presentation of recurrence, respectively. The 1 and 3 years DSS rates were 43.5%, and 20.0% for the entire cohort, and 69.0%, and 31.8% for the patients who had not systemic recurrence at presentation of recurrence, respectively. All patients who had systemic recurrence initially (n = 13) died within 9 months (median = 4 months, range: 1-9 months). This study reveals that survival outcomes are unfavorable in the CRT failures and careful patient selection is critical to minimize failures. In the presence of systemic recurrence, disease course is aggressive.
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Affiliation(s)
- Utku Aydil
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Müge Akmansu
- 2 Department of Radiation Oncology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Özge Gümüşay
- 3 Department of Medical Oncology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Fakih Cihat Eravcı
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Faruk Kadri Bakkal
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Ömer Yazıcı
- 2 Department of Radiation Oncology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Yusuf Kızıl
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Mehmet Ekrem Zorlu
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Ramazan Yıldız
- 3 Department of Medical Oncology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
| | - Ahmet Köybaşıoğlu
- 4 Department of Otorhinolaryngology, Head & Neck Surgery, Lösev Ankara Hospital, Ankara, Turkey
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2
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Rodrigues J, Breda E, Monteiro E. Surgically-Treated Locoregionally Advanced Hypopharyngeal Cancer: Outcomes. Int Arch Otorhinolaryngol 2018; 22:443-448. [PMID: 30357103 PMCID: PMC6197975 DOI: 10.1055/s-0038-1641562] [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: 09/29/2017] [Accepted: 02/05/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction
Hypopharyngeal tumors are head and neck malignancies associated with a great mortality rate, and the treatment of advanced lesions constitutes a challenging problem. Pharyngolaryngectomy continues to be the gold standard treatment modality for locally-advanced diseases, and it is currently used as the primary treatment or in cases of relapse after an organ preservation strategy.
Objective
This study aims to compare the survival rates of patients with advanced hypopharyngeal tumors treated with pharyngolaryngectomy as a primary or salvage option, and identify possible prognostic factors.
Methods
All patients with advanced hypopharyngeal squamous cell carcinomas who performed pharyngolaryngectomy between 2007 and 2014 were reviewed retrospectively.
Results
A total of 87 patients fulfilled the aforementioned criteria, and the sample had a mean age of 57.2 years and a male predominance of 43:1. The tumors were located in the pyriform sinus walls (81 tumors), in the posterior pharyngeal wall (4 tumors) and in the postcricoid region (2 tumors). A total of 60 patients underwent surgery as the primary treatment option, and 27 were submitted to salvage pharyngolaryngectomy after a previous treatment with chemoradiotherapy or radiotherapy. The 5-year overall survival was of 25.9%, the 5-year disease-free survival was of 24.2%, and the disease-specific survival was of 29.5%.
Conclusion
The patients treated with pharyngolaryngectomy as the primary option revealed a better 5-year-disease free survival than the patients who underwent the salvage surgery (35.8% versus 11.7% respectively;
p
< 0.05). The histopathological criteria of capsular rupture of the lymph nodes (30.1% versus 19.8% respectively for the primary and salvage groups;
p
< 0.05) and vascular invasion (30.5% versus 22.5% respectively;
p
< 0.05) reduced the 5-year disease-free survival. Pharyngolaryngectomy as the primary intent revealed a lower local recurrence rate than the salvage surgery (40.6% versus 83.3% respectively;
p
< 0.05).
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Affiliation(s)
- Jorge Rodrigues
- Department of Otorhinolaringology, Hospital da Senhora da Oliveira Guimarães EPE, Creixomil, Guimarães, Portugal.,Department of Anatomy, University of Porto, Portugal
| | - Eduardo Breda
- Department of Otorhinolaringology, Instituto Português de Oncologia do Porto Francisco Gentil EPE, Porto, Portugal
| | - Eurico Monteiro
- Department of Otorhinolaringology, Instituto Português de Oncologia do Porto Francisco Gentil EPE, Porto, Portugal
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MacNeil S, Liu K, Shariff S, Thind A, Winquist E, Yoo J, Nichols A, Fung K, Hall S, Garg A. Secular trends in the survival of patients with laryngeal carcinoma, 1995-2007. Curr Oncol 2015; 22:e85-99. [PMID: 25908925 PMCID: PMC4399628 DOI: 10.3747/co.22.2361] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Recent reports suggest a decline over time in the survival of patients newly diagnosed with laryngeal cancer in spite of developments in treatment practices. Our study set out to determine whether the survival of patients with laryngeal cancer in Ontario has changed over time. METHODS This population-based cohort study of patients diagnosed with laryngeal cancer in the province of Ontario between 1995 and 2007 used data extracted from linked provincial administrative and registry databases. Its main outcomes were overall survival, laryngectomy-free survival, and survival ratio relative to an age- and sex-matched general population. RESULTS The 4298 patients newly diagnosed with laryngeal cancer during the period of interest were predominantly men (n = 3615, 84.1%) with glottic cancer (n = 2787, 64.8%); mean age in the group was 66 years (interquartile range: 59-74 years). Patient demographics did not significantly change over time. Overall, 5-year survival was 57.4%; laryngectomy-free survival was 45.4%. Comparing patients from three eras (1995-1998, 1999-2003, 2004-2007) and adjusting for age, sex, and comorbidity status, we observed no differences in overall survival or laryngectomy-free survival over time. The 5-year relative survival ratio for patients with laryngeal cancer compared with an age- and sex-matched group from the general population was 81.1% for glottic cancer and 44.5% for supraglottic cancer. CONCLUSIONS In patients with a new diagnosis of laryngeal cancer, overall and laryngectomy-free survival have remained unchanged since the mid-1990s. New methods to improve survival and the rate of laryngeal preservation in this patient population are needed.
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Affiliation(s)
- S.D. MacNeil
- Department of Otolaryngology–Head and Neck Surgery, Western University, London, ON
- Institute for Clinical and Evaluative Sciences, Toronto, ON
- Department of Oncology, Western University, London, ON
| | - K. Liu
- Institute for Clinical and Evaluative Sciences, Toronto, ON
| | - S.Z. Shariff
- Institute for Clinical and Evaluative Sciences, Toronto, ON
| | - A. Thind
- Institute for Clinical and Evaluative Sciences, Toronto, ON
- Department of Epidemiology and Biostatistics, Western University, London, ON
- Department of Family Medicine, Western University, London, ON
| | - E. Winquist
- Department of Oncology, Western University, London, ON
| | - J. Yoo
- Department of Otolaryngology–Head and Neck Surgery, Western University, London, ON
- Department of Oncology, Western University, London, ON
| | - A. Nichols
- Department of Otolaryngology–Head and Neck Surgery, Western University, London, ON
- Department of Oncology, Western University, London, ON
| | - K. Fung
- Department of Otolaryngology–Head and Neck Surgery, Western University, London, ON
- Department of Oncology, Western University, London, ON
| | - S. Hall
- Institute for Clinical and Evaluative Sciences, Toronto, ON
- Department of Otolaryngology–Head and Neck Surgery, Cancer Care and Epidemiology, Queen’s University, Kingston, ON
| | - A.X. Garg
- Institute for Clinical and Evaluative Sciences, Toronto, ON
- Department of Epidemiology and Biostatistics, Western University, London, ON
- Division of Nephrology, Department of Medicine, Western University, London, ON
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4
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Karatzanis AD, Psychogios G, Waldfahrer F, Kapsreiter M, Zenk J, Velegrakis GA, Iro H. Management of locally advanced laryngeal cancer. J Otolaryngol Head Neck Surg 2014; 43:4. [PMID: 24472173 PMCID: PMC3909348 DOI: 10.1186/1916-0216-43-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 01/26/2014] [Indexed: 12/18/2022] Open
Abstract
Background Management of advanced laryngeal cancer is complex and ideal strategy is yet to be defined. This study evaluates the experience of a single head and neck oncologic centre in the management of T4 laryngeal cancer. Methods Retrospective assessment of cases primarily treated for T4a squamous cell carcinoma of the larynx, between 1980 and 2007, at a tertiary referral center. Results A total of 384 cases were studied. Five-year disease specific survival was 56.2% and local control 87.4%. Regional and distal control estimates were 90.3% and 88.3% respectively. Prognosis was significantly superior for cases treated with primary surgery compared to cases solely managed with non-surgical modalities. Positive surgical margins and regional disease worsened prognosis. Conclusion This study suggests that primary surgery remains a key element in the treatment of advanced laryngeal cancer. The need for well-designed, prospective, randomised studies in order to further evaluate the remaining role of primary surgery in the modern management of locally advanced laryngeal lesions is emphasized.
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Affiliation(s)
| | | | | | | | | | | | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg Medical School, Erlangen, Germany.
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5
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Pezier TF, Nixon IJ, Joshi A, Guerrero-Urbano T, Oakley R, Jeannon JP, Simo R. Factors predictive of outcome following primary total laryngectomy for advanced squamous cell carcinoma. Eur Arch Otorhinolaryngol 2013; 271:2503-9. [DOI: 10.1007/s00405-013-2779-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/11/2013] [Indexed: 01/22/2023]
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Azevedo EHM, Montoni N, Gonçalves Filho J, Kowalski LP, Carrara-de Angelis E. Vocal Handicap and Quality of Life After Treatment of Advanced Squamous Carcinoma of the Larynx and/or Hypopharynx. J Voice 2012; 26:e63-71. [DOI: 10.1016/j.jvoice.2011.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 02/17/2011] [Indexed: 11/16/2022]
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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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8
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Neck Dissection for Laryngeal Cancer. J Am Coll Surg 2008; 207:587-93. [DOI: 10.1016/j.jamcollsurg.2008.06.337] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 06/23/2008] [Accepted: 06/23/2008] [Indexed: 11/22/2022]
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9
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Genden EM, Ferlito A, Rinaldo A, Silver CE, Fagan JJ, Suárez C, Langendijk JA, Lefebvre JL, Bradley PJ, Leemans CR, Chen AY, Jose J, Wolf GT. Recent changes in the treatment of patients with advanced laryngeal cancer. Head Neck 2008; 30:103-10. [PMID: 17902151 DOI: 10.1002/hed.20715] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Since the original data from the Department of Veterans Affairs Laryngeal Cancer Study Group demonstrated that nonsurgical therapy could achieve survival rates comparable to total laryngectomy in selected cases, there has been a progressive increase in employment of nonsurgical therapy for the management of advanced laryngeal cancer. Both neoadjuvant chemotherapy followed by conventionally fractionated or hyperfractioned radiotherapy for chemotherapy responders, or simultaneously administered chemoradiation has resulted in a significant number of patients who achieved cure while preserving their larynges. Nevertheless, combined chemotherapy and external beam radiation is associated with a variety of acute and chronic sequelae that can have a debilitating impact on function and quality of life. Although no therapeutic option is without risk, the decision regarding the modality of therapy for a patient with advanced laryngeal cancer should prompt a careful review of the current surgical techniques available for treatment. Data on quality of life and aging, as well as advances in minimally invasive surgical techniques, are available today that were not available at the time of the Veterans study. Selection of optimal therapy is often complex and raises the question whether the pendulum may have swung too far in the direction of nonsurgical therapy for advanced laryngeal cancer. This article reviews the current options available for a patient with advanced laryngeal cancer and discusses the impact of therapy.
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Affiliation(s)
- Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, The Mount Sinai Medical Center, New York, NY, USA
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10
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Majem M, Mesia R, Mañós M, Gomez J, Galiana R, Cardenal F, Juan A, Montes A, Perez FJ, Nogues J, Llluch JRG. Does induction chemotherapy still have a role in larynx preservation strategies? The experience of Institut Catala d'Oncologia in stage III larynx carcinoma. Laryngoscope 2006; 116:1651-6. [PMID: 16954998 DOI: 10.1097/01.mlg.0000231736.08477.47] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radiotherapy with concurrent cisplatin is the standard alternative to total laryngectomy for patients with locally advanced laryngeal cancer. The value of induction chemotherapy in larynx-preservation therapies remains unknown. Hyperfractionation radiotherapy might improve disease-free survival. METHODS From August 1993 to August 2004, 71 patients with T3N0-1 larynx tumors and eligible for total laryngectomy received induction chemotherapy with three cycles of cisplatin plus fluorouracil. Clinical tumor response was assessed by indirect laryngoscopy and computed tomography scan. Patients with complete response received hyperfractionation radiotherapy, whereas those without complete response were proposed for total laryngectomy. RESULTS A total of 71 consecutive patients were included. Thirty-three patients achieved complete response to induction chemotherapy (46.5%), four of them presented a tumor relapse, and all underwent salvage surgery. Seventy-six percent of surviving patients preserved a functional larynx. Despite not achieving complete response, 15 patients refused total laryngectomy and received hyperfractionation radiotherapy. Seven patients presented a tumor relapse and salvage surgery was performed in three of them. Fifty percent of surviving patients preserved a functional larynx. Twenty-two patients without complete response underwent total laryngectomy; three of them presented a tumor relapse but none could be rescued. With a median follow up of 68 months, 5 five-year overall survival, 5-year disease-free survival, and 5-year larynx function preservation survival rates were 68% (confidence interval [CI], 57-80), 75% (CI, 64-87), and 42% (CI, 29-54), respectively. No differences in overall survival were observed between groups. Five-year disease-free survival of patients without complete response who received hyperfractionation radiotherapy was significantly lower than that of the other two groups (P < .02). Ten patients with larynx preservation and no tumor relapse had chronic toxicity that caused the loss of larynx function: seven patients required permanent tracheotomy, two died from pneumonia, and one patient died as a result of a laryngeal necrosis. CONCLUSIONS Patients with complete response to induction chemotherapy in laryngeal carcinoma have a high probability of cure after hyperfractionation radiotherapy. However, hyperfractionation radiotherapy induces a high degree of toxicity that reduces the laryngeal function preservation rate and may jeopardize overall survival.
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Affiliation(s)
- Margarita Majem
- Department of Medical Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.
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Jalisi M, Jalisi S. Advanced laryngeal carcinoma: surgical and non-surgical management options. Otolaryngol Clin North Am 2005; 38:47-57, viii. [PMID: 15649498 DOI: 10.1016/j.otc.2004.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This article discusses the surgical and non-surgical management of advanced laryngeal cancers.
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Affiliation(s)
- M Jalisi
- Department of Otolaryngology, College of Physicians and Surgeons, Pakistan.
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12
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Ferlito A, Rogers SN, Shaha AR, Bradley PJ, Rinaldo A. Quality of life in head and neck cancer. Acta Otolaryngol 2003; 123:5-7. [PMID: 12625565 DOI: 10.1080/0036554021000028072] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Affiliation(s)
- Alfio Ferlito
- Department of Otolaryngology--Head and Neck Surgery, University of Udine, Italy.
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