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Vasudevan SS, Zulli A, Olinde L, Pang J, Nathan CAO, Asarkar AA. Survival Outcomes of Transoral Microsurgery in T3/T4a Laryngeal Tumors: Systematic Review and Meta-Analysis. Laryngoscope 2024. [PMID: 39140205 DOI: 10.1002/lary.31695] [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: 05/13/2024] [Revised: 07/17/2024] [Accepted: 07/30/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE To critically evaluate oncological and functional outcomes following transoral laser microsurgery (TLM) in patients with T3/T4a glottic and supraglottic squamous cell carcinoma (SCC). DATA SOURCES A comprehensive search of five major databases-PubMed, Embase, Scopus, ScienceDirect, and Web of Science-was conducted using a combination of relevant keywords and MeSH terms. REVIEW METHODS Systematic review and meta-analysis of odds ratio (OR), hazards ratio (HR), and proportion, focusing on oncological and functional outcomes of TLM in advanced T3/T4a glottic and supraglottic tumors. A random-effects meta-analysis model was employed. RESULTS The review incorporated 29 cohort studies, representing a total of 1,897 patients undergoing TLM for T3/T4a glottic and supraglottic SCC. The cumulative 5-year disease-free survival (DFS) rate for T3 glottic and supraglottic tumors was 44.4% (95% CI: 47-66%) and 62.8% (95% CI: 63-81%), while the 5-year DFS for T4 glottic and supraglottic tumors was 41.1% (95% CI: 33.4-49.2%) and 32.9% (95% CI: 19.3-50.1%), respectively. T3 glottic tumors exhibited a 2.5-fold significantly higher odds of local recurrence post-TLM compared to their T3 supraglottic tumors (95% CI: 1.6-3.9, p < 0.0001). Laryngeal preservation rates for T3glottic and supraglottic tumors were 68.9% (95% CI: 48.7-83.8%) and 88.4% (95% CI: 79.4-93.8%), respectively. Both groups showed comparable rates of tracheostomy (p = 0.48) and gastrostomy performed (p = 0.17). CONCLUSIONS This meta-analysis suggests that TLM is a viable larynx preservation approach in select patients with T3/T4a glottic and supraglottic tumors. However, glottic tumors may have less favorable outcomes after TLM compared to those with advanced supraglottic tumors. LEVEL OF EVIDENCE N/A Laryngoscope, 2024 Laryngoscope, 2024.
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Affiliation(s)
- Srivatsa Surya Vasudevan
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Adam Zulli
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Lindsay Olinde
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - John Pang
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Cherie-Ann O Nathan
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Surgery, Overton Brooks Veterans Administration Medical Center, Shreveport, Louisiana, USA
| | - Ameya A Asarkar
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
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Sampieri C, Cioccoloni E, Costantino A, Kim D, Lee K, Meccariello G, Cammaroto G, Vicini C, Kim SH. Neoadjuvant chemotherapy followed by transoral robotic surgery versus upfront surgery for locoregionally advanced oropharyngeal carcinoma: A propensity score matched analysis. Head Neck 2024. [PMID: 39087607 DOI: 10.1002/hed.27904] [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: 01/05/2024] [Revised: 06/09/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Transoral robotic surgery (TORS) performed after neoadjuvant chemotherapy (NAC) is a promising treatment for advanced-stage oropharyngeal carcinoma (OPSCC) able to reduce the adjuvant therapy administration rate. METHODS A retrospective bi-centric study was conducted to analyze NAC + TORS versus upfront TORS patients. A 1:1 propensity score matching was used to compare the two groups. RESULTS Among the 300 patients with stage III-IV OPSCC, 204 patients were matched for comparing NAC + TORS versus upfront TORS. Between the two groups, no significant difference was observed in recurrences and in survival for RFS, OS, and DSS. In the NAC + TORS p16-positive population, adjuvant therapy could be spared in 51% versus 16% in the upfront surgery cohort (p < 0.001) due to the lower frequency of pathological risk factors after NAC. CONCLUSIONS NAC followed by TORS for locoregionally advanced OPSCC demonstrated to achieve non-inferior survival outcomes to upfront surgery, while in the p16-positive population allowed to significantly spare adjuvant therapy.
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Affiliation(s)
- Claudio Sampieri
- Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
- Department of Otorhinolaryngology, Hospital Clínic, Barcelona, Spain
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Eleonora Cioccoloni
- Unit of Otolaryngology, Head-Neck and Oral Surgery, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Andrea Costantino
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Dahee Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyuin Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Giuseppe Meccariello
- Unit of Otolaryngology, Head-Neck and Oral Surgery, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Giovanni Cammaroto
- Unit of Otolaryngology, Head-Neck and Oral Surgery, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Claudio Vicini
- Unit of Otolaryngology, Head-Neck and Oral Surgery, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
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Li J, He S, Liu J, Deng D, Dong Y, Pang W, Minzi M, Qiu K, Zeng J, Song Y, Rao Y, Zhao Y, Xu X, Zhang S, Jianjun R. Prognostic effects of different treatment modalities for hypopharyngeal squamous cell carcinoma: Experience of two tertiary hospitals in Southwestern China. Heliyon 2024; 10:e28496. [PMID: 38601520 PMCID: PMC11004745 DOI: 10.1016/j.heliyon.2024.e28496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
Background The prognostic effects of different treatment modalities on patients with hypopharyngeal squamous cell carcinoma (HPSCC) remain unclear. Methods HPSCC patients diagnosed and treated at either West China Hospital or Sichuan Cancer Hospital between January 1, 2009, and December 31, 2019, were enrolled in this retrospective, real-world study. Survival rates were presented using Kaplan-Meier curves and compared using log-rank tests. Univariable and multivariable Cox proportional hazards regression models were used to identify the predictors of overall survival (OS). Subgroup analyses were conducted for patients with advanced-stage HPSCC (stages III and IV and category T4). Results A total of 527 patients with HPSCC were included. Patients receiving SRC (surgery, radiotherapy [RT], and chemotherapy) showed the best OS (p < 0.0001). In comparison with RT alone, both surgery alone (all cases: hazard ratio [HR] = 0.39, p = 0.0018; stage IV cases: HR = 0.38, p = 0.0085) and surgery-based multimodality treatment (SBMT; all cases: HR = 0.27, p < 0.0001; stage IV cases: HR = 0.30, p = 0.00025) showed prognostic benefits, while SBMT also showed survival priority over chemoradiotherapy (CRT; all cases: HR = 0.52, p < 0.0001; stage IV cases: HR = 0.59, p = 0.0033). Moreover, patients who underwent surgery alone had comparable OS to those who underwent SBMT (all patients: p = 0.13; stage IV cases: p = 0.34), while CRT yielded similar prognostic outcomes as RT alone (all patients: p = 0.054; stage IV cases: p = 0.11). Conclusions Surgery alone was comparable to SBMT and superior to RT/CRT in terms of OS in patients with HPSCC. We suggest that surgery should be encouraged for the treatment of HPSCC, even in patients with advanced-stage disease.
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Affiliation(s)
- Junhong Li
- Department of Otolaryngology-Head & Neck Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Shanshan He
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Sichuan Cancer Center, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
- Sichuan Provincial People's Hospital Jinniu Hospital, China
| | - Jifeng Liu
- Department of Otolaryngology-Head & Neck Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Di Deng
- Department of Otolaryngology-Head & Neck Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yijun Dong
- Department of Otolaryngology-Head & Neck Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Wendu Pang
- Department of Otolaryngology-Head & Neck Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Mao Minzi
- Department of Otolaryngology-Head & Neck Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Qiu
- Department of Otolaryngology-Head & Neck Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Zeng
- Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Yao Song
- Department of Otolaryngology-Head & Neck Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yufang Rao
- Department of Otolaryngology-Head & Neck Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Zhao
- Department of Otolaryngology-Head & Neck Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xinyin Xu
- Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Shichuan Zhang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Sichuan Cancer Center, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
| | - Ren Jianjun
- Department of Otolaryngology-Head & Neck Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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Locatello LG, Costantino A, Maniaci A, Fermi M, Barillari MR, Sampieri C, Bellini E, Serafini E, Jiang S, Nocera F, Asaro A, Midolo M, Rodio A, Piersiala K, Sooriyamoorthy T, Dimitriadis PA, Mannelli G. Does sex influence the prognosis of laryngeal cancer? A systematic review and a meta-analysis. Am J Otolaryngol 2024; 45:104195. [PMID: 38134851 DOI: 10.1016/j.amjoto.2023.104195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Luca Giovanni Locatello
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria; Department of Otorhinolaryngology, University Hospital "Santa Maria Della Misericordia", Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, MI, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
| | - Antonino Maniaci
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria; Department of Medical, Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Italy; Faculty of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy
| | - Matteo Fermi
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Maria Rosaria Barillari
- Department of Mental and Physical Health and Preventive Medicine, Audiology and Phoniatrics Unit, Luigi Vanvitelli University Hospital, Naples, Italy
| | - Claudio Sampieri
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Elisa Bellini
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Edoardo Serafini
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Serena Jiang
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Nocera
- Department of Medical, Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Italy
| | - Antonino Asaro
- Department of Medical, Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Italy
| | - Mario Midolo
- Department of Medical, Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Italy
| | - Angelica Rodio
- Department of Mental and Physical Health and Preventive Medicine, Audiology and Phoniatrics Unit, Luigi Vanvitelli University Hospital, Naples, Italy
| | - Krzysztof Piersiala
- Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Thushanth Sooriyamoorthy
- Department of Otolaryngology - Head and Neck Surgery, Lister Hospital, Coreys Mill Lane, SG1 4AB Stevenage, UK
| | - Panagiotis A Dimitriadis
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria; Department of Otolaryngology - Head and Neck Surgery, Lister Hospital, Coreys Mill Lane, SG1 4AB Stevenage, UK
| | - Giuditta Mannelli
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Su L, Wu S, Huang C, Zhuo X, Chen J, Jiang X, Kong X, Lv C, Xu Q, Han P, Huang X, Wong PP. Chemoresistant fibroblasts dictate neoadjuvant chemotherapeutic response of head and neck cancer via TGFα-EGFR paracrine signaling. NPJ Precis Oncol 2023; 7:102. [PMID: 37821657 PMCID: PMC10567732 DOI: 10.1038/s41698-023-00460-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
Conventional chemotherapy targets malignant cells without evaluating counter protection from the tumor microenvironment that often causes treatment failure. Herein, we establish chemoresistant fibroblasts (rCAFs) as regulators of neoadjuvant chemotherapeutic (NACT) response in head and neck squamous cell carcinoma (HNSCC). Clinically, high expression of CAF-related gene signature correlates with worse prognosis and chemotherapeutic response in multiple cancers, while the population of CAFs in the residual tumors of chemoresistant HNSCC patients remains unchanged after NACT treatment, compared to chemosensitive patients. Using a murine cancer model or patient-derived organoid, and primary CAFs isolated from chemo-sensitive (sCAFs) or -resistant patients, we show that rCAFs, but not sCAFs, are resistant to chemotherapy-induced apoptosis while reducing HNSCC cell chemosensitivity via paracrine signals. Combined multi-omics and biochemical analyses indicate an elevated PI3K/AKT/p65 driven cell survival and cytokine production in rCAFs, while rCAF-secreted TGFα promotes cancer cell chemoresistance by activating EGFR/Src/STAT3 survival signaling axis. Treatment with anti-EGFR cetuximab restores the chemosensitivity of tumors derived from co-injection of cancer cells and rCAFs in vivo, while the serum level of TGFα determines NACT response in HNSCC patients. Overall, our findings uncover a novel insight whereby the crosstalk between tumor cell and rCAF determines chemotherapeutic response and prognosis in cancer patients.
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Affiliation(s)
- Liangping Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA medicine, Sun Yat-sen Memorial Hospital, State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, 510120, China
- Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Sangqing Wu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA medicine, Sun Yat-sen Memorial Hospital, State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, 510120, China
- Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Cheng Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA medicine, Sun Yat-sen Memorial Hospital, State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, 510120, China
- Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Xianhua Zhuo
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA medicine, Sun Yat-sen Memorial Hospital, State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, 510120, China
- Department of Otolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Jiali Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA medicine, Sun Yat-sen Memorial Hospital, State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, 510120, China
- Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Xue Jiang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA medicine, Sun Yat-sen Memorial Hospital, State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, 510120, China
- Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Xiangzhan Kong
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA medicine, Sun Yat-sen Memorial Hospital, State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, 510120, China
- Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Cui Lv
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA medicine, Sun Yat-sen Memorial Hospital, State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, 510120, China
- Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Qiuping Xu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA medicine, Sun Yat-sen Memorial Hospital, State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, 510120, China
- Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Ping Han
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA medicine, Sun Yat-sen Memorial Hospital, State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, 510120, China.
- Department of Otolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
| | - Xiaoming Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA medicine, Sun Yat-sen Memorial Hospital, State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, 510120, China.
- Department of Otolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
| | - Ping-Pui Wong
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA medicine, Sun Yat-sen Memorial Hospital, State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, 510120, China.
- Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
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Almas S, Jeffery CC. Late laryngeal dysfunction in head and neck cancer survivors. Laryngoscope Investig Otolaryngol 2023; 8:1272-1278. [PMID: 37899877 PMCID: PMC10601572 DOI: 10.1002/lio2.1128] [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: 04/30/2023] [Revised: 07/05/2023] [Accepted: 07/16/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives Head and neck cancer (HNC) survivorship issues are areas of increasing research interest. Laryngeal dysfunction in HNC patients is particularly important given the importance of the larynx in voice, swallowing, and airway protection. The objective of our study is to characterize late laryngeal dysfunction in a cohort of long-term HNC survivors. Methods HNC survivors who were at least 2 years post-treatment were recruited prospectively for standard collection of videolaryngoscopy findings, videofluoroscopic swallowing studies, and assessment of clinical outcomes. Descriptive statistics were performed and clinical presentation and outcomes were compared between survivors >10 years and <10 years post-treatment. Additional factor analysis to correlate clinical outcomes with clinical variables was performed. Results Thirty participants were analyzed with a mean age of 66 years. The majority were male (80%) patients treated for oropharyngeal squamous cell carcinoma (67%). Within the cohort, 43% underwent primary chemoradiation therapy and had 13% radiation alone. Common presenting symptoms included swallowing dysfunction (83%), voice change (67%), and chronic cough (17%). Laryngeal findings on video laryngoscopy include vocal fold motion abnormalities (VFMA) in over half of participants (61%) and mucosal changes in 20%. A weak correlation was found between time since treatment and laryngeal dysfunction (r = .182, p = .34), and no correlation was found between age, sex, time since treatment, or primary site and the presence or absence of VFMA, G-tube status, or tracheostomy-tube status. Conclusion Late laryngeal dysfunction in HNC survivors contributes to significant morbidity, is difficult to treat, and remains static decades after treatment for their original cancer. Lay Summary The voice-box, or the larynx, plays an important role in voice, swallowing and airway protection. It is particularly vulnerable to radiation-related damage and changes. This study demonstrates the sequelae of long-term damage of the larynx in head and cancer survivors. Level of Evidence IV.
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Affiliation(s)
- Sarah Almas
- Division of Otolaryngology‐Head and Neck Surgery, Department of Surgery, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - Caroline C. Jeffery
- Division of Otolaryngology‐Head and Neck Surgery, Department of Surgery, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
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7
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罗 希, 孙 士, 徐 艺, 黄 晓, 王 凯, 吴 润, 王 静, 张 烨, 张 江, 陈 雪, 曲 媛, 罗 京, 易 俊. [Comparison of different laryngeal preservation strategies based on chemoradiotherapy in locally advanced hypopharyngeal carcinoma]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:708-714. [PMID: 37640994 PMCID: PMC10722127 DOI: 10.13201/j.issn.2096-7993.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Indexed: 08/31/2023]
Abstract
Objective:This study aimed to evaluate the clinical features and treatment outcomes of the value of response-adapted treatment following radiotherapy and induction chemotherapy follwing subsequent comprehensive therapy in patients with resectable locally advanced hypopharyngeal carcinoma. Methods:This cohort study was conducted from September 2010 to September 2020 in our hospital, 231 patients pathologically confirmed stage Ⅲ and ⅣB resectable locally advanced hypopharyngeal carcinoma included. For the IC-directed ART strategy, IC is used to select good candidates to receive radical RT or CCRT, and others undergo surgery. He response-adapted strategy was determined based on the primary tumor response, which was evaluated at a dose of 50 Gy. If the response reached complete response or partial response(more than 80% tumor regression), patients received radical RT or CCRT; otherwise, they received surgery, if possible, at 4 to 6 weeks after RT. The end points of the study were OS(overall survival), progression free survival(PFS), locoregional recurrence-free survival(LRRFS) and LDFS. Results:In IC-directed group, 75.0%(57/76) patients reached PR after 2 cycles of induction chemotherapy. While in RT-directed group, 70.3%(109/155) patients reached large PR at dose of 50 Gy. The median interquartile range follow-up period of the whole cohort was 63.8 months. The 5-year OS, PFS, LRRFS and SFL of the whole cohort were 47.9%、39.6%、44.3% and 36.2%, respectively. In evaluations based on the different treatment strategies, the 5-year OS and SFL were 51.3% versus 37.0%(HR 0.67; 95%CI 0.43-1.05; P=0.07) and 27.8% versus 39.8%(HR 0.68; 95%CI 0.46-0.99; P=0.04) between IC-directed and RT-directed groups. In additional, surgery complications did not significantly differ between these two groups. Conclusion:In this cohort study, the response-adapted strategy based on an early RT response facilitated better treatment tailoring, and higher laryngeal preservation compared with IC-directed strategies. This approach could provide a feasible laryngeal preservation strategy in patients with resectable locally advanced hypopharyngeal carcinoma.
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Affiliation(s)
- 希 罗
- 国家癌症中心 肿瘤临床研究中心 北京协和医学院中国医学科学院肿瘤医院放疗科(北京,100021)Department of Radiation Oncology National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - 士然 孙
- 国家癌症中心 肿瘤临床研究中心 北京协和医学院中国医学科学院肿瘤医院放疗科(北京,100021)Department of Radiation Oncology National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - 艺 徐
- 国家癌症中心 肿瘤临床研究中心 北京协和医学院中国医学科学院肿瘤医院放疗科(北京,100021)Department of Radiation Oncology National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - 晓东 黄
- 国家癌症中心 肿瘤临床研究中心 北京协和医学院中国医学科学院肿瘤医院放疗科(北京,100021)Department of Radiation Oncology National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - 凯 王
- 国家癌症中心 肿瘤临床研究中心 北京协和医学院中国医学科学院肿瘤医院放疗科(北京,100021)Department of Radiation Oncology National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - 润叶 吴
- 国家癌症中心 肿瘤临床研究中心 北京协和医学院中国医学科学院肿瘤医院放疗科(北京,100021)Department of Radiation Oncology National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - 静波 王
- 国家癌症中心 肿瘤临床研究中心 北京协和医学院中国医学科学院肿瘤医院放疗科(北京,100021)Department of Radiation Oncology National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - 烨 张
- 国家癌症中心 肿瘤临床研究中心 北京协和医学院中国医学科学院肿瘤医院放疗科(北京,100021)Department of Radiation Oncology National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - 江鹄 张
- 国家癌症中心 肿瘤临床研究中心 北京协和医学院中国医学科学院肿瘤医院放疗科(北京,100021)Department of Radiation Oncology National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - 雪松 陈
- 国家癌症中心 肿瘤临床研究中心 北京协和医学院中国医学科学院肿瘤医院放疗科(北京,100021)Department of Radiation Oncology National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - 媛 曲
- 国家癌症中心 肿瘤临床研究中心 北京协和医学院中国医学科学院肿瘤医院放疗科(北京,100021)Department of Radiation Oncology National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - 京伟 罗
- 国家癌症中心 肿瘤临床研究中心 北京协和医学院中国医学科学院肿瘤医院放疗科(北京,100021)Department of Radiation Oncology National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - 俊林 易
- 国家癌症中心 肿瘤临床研究中心 北京协和医学院中国医学科学院肿瘤医院放疗科(北京,100021)Department of Radiation Oncology National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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Shelan M, Anschuetz L, Schubert A, Bojaxhiu B, Aebersold DM, Elicin O, Giger R. Superior loco-regional control after primary surgery compared to chemo-radiotherapy for advanced stage laryngeal cancer. Front Oncol 2023; 13:1132486. [PMID: 37593093 PMCID: PMC10431594 DOI: 10.3389/fonc.2023.1132486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/05/2023] [Indexed: 08/19/2023] Open
Abstract
Objective The optimal strategy to treat loco-regionally advanced squamous cell carcinoma of the larynx (LSCC) remains to be defined. The goal of this single institution retrospective study was to report on oncologic outcome of advanced LSCC treated with curative intent. Methods Patients diagnosed and treated for stage T3-T4a LSCC between 2001 and 2014 were retrospectively analyzed. Time-to-event endpoints were calculated beginning from the date of histologic diagnosis, which were analyzed with log-rank test and Cox proportional hazard models. Results The cohort was divided into two subgroups: primary radiotherapy with concomitant cisplatin (CRT) (n=30, 38%) and primary surgery (n=48, 62%). Median follow-up was 56 months. Locoregional control (LRC) for the primary surgery and CRT were 95% and 50% in 5 years, respectively (p<0.01). Progression free survival (PFS) for the primary surgery and CRT were 61% and 38% in 5 years, respectively (p=0.23). The overall survival (OS) after primary surgery and CRT in 5 years were 63% vs. 65%, respectively (p=0.93). The 5-years LRC was significantly superior after surgery compared to RT for cT3 primaries (100% vs 50%, p= 0.0022). No significant differences were observed in the remaining subgroups regarding cT stage and PFS or OS. Conclusion Our series demonstrated superior LRC after primary surgery followed by risk-adapted adjuvant (C)RT compared to primary CRT in cT3 LSCC, but no significant difference in PFS or OS in locally-advanced LSCC. The optimal patient selection criteria for the ideal treatment for loco-regionally advanced LSCC still needs to be defined.
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Affiliation(s)
- Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian Schubert
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beat Bojaxhiu
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel M. Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Sampieri C, Costantino A, Pirola F, Kim D, Lee K, Kim SH. Neoadjuvant chemotherapy combined with transoral robotic surgery for stage III and IV laryngeal and hypopharyngeal carcinomas. Oral Oncol 2023; 140:106371. [PMID: 36996605 DOI: 10.1016/j.oraloncology.2023.106371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/23/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES To analyze the oncological and functional outcomes of patients with stage III-IV laryngo-hypopharyngeal cancer who underwent neoadjuvant chemotherapy (NAC) with subsequent transoral robotic surgery (TORS). MATERIALS AND METHODS A single-center retrospective cohort study included a total of 100 patients (median age of 67.0) affected by stage III-IV supraglottic or hypopharyngeal cancer. All patients underwent NAC followed by TORS and risk-adjusted adjuvant therapy. The primary outcome was recurrence-free survival (RFS). RESULTS The median follow-up time was 24.0 months. Estimated 2-year (95% CI) OS, DSS, and RFS were 75% (66% - 85%), 84% (76% - 92%), and 65% (56% - 76%), respectively. Among the 11 patients who relapsed on the primary site, 3 underwent salvage total laryngectomy, 3 underwent salvage CRT, and the others receive palliation or supportive care. At 6 months from surgery, 17 patients were still tracheostomized or had a stoma retainer, while 15 were gastrostomy dependent. At the Cox multivariable analysis, the clinical stage at presentation, the number of NAC cycles, and the presence of LVI were found to be independently correlated with the RFS. CONCLUSION This study demonstrates that NAC followed by TORS can obtain good tumor control, survival, and organ preservation rates in stage III-IV laryngo-hypopharyngeal cancer.
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Affiliation(s)
- Claudio Sampieri
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy; Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Andrea Costantino
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI), Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (MI), Italy.
| | - Francesca Pirola
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI), Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (MI), Italy.
| | - Dahee Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Kyuin Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Marruecos-Querol J, Rubió-Casadevall J, Lozano A, Buxó M, Puigdemont M, Linares I, Planas I, Vayreda J, Cirauqui B, Taberna M, Quiroga V, Tobed M, Borés A, Recalde S, Saigi M, Felip E, Eraso A, Mesía R. Validation of a prognostic model for predicting larynx preservation outcome (TALK score) in a Southern European population. Clin Transl Oncol 2023:10.1007/s12094-023-03121-9. [PMID: 36943650 DOI: 10.1007/s12094-023-03121-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/09/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Larynx preservation is the current standard for locally advanced (LA) laryngeal/hypopharyngeal tumors, but not all patients respond as expected. TALK score model measures four variables (T-staging, albumin levels, liquor consumption and Karnofsky score) to determine which cases are best suited to preservation treatment scheme. We aimed to validate this prognostic model in a Southern European population. METHODS We retrospectively evaluated 175 patients diagnosed from July 2008 to December 2015 with LA laryngeal/hypopharyngeal carcinoma and treated with a laryngeal preservation scheme comprising induction chemotherapy followed by concomitant chemotherapy and radiotherapy. We applied the TALK score model to predict larynx preservation rate. RESULTS Of the 175 patients evaluated, 96.6% were men, 98.3% were smokers and 77.1% misused alcohol. Tumors were laryngeal 66.3% vs 33.7% in hypopharynx, and all were either stage III (37.7%) or stage IV (62.3%). TALK prognostic subgroups were: good risk 40.0%; intermediate risk 52.5%; and poor risk 7.5%. With a median follow-up of 40.1 months, larynx preservation rate, laryngectomy-free survival and overall survival at 3 years was 84.5%, 63.7% and 68.2%, respectively. Although TALK score was not predictive of 3-year larynx preservation rate (good risk 85.5%; intermediate risk 83.1%; poor risk 91.6%), it was predictive of 3-year overall survival (good risk 81.9%; intermediate risk 62.9%; poor risk 33.5%) and 3-year laryngectomy-free survival (good risk 75.6%; intermediate risk 59.6%; poor risk 30.7%). CONCLUSION TALK model could predict OS and laryngectomy-free survival, helping clinicians to decide which patients should avoid laryngeal preservation and undergo laryngectomy after diagnosis.
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Affiliation(s)
- Jordi Marruecos-Querol
- Radiation Oncology Department, Catalan Institute of Oncology, ICO Girona, Girona, Spain.
| | | | - Alicia Lozano
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Buxó
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Montserrat Puigdemont
- Epidemiology Unit and Girona Cancer Registry, Descriptive Epidemiology, Genetics and Cancer Prevention Group, IDIBGI, Catalan Institute of Oncology, Girona, Spain
| | - Isabel Linares
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Isabel Planas
- Radiation Oncology Department, Catalan Institute of Oncology, Badalona, Spain
| | - Jordi Vayreda
- Radiation Oncology Department, Catalan Institute of Oncology, ICO Girona, Girona, Spain
| | - Beatriz Cirauqui
- Medical Oncology Department, Catalan Institute of Oncology, Badalona, Spain
| | - Miren Taberna
- Medical Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Vanesa Quiroga
- Medical Oncology Department, Catalan Institute of Oncology, Badalona, Spain
| | - Marc Tobed
- Otorhinolaryngology Department, Dr. Trueta Hospital, Girona, Spain
| | - Antoni Borés
- Otorhinolaryngology Department, Dr. Trueta Hospital, Girona, Spain
| | - Sonia Recalde
- Medical Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Saigi
- Medical Oncology Department, Catalan Institute of Oncology, Badalona, Spain
| | - Eudald Felip
- Medical Oncology Department, Catalan Institute of Oncology, Badalona, Spain
| | - Aranzazu Eraso
- Radiation Oncology Department, Catalan Institute of Oncology, ICO Girona, Girona, Spain
| | - Ricard Mesía
- Medical Oncology Department, Catalan Institute of Oncology, Badalona, Spain
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Lin TY, Lee TL, Hsu YB, Tai SK, Wang LW, Yang MH, Chu PY. Survival analyses of different treatment modalities and clinical stage for hypopharyngeal carcinoma. Front Oncol 2023; 13:1109417. [PMID: 36937435 PMCID: PMC10020644 DOI: 10.3389/fonc.2023.1109417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Objective We investigated the effects of different treatment modalities and clinical stage for hypopharyngeal carcinoma (HPC) patients. Methods Between February 2004 and December 2012, 167 HPC patients were reviewed. We calculated overall survival (OS), progression-free survival (PFS), local failure-free survival (LFFS), regional failure-free survival (RFFS), and distant metastasis failure-free survival (DMFFS) using the Kaplan-Meier method and compared various survival outcomes between definitive chemoradiotherapy (CRT) and surgery-based therapy (SBT). Results There were no significant differences in baseline characteristics between SBT (n = 102) and definitive CRT (n = 65) groups. The 5-year rates of OS (59.7% vs. 24.0%, p < 0.0001) and PFS (49.9% vs. 22.6%, p = 0.0002) were significantly better in patients who received SBT than in those who received definitive CRT. The SBT group also obtained better LFFS (p < 0.0001), RFFS (p = 0.0479), and DMFFS (p = 0.0110). We did similar analyses by different T-classification (T1-2, T3, and T4) and found that SBT had better OS (p < 0.0001 and p = 0.0020), PFS (p < 0.0001 and p = 0.0513), LFFS (p = 0.0002 and p = 0.0075), RFFS (p = 0.1949 and p = 0.0826), and DMFFS (p = 0.0248 and p = 0.0436) in the T4 and T1-2 subgroups but similar OS (p = 0.9598), PFS (p = 0.5052), RFFS (p = 0.9648), and DMFFS (p = 0.8239) in T3 patients. Analyses by different overall stages revealed no differences between definitive CRT and SBT for stage III patients but significantly better results for stage IV patients who received SBT. Conclusions SBT can obtain significant survival benefits when compared with definitive CRT for the whole cohort of patients. Definitive CRT has similar survival outcomes compared with SBT only for T3 tumors or overall stage III disease.
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Affiliation(s)
- Tian-Yun Lin
- Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsung-Lun Lee
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Bin Hsu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shyh-Kuan Tai
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ling-Wei Wang
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Muh-Hwa Yang
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pen-Yuan Chu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Pen-Yuan Chu, ;
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12
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Wan M, Zhao D, Liu W, Huang Z, Xu X, Zheng B, Xiao S, Sun Y, Wang W. Pretherapy platelet-to-lymphocyte ratio as a prognostic parameter for locally advanced hypopharyngeal cancer patients treated with radiotherapy combined with chemotherapy. Eur Arch Otorhinolaryngol 2022; 279:5859-5868. [PMID: 35849189 DOI: 10.1007/s00405-022-07495-4] [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: 03/05/2022] [Accepted: 06/07/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE This study aimed to identify whether the platelet-to-lymphocyte ratio (PLR) correlated with the prognosis of patients with locally advanced hypopharyngeal squamous cell carcinoma (LA-HPSCC) undergoing radiotherapy combined with chemotherapy. METHODS This study enrolled 103 patients diagnosed with LA-HPSCC and treated with radiotherapy combined with chemotherapy between 2008 and 2021. The optimal PLR cut-off value was chosen from the receiver operating characteristic (ROC) curve analysis. According to the cut-off value of PLR, patients were divided into two groups: a low PLR group (< 133.06) and a high PLR group (≥ 133.06). Propensity score matching (PSM) was used to balance the confounding factors between the two PLR groups. Univariate and multivariate Cox proportional hazard regression models, the Kaplan-Meier curve by the log-rank test, and univariate and multivariate Fine-Gray competing risk models were all used for assessment. RESULTS After PSM, 27 pairs were left, and the high PLR group correlated with higher local failure (sHR 6.91, 95% CI 2.14-22.35, p = 0.001) in the multivariate Fine-Gray competing risk model. Moreover, the low PLR group had a significantly longer 3-year progression-free survival (43.7% vs. 29.2%, p = 0.038) and overall survival (55.1% vs. 32.1%, p = 0.034) than the high PLR group had. Multivariate Cox analysis showed that a low PLR was an independent protective factor for PFS (HR 0.43, 95% CI 0.21-0.92, p = 0.019) and OS (HR 0.46, 95% CI 0.22-0.96, p = 0.039) in patients with LA-HPSCC. CONCLUSION Pretherapy PLR might be a factor in predicting the risk of local failure and survival in LA-HPSCC patients undergoing radiotherapy combined with chemotherapy.
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Affiliation(s)
- Meng Wan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142, People's Republic of China
| | - Dan Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142, People's Republic of China
| | - Weixin Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142, People's Republic of China
| | - Zhou Huang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142, People's Republic of China
| | - Xiaolong Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142, People's Republic of China
| | - Baomin Zheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142, People's Republic of China
| | - Shaowen Xiao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142, People's Republic of China
| | - Yan Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142, People's Republic of China.
| | - Weihu Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142, People's Republic of China.
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Mohamad I, Almousa A, Taqash A, Mayta E, Abuhijla F, Ghatasheh H, Ababneh H, Wahbeh L, Abuhijlih R, Hussein T, Al‐Gargaz W, Hosni A. Primary radiation therapy for advanced-stage laryngeal cancer: A laryngo-esophageal dysfunction disease-free survival. Laryngoscope Investig Otolaryngol 2022; 7:1866-1874. [PMID: 36544959 PMCID: PMC9764778 DOI: 10.1002/lio2.972] [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: 07/06/2022] [Revised: 08/30/2022] [Accepted: 10/29/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To evaluate the outcomes of advanced-stage laryngeal squamous cell carcinoma (SCC) patients treated with functional-preservation strategy with a specific focus on laryngo-esophageal dysfunction disease-free survival (LEDDFS). Methods and materials A retrospective review was conducted of stage III-IVB laryngeal SCC patients who were treated with curative-intent radiotherapy (RT) (2007-2018). Patients were preferentially managed with upfront chemoradiation (CCRT); except for those with cN2-3, cT4, or large volume cT3 (induction chemotherapy followed by RT or CCRT is an option), and those who were unfit or declined chemotherapy (received altered RT). The primary endpoint was 3-year LEDDFS, and secondary endpoints were 3-year local failure (LF), regional failure (RF), distant metastasis (DM), overall survival (OS), disease-free survival (DFS), and acute and late toxicities. Cox proportional hazard tests were used for multivariable analysis (MVA). Results A total of 213 cases were included. With a median follow-up of 37 months, the 3-year LEDDFS was 50%, while the 3-year OS, DFS, LF, RF, and DM were 81%, 74%, 9%, 5%, and 7%, respectively. On MVA, cT4-category was the only predictor of inferior LEDDFS (HR: 0.47, [95% CI: 0.29-0.74], p < .01). The most common grade ≥ 3 acute and late radiation therapy oncology group (RTOG) toxicity were esophageal toxicity: 16.7% and 29.6%, respectively. Conclusions Primary RT resulted in favorable oncologic and functional outcomes in only half of the advanced-stage laryngeal cancer patients. Future clinical trials are required to investigate further treatment options aiming to improve the oncologic and maintain functional outcomes with utilization of LEDDFS as the primary endpoint. Level of evidence 4.
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Affiliation(s)
- Issa Mohamad
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Abdelatif Almousa
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Ayat Taqash
- Department of BiostatisticsKing Hussein Cancer CenterAmmanJordan
| | - Ebrahim Mayta
- Department of Surgical OncologyKing Hussein Cancer CenterAmmanJordan
| | - Fawzi Abuhijla
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Hamza Ghatasheh
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Hazem Ababneh
- Department of Radiation OncologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Lina Wahbeh
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Ramiz Abuhijlih
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Tariq Hussein
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Wisam Al‐Gargaz
- Department of Surgical OncologyKing Hussein Cancer CenterAmmanJordan
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer CentreUniversity Health Network, University of TorontoTorontoOntarioCanada
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Li R, Ye L, Zhu Y, Ding H, Wang S, Ying H, Wu C, Zhou L, Wang X, Tian S. Induction chemotherapy of modified docetaxel, cisplatin, 5-fluorouracil for laryngeal preservation in locally advanced hypopharyngeal squamous cell carcinoma. Head Neck 2022; 44:2018-2029. [PMID: 35915867 DOI: 10.1002/hed.27119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/22/2022] [Accepted: 05/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Previous studies have investigated the value of induction chemotherapy (IC) in organ preservation strategies for head and neck cancers. This study evaluated the effectiveness of sequential IC with radiotherapy as a laryngeal preservation strategy for locally advanced hypopharyngeal carcinoma (LAHSCC). METHODS One hundred and forty-two consecutive patients with LAHSCC were retrospectively analyzed who received three IC regimens from 2015 to 2019. RESULTS In the TP (docetaxel plus cisplatin), TPF (TP plus 5-fluorouracil), and TPX (TP plus capecitabine) IC groups, there were 51, 29, and 62 patients, respectively. The primary tumor objective response rates were 51%, 55.2%, and 71%, and the 3-year survival rates with preserved larynx were 36.6%, 31.8%, and 51.2%, respectively (p = 0.03). There was no difference in overall survival and the adverse events were tolerable. CONCLUSIONS The TPX regimen displayed good efficacy and safety, indicating its potential as a therapeutic IC regimen for LAHSCC.
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Affiliation(s)
- Ruichen Li
- Department of Radiation Oncology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Lulu Ye
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yi Zhu
- Department of Radiation Oncology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Hao Ding
- Department of Radiation Oncology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Shengzi Wang
- Department of Radiation Oncology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Hongmei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Chunping Wu
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Liang Zhou
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Xiaoshen Wang
- Department of Radiation Oncology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Shu Tian
- Department of Radiation Oncology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
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15
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Lee MY, Belfiglio M, Zeng J, Fleming CW, Koyfman S, Joshi NP, Lamarre E, Prendes B, Scharpf J, Lorenz RR, Woody NM, Adelstein DJ, Geiger JL, Chute DJ, Ku JA. Primary Total Laryngectomy versus Organ Preservation for Locally Advanced T3/T4a Laryngeal Cancer. Laryngoscope 2022; 133:1122-1131. [PMID: 35754153 DOI: 10.1002/lary.30254] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/11/2022] [Accepted: 05/31/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Organ preservation (OP) treatment for advanced laryngeal cancer has increased compared to primary total laryngectomy. Our study compares oncologic and functional outcomes between these approaches. STUDY DESIGN Retrospective cohort study. SETTING Single tertiary care institution. METHODS Retrospective review of patients receiving primary total laryngectomy or OP for laryngeal cancer between 1/1/2000 and 12/31/2018. RESULTS A total of 118 patients received primary total laryngectomy and 119 received OP. Overall survival was similar between total laryngectomy and OP. When stratified by T stage, disease-free survival was worse among T3 patients receiving OP versus total laryngectomy. In T3 patients, 28 OP patients experienced local recurrence (28.9%) compared to 3 total laryngectomy patients (7.1%; p < 0.01). In total, 20 OP patients with local recurrence received salvage surgery. These patients had similar overall survival to patients who underwent initial total laryngectomy (TL). About 14 OP patients with local recurrence did not receive salvage surgery. About 89 (75.4%) TL patients achieved normal diet as compared to 64 (53.8%) OP patients (p < 0.001). In TL patients, 106 (89.8%) received primary or secondary tracheoesophageal-prosthesis, 82 (77.4%) of whom achieved completely understandable speech. CONCLUSIONS There was no difference in survival by treatment in T4 patients, possibly because of strict patient selection. However, disease-free survival was worse in T3 patients receiving OP, likely due to a high local recurrence rate. Approximately 40% of patients with local recurrence were not eligible for salvage laryngectomy. TL patients had comparable swallowing and speech outcomes with OP patients. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Maxwell Y Lee
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Mario Belfiglio
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Johnathan Zeng
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Christopher W Fleming
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Shlomo Koyfman
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Nikhil P Joshi
- Department of Radiation Oncology, Rush University Medical Center, Cleveland, Ohio, USA
| | - Eric Lamarre
- Head and Neck Cancer Program, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Brandon Prendes
- Head and Neck Cancer Program, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Joseph Scharpf
- Head and Neck Cancer Program, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Robert R Lorenz
- Head and Neck Cancer Program, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Neil M Woody
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - David J Adelstein
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Jessica L Geiger
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Deborah J Chute
- Department of Pathology, Cleveland Clinic Pathology and Laboratory Medicine Institute, Cleveland, Ohio, USA
| | - Jamie A Ku
- Head and Neck Cancer Program, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
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16
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Luo X, Huang X, Liu S, Wang X, Luo J, Xiao J, Wang K, Qu Y, Chen X, Zhang Y, Wang J, Zhang J, Xu G, Gao L, Wu R, Yi J. Response-Adapted Treatment Following Radiotherapy in Patients With Resectable Locally Advanced Hypopharyngeal Carcinoma. JAMA Netw Open 2022; 5:e220165. [PMID: 35191967 PMCID: PMC8864511 DOI: 10.1001/jamanetworkopen.2022.0165] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Laryngeal preservation strategies for resectable locally advanced hypopharyngeal carcinoma (LAHPC) have been explored. However, the optimal strategy remains unclear. OBJECTIVE To evaluate a response-adapted strategy based on an early response to radiotherapy (RT) in patients with resectable LAHPC. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted from May 2009 to October 2019 with a median (IQR) follow-up period of 66.5 (44.7-97.0) months. The study was conducted at a tertiary academic medical center and included 423 patients pathologically confirmed stage III and IVB LAHPC. A total of 250 patients with previous cancer history, synchronous primary cancer, stage I or II, or with unresectable hypopharyngeal carcinoma were excluded. EXPOSURES Patients who reached 80% or greater tumor regression when evaluated endoscopically and by imaging methods at 50 Gy received definitive RT or concurrent chemoradiotherapy, and those with less than 80% regression underwent surgery 4 to 6 weeks after RT. MAIN OUTCOMES AND MEASURES Five-year overall survival and survival with a functional larynx. RESULTS Overall, 423 patients were included in the study (median [IQR] age, 55 [50-63] years; 408 [96.5%] men and 15 [3.5%] women). The response-adapted and primary surgery groups had significantly better survival than the primary RT group (52.7% and 54.4% vs 27.7%, respectively; P < .001). The response-adapted and primary surgery groups had similar 5-year overall survival of 52.7% vs 54.4%, respectively (hazard ratio [HR], 1.02; 95% CI, 0.75 to 1.39; P = .89). The response-adapted group had better 5-year survival with functional larynx than the primary surgery group (40.6% vs 33.9%; HR, 0.64; 95% CI, 0.49 to 0.84, P = .001). Surgery complications did not significantly differ between the 2 groups. Among patients in the response-adapted group who required total laryngectomy (n = 186) as indicated by pretreatment evaluation, the 5-year cumulative Kaplan-Meier survival with functional larynx was 39.8%. CONCLUSIONS AND RELEVANCE In this cohort study, the response-adapted strategy based on an early RT response facilitated better treatment tailoring, maximum tumor control, and higher laryngeal preservation compared with primary surgery and primary RT strategies. This approach could provide a feasible laryngeal preservation strategy in patients with LAHPC.
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Affiliation(s)
- Xi Luo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaodong Huang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shaoyan Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaolei Wang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingwei Luo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianping Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Qu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuesong Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingbo Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianghu Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guozhen Xu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Gao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runye Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junlin Yi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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17
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Therapeutic strategies, oncologic and swallowing outcomes and their predictive factors in patients with locally advanced hypopharyngeal cancer. Eur Arch Otorhinolaryngol 2022; 279:3629-3637. [DOI: 10.1007/s00405-021-07196-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/20/2021] [Indexed: 12/17/2022]
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18
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Lim AE, Woodley N, Ton T, Lewis K, Ferrier K, Mohd Slim MA, Montgomery J, Douglas CM. A retrospective study comparing organ preserving therapy with surgical intervention in advanced laryngeal cancer. Clin Otolaryngol 2021; 47:380-387. [PMID: 34939326 DOI: 10.1111/coa.13906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/18/2021] [Accepted: 12/04/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Alison E Lim
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow
| | - Niall Woodley
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow
| | - Trung Ton
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow
| | | | | | | | | | - Catriona M Douglas
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow
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19
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Szturz P, Vinches M, Remenár É, van Herpen CML, Abdeddaim C, Stewart JS, Fortpied C, Vermorken JB. Prognostic factor analysis and long-term results of the TAX 323 (EORTC 24971) study in unresectable head and neck cancer patients. Eur J Cancer 2021; 156:109-118. [PMID: 34425403 DOI: 10.1016/j.ejca.2021.07.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the TAX 323 (EORTC 24971) phase III trial enrolling patients with unresectable locoregionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN), the addition of docetaxel (T) to cisplatin and 5-fluorouracil (PF)-based induction chemotherapy prior to definite radiotherapy significantly improved progression-free survival (PFS) and overall survival (OS). METHODS The data were updated for PFS, OS and treatment-related long-term side-effects. Baseline clinical and laboratory data of 17 variables were collected and subjected to univariate and multivariate prognostic factor analyses for OS. RESULTS All 358 patients randomised between 1999 and 2002 were included in the long-term analysis with a median follow-up of 8.6 years. The primary end-point of PFS remained significantly improved with TPF compared with PF (adjusted hazard ratio [HR], 0.70; 95% CI, 0.56-0.88, p = 0.002), translating into a persisting benefit in OS (adjusted HR, 0.75; 95% CI, 0.60-0.95, p = 0.015). Long-term side-effects in the TPF/PF arms comprised tracheostomy (7%/5%), feeding tube dependency (3%/6%) and gastrostomy (11%/11%). Second malignancy occurred in 8%/3%, respectively. Out of 177 patients randomised to the TPF arm, 160 were included in the multivariate analysis. Grade 2 or more dysphagia (p = 0.002) and grade 2 or more pain (p = 0.004) at baseline were identified as independent negative prognostic factors. In addition, OS differed across primary tumour sites (p = 0.027) and was worse in patients with a higher N-stage (p = 0.025). CONCLUSIONS In LA-SCCHN patients treated with sequential chemoradiotherapy, TPF induction chemotherapy demonstrated long-lasting efficacy, superior to the PF regimen. Higher-grade dysphagia and pain are unfavourable prognosticators.
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Affiliation(s)
- Petr Szturz
- Medical Oncology, Department of Oncology, University of Lausanne (UNIL) and Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Marie Vinches
- The European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Éva Remenár
- Hospitalier Order of Saint John of God Hospital Buda, Budapest, Hungary
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Catherine Fortpied
- The European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Jan B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
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20
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Hochfelder CG, Mehta V, Kabarriti R, McGinn AP, Castellucci E, Ow TJ. Survival analysis of patients with advanced hypopharyngeal cancer comparing patients who received primary surgery to those who received chemoradiation: An analysis of the NCDB. Oral Oncol 2021; 121:105470. [PMID: 34418696 DOI: 10.1016/j.oraloncology.2021.105470] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The objective of this study was to use the American College of Surgeons' National Cancer Database (NCDB) to examine the association between primary treatment and overall survival (OS) among patients with locoregionally advanced hypopharyngeal cancer. METHODS 6,055 adult patients diagnosed between 2004 and 2015 with stage III or IV, M0, hypopharyngeal squamous cell carcinoma were identified within the NCDB. Patients who received primary chemoradiation (CRT) were compared to those that received surgery with adjuvant radiation or chemoradiation (S + Adj). OS was compared between treatment groups using Kaplan-Meier analyses, propensity score adjustment, and Cox regression analyses. RESULTS The median survival was 22.7 months (IQR 11.0-49.0). The S + Adj group had a significantly higher comorbidity score, higher grade disease, and more advanced stage disease than the CRT group. S + Adj was associated with significantly improved survival when compared to CRT (p < 0.0001). A propensity score adjusting for facility type, facility location, care at multiple facilities, histology, and T stage was developed. S + Adj was associated with longer survival (HR: 0.72, 95% CI: 0.64-0.80) when compared to CRT in a multivariable Cox regression analysis (adjusting for age, race and ethnicity, insurance status, a comorbidity index, diagnosis year, treatment delay, N stage, and the propensity score). S + Adj was associated with significantly improved survival among those with T2 disease (p = 0.02), T3 disease (p = 0.02), and T4 disease (p < 0.0001) in sensitivity analyses examining these subcohorts independently. CONCLUSIONS Among patients with advanced hypopharyngeal cancer reported in NCDB, treatment with S + Adj was associated with longer survival compared to those treated with primary CRT.
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Affiliation(s)
- Colleen G Hochfelder
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI 48109, United States
| | - Vikas Mehta
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, United States
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E. 210th Street, Bronx, NY 10467, United States
| | - Aileen P McGinn
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, 1300 Morris Park Ave, Bronx, NY 10461, United States
| | - Enrico Castellucci
- Department of Medical Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E. 210th Street, Bronx, NY 10467, United States
| | - Thomas J Ow
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, United States; Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, United States.
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21
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Benson R, Mallick S, Rath GK. Neoadjuvant Chemotherapy for Larynx Preservation: Has it Lost Importance? Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_99_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AbstractOver the time, the aim of treatment for locally advanced laryngeal and hypopharyngeal carcinoma has changed from cure to cure with the functional larynx. Chemoradiation has emerged as the most important therapeutic modality for patients with locally advanced disease. However, systemic failure remains an important area of concern. Induction chemotherapy has emerged as promising organ preservation approach as it gives an window to select responders and continuing treatment with nonsurgical approach as well as reduces systemic recurrence and improve survival with a functional larynx. However, there are questions about the efficacy of this approach. In this context, we aim to evaluate the trials for locally advanced laryngeal and hypopharyngeal cancer attempting to optimize therapeutic outcome with addition of induction chemotherapy. This present review intends to look into the therapeutic ratio of induction chemotherapy for disease control, organ preservation.
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Affiliation(s)
- Rony Benson
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Supriya Mallick
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - G K Rath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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22
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León X, Montoro V, García J, López M, Farré N, Majercakova K, Gallego Ó, López-Pousa A, Quer M. Organ Preservation in Patients With Advanced Laryngeal Tumours. Results of Induction Chemotherapy Versus Chemoradiotherapy in Actual Clinical Practice. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otoeng.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Bernadach M, Lapeyre M, Dillies AF, Miroir J, Casile M, Moreau J, Molnar I, Ginzac A, Pham-Dang N, Saroul N, Durando X, Biau J. Predictive factors of toxicity of TPF induction chemotherapy for locally advanced head and neck cancers. BMC Cancer 2021; 21:360. [PMID: 33827483 PMCID: PMC8025378 DOI: 10.1186/s12885-021-08128-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/23/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The rate of toxic deaths related to induction chemotherapy in the treatment of locally advanced head and neck cancers is unacceptable and calls into question this therapeutic strategy, which is however highly effective in terms of rate and speed of response. The purpose of the study was to investigate predictive factors of toxicity of induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (TPF) in locally advanced head and neck cancers (LAHNC). METHODS Between June 2009 and December 2017, 113 patients treated consecutively with TPF were included retrospectively. Patients were receiving induction chemotherapy for either an inoperable cancer or laryngeal preservation. For inoperable cancer, induction chemotherapy was proposed to patients presenting either a large tumor with strong symptoms (dyspnea, dysphagia, pain) or a tumor with rapid progression. Risk factors were chosen among the initial patient and tumour characteristics and chemotherapy modalities. RESULTS Eighty-nine patients (79%) were male; the median age was 58 years [32-71]. Sixty-nine (61%) patients were treated for inoperable cancer and 44 (39%) for laryngeal preservation. 45% had stage IVa cancer, 28% stage III and 25% stage IVb. Sixty percent of patients had a partial response after TPF, 22% had a complete response, 12% were stable, 5% were progressing, and 1% had a discordant response. Thirty-four patients (30%) received enteral feeding during induction chemotherapy with TPF. The possibility of oral feeding without a tube was predictive of a better response (p = 0.003). Seven (6%) patients died during TPF. There was an increased risk of death with preexisting liver dysfunction (liver dysmorphia on imaging or decrease prothrombin rate) (p = 0.032). There was an increased risk of grade ≥ 3 infection if an enteral feeding occurred during the period of induction chemotherapy (p = 0.03). CONCLUSIONS TPF induction chemotherapy had an 82% objective response rate with 6% toxic deaths. Nutritional status and the presence of hepatic dysfunction are significant risk factors to be taken into account in therapeutic decisions.
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Affiliation(s)
- Maureen Bernadach
- Medical Oncology Department, Jean PERRIN Center, 63011, Clermont-Ferrand, France.,Clinical Research Division, Delegation for Clinical Research and Innovation, Jean PERRIN Center, 63011, Clermont-Ferrand, France.,Clinical Investigation Center, UMR501, 63011, Clermont-Ferrand, France
| | - Michel Lapeyre
- Radiotherapy department, Centre de Lutte Contre le Cancer Jean PERRIN, 58 Rue Montalembert, 63011, Clermont-Ferrand, France
| | | | - Jessica Miroir
- Radiotherapy department, Centre de Lutte Contre le Cancer Jean PERRIN, 58 Rue Montalembert, 63011, Clermont-Ferrand, France
| | - Melanie Casile
- Clinical Research Division, Delegation for Clinical Research and Innovation, Jean PERRIN Center, 63011, Clermont-Ferrand, France.,Clinical Investigation Center, UMR501, 63011, Clermont-Ferrand, France.,Clermont Auvergne University, INSERM, U1240, Molecular Imaging and Theranostic Strategies, Jean PERRIN Center, 63011, Clermont-Ferrand, France
| | - Juliette Moreau
- Radiotherapy department, Centre de Lutte Contre le Cancer Jean PERRIN, 58 Rue Montalembert, 63011, Clermont-Ferrand, France
| | - Ioana Molnar
- Clinical Research Division, Delegation for Clinical Research and Innovation, Jean PERRIN Center, 63011, Clermont-Ferrand, France.,Clinical Investigation Center, UMR501, 63011, Clermont-Ferrand, France.,Clermont Auvergne University, INSERM, U1240, Molecular Imaging and Theranostic Strategies, Jean PERRIN Center, 63011, Clermont-Ferrand, France
| | - Angeline Ginzac
- Clinical Research Division, Delegation for Clinical Research and Innovation, Jean PERRIN Center, 63011, Clermont-Ferrand, France.,Clinical Investigation Center, UMR501, 63011, Clermont-Ferrand, France.,Clermont Auvergne University, INSERM, U1240, Molecular Imaging and Theranostic Strategies, Jean PERRIN Center, 63011, Clermont-Ferrand, France
| | - Nathalie Pham-Dang
- Department of Maxillofacial and Plastic Surgery, Estaing University Hospital Center Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Nicolas Saroul
- Department of Otorhinolaryngology - Head and Neck Surgery, Gabriel Montpied University Hospital Center, 63000, Clermont-Ferrand, France
| | - Xavier Durando
- Medical Oncology Department, Jean PERRIN Center, 63011, Clermont-Ferrand, France.,Clinical Research Division, Delegation for Clinical Research and Innovation, Jean PERRIN Center, 63011, Clermont-Ferrand, France.,Clinical Investigation Center, UMR501, 63011, Clermont-Ferrand, France.,Clermont Auvergne University, INSERM, U1240, Molecular Imaging and Theranostic Strategies, Jean PERRIN Center, 63011, Clermont-Ferrand, France
| | - Julian Biau
- Radiotherapy department, Centre de Lutte Contre le Cancer Jean PERRIN, 58 Rue Montalembert, 63011, Clermont-Ferrand, France. .,Clermont Auvergne University, INSERM, U1240, Molecular Imaging and Theranostic Strategies, Jean PERRIN Center, 63011, Clermont-Ferrand, France.
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Lacas B, Carmel A, Landais C, Wong SJ, Licitra L, Tobias JS, Burtness B, Ghi MG, Cohen EEW, Grau C, Wolf G, Hitt R, Corvò R, Budach V, Kumar S, Laskar SG, Mazeron JJ, Zhong LP, Dobrowsky W, Ghadjar P, Fallai C, Zakotnik B, Sharma A, Bensadoun RJ, Ruo Redda MG, Racadot S, Fountzilas G, Brizel D, Rovea P, Argiris A, Nagy ZT, Lee JW, Fortpied C, Harris J, Bourhis J, Aupérin A, Blanchard P, Pignon JP. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group. Radiother Oncol 2021; 156:281-293. [PMID: 33515668 DOI: 10.1016/j.radonc.2021.01.013] [Citation(s) in RCA: 148] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE The Meta-Analysis of Chemotherapy in squamous cell Head and Neck Cancer (MACH-NC) demonstrated that concomitant chemotherapy (CT) improved overall survival (OS) in patients without distant metastasis. We report the updated results. MATERIALS AND METHODS Published or unpublished randomized trials including patients with non-metastatic carcinoma randomized between 1965 and 2016 and comparing curative loco-regional treatment (LRT) to LRT + CT or adding another timing of CT to LRT + CT (main question), or comparing induction CT + radiotherapy to radiotherapy + concomitant (or alternating) CT (secondary question) were eligible. Individual patient data were collected and combined using a fixed-effect model. OS was the main endpoint. RESULTS For the main question, 101 trials (18951 patients, median follow-up of 6.5 years) were analyzed. For both questions, there were 16 new (2767 patients) and 11 updated trials. Around 90% of the patients had stage III or IV disease. Interaction between treatment effect on OS and the timing of CT was significant (p < 0.0001), the benefit being limited to concomitant CT (HR: 0.83, 95%CI [0.79; 0.86]; 5(10)-year absolute benefit of 6.5% (3.6%)). Efficacy decreased as patients age increased (p_trend = 0.03). OS was not increased by the addition of induction (HR = 0.96 [0.90; 1.01]) or adjuvant CT (1.02 [0.92; 1.13]). Efficacy of induction CT decreased with poorer performance status (p_trend = 0.03). For the secondary question, eight trials (1214 patients) confirmed the superiority of concomitant CT on OS (HR = 0.84 [0.74; 0.95], p = 0.005). CONCLUSION The update of MACH-NC confirms the benefit and superiority of the addition of concomitant CT for non-metastatic head and neck cancer.
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Affiliation(s)
- Benjamin Lacas
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France
| | | | | | | | | | | | | | | | | | - Cai Grau
- H. Lee Moffitt Cancer Center & Research Institute, USA
| | | | | | - Renzo Corvò
- Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer, India
| | - Volker Budach
- State University of New York Downstate Medical Center, USA
| | | | | | | | | | | | - Pirus Ghadjar
- Johns Hopkins Univ/Sidney Kimmel Cancer Center, MD, USA
| | - Carlo Fallai
- Centre Hospitalier Universitaire de Tours, France
| | | | - Atul Sharma
- Cancer Research UK & UCL Cancer Trials Centre, UK
| | | | | | - Séverine Racadot
- Princess Margaret Cancer Centre/University of Toronto, Ontario, Canada
| | | | | | - Paolo Rovea
- Kragulevac University Hospital, Yugoslavia, Serbia
| | | | | | | | | | | | - Jean Bourhis
- Institut Saint Catherine, France; Stanford University School of Medicine, CA, USA
| | - Anne Aupérin
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France
| | - Pierre Blanchard
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France; University of Texas-MD Anderson Cancer Center, USA.
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Sinha S, Agarwal JP, Mahajan A, Chaturvedi P, Balaji A, Juvekar S, Gupta T, Budrukkar A, Murthy V, Mummudi N, Swain M, Jadhav R, Laskar SG. Implications of limited exolaryngeal disease and cricoarytenoid joint involvement in organ conservation protocols for laryngopharyngeal cancers: Results from a prospective study. Head Neck 2020; 43:1289-1299. [PMID: 33368793 DOI: 10.1002/hed.26593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/13/2020] [Accepted: 12/17/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To identify clinicoradiological factors that determine functional outcomes in laryngopharyngeal cancers treated with chemoradiotherapy. METHODS One hundred patients of locally advanced laryngopharyngeal cancers who were treated with chemoradiotherapy were accrued in this prospective study. The coprimary endpoint of the study was local control (LC) and functional larynx preservation survival (FLPS). RESULTS The median follow-up was 39 months. Thirty-nine patients had a local failure of which 17 underwent a salvage laryngectomy. A dysfunctional larynx with clinic-radiologically disease was seen in only 1 patient. Factors significant for LC were thyroid cartilage erosion/lysis and cricoarytenoid joint involvement. Within the T4a subset, patients with exolaryngeal disease through the soft tissue framework had significantly better LC and FLPS than those with cartilage erosion/lysis. CONCLUSIONS Patients with limited exolaryngeal disease through the soft-tissue framework can be considered for functional organ preservation, while those with thyroid cartilage involvement and cricoarytenoid joint involvement are not suitable.
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Affiliation(s)
- Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Mahajan
- Department of Radio-Diagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head & Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Arun Balaji
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shashikant Juvekar
- Department of Radio-Diagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rakesh Jadhav
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Chou WC, Chang PH, Chen PT, Wang HM, Yeh KY, Lu CH, Hung YS, Tung-Chieh Chang J, Tsang NM, Ho YW, Chen SY, Lee SH, Hung CY, Wang LJ, Liao KC, Lin CH, Tang WR, Lin YC. Clinical Significance of Vulnerability Assessment in Patients with Primary Head and Neck Cancer Undergoing Definitive Concurrent Chemoradiation Therapy. Int J Radiat Oncol Biol Phys 2020; 108:602-611. [DOI: 10.1016/j.ijrobp.2020.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 12/05/2019] [Accepted: 01/06/2020] [Indexed: 12/27/2022]
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Dharmarajan KV, Mohile SG. Can Geriatric Assessment Measures Be Used to Determine Cancer Treatment Vulnerability in Nongeriatric Patients? Int J Radiat Oncol Biol Phys 2020; 108:612-614. [PMID: 32976787 DOI: 10.1016/j.ijrobp.2020.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Kavita V Dharmarajan
- Department of Radiation Oncology, Brookdale Department of Geriatrics and Palliative Medicine, the Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Supriya G Mohile
- Division of Hematology/Oncology, Departments of Medicine and Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
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Broes S, Saesen R, Lacombe D, Huys I. Past, Current, and Future Cancer Clinical Research Collaborations: The Case of the European Organisation for Research and Treatment of Cancer. Clin Transl Sci 2020; 14:47-53. [PMID: 32799428 PMCID: PMC7877867 DOI: 10.1111/cts.12863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/14/2020] [Indexed: 12/21/2022] Open
Abstract
Although collaborations between academic institutions and industry have led to important scientific breakthroughs in the discovery stage of the pharmaceutical research and development process, the role of multistakeholder partnerships in the clinical development of anticancer medicines necessitates further clarification. The benefits associated with such cooperation could be undercut by the conflicting goals and motivations of the actors included. The aim of this review was to identify and characterize past, present, and future stakeholder partnership models in cancer clinical research through the lens of the European Organisation for Research and Treatment of Cancer (EORTC). Based on the analysis of several landmark EORTC trials performed across the span of three decades, four existing models of stakeholder cooperation were delineated and characterized. Additionally, a hypothetical fifth model representing a potential future collaborative framework for cancer clinical research was formulated. These models mainly differ in terms of the nature and responsibilities of the partners included and show that clinical research partnerships in oncology have evolved over time from small‐scale academia‐industry collaborations to complex interdisciplinary cooperation involving many different stakeholders.
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Affiliation(s)
- Stefanie Broes
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Robbe Saesen
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Denis Lacombe
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, Katholieke Universiteit Leuven, Leuven, Belgium
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29
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Musoro JZ, Coens C, Singer S, Tribius S, Oosting SF, Groenvold M, Simon C, Machiels JP, Grégoire V, Velikova G, Cocks K, Sprangers MAG, King MT, Bottomley A. Minimally important differences for interpreting European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 scores in patients with head and neck cancer. Head Neck 2020; 42:3141-3152. [PMID: 32627261 DOI: 10.1002/hed.26363] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We aimed to estimate minimally important difference (MID) for interpreting group-level change over time for European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire core 30 (EORTC QLQ-C30) scores in head and neck cancer. METHODS Data were derived retrospectively from two published EORTC trials. Clinical anchors were selected using correlation strength and clinical plausibility of the given anchor/QLQ-C30 scale pair. MIDs for within-group and between-group change were estimated via the mean change method and linear regression, respectively. Distribution-based MIDs were also examined. MIDs for two of the scales, dyspnea and nausea/vomiting, are more uncertain considering their low correlations with the anchors. RESULTS Anchor-based MIDs could be determined for deterioration in 7 of the 14 QLQ-C30 scales assessed, and in 3 scales for improvement. MIDs varied by scale, direction of change, and anchor. Absolute MID values ranged from 5 to 15 points for within-group change and 4 to 12 for between-group change. Most MIDs were within 4 to 10 points. CONCLUSIONS Our findings, if confirmed, will aid interpreting changes in selected QLQ-C30 scale scores over time and inform sample size calculations in future clinical trials in head and neck cancer.
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Affiliation(s)
- Jammbe Z Musoro
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Susanne Singer
- Division of Epidemiology and Health Services Research University Medical Centre, Institute of Medical Biostatistics, Epidemiology and Informatics, Mainz, Germany.,University Cancer Centre Mainz, Mainz, Germany
| | - Silke Tribius
- Department of Radiation Oncology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Sjoukje F Oosting
- University Medical Center Groningen, Department of Medical Oncology, University of Groningen, Groningen, The Netherlands
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen and Bispebjerg Hospital, Copenhagen, Denmark
| | - Christian Simon
- Department of Otolaryngology, Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Jean-Pascal Machiels
- Institut Roi Albert II, Service d'oncologie médicale, Cliniques universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale, U C Louvain, Brussels, Belgium
| | | | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's Hospital, Leeds, UK
| | - Kim Cocks
- Department of Health Sciences, University of York, York, UK.,Adelphi Values, Bollington, UK
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Cancer Center, Amsterdam, The Netherlands
| | - Madeleine T King
- Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
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30
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Kubo K, Murakami Y, Kenjo M, Imano N, Takeuchi Y, Nishibuchi I, Kimura T, Kawahara D, Ueda T, Takeno S, Nagata Y. Long-term outcomes of induction chemotherapy followed by chemoradiotherapy using volumetric-modulated arc therapy as an organ preservation approach in patients with stage IVA-B oropharyngeal or hypopharyngeal cancers. JOURNAL OF RADIATION RESEARCH 2020; 61:554-562. [PMID: 32548612 PMCID: PMC7336564 DOI: 10.1093/jrr/rraa033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/27/2020] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
The present study aimed to analyze treatment outcomes after induction chemotherapy followed by chemoradiotherapy (CRT) using volumetric-modulated arc therapy (VMAT) in patients with stage IVA-B oropharyngeal cancer (OPC) or hypopharyngeal cancer (HPC), with long-term observation, including examination of larynx preservation. A total of 60 patients with stage IVA-B OPC or HPC, who underwent induction TPF chemotherapy (a combination regimen consisting of docetaxel, cisplatin, and 5-fluorouracil) followed by CRT using VMAT were analyzed. Overall survival (OS), progression-free survival (PFS), laryngoesophageal dysfunction-free survival (LEDFS), and locoregional control (LRC) were calculated and compared. Univariate and multivariate analyses were performed to determine statistical differences in OS and LEDFS. The median follow-up period at the time of evaluation was 61 months. Twenty-six (43%) patients had OPC and 34 (57%) had HPC. The 5-year OS, PFS, LEDFS, and LRC rates were 57%, 52%, 52%, and 68%, respectively. Response to TPF therapy was the only significant predictive factor of OS and LEDFS in multivariate analyses. Regarding long-term toxicities, grade ≥ 2 late toxicities accounted for 15%. No patients experienced grade ≥ 3 xerostomia, and 5% of all patients developed grade 3 dysphagia. With long-term observation, the OS, PFS, and LEDFS rates were relatively good, and the incidence of late toxicities was low. TPF followed by CRT using VMAT was feasible and more effective in those who responded to induction chemotherapy.
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Affiliation(s)
- Katsumaro Kubo
- Department of Radiation Oncology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Masahiro Kenjo
- Hiroshima High-Precision Radiotherapy Cancer Center, 2-2 Futabanosato Higashi-ku Hiroshima-shi, Hiroshima 732-0057, Japan
| | - Nobuki Imano
- Department of Radiation Oncology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Yuki Takeuchi
- Department of Radiation Oncology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Daisuke Kawahara
- Department of Radiation Oncology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Tsutomu Ueda
- Department of Otorhinolaryngology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Sachio Takeno
- Department of Otorhinolaryngology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
- Hiroshima High-Precision Radiotherapy Cancer Center, 2-2 Futabanosato Higashi-ku Hiroshima-shi, Hiroshima 732-0057, Japan
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31
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Foster CC, Seiwert TY, MacCracken E, Blair EA, Agrawal N, Melotek JM, Portugal L, Brisson RJ, Gooi Z, Spiotto MT, Vokes EE, Haraf DJ. Dose and Volume De-Escalation for Human Papillomavirus–Positive Oropharyngeal Cancer is Associated with Favorable Posttreatment Functional Outcomes. Int J Radiat Oncol Biol Phys 2020; 107:662-671. [DOI: 10.1016/j.ijrobp.2020.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/25/2020] [Accepted: 04/08/2020] [Indexed: 01/07/2023]
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León X, Montoro V, García J, López M, Farré N, Majercakova K, Gallego Ó, López-Pousa A, Quer M. Organ preservation in patients with advanced laryngeal tumours. Results of induction chemotherapy versus chemoradiotherapy in actual clinical practice. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:143-151. [PMID: 32475610 DOI: 10.1016/j.otorri.2020.02.007] [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: 11/09/2019] [Revised: 01/19/2020] [Accepted: 02/04/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES A high percentage of patients with locally advanced larynx carcinomas are candidates for inclusion in organ preservation protocols. The objective of this study is to compare the results of two schemes of preservation, induction chemotherapy versus chemoradiotherapy, in patients with locally advanced larynx carcinomas in the context of actual clinical practice. METHODS Our retrospective study included 157 patients with locally advanced tumours of the larynx (T3-T4) treated with induction chemotherapy (n = 121) or chemoradiotherapy (n = 36). RESULTS From 121 patients who began treatment with induction chemotherapy, 6 died due to toxicity, 37 were treated with surgery, and 78 completed the preservation scheme; 36 patients received treatment with chemoradiotherapy. There were no significant differences in 5-year disease-specific survival between both treatments: 68.9% in induction chemotherapy versus 75.7% in chemoradiotherapy (p = 0.259). In 45.9% of patients the laryngeal function was preserved. Patients treated with chemoradiotherapy had a tendency to have better 5-year laryngeal dysfunction-free survival than patients treated with induction chemotherapy (55.6% versus 44.8%, p = 0.079). CONCLUSION Patients included in a protocol of organ preservation achieved a 5-year laryngeal dysfunction-free survival of 45.9%. There were no significant differences in disease-specific survival among patients treated with induction chemotherapy or chemoradiotherapy.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España.
| | - Victoria Montoro
- Servicio de Otorrinolaringología, Hospital de Mollet, Mollet del Vallés, Barcelona, España
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Nuria Farré
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Katarina Majercakova
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Óscar Gallego
- Servicio de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Antonio López-Pousa
- Servicio de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España
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Differential Change in Size of Human Papillomavirus-Positive Cystic Versus Solid Squamous Cell Carcinoma Lymph Node Metastases in Response to Induction Chemotherapy. J Comput Assist Tomogr 2020; 44:389-392. [PMID: 32176158 DOI: 10.1097/rct.0000000000000998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE According to certain cancer treatment protocols, the response to induction chemotherapy of lymph node metastases based on radiographic measurements guides further management. The aim of this study is to verify the observation that cystic metastatic lymph nodes tend not to shrink as rapidly as solid metastatic lymph nodes in response to induction chemotherapy in patients with human papillomavirus-related oropharyngeal squamous cell carcinoma. METHODS The lymphadenopathy in a cohort of patients from a clinical trial with human papillomavirus-related oropharyngeal squamous cell carcinoma with both baseline and postinduction chemotherapy (carboplatin/paclitaxel/cetuximab) contrast-enhanced neck computed tomography was retrospectively reviewed. The appearance of the metastatic lymph nodes on computed tomography was characterized as cystic or solid. A cystic lymph node was defined as having a hypoattenuating component greater than 20% of the total volume. The rates of short-axis and volume changes of cystic and solid lymph nodes were compared using 1-tailed t test. RESULTS A total of 46 patients were included in this study, comprising 39 solid and 45 cystic lymph nodes. The rate of short-axis decrease was significantly greater for solid (1.33% per day) than cystic (1.08% per day) lymph nodes (P = 0.036). Likewise, the rate of volume decrease was significantly greater for solid (2.13% per day) than cystic (1.87% per day) lymph nodes (P = 0.014). CONCLUSIONS This study suggests that in patients with human papillomavirus-related oropharyngeal squamous cell carcinoma solid lymph node metastases generally decrease in size at a greater rate than cystic lymph nodes after induction chemotherapy.
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Santos M, Monteiro E. Time between Diagnosis and Treatment of Hypopharynx and Larynx Cancer: Are Longer Delays Associated with Higher Discrepancy between Clinical and Pathological Staging? Int Arch Otorhinolaryngol 2020; 25:e108-e114. [PMID: 33542760 PMCID: PMC7851371 DOI: 10.1055/s-0040-1708898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 01/19/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction
At the time of diagnosis, treatment strategies for cancer are largely based upon clinical staging. However, discrepancy between clinical and pathological staging has been reported.
Objective
To assess the rate of staging discrepancy in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma (LHSCC), the potential influence of higher interval of time from diagnosis to primary surgical treatment, and whether this has any impact on survival outcomes.
Methods
Retrospective study of patients with LHSCC proposed for primary surgical treatment.
Results
The study population included 125 Caucasian patients with LHSCC. The level of agreement between clinical and pathological tumor staging was moderate (Cohen’s Kappa: 0.400;
p
< 0.001) and similar result was found for node staging (Cohen’ Kappa: 0.520;
p
< 0.001). The mean time between diagnosis and surgical treatment was 26.66 days and no statistically significant influence was found with staging discrepancy. The sample presented a 5-year Overall Survival (OS) of 58.2% and a Disease-specific survival (DSS) of 72.6%. No statistically significant impact of staging discrepancy on survival was found.
Conclusion
For advanced LHSCC, based on the findings of physical examination, endoscopy and imaging, is possible to achieve a moderate accuracy between clinical and pathological staging which allows a reliable counselling and treatment planning. Interval of time under 3–4 weeks between diagnosis and surgical treatment does not influence the rate of discrepancy. However, almost 30% of staging discrepancy is expected due to false negatives of imaging and limitations of physical exams.
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Affiliation(s)
- Mariline Santos
- Department of Otolaryngology, Head and Neck Surgery, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Eurico Monteiro
- Department of Otolaryngology, Head and Neck Surgery, Portuguese Institute of Oncology, Porto, Portugal
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Elicin O, Giger R. Comparison of Current Surgical and Non-Surgical Treatment Strategies for Early and Locally Advanced Stage Glottic Laryngeal Cancer and Their Outcome. Cancers (Basel) 2020; 12:cancers12030732. [PMID: 32244899 PMCID: PMC7140062 DOI: 10.3390/cancers12030732] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/05/2020] [Accepted: 03/16/2020] [Indexed: 12/27/2022] Open
Abstract
For the treatment of early and locally advanced glottic laryngeal cancer, multiple strategies are available. These are pursued and supported by different levels of evidence, but also by national and institutional traditions. The purpose of this review article is to compare and discuss the current evidence supporting different loco-regional treatment approaches in early and locally advanced glottic laryngeal cancer. The focus is kept on randomized controlled trials, meta-analyses, and comparative retrospective studies including the treatment period within the last twenty years (≥ 1999) with at least one reported five-year oncologic and/or functional outcome measure. Based on the equipoise in oncologic and functional outcome after transoral laser surgery and radiotherapy, informed and shared decision-making with and not just about the patient poses a paramount importance for T1-2N0M0 glottic laryngeal cancer. For T3-4aN0-3M0 glottic laryngeal cancer, there is an equipoise regarding the partial/total laryngectomy and non-surgical modalities for T3 glottic laryngeal cancer. Patients with extensive and/or poorly functioning T4a laryngeal cancer should not be offered organ-preserving chemoradiotherapy with salvage surgery as a back-up plan, but total laryngectomy and adjuvant (chemo) radiation. The lack of high-level evidence comparing contemporary open or transoral robotic organ-preserving surgical and non-surgical modalities does not allow any concrete conclusions in terms of oncological and functional outcome. Unnecessary tri-modality treatments should be avoided. Instead of offering one-size-fits-all approaches and over-standardized rigid institutional strategies, patient-centered informed and shared decision-making should be favored.
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Affiliation(s)
- Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland;
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
- Correspondence:
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Agarwal JP, Sinha S, Goda JS, Joshi K, Mhatre R, Kannan S, Laskar SG, Gupta T, Murthy V, Budrukkar A, Mummudi N, Ganeshan B. Tumor radiomic features complement clinico-radiological factors in predicting long-term local control and laryngectomy free survival in locally advanced laryngo-pharyngeal cancers. Br J Radiol 2020; 93:20190857. [PMID: 32101463 DOI: 10.1259/bjr.20190857] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To study if pre-treatment CT texture features in locally advanced squamous cell carcinoma of laryngo-pharynx can predict long-term local control and laryngectomy free survival (LFS). METHODS Image texture features of 60 patients treated with chemoradiation (CTRT) within an ethically approved study were studied on contrast-enhanced images using a texture analysis research software (TexRad, UK). A filtration-histogram technique was used where the filtration step extracted and enhanced features of different sizes and intensity variations corresponding to a particular spatial scale filter (SSF): SSF = 0 (without filtration), SSF = 2 mm (fine texture), SSF = 3-5 mm (medium texture) and SSF = 6 mm (coarse texture). Quantification by statistical and histogram technique comprised mean intensity, standard-deviation, entropy, mean positive pixels, skewness and kurtosis. The ability of texture analysis to predict LFS or local control was determined using Kaplan-Meier analysis and multivariate cox model. RESULTS Median follow-up of patients was 24 months (95% CI:20-28). 39 (65%) patients were locally controlled at last follow-up. 10 (16%) had undergone salvage laryngectomy after CTRT. For both local control & LFS, threshold optimal cut-off values of texture features were analyzed. Medium filtered-texture feature that were associated with poorer laryngectomy free survival were entropy ≥4.54, (p = 0.006), kurtosis ≥4.18; p = 0.019, skewness ≤-0.59, p = 0.001, and standard deviation ≥43.18; p = 0.009). Inferior local control was associated with medium filtered features entropy ≥4.54; p 0.01 and skewness ≤ - 0.12; p = 0.02. Using fine filters, entropy ≥4.29 and kurtosis ≥-0.27 were also associated with inferior local control (p = 0.01 for both parameters). Multivariate analysis showed medium filter entropy as an independent predictor for LFS and local control (p < 0.001 & p = 0.001). CONCLUSION Medium texture entropy is a predictor for inferior local control and laryngectomy free survival in locally advanced laryngo-pharyngeal cancer and this can complement clinico-radiological factors in predicting prognosticating these tumors. ADVANCES IN KNOWLEDGE Texture features play an important role as a surrogate imaging biomarker for predicting local control and laryngectomy free survival in locally advanced laryngo-pharyngeal tumors treated with definitive chemoradiation.
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Affiliation(s)
- Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India, 400012
| | - Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India, 400012
| | - Jayant Sastri Goda
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India, 400012
| | - Kishor Joshi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India, 400012
| | - Ritesh Mhatre
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India, 400012
| | - Sadhana Kannan
- Department of Biostatistics Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India, 400012
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India, 400012
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India, 400012
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India, 400012
| | | | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India, 400012
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
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Kawakita D, Abdelaziz S, Chen Y, Rowe K, Snyder J, Fraser A, Smith K, Herget K, Deshmukh V, Newman M, Monroe M, Hashibe M. Adverse respiratory outcomes among head and neck cancer survivors in the Utah Cancer Survivors Study. Cancer 2019; 126:879-885. [PMID: 31721181 DOI: 10.1002/cncr.32617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/09/2019] [Accepted: 10/12/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The number of head and neck cancer (HNC) survivors has been increasing because of improving survival in the United States. The aim of this study was to evaluate the incidence of respiratory disease diagnoses in HNC survivors in comparison with cancer-free individuals. A second aim was to investigate risk factors for respiratory disease among HNC survivors. METHODS Patients with HNC diagnosed from 1996 to 2012 were identified in the Utah Cancer Registry (n = 1901). Up to 5 cancer-free individuals from the general population (n = 7796) were matched to each HNC survivor by birth year, sex, birth state, and follow-up time. Electronic medical records and statewide health care facility data were used to identify a disease diagnosis after the cancer diagnosis. Cox proportional hazards models were used to estimate the risks of respiratory diseases. RESULTS The median follow-up times were 4.5 years for HNC survivors and 7.8 years for the general population cohort. The risks of respiratory infection (hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.40-1.90), chronic obstructive pulmonary diseases and bronchiectasis (HR, 2.65; 95% CI, 2.13-3.29), and aspiration pneumonitis (HR, 6.21; 95% CI, 3.98-9.68) were higher among HNC survivors than the general population cohort more than 5 years after the cancer diagnosis. Age at diagnosis, baseline body mass index, sex, baseline smoking status, treatment modality, primary site, and stage were associated with the risk of adverse respiratory outcomes among HNC survivors. CONCLUSIONS The risk of adverse respiratory outcomes was much higher among HNC survivors than the general population cohort. Multidisciplinary care is needed to prevent the occurrence of adverse respiratory outcomes among HNC survivors.
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Affiliation(s)
- Daisuke Kawakita
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Otorhinolaryngology-Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Sarah Abdelaziz
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Yuji Chen
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, Utah
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, Utah
| | - Alison Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Ken Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kimberly Herget
- Utah Cancer Registry, University of Utah, Salt Lake City, Utah
| | | | | | - Marcus Monroe
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
- Utah Cancer Registry, University of Utah, Salt Lake City, Utah
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Cortese S, Muratori E, Mastronicola R, Roch M, Beulque E, Rauch P, Dekerle L, Deganello A, Dolivet G. Partial pharyngolaryngectomy with infrahyoid flap: Our experience. Am J Otolaryngol 2019; 40:102271. [PMID: 31445929 DOI: 10.1016/j.amjoto.2019.08.002] [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: 03/06/2019] [Revised: 07/27/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
AIM We evaluated a cohort of advanced hypopharyngeal squamous cell carcinoma, treated with conservative surgery, reconstruction with infrahyoid flap and radio-chemotherapy. METHODS We used partial pharyngo-laryngectomy and radio-chemotherapy to treat fifty-seven patients with stage III-IV hypopharyngeal SCC from November 1994 to December 2011. Clinical examination and speech therapy evaluation were used for estimation of laryngeal function. RESULTS All patients received a partial pharyngo-laryngectomy. All patients underwent neck dissection; 56 patients received bilateral neck dissection. Reconstruction was achieved by infra-hyoid flap. Five-year overall and disease-specific survival rates were 54.4% and 61.4%, respectively. Successful laryngeal function preservation with complete five-year remission was achieved in 44% of the patients. CONCLUSION Selected even if advanced carcinomas of the hypopharynx maybe treated with partial pharyngo-laryngectomy with reconstruction with pedicled flap. Both oncological and functional results showed a good outcome.
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Santos M, Monteiro E. Is Increased Time From Diagnosis to Treatment in Advanced Hypopharynx Cancer Associated With Poorer Outcomes: A Single-Centre Analysis. EAR, NOSE & THROAT JOURNAL 2019; 100:454-459. [PMID: 31569981 DOI: 10.1177/0145561319878926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the potential influence of increased time from diagnosis to treatment on survival outcomes in patients with locoregionally advanced hypopharyngeal squamous cell carcinoma (HSCC). METHODS Retrospective study of patients with a primary diagnosis of HSCC proposed for primary surgical treatment. RESULTS The study population included a total of 121 Caucasian patients (121 males) with HSCC. Mean age at diagnosis was 60.4 years (range: 43-83 years). All patients had cT3 or cT4 hypopharyngeal tumors. The sample presented a 5-year overall survival (OS) of 59.6% and a disease-specific survival of 74.9%. Considering univariable analysis (unadjusted), duration of adjuvant treatment (T5), pN, margins, and extracapsular spread (ECS) are factors associated with poorer survival outcomes. An increase in T5 was associated with lower OS. Results revealed that T5 higher than 43 days, pN1, pN2, pN3, no free margins, and presence of ECS were associated with lower OS. These patients have 7.465 higher hazard of death. CONCLUSION This study suggests that duration of adjuvant therapy may be more important than other timing metrics from diagnosis to treatment. For locoregionally advanced HSCC, duration of adjuvant therapy after primary surgery higher than 6 weeks is an important feature for worse survival outcome. Preventing strategies in order to avoid radiotherapy or chemoradiotherapy breaks should be developed and optimized.
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Affiliation(s)
- Mariline Santos
- Department of Otolaryngology, Head and Neck Surgery, 112085Centro Hospitalar Universitário do Porto, Portugal
| | - Eurico Monteiro
- Department of Otolaryngology, Head and Neck Surgery, 59035Portuguese Institute of Oncology, Porto, Portugal
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Toxicité de la chimiothérapie d’induction par docétaxel, platine, 5-fluorouracile (TPF) pour les cancers des voies aérodigestives supérieures localement évolués en routine clinique : importance du statut nutritionnel. Cancer Radiother 2019; 23:273-280. [DOI: 10.1016/j.canrad.2018.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/09/2018] [Accepted: 08/18/2018] [Indexed: 12/14/2022]
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Anschuetz L, Shelan M, Dematté M, Schubert AD, Giger R, Elicin O. Long-term functional outcome after laryngeal cancer treatment. Radiat Oncol 2019; 14:101. [PMID: 31186027 PMCID: PMC6558792 DOI: 10.1186/s13014-019-1299-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/16/2019] [Indexed: 12/23/2022] Open
Abstract
Background The functional outcome after the treatment of laryngeal cancer is tightly related to the quality of life of affected patients. The aim of this study is to describe the long-term morbidity and functional outcomes associated with the different treatment modalities for laryngeal cancer. Methods Retrospective chart review of 477 patients undergoing curatively intended treatment for laryngeal cancer at our tertiary referral center from 2001 to 2014: Details on patient and disease characteristics, diagnostics and treatment related functional outcomes were analyzed. Results With a median follow-up of 51 months, the crude rate of functional larynx preservation was 74.6%. Radiotherapy +/− chemotherapy was the dominant treatment modality (n = 359–75.3%), whereas 24.7% (n = 118) underwent primary surgery, with 58.5% (69) receiving adjuvant treatment. The 5-year laryngectomy-free survival was 57% (95% CI, 48–66%) after surgery vs. 69% (95% CI, 64–75%) after chemoradiotherapy (p < 0.01). In stage III-IVB, these rates were 26% (95% CI, 16–39%) vs. 47% (95% CI, 36–59%), respectively (p < 0.01). Aspiration occurred in 7%, tracheostomy was necessary in 19.8% and feeding tube placement in 25.4%. Feeding tube and tracheostomy necessity was higher in the initially surgically treated group. Primary surgery (HR: 1.67, 95% CI: 1.19–2.32; p < 0.01), stage III-IVB (HR: 4.07, 95% CI: 2.97–5.60; p < 0.01) and tumor recurrence (HR: 3.83, 95% CI: 2.79–5.28; p < 0.01) remained as adverse factors for laryngectomy-free survival. Conclusions Preserving the laryngeal function after cancer treatment is challenging. Advanced tumor stages, primary surgery and recurrence are related to a poor functional outcome. Therefore, the criteria for initial decision-making needs to be further refined. Electronic supplementary material The online version of this article (10.1186/s13014-019-1299-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lukas Anschuetz
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Marco Dematté
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.,Department of Otorhinolaryngology, Head & Neck Surgery, Head and Neck and Sensory Organs Department, Sant'Orsola-Malpighi Hospital, University of Bologna, 40138, Bologna, Italy
| | - Adrian D Schubert
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
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Argiris A, Lefebvre JL. Laryngeal Preservation Strategies in Locally Advanced Laryngeal and Hypopharyngeal Cancers. Front Oncol 2019; 9:419. [PMID: 31214491 PMCID: PMC6554412 DOI: 10.3389/fonc.2019.00419] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 05/02/2019] [Indexed: 11/13/2022] Open
Abstract
For long, the treatment of locoregionally advanced laryngeal and hypopharyngeal squamous cell cancers (SCC) consisted of either total laryngectomy (TL) or definitive radiotherapy (RT). The development of induction cisplatin plus 5-fluorouracil (PF) and the correlation between chemosensitivity and radiosensitivity in previously untreated patients opened a new era of treatment aiming at laryngeal preservation (LP). The fundamental concept was to employ induction PF in order to select patients for subsequent treatment with either TL or RT according to tumor response to PF. The first two trials (VALGSG for laryngeal SCC and EORTC 24891 for hypopharyngeal SCC) concluded that such an approach could preserve nearly 60% of larynx without deleterious impact on survival. The EORTC 24954 trial compared 4 cycles of induction PF followed by RT in good responders vs. alternating PF-RT in laryngeal and hypopharyngeal SCC. There was no significant difference in 5-year overall survival with a functional larynx between the two arms (31 vs. 35%). The GORTEC 2000-01 trial compared induction PF to induction PF plus docetaxel (TPF) both followed by RT in good responders in larynx and hypopharynx SCC. The 5-year LP was significantly higher in the TPF arm (60 vs. 39%) but without a difference in survival. The RTOG 91-11 trial compared induction PF followed by RT in good responders vs. concurrent chemoradiotherapy (chemo-RT) vs. RT alone in laryngeal SCC. There was no significant difference in 5-year laryngectomy-free survival between the patients treated with induction chemotherapy (44%) vs. those treated with chemo-RT (47%), both being superior to RT alone (34%). At 5 years, LP was superior with chemo-RT: 84 vs. 71% with induction PF. Two phase II trials explored the role of cetuximab (E) in LP in laryngeal and hypopharyngeal SCC. The TREMPLIN trial compared RT+E or chemo-RT (RT + P) after TPF. The DeLOS-II trial compared TPE followed by RT+E vs. TP followed by RT. However, these trials failed to indicate an advantage for the incorporation of E in the treatment paradigm. To date, two approaches for LP have been validated: induction TPF followed by RT for laryngeal and hypopharyngeal SCC and concurrent chemo-RT for laryngeal SCC. An ongoing trial (SALTORL) is comparing these two approaches, induction TPF and chemo-RT, in laryngeal/ hypopharyngeal SCC.
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Affiliation(s)
- Athanassios Argiris
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
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Head and Neck Cancers. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-97145-2_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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Karabajakian A, Gau M, Reverdy T, Neidhardt EM, Fayette J. Induction Chemotherapy in Head and Neck Squamous Cell Carcinoma: A Question of Belief. Cancers (Basel) 2018; 11:cancers11010015. [PMID: 30583519 PMCID: PMC6357133 DOI: 10.3390/cancers11010015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 12/17/2018] [Accepted: 12/20/2018] [Indexed: 01/04/2023] Open
Abstract
Induction chemotherapy (IC) in locally advanced head and neck squamous cell carcinoma (LA HNSCC) has been used for decades. However, its role is yet to be clearly defined outside of larynx preservation. Patients with high risk of distant failure might potentially benefit from sequential treatment. It is now widely accepted that TPF (docetaxel, cisplatin, and fluorouracil) is the standard IC regimen. Essays that have compared this approach with the standard of care, concurrent chemoradiotherapy (CCRT), are mostly inconclusive. Radiotherapy (RT) can be used in the post-IC setting and be sensitized by chemotherapy or cetuximab. Again, no consensus exists but there seems to be trend in favor of potentiation by cisplatin. Less toxic schemes of IC are tested as toxicity is a major issue with TPF. IC might have an interesting role in human papilloma virus (HPV)-related LA HNSCC and lead to CCRT de-escalation.
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Affiliation(s)
- Andy Karabajakian
- Rhône-Alpes, Centre de Lutte Contre le Cancer Léon Bérard, 69008 Lyon, France.
| | - Max Gau
- Rhône-Alpes, Centre de Lutte Contre le Cancer Léon Bérard, 69008 Lyon, France.
| | - Thibault Reverdy
- Rhône-Alpes, Centre de Lutte Contre le Cancer Léon Bérard, 69008 Lyon, France.
| | - Eve-Marie Neidhardt
- Rhône-Alpes, Centre de Lutte Contre le Cancer Léon Bérard, 69008 Lyon, France.
| | - Jérôme Fayette
- Rhône-Alpes, Centre de Lutte Contre le Cancer Léon Bérard, 69008 Lyon, France.
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Liu S, Fang J, Ma H, Meng L, Bai Y, Feng L, Lian M, Li P, Zhong Q, Hou L. Rational choice of induction chemotherapy-based larynx preservation for hypopharyngeal cancer. Acta Otolaryngol 2018; 138:1146-1153. [PMID: 30663475 DOI: 10.1080/00016489.2018.1506152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Backgroud: Induction chemotherapy, as a larynx preservation treatment, has been available for over 20 years. We conducted a retrospective study to evaluate the efficacy of this protocol with taxene, cisplatin and 5-fluorouracil in Chinese patients with hypopharyngeal cancer that chose preservation strategy. MATERIAL AND METHODS 170 patients with locally advanced hypopharyngeal cancer were assigned to receive induction chemotherapy. 107 patients (63%) with complete response or partial response received larynx preservation treatment and 63 non-responders (37%) received radical surgery. RESULTS Median survival time was 30 months (range: 3-59 months). 63 patients (37%) had local-regional failure and 15 (9%) had distant metastasis. Three-year LFS was 27.8% (95% CI: 23.6-32.0%). The estimated three-year overall survival rate was 44.5% (95% CI: 39.5-49.5%). There was no significant difference in the three-year survival rate between responders (44.8%) and non-responders (43.9%) (p = .237), however patients with a partial response had a significant decrease in survival (32.2%) (p < .001). CONCLUSIONS In patients with hypopharyngeal cancer, ICT with TPF regimen followed by RT, as a larynx preservation treatment, may be suitable for complete responders, but not partial responders.
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Affiliation(s)
- Shuzhou Liu
- Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Beijing, China
- Otorhinolaryngology Head and Neck Surgery, Hainan General Hospital, Haikou, China
| | - Jugao Fang
- Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Beijing, China
- Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing, China
| | - Hongzhi Ma
- Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Beijing, China
| | - Lingzhao Meng
- Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yunfei Bai
- Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Ling Feng
- Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Beijing, China
| | - Meng Lian
- Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Beijing, China
| | - Pingdong Li
- Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Beijing, China
| | - Qi Zhong
- Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Beijing, China
| | - Lizhen Hou
- Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Beijing, China
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From VA Larynx to the future of chemoselection: Defining the role of induction chemotherapy in larynx cancer. Oral Oncol 2018; 86:200-205. [DOI: 10.1016/j.oraloncology.2018.09.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 01/18/2023]
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Garneau JC, Bakst RL, Miles BA. Hypopharyngeal cancer: A state of the art review. Oral Oncol 2018; 86:244-250. [DOI: 10.1016/j.oraloncology.2018.09.025] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
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Sittitrai P, Reunmarkkaew D, Chaiyasate S. The role of induction chemotherapy followed by surgery in unresectable stage IVb laryngeal and hypopharyngeal cancers: a case series. J Otolaryngol Head Neck Surg 2018; 47:62. [PMID: 30326958 PMCID: PMC6192312 DOI: 10.1186/s40463-018-0310-y] [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: 01/16/2018] [Accepted: 10/01/2018] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this study was to evaluate the benefit of induction chemotherapy followed by surgery in locally advanced unresectable stage IVb laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC). Methods Data of patients with stage IVb LHSCC who received induction chemotherapy for the purpose of tumor resection between January 2007 and January 2016 were retrospectively collected. Definitive surgery with postoperative adjuvant therapy was performed in patients whose tumors became resectable (resectable group). Chemoradiotherapy, radiotherapy, or supportive care was considered in patients whose tumors remained unresectable (unresectable group). Results Thirty-two patients were identified; the tumor resectability rate after induction chemotherapy was approximately 56%. The median overall survival (OS) rates of the resectable and unresectable groups were 20.0 months (range, 16.0–35.5 months) and 9.5 months (range, 6.0–15.0 months), respectively (p = 0.008). The estimated 2-year OS rates of the resectable and unresectable groups were 59.5% (95% confidence interval [CI], 33.2–78.3%) and 10.7% (95% CI, 1.1–35.4%), respectively (p = 0.008). The estimated 2-year disease-free survival (DFS) rates of the resectable and unresectable groups were 53.5% (95% CI, 27.9–73.6%), and 14.3% (95% CI, 2.3–36.6%), respectively (p = 0.009). On multivariate analysis, factors positively impacting OS and DFS in all patients were surgical resection, a laryngeal primary site, and induction chemotherapy with docetaxel, cisplatin, and fluorouracil. Conclusions In advanced unresectable stage IVb LHSCC patients, surgical resection following induction chemotherapy appears to improve survival outcomes.
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Affiliation(s)
- Pichit Sittitrai
- Department of Otolaryngology, Chiang Mai University, Chiang Mai, 50200, Thailand.
| | | | - Saisaward Chaiyasate
- Department of Otolaryngology, Chiang Mai University, Chiang Mai, 50200, Thailand
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Bonomi MR, Blakaj A, Blakaj D. Organ preservation for advanced larynx cancer: A review of chemotherapy and radiation combination strategies. Oral Oncol 2018; 86:301-306. [PMID: 30409316 DOI: 10.1016/j.oraloncology.2018.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/26/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
The larynx is an organ of the upper aerodigestive tract that is involved in many critical functions such as breathing, speaking, and swallowing. As a result, both larynx cancer and its treatment may significantly affect quality of life. The management of laryngeal cancer has focused on improving survival while preserving the function of the organ. This manuscript focuses on the use of chemotherapy and radiation therapy as a non-surgical approach and potential organ preservation strategy for patients with advanced larynx cancer. We review the key clinical data on the following treatment courses: (1) induction chemotherapy followed by definitive radiation therapy, (2) concurrent chemotherapy and radiation, and (3) induction chemotherapy followed by concurrent chemo-radiation. We also review the clinical data on organ preservation for patients with hypopharynx cancers. Results from phase III studies suggest that patients with advanced T4 cancers have better outcomes with a primary surgical approach, while for patients with T2N+ and T3 tumors, definitive concurrent chemotherapy and radiation or induction chemotherapy followed by definitive radiation therapy are acceptable options. Choosing the optimal treatment strategy depends on patients' desires, tumor extent, and adequate follow-up to detect early recurrences in cases of larynx preservation treatments. To proceed with an organ preservation strategy, the patient should have a good pre-treatment larynx function, and there must be a high level of skill and cooperation among various disciplines.
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Affiliation(s)
- Marcelo R Bonomi
- The Ohio State University, Division of Medical Oncology, 320 West 10th Avenue, Columbus, OH 43210, USA.
| | - Adriana Blakaj
- Yale School of Medicine, Department of Therapeutic Radiology, 35 Park St., New Haven, CT 06519, USA
| | - Dukagjin Blakaj
- The Ohio State University, Department of Radiation Oncology, 320 West 10th Avenue, Columbus, OH 43210, USA
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