Laryngeal preservation with supracricoid partial laryngectomy results in improved quality of life when compared with total laryngectomy

Functional or radical surgical treatment of laryngeal chondrosarcoma, analysis of survival and prognostic factors: A REFCOR and NetSarc-ResOs multicenter study of 74 cases

INTRODUCTION

Laryngeal chondrosarcoma (LCS) is a rare tumor of slow evolution whose treatment is poorly codified. For a long time, a radical treatment by total laryngectomy (TL) was proposed. More recent studies tend to propose a conservative surgical approach of the larynx. The objective of this study was to compare the overall survival (OS) of total laryngectomized patients (TL+) versus non-laryngectomized patients (TL-). The secondary objectives were to analyse the reoperation free survival (RFS), the total laryngectomy free survival (TLFS) and to identify the preoperative factors leading surgeons to propose TL.

MATERIALS AND METHODS

A retrospective analysis of prospectively collected incident cases from the REFCOR and NetSarc-ResOs multicenter databases between March 1997 and June 2021 was conducted. A propensity score matching analysis was performed to compare the OS of TL+ and TL-patients.

RESULTS

74 patients were included. After propensity score, the 5-year OS of TL+ and TL-patients was comparable (100 %, p = 1). The 5-year RFS rate was 69.2 % (95 % CI [57.5-83.4]) and the 5-year TLFS was 61.7 % (95 % CI [50.4-75.5]). Cricoid involvement greater than 50 % (HR 3.58; IC 95 % [1.61-7.92] p < 0.001), an ASA score of 3 or 4 (HR 5.07; IC 95 % [1.64-15.67] p = 0.009) and involvement of several cartilages (HR 5.26; IC 95 % [1.17-23.6] p = 0.04) are prognostic factors for TL. Dyspnea caused by the tumour is a prognostic factor for reoperation (HR 2.59; IC 95 % [1.04-6.45] p = 0.03).

CONCLUSION

These results demonstrate that conservative treatment should be considered as first-line treatment for laryngeal chondrosarcoma.

Validation of a prognostic model for predicting larynx preservation outcome (TALK score) in a Southern European population

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.

Toward a robust swallowing detection for an implantable active artificial larynx: a survey

Total laryngectomy consists in the removal of the larynx and is intended as a curative treatment for laryngeal cancer, but it leaves the patient with no possibility to breathe, talk, and swallow normally anymore. A tracheostomy is created to restore breathing through the throat, but the aero-digestive tracts are permanently separated and the air no longer passes through the nasal tracts, which allowed filtration, warming, humidification, olfaction, and acceleration of the air for better tissue oxygenation. As for phonation restoration, various techniques allow the patient to talk again. The main one consists of a tracheo-esophageal valve prosthesis that makes the air passes from the esophagus to the pharynx, and makes the air vibrate to allow speech through articulation. Finally, swallowing is possible through the original tract as it is now isolated from the trachea. Yet, many methods exist to detect and assess a swallowing, but none is intended as a definitive restoration technique of the natural airway, which would permanently close the tracheostomy and avoid its adverse effects. In addition, these methods are non-invasive and lack detection accuracy. The feasibility of an effective early detection of swallowing would allow to further develop an implantable active artificial larynx and therefore restore the aero-digestive tracts. A previous attempt has been made on an artificial larynx implanted in 2012, but no active detection was included and the system was completely mechanic. This led to residues in the airway because of the imperfect sealing of the mechanism. An active swallowing detection coupled with indwelling measurements would thus likely add a significant reliability on such a system as it would allow to actively close an artificial larynx. So, after a brief explanation of the swallowing mechanism, this survey intends to first provide a detailed consideration of the anatomical region involved in swallowing, with a detection perspective. Second, the swallowing mechanism following total laryngectomy surgery is detailed. Third, the current non-invasive swallowing detection technique and their limitations are discussed. Finally, the previous points are explored with regard to the inherent requirements for the feasibility of an effective swallowing detection for an artificial larynx. Graphical Abstract.

Oncological Outcomes of Primary vs. Salvage OPHL Type II: A Systematic Review

Background: Open partial horizontal laryngectomy type II (OPHL type II) has two main aims: oncological radicality and laryngeal preservation. The aim of this review is to define and emphasize the oncological efficacy of OPHL type II, both as primary and salvage surgery, by analyzing the latest literature. Methods: The research was carried out on Pubmed, Scopus and Web of Science databases, by using strict keywords. Oncological outcomes were evaluated by the following parameters: overall survival, disease-specific survival, disease-free survival, local control, laryngeal preservation, local recurrence. Results: The review included 19 articles divided into three groups: (1) primary OPHL type II, (2) salvage OPHL type II, (3) adjuvant radiotherapy after primary OPHL type II. The articles showed excellent results as far as oncological radicality and organ preservation. Conclusions: This review demonstrated that OPHL type II is useful to obtain oncological radicality both as primary surgery and salvage surgery. Nevertheless, the only criterion that determined the positive outcome and efficacy of this technique is the strict selection of patient and tumor.

Characteristics that predict penetration - aspiration in elderly patients following supracricoid laryngectomy with cricohyoidoepiglottopexy - a videofluoroscopic study

Objective

This study aimed to determine the incidence of laryngeal penetration and aspiration in elderly patients who underwent supracricoid laryngectomy with cricohyoidoepiglottopexy for laryngeal cancer.

Method

A retrospective analysis of dynamic videofluoroscopic swallowing studies was performed in patients who had received supracricoid laryngectomy with cricohyoidoepiglottopexy as a treatment for laryngeal cancers. Digital analysis of videofluoroscopic swallowing studies included measurements of displacement and timing related to swallowing safety.

Results

Videofluoroscopic swallowing studies from 52 patients were analysed. All participants were male and over 65 years old. Studies were performed five years after surgery. Among 52 videofluoroscopic swallowing studies, analysis showed that elevated pharyngeal constriction ratio (pharyngeal constriction ratio more than 0.0875, odds ratio = 5.2, p = 0.016), reduced pharyngoesophageal sphincter opening time (pharyngoesophageal sphincter open less than 0.6 seconds, odds ratio = 11.6, p = 0.00018) and reduced airway closure time (airway close less than 0.6 seconds, odds ratio = 10.6, p = 0.00057) were significantly associated with aspiration.

Conclusion

Deteriorated pharyngeal constriction, shortened airway closure and reduced pharyngoesophageal sphincter opening time are key factors for predicting laryngeal penetration or aspiration after supracricoid laryngectomy with cricohyoidoepiglottopexy.

Quality of Life with Voice Prosthesis after Total Laryngectomy

Introduction

The loss of voice after total laryngectomy is one of the main impairments in personal and social life. In order to prevent potential psycho-social consequences in the patient and his family, the restoration of phonatory function is the main objective of post-laryngectomy rehabilitation. The aim of this study was to assess quality of life in patients who received prosthetic voice after total laryngectomy.

Materials and Methods

Over a one-year period, 51 patients with voice prostheses after total laryngectomy were recruited. 32 patients (62.74%) were administered radiation therapy and 9 patients (17.64%) underwent to surgical reconstruction with flaps. Each patient was administered the VHI-10 and V-RQOL self-assessment questionnaires.

Results

The study showed that vocal restoration with voice prosthesis allows patients to recover a significant degree of quality of life after total laryngectomy. The average score on the V-RQOL questionnaire was 75.9 and on the VHI-10 questionnaire was 13.5. It has not been shown a statistically significant correlation between quality of life after tracheoesophageal prosthesis and radiation therapy, chemotherapy or reconstruction flaps. Younger patients showed, on average, a higher score at V-RQOL. These results allow to state that, after prosthetic rehabilitation, at least 75% of patients experienced an increase in quality of life. Moreover, the prosthetic technique (primary vs secondary) does not affect the long-term outcome and radiotherapy, chemotherapy or reconstruction flaps are not absolute contraindications to rehabilitation with voice prosthesis.

Conclusion

After total laryngectomy, rehabilitation with tracheoesophageal prosthesis is a satisfactory choice to restore the patient's ability to communicate verbally.

Chronic Pain Management in Head and Neck Oncology

Pain is epidemic in patients with head and neck cancer. Providers involved in the care of patients with head and neck cancer should be able to describe the common pain syndromes experienced by these patients, identify patients at risk of pain, and provide multimodal treatment of chronic pain. Treatment of chronic pain encompasses analgesic medications; adjuvant pharmacotherapy, including antidepressants and anticonvulsants; interventional techniques; as well as integrative medicine.

Substitution Voice Rehabilitation After Open Partial Horizontal Laryngectomy Through the Proprioceptive Elastic Method (PROEL): A Preliminary Study

OBJECTIVE

The aim was to investigate the efficacy of the Proprioceptive Elastic Method (PROEL) in the rehabilitation of the substitution voice after open partial horizontal laryngectomy (OPHL).

STUDY DESIGN

Prospective outcome study.

METHODS

Fifteen patients surgically treated by OPHL type II or type III for laryngeal cancer were recruited (experimental group). Each patient underwent a specific program of voice rehabilitation based on the PROEL method with the same speech and language pathologist. Acoustic-aerodynamic analysis: maximum phonation time (MPT); spectrographic classification (Titze's modified classification), perceptual analysis (INFVo rating scale) and self-assessments (SECEL questionnaire) were performed before the treatment (T0), after 3 months of rehabilitation (T1), and at the end of the 6-month rehabilitation program (T2). A control sample of other 15 patients who underwent OPHL type II or type III and who underwent a standard perioperative rehabilitation was randomly extracted from an historical database and compared to the experimental group.

RESULTS

Significative voice improvements between T0-T1 and T2 were found for acoustic, aerodynamic, perceptual, and self-assessments analysis in the experimental group. Significative differences were found between the experimental group at T2 and the control sample for aerodynamic, self-assessment, and perceptual analysis.

CONCLUSIONS

The results of the present study support PROEL method as an effective approach for substitution voice rehabilitation after OPHL type II and III. Randomized controlled trials on larger groups of patients are needed in future in order to compare PROEL with other rehabilitative approaches.

Obstructive sleep apnea in patients with laryngeal cancer after supracricoid or vertical partial laryngectomy

Objective

To investigate whether partial laryngectomy is a risk factor for obstructive sleep apnea (OSA) and the effect of different partial laryngectomy methods on OSA.

Method

A prospective study was carried out involving 40 patients who underwent supracricoid partial laryngectomy (SCPL) (24) or vertical partial laryngectomy (VPL) (16) for carcinoma of the larynx. Apnea-hypopnea index (AHI) and oxygen saturation determined by polysomnography (PSG), Epworth sleepiness scale (ESS) score, and body mass index (BMI) were evaluated in patients before surgery, on the day of tracheal tube removal and three months later. In patients who developed apnea, laryngoscopy, Muller’s test, computer tomography (CT) and dynamic sleep magnetic resonance imaging (MRI) were performed to assess the location of airway stenosis and collapse.

Results

The AHI (P<0.001) increased and the lowest oxygen saturation (P<0.001), ESS score (P<0.001) and BMI (P=0.017) decreased after extubation compared with before surgery. Three months after extubation, the same changes were found in AHI (P<0.001) and the lowest oxygen saturation (P<0.001), but the ESS score (P<0.001) increased compared with that preoperatively. The AHI in the SCPL group was significantly higher than that in the VPL group post-operatively (P=0.010), while the miniSpO2 in the SCPL group was lower than that of the VPL group (P=0.022). Laryngoscopy showed that the patients with partial excision of the larynx had a narrowed retropalatal and retrolingual space post-operatively. Muller's test showed the collapse of the retropalatal and retrolingual space, and the CT scan showed that the tongue root was positioned lower in the SCPL group. Compared with the retropalatal and retrolingual space in the expiratory phase according to dynamic sleep MRI, the space in the inspiratory phase was clearly decreased.

Conclusion

Laryngeal function preservation surgery for laryngeal cancer results in the occurrence of OSA by altering the anatomical structure of the larynx and pharynx. OSA was more severe in patients undergoing SCPL than in patients undergoing VPL. The effect of partial laryngectomy on OSA may be related to the surgical method used.

Limitations and Opportunities in Open Laryngeal Organ Preservation Surgery: Current Role of OPHLs

The current trend for treatment of intermediate-early advanced laryngeal cancer is essentially oriented toward preservation of organ and laryngeal function, and with a good potential for treating the disease. This goal can be achieved by adopting open laryngeal organ preservation surgery (OLOPS), at present mainly represented by open partial horizontal laryngectomies (OPHLs). An approach using rigorous selection criteria based on both the general condition of the patient and the local and regional extent of the disease gives excellent oncological and functional results in untreated patients. Similar outcomes, albeit slightly worse, are also obtainable in radio-recurrent and laser-recurrent patients. Troublesome postoperative management and the inconsistency of functional recovery are the main limitations for extensive application of this therapeutic strategy. The future direction is represented by simplification of the indications identifying iso-prognostic sub-categories within the T-stage, wider consensus on rehabilitation protocols, hybrid approaches to the larynx, and open minimally invasive access.

Effects of occupational status on social adjustment after laryngectomy in patients with laryngeal and hypopharyngeal cancer

Purpose

This study was performed to examine the relationship of social adjustment with occupation and life changes in patients with laryngeal and hypopharyngeal cancer, from before laryngectomy to 1 year after hospital discharge.

Methods

The subjects were 27 patients with laryngeal and hypopharyngeal cancer who were admitted to hospital for laryngectomy and provided informed consent for participation in the study. The patients answered questionnaire surveys before surgery, and 3, 6, and 12 months after hospital discharge. Regarding social adjustment, social functioning (SF) and mental health (MH) in SF-36V2 were used as dependent variables, and time, occupation status, age, family structure, and sex as independent variables. Repeated measures analysis of variance was used to examine the main effect, and second- and third-order interactions were also examined.

Results

The age of the subjects was 62.9 ± 6.4 years and about 30% had an occupation. Loss of voice was the reason for 30% leaving work. In an examination of the main effects of the four variables, only age was significant regarding SF, and SF was favorable in subjects aged ≥ 64 years old. Regarding MH, age and family structure were significant, and MH was higher in older subjects who lived alone. The interaction between time and the other 3 variables was not significant. Only time/age/occupation was significant for MH. Regarding SF, a weak interaction was suggested, but it was not significant.

Conclusion

Older subjects showed better social adjustment, and those who lived alone had better MH. These findings may have been due to a reduced environmental influence. MH of subjects with an occupation decreased more at 3 months or later after hospital discharge, compared to those without an occupation. Especially for younger patients, development of new approaches is required to allow families and colleagues of patients to understand the difficulties of patients with laryngeal and hypopharyngeal cancer.

Matched-pair analysis of survival in the patients with T3 laryngeal squamous cell carcinoma treated with supracricoid partial laryngectomy or total laryngectomy

Background

The survival outcomes between supracricoid partial laryngectomy (SCPL) and total laryngectomy (TL) were compared in the groups of matched-pair patients with T3 laryngeal squamous cell carcinoma (LSCC).

Methods

Patients with T3 LSCC were matched based on prognostic factors. The Kaplan–Meier curve and the Cox proportional hazards model were used for analysis on survival.

Results

A total of 212 patients with T3 LSCC were included after matching (106 underwent SCPL and 106 underwent TL). Multivariable analysis showed no differences in overall survival (hazard risk [HR]=1.15; 95% CI: 0.79–1.67; P=0.47), disease-specific survival (HR=1.11; 95% CI: 0.69–1.80; P=0.66), and recurrence-free survival (HR=1.07; 95% CI: 0.68–1.68; P=0.77) between the SCPL group and TL group.

Conclusion

SCPL provides reliable therapeutic outcomes and can be used to avoid a TL surgery in some patients with advanced primary laryngeal cancer.

Supracricoid laryngectomy for recurrent laryngeal cancer after chemoradiotherapy: a systematic review and meta-analysis

Residual or recurrent laryngeal cancer after irradiation is a difficult clinical problem with a rate that ranges from 13% to 36% of cases. Supracricoid laryngectomy (SCL) with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy (CHEP) provide reliable oncological and functional results for selected primary and recurrent patients with glottic and supraglottic carcinomas. We conducted a systematic review and meta-analysis to assess the oncological and functional outcomes of patients treated with open partial horizontal laryngectomy types IIa and IIb (CHEP, CHP) in terms of the recurrence of squamocellular cancer of the larynx after radiotherapy failure. The databases searched included MEDLINE, PubMed and EMBASE (from January 1990 to December 2015, English language). The meta-analysis was performed with a mixed random effects model using the DerSimonian and Laird method. The heterogeneity was measured with the I² statistic. Fourteen papers out of 276 were included and comprised a total of 291 patients. The five-year overall survival was 80.2% (CI 0.719-0.885; I² = 62%; p = 0.003), and the 5-year disease-free survival was 89.5% (CI 0.838-0.952; I² = 52%; p = 0.022). The indications for SCL after the failure of radiation therapy (RT) were similar to those specified for previously untreated patients. We therefore hypothesised that careful assessment of tumour extension might be responsible for the high 5-year OS and 5-year DFS. The early postoperative recovery outcomes indicated that the mean time until decannulation was 35.6 days (CI 24.3-46.9; I² = 95%; p < 0.001), and the mean time until nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG) removal was 28.3 days (CI 22.7-33.8; I² = 86%; p< = 0.001). These data are according to authors who prefer the initial removal of the NGT and the initiation of oral alimentation with a tracheostomy tube to protect and clean the airways and permit the suction of any residual food that might be present.

Comparison of Treatment Outcomes for T3 Glottic Squamous Cell Carcinoma: A Meta-Analysis

Objectives

This study compared the survival outcomes, local control rate, and laryngeal preservation rate of various treatment strategies in the treatment of T3 squamous cell carcinoma of the glottis using proportional meta-analyses.

Methods

Twenty-five retrospective case-series studies were included in these analyses. Treatment strategies were classified as total laryngectomy (TL), open partial laryngectomy (PL), transoral laser microsurgery (TLM), chemo-radiation therapy (CRT), and radiation therapy (RT) alone.

Results

The overall survival rate and disease-specific survival rate among laryngeal preservation treatments did not differ from the overall survival rate of TL. However, the local control rate was lower with RT than TL and PL, and laryngeal preservation rates of TLM and CRT were higher than RT alone.

Conclusion

Consideration of preservation of laryngeal function is necessary when treating T3 glottic squamous cell carcinoma. PL, TLM, and, CRT are considered more appropriate initial laryngeal preservation strategies if available.

Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

Purpose To update the guideline recommendations on the use of larynx-preservation strategies in the treatment of laryngeal cancer. Methods An Expert Panel updated the systematic review of the literature for the period from January 2005 to May 2017. Results The panel confirmed that the use of a larynx-preservation approach for appropriately selected patients does not compromise survival. No larynx-preservation approach offered a survival advantage compared with total laryngectomy and adjuvant therapy as indicated. Changes were supported for the use of endoscopic surgical resection in patients with limited disease (T1, T2) and for initial total laryngectomy in patients with T4a disease or with severe pretreatment laryngeal dysfunction. New recommendations for positron emission tomography imaging for the evaluation of regional nodes after treatment and best measures for evaluating voice and swallowing function were added. Recommendations Patients with T1, T2 laryngeal cancer should be treated initially with intent to preserve the larynx by using endoscopic resection or radiation therapy, with either leading to similar outcomes. For patients with locally advanced (T3, T4) disease, organ-preservation surgery, combined chemotherapy and radiation, or radiation alone offer the potential for larynx preservation without compromising overall survival. For selected patients with extensive T3 or large T4a lesions and/or poor pretreatment laryngeal function, better survival rates and quality of life may be achieved with total laryngectomy. Patients with clinically involved regional cervical nodes (N+) who have a complete clinical and radiologic imaging response after chemoradiation do not require elective neck dissection. All patients should undergo a pretreatment baseline assessment of voice and swallowing function and receive counseling with regard to the potential impact of treatment options on voice, swallowing, and quality of life. Additional information is available at www.asco.org/head-neck-cancer-guidelines and www.asco.org/guidelineswiki .

Lateral cervical approach for supracricoid partial laryngectomy

INTRODUCTION

The supracricoid partial laryngectomy has been described for the treatment of T3 laryngeal glottic and supraglottic tumors as well as upfront and salvage surgery. Good oncological and functional outcomes are expected, while the post-operative rehabilitation can be quite difficult for the patient. Early and late complications can occur especially in salvage surgery. Neck dissection according to the T stage is often associated with the resection of the primary tumor.

OBJECTIVE

To verify the feasibility of a minimally invasive procedure for supracricoid partial laryngectomy by adopting the lateral cervical approach.

METHODS/RESULTS

A 61-year old man affected by a cT3N0 glottic cancer already treated 10years prior with radiotherapy for oropharyngeal cancer underwent supracricoid laryngectomy using the lateral approach. The key point of the procedure was a subfascial dissection with the harvesting of anterior cervical flap including skin, fat, platysma, fascia superficialis, anterior jugular veins, homo- and sterno-hyoid muscles.

CONCLUSION

Supracricoid laryngectomy by a lateral approach is feasible and safe; it allows to perform a simultaneous neck dissection and the removal of the entire laryngeal specimen preserving ample healthy tissue compared to the classic anterior approach.

Telephonic voice intelligibility after laryngeal cancer treatment: is therapeutic approach significant?

The aim was to investigate telephonic voice intelligibility in patients treated for laryngeal cancer using different approaches. In total, 90 patients treated for laryngeal cancer using different approaches and 12 healthy volunteers were recruited. Each patient and each healthy control read a list of words and sentences during a telephone call. Six auditors listened to each telephonic recording and transcribed the words and sentences they understood. Mean intelligibility rates for each treatment were assessed and compared. Regarding words, the poorest intelligibility was noted for type II open partial horizontal laryngectomies, followed by total laryngectomies. The best intelligibility was found for transoral laser microsurgery, followed by radiotherapy alone. For sentences, the poorest intelligibility was noted for type II open partial horizontal laryngectomies, followed by chemoradiotherapy. The best intelligibility was found for radiotherapy alone and transoral laser microsurgery. More aggressive surgery as well as chemoradiotherapy correlated with significantly poorer outcomes. Transoral laser microsurgery or radiotherapy alone ensured the best telephonic voice intelligibility. Intermediate-advanced T stages at diagnosis also showed significantly poorer intelligibility outcomes, suggesting that T stage represents an independent negative prognostic factor for voice intelligibility after treatment.

A systematic review of patient-reported outcome measures in head and neck cancer surgery

Objective

To identify, summarize, and evaluate patient-reported outcome questionnaires for use in head and neck cancer surgery with the view to making recommendations for future research.

Data Sources

A systematic review of the English-language literature, with the use of head-and-neck-surgery-specific keywords, was performed in the following databases: Medline, Embase, HAPI, CINAHL, Science/Social Sciences Citation Index, and PsycINFO from 1966 to March 2006.

Data Extraction and Study Selection

All English-language instruments identified as patient-reported outcome questionnaires that measure quality of life and/or satisfaction that had undergone development and validation in a head and neck cancer surgery population were included.

Data Synthesis

Twelve patient-reported outcome questionnaires fulfilled our inclusion criteria. Of these, four were developed from expert opinion alone or did not have a published development process and seven questionnaires lacked formal item reduction. Only three questionnaires (EORTC Head and Neck Module, University of Michigan Head and Neck Quality-of-life Questionnaire, and Head and Neck Cancer Inventory) fulfilled guidelines for instrument development and evaluation as outlined by the Medical Outcomes Trust.

Conclusions

Rigorous instrument development is important for creating valid, reliable, and responsive disease-specific questionnaires. As a direction for future instrument development, an increased focus on qualitative research to ensure patient input may help to better conceptualize and operationalize the variables most relevant to head and neck cancer surgery patients. In addition, the use of alternative methods of psychometric data analysis, such as Rasch, may improve the value of health measurement in clinical practice for individual patients.

Oncologic and functional results of supracricoid partial laryngectomy with cricohyoidopexy

OBJECTIVE: Supracricoid partial laryngectomy with cricohyoidopexy (SPL-CHP) is an alternative technique described for extensive tumors of the larynx that are beyond the limits of classical conservation partial laryngectomy and otherwise would be treated by total laryngectomy.

STUDY DESIGN AND SETTING: Forty-six patients with carcinoma of the larynx underwent SPL-CHP between 1991 and 2003. The median age was 54 (range, 37 to 72). In 28 cases both arytenoids were spared; in 17 cases, 1 arytenoid was spared; and in 1 case, 2 arytenoids were resected. Bilateral elective neck dissections were performed in supraglottic carcinomas. In glottic carcinomas, neck dissection was performed in the presence of clinically positive lymph nodes. None of the patients were treated with postoperative radiation therapy.

RESULTS: Forty-five patients were successfully decannulated; 1 patient with 2 arytenoids resected could not tolerate decannulation. The mean time for decannulation was 20 days (range, 9 to 60 days) when both arytenoids were spared with SPL-CHP, and 41 days (range, 13 to 150 days) for SPL-CHP when 1 arytenoid was spared. The average time for removal of the feeding tube was 21 days (range, 9 to 60 days) when both arytenoids were spared, and 40 days (range, 16 to 127 days) when 1 arytenoid was spared. The removal time of the feeding tube of the patient with 2 arytenoids resected was postoperative day 63. In 2 patients, aspiration pneumonia occurred as a result of swallowing impairment. In none of the patients temporary or permanent gastrostomy was needed. Two patients had local recurrence and were treated with a total laryngectomy; they are still alive. In 2 patients, secondary primary tumors were detected. The 3-year overall and cause-specific actuarial survival rates were 95.7% and 87.5%, respectively.

CONCLUSIONS: Although prolonged hospitalization and delaying physiological functions can be termed as disadvantages of SPL-CHP, the operation is a reliable and oncologically valid procedure in selected cases of cancer of the larynx who would otherwise be operated by total laryngectomy.

Post-Surgical and Oncologic Outcomes of Supracricoid Partial Laryngectomy: A Single-Institution Report of Ninety Cases

OBJECTIVE

The aim of this study was to report the post-surgical and oncologic outcomes of patients who underwent supracricoid partial laryngectomy (SCPL).

METHODS

90 patients who underwent SCPL between 1994 and 2014 were reviewed. 45 patients underwent cricohyoidopexy (CHP) and 45 patients cricohyoidoepiglottopexy (CHEP). Median nasogastric (NG) tube removal time, decannulation time, overall survival, disease-free survival and local control rates were calculated. The effect of the type of surgery on functional and oncologic outcomes were assessed.

RESULTS

Median NG tube removal time was 16.5 days (IQR = 10) and 14 days (IQR = 9) in CHP and CHEP patients, respectively (p > 0.05). Median decannulation time was 30 days (IQR = 26) and 19 days (IQR = 15) in CHP and CHEP patients, respectively (p < 0.05). Resection of one arytenoid significantly increased NG tube removal time. Median follow-up time was 55 months. There were 15 oncologic failures and the median time interval for tumor recurrence was 9 months. Five-year overall survival rate was 80.4%. The 3- and 5-year disease-free specific survival rates were 81.7 and 76.7%, respectively.

CONCLUSIONS

Given the more extensive surgery applied for CHP, functional outcomes were better in patients with CHEP. Resection of an arytenoid had a negative outcome on swallowing.

Long-term functional results after open partial horizontal laryngectomy type IIa and type IIIa: A comparison study

BACKGROUND

The purpose of this study was to compare long-term swallowing, voice results, and quality of life (QOL) after open partial horizontal laryngectomy (OPHL) type IIa and type IIIa.

METHODS

Twenty-three patients after OPHL type IIa and 18 patients after OPHL type IIIa were involved. Swallowing skills and neoglottis' motility and vibrations were videoendoscopically assessed. Aerodynamic measures, spectrogram analysis, aspiration pneumonia, body weight variations, and voice perceptual assessment were performed. Generic voice-related and swallowing-related QOL were assessed. Data were statistically compared using Mann-Whitney U test or Fisher exact tests, as appropriate.

RESULTS

Significant differences were found only for the residue with solids and for the intelligibility (I) parameter of the overall quality impression and intelligibility, additive and unnecessary noise, speech fluency, and presence of voiced segments scale with patients of the OPHL type IIIa group showing worse performances than the OPHL type IIa group.

CONCLUSION

Patients who underwent OPHL type IIa and type IIIa show comparable long-term functional outcomes. OPHL type IIIa represents a valid surgical alternative to OPHL type IIa. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1427-E1435, 2016.

Evaluation of health-related quality of life with EORTC QLQ-C30 and QLQ-H&N35 in Romanian laryngeal cancer patients

The aims of this study were to evaluate the health-related quality of life (HRQL) according to: type of surgery, adjuvant oncological treatment and postoperative complications. We performed a retrospective case-control study between October 2013 and November 2014 at the Ear Nose and Throat Clinic of Cluj-Napoca. We included patients diagnosed with laryngeal or hypopharyngeal cancer treated with total or partial laryngectomy, and a sample of healthy volunteers recruited from the hospital stuff. We used the European Organisation for Research and Treatment of Cancer (EOTRC) core questionnaires (the QLQ-C30 version 3) and the head and neck cancer module (the QLQ-H&N35). We included in the study 80 patients diagnosed and surgically treated for laryngeal/hypopharyngeal squamous cell carcinoma and 20 healthy volunteers. Median age of the patients was 59.90 years. The most common location was the larynx, in 72 (90 %) of cases and the hypopharynx in 8 (10 %) cases. Sixty-six (82, 50 %) underwent total laryngectomy and 14 (17, 50 %) a partial laryngectomy. Forty-eight patients had received external radiation therapy, with adjuvant chemotherapy in 25 patients. Postoperative complication rates were 14 (17, 50 %) cases. We found a low score in total laryngectomy group regarding functional scales: role (28.03), emotional (37.75) and social (37.88) and a high score on insomnia (35.86) and financial difficulties (45.45). Partial laryngectomy group had a high score on functional scales: role (47.62), emotional (51.19) and social (52.38). These two QOL instruments were effective for Romanian patients. The QLQ-H&N35 questionnaire discriminating better the problems between groups compared with QLQ-C30.

Quality of Life After Conservation Surgery for Laryngeal Cancer

Quality of life preservation has become an essential goal of treatment in the management of laryngeal carcinoma. Although established treatments of reference such as total laryngectomy and chemoradiation protocols have focused on survival and anatomic preservation of the larynx, they still generate considerable functional morbidity with detrimental effects on quality of life. Transoral and transcervical partial laryngectomy techniques can offer significant advantages when used prudently after proper patient selection. The growing relevance of those techniques in the management of advanced and recurrent laryngeal carcinoma deserves particular attention, with potential for improved quality of life without compromising oncologic outcomes.

The Effect of Arytenoidectomy on Functional and Oncologic Results of Supracricoid Partial Laryngectomy

OBJECTIVE

The effect of arytenoid resection was investigated in patients who had undergone supracricoid partial laryngectomy (SCPL) by comparing functional and oncologic results between patients with both arytenoids preserved with those with one arytenoid resected.

METHODS

Patients were divided into 2 groups: (1) both arytenoids preserved SCPL (BASCL) cases and (2) one arytenoid preserved SCPL (OASCL). The functional outcomes of the 2 groups were compared in terms of nasogastric tube removal time, decannulation time, incidence of aspiration pneumonia, and Performance Status Scale Scores for Head and Neck Cancer Patients for the late postoperative period. Additionally, the oncologic outcomes of both groups were compared using the 5-year local control rate, overall survival, disease-specific survival, and larynx preservation rate.

RESULTS

Of the 68 patients who were enrolled in the study, 20 of them were in the OASCL group and 48 in BASCL group. There was no statistically significant difference in the early and late functional outcomes, and the oncologic outcomes were also similar.

CONCLUSION

In addition to the proven oncologic safety, arytenoid resection does not increase the functional morbidity of the SCPL.

[Operation treatment results of laryngeal cancer in different types of partial laryngectomy based on own material]

THE AIM

of the study was to evaluate the oncological results of laryngeal cancer treatment performed in the Laryngology University Ward in Zabrze in the years 1990-2000, depending on the type of partial surgery applied.

MATERIALS AND METHODS

Retrospective clinical material includes 209 patients in whom surgery was a primary treatment method. No distant metastases (M1) or another malignant cancer were found. In all 209 patients the squamous cell carcinoma of various degree of malignancy (G1-G3) was found. The most common operation in the analyzed group was a chordectomy - 83 surgeries (40%), next, vertical partial laryngectomies - 38 (18%), horizontal glottis surgeries - 28 (13%). In 79 patients (38%) partial laryngectomy was complemented with a nodal operation. The median of the observation period was 9 years. Local recurrence, nodal recurrence and distant metastasis are rated as treatment failure. Treatment effectiveness was evaluated with relation to overall survival, disease-free survival, cause specific survival and local control. All the above-mentioned parameters were analyzed with the updated percentages method. The level of statistical significance was assumed to be p≤0.05.

RESULTS

The best oncological results were observed after vertical operations. In the vertical operations group the most favourable oncological results were noted after chordectomy. 83% overall survivals, 82% disease-free survivals, 93% cause specific survivals and 96% local controls in the 5-year observation. On the other hand, the least favourable treatment results were observed after ¾ subtotal partial operation, after horizontal supraglottic operation and after reconstruction operation with CHP. Statistically significant differences in treatment results between the groups of patients after various types of partial operations were found in relation to local controls and disease-free survivals.

Swallowing, voice, and quality of life after supratracheal laryngectomy: preliminary long-term results

BACKGROUND

The purpose of this study was to report preliminary long-term outcomes after supratracheal laryngectomy (STL).

METHODS

Twenty-two male patients who underwent STL were involved in this study. Swallowing skills, neoglottis motility, and vibrations were videoendoscopically assessed. Aerodynamic measures, spectrogram analysis, aspiration pneumonia, body weight variations, and voice perceptual assessment were performed. Generic, voice-related, and swallowing-related quality of life (QOL) were assessed.

RESULTS

Aspiration was found in 10, 2, and 5 patients, respectively, for liquids, semisolids, and solids. Neoglottis motility was generally preserved, whereas vibration was impaired. Aerodynamic measures showed a poor performance. Perceptual assessment revealed highly dysphonic voices. In only 8 patients, a harmonic structure was visible in the spectrograms. Aspiration pneumonia occurred in 2 patients. Preoperative weight was maintained in 16 patients. Generic, voice-related, and swallowing-related QOL revealed satisfied patients.

CONCLUSION

After STL, swallowing was sufficiently restored and QOL was satisfactory, whereas the voice was severely impaired even if oral communication was well preserved.

Treatment of laryngeal cancer: the permanent challenge

There are many options to treat larynx cancers. Throughout the 20th century, surgical research has provided many partial surgery techniques (either open surgery or endoscopic CO2 surgery). In parallel, the modification of radiotherapy schedules has notably improved the local control with definitive irradiation. The appearance of active chemotherapy regimens has also modified the concept of treatment for advanced disease, allowing a decrease in the total indications of laryngectomy, although this remains the treatment of choice in some cases. The selection of the most appropriate treatment is based on a multidisciplinary approach. Early diseases may be treated by open surgery, endoscopic laser CO2 surgery or irradiation. Some advanced diseases may be treated by partial surgery, but the majority are theoretically candidates for radical surgery when resectable. In many instances, but not in all, chemotherapy-based larynx-preserving protocols may avoid performing such mutilating surgery. When inoperable, larynx cancers are better treated by combined chemotherapy and irradiation when the performance status of the patient is compatible with such an intensive regimen.

Supracricoid partial laryngectomy: analyses of oncologic and functional outcomes

OBJECTIVE

The aim of this study was to analyze the functional and oncologic results of supracricoid partial laryngectomy.

STUDY DESIGN

Case series with chart review.

SETTING

Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.

SUBJECT AND METHODS

The medical records of 56 patients, who underwent supracricoid partial laryngectomy between March 2002 and December 2010, were reviewed in this study. Forty-three patients underwent supracricoid partial laryngectomy with cricohyoidopexy, and 13 patients underwent cricohyoidoepiglottopexy. The overall and disease-specific survival, local control rates, and the mean time of decannulation and nasogastric tube removal were evaluated. Association of type of surgery with the functional and oncologic outcomes was evaluated and statistically compared.

RESULTS

The median follow-up period was 58 months. The 1-, 3-, and 5-year overall survival rates were 100%, 96.4%, and 82.1%, respectively. The 1-, 3-, and 5-year local control rates were 100%, 96.1%, and 92.5%, respectively. Type of surgery did not show any significant difference in survival and local control rates (P = .546, P = .455). The mean (SD) decannulation and nasogastric feeding tube removal time was 11.43 (2.03) and 16.79 (3.51) days, respectively. The mean time of decannulation and nasogastric tube removal was significantly longer in patients who underwent cricohyoidopexy when compared with those who underwent cricohyoidoepiglottopexy (P = .002, P = .000).

CONCLUSION

Although delaying deglutition functions could be termed a disadvantage of supracricoid laryngectomy, especially with cricohyoidopexy, supracricoid laryngectomy has reliable oncologic and functional results for locally advanced laryngeal cancers while maintaining laryngeal functions.

Correlation between coping strategies and subjective assessment of the voice-related quality of life of patients after resection of T1 and T2 laryngeal tumours

When coming to terms with a diagnosis of laryngeal cancer, patients find different ways of coping with their illness. These may or may not be related to communication. Vocal aspects of quality of life are particularly important with cancer of the larynx. The correlation between coping and subjective assessment of the voice-related quality of life was assessed in a cross-sectional study of patients after resection of T1 and T2 laryngeal tumours. As part of follow-up care, 55 male cancer patients with partial laryngectomy were asked about their voice-related quality of life and their coping strategies. The Voice-Related Quality of Life Questionnaire (V-RQOL) and the Trier Coping Scales (TCS) were used as survey instruments. The voice-related quality of life of the patients was assessed on average as medium to good. The coping strategy most frequently chosen by patients was 'threat prevention', followed by 'search for social integration', 'rumination', 'search for information and experience exchange' and 'search for support in religion'. Correlations between coping strategy and the voice-related quality of life were weak to moderate and somewhat inconsistent in this patient population. There was no consistent or strong correlation between voice-related quality of life and coping strategies in male patients with partial laryngectomy, so that individual differences appeared to be more important in coping with illness than primarily voice-related factors such as the voice-related quality of life.

Head and neck cancer pain: systematic review of prevalence and associated factors

OBJECTIVES

Pain is a major symptom in patients with cancer; however information on head and neck cancer related pain is limited. The aim of this review was to investigate the prevalence of pain and associated factors among patients with HNC.

MATERIAL AND METHODS

The systematic review used search of MEDLINE, EMBASE and CINAHL databases to December 2011. Cancers of the oral mucosa, oropharynx, hypopharynx and larynx were included in this review with pain as main outcome. The review was restricted to full research reports of observational studies published in English. A checklist was used to assess the quality of selected studies.

RESULTS

There were 82 studies included in the review and most of them (84%) were conducted in the past ten years. Studies were relatively small, with a median of 80 patients (IQR 44, 154). The quality of reporting was variable. Most studies (77%) used self-administered quality of life questionnaires, where pain was a component of the overall scale. Only 33 studies reported pain prevalence in HNC patients (combined estimate from meta-analysis before (57%, 95% CI 43% - 70%) and after (42%, 95% CI 33% - 50%) treatment. Only 49 studies (60%) considered associated factors, mostly tumour- or treatment-related.

CONCLUSIONS

The study has shown high levels of pain prevalence and some factors associated with higher levels of pain. There is a need for higher quality studies in a priority area for the care of patients with head and neck cancer.

Oncologic outcomes after supracricoid partial laryngectomy

OBJECTIVE

To review the oncologic outcomes of a series of supracricoid partial laryngectomy.

DESIGN

Case series with chart review.

SETTING

La Paz University Hospital, Madrid, Spain.

PATIENTS

Forty-one patients with glottic or supraglottic squamous cell carcinoma who underwent supracricoid partial laryngectomy between 1998 and 2008 at the authors' institution.

MAIN OUTCOME MEASURE

Local control rate, specific-disease survival rate, and overall survival rate.

RESULTS

All patients were male, with a mean age of 56 years (range, 38-71 years). Forty-one percent of tumors were classified as locally advanced carcinomas (T3-T4). Thirty-three patients (80%) underwent supracricoid laryngectomy with cricohyoidoepiglottopexy. Epiglottis was resected in the remaining 8 patients. One patient died in the immediate postoperative period because of cardiac tamponade, 6 developed pneumonia, 2 had a postoperative bleeding that required reintervention, and 2 developed pharyngocutaneous fistula. The median follow-up period was 43 months. More than 85% of the patients completed more than 2 years of follow-up. Five-year actuarial local control rate was 80%, being 92% for T1-T2 tumors and 67% for locally advanced tumors. Thirty-five patients (85%) preserved their larynx. The 6 patients who underwent total laryngectomy had a local recurrence or a regional recurrence that infiltrated the larynx. No laryngectomy was performed for functional reasons.

CONCLUSION

Supracricoid partial laryngectomy is an oncologically safe procedure to preserve laryngeal functions in selected patients with glottic and supraglottic carcinomas.

Experience with supracricoid laryngectomy variants

BACKGROUND

The purpose of this study was to evaluate the outcomes after supracricoid laryngectomy (SCL) as an alternative to total laryngectomy (TL) for treatment of laryngeal cancer.

METHODS

This retrospective study involved 333 patients who underwent 4 types of SCL for squamous cell carcinoma of the larynx in an Egyptian hospital between May 1984 and May 2007. Both functional outcomes and oncological outcomes were evaluated.

RESULTS

Surgical margins were free from tumor invasion. The overall 5-year survival rate was 74%. Three hundred nine patients (92.8%) were decannulated, whereas 8 patients had permanent stenosis, 6 patients underwent TL, and 10 patients died. Only 7 patients (2.1%) had persistent aspiration; 6 of these patients underwent TL, whereas 1 patient died of pneumonia. The voice intelligibility score ranged from 70% to 100%, with a mean score of 89%. The score was highest when both arytenoids were preserved (mean, 95%). Ten patients died of complications directly related to the surgery.

CONCLUSION

Supracricoid laryngectomy is effective for managing laryngeal cancer. Modification of the technique to permit resection of both arytenoids is possible in select patients.

Standardization of the Arabic version of the Voice Handicap Index: an investigation of validity and reliability

Validity and reliability of the Arabic version of the VHI (VHI-Arab) were investigated. Possible effects of participant-inherent factors (i.e. age, sex) on participant (77 females, 35 males) responses were also investigated. Results showed high internal consistency (Cronbach's alpha r > 0.857 for all scores). Test-retest reliability was found to be strong (r > 0.87 for all scores). Validity results indicated significant moderate correlations between total VHI score and responses to severity (r = 0.521, P = 0.015) and satisfaction (r = 20.556, P = 0.009) questions. VHI-Arab was found to be unaffected by age (P > 0.10 for all scores) or sex (P > 0.05). This study produced a valid and reliable instrument for measuring participation restriction in Arabic-speaking individuals with voice disorders.

Speech Outcome of Supracricoid Partial Laryngectomy: Comparison with Total Laryngectomy and Anatomic Considerations

OBJECTIVE: We studied speech after a supracricoid partial laryngectomy (SCPL) and compared it to speech after a total laryngectomy and insertion of voice prosthesis (TL-VP). We also determined the anatomical factors related to speech after SCPL.

STUDY DESIGN AND SETTING: Historic cohort study. Patients were recruited for data collection.

SUBJECTS AND METHODS: We enrolled 28 patients who had undergone SCPL or TL-VP for laryngeal cancer from 1995 to 2005 (15 with SCPL and 13 with TL-VP). Patients had no recurrence, no respiratory problems, and were followed-up more than one year. Using sustained vowel phonation and standard paragraph reading, maximum phonation time, maximum loudness, total time for reading the paragraph, number of syllables per breath, and speech intelligibility were tested, and the patients' self satisfaction was evaluated using the Voice Handicap Index questionnaire. In addition, we performed stroboscopic examination for the SCPL group to study the configuration of the neoglottis during phonation.

RESULTS: Maximum phonation time was longer in the TL-VP group than in the SCPL group ( P = 0.048). There was no significant difference in the other parameters between the groups. With stroboscopic examination, we observed widely variable findings with reference to arytenoid mobility, mucosal vibration, and neoglottic occlusion in the SCPL group.

CONCLUSIONS: Speech after SCPL was not better than speech after TL-VP and was widely variable. The configuration of the neoglottis during phonation in the SCPL group was also variable. We believe that some technical refinement during the operation could improve speech outcome after SCPL.

Emerging applications of stereotactic radiotherapy in head and neck cancer

Advances in the management of locally advanced head and neck cancer (HNC) have been focused on treatment intensification, including concomitant chemoradiotherapy, biological agents, and combining surgery with chemoradiotherapy. Despite these improvements, locoregional recurrence still constitutes the main pattern of treatment failure. As improvements in radiotherapy delivery and image-guided therapy have come to fruition, the principles of stereotactic radiosurgery are now being applied to extracranial sites, leading to stereotactic body radiotherapy. This article focuses on the emerging evidence for the use of stereotactic body radiotherapy for treatment of HNC as a boost after conventional external-beam radiotherapy, and also as reirradiation in recurrent or second primary HNC.

[Measuring quality of life in head and neck cancer. Current status and future needs]

This review presents the current knowledge and methods of measuring disease-related quality of life in oncology, with particular emphasis on laryngeal and hypopharyngeal cancer. In addition to the currently popular and well-established instruments, specifics of the initial interview process, collection of psychiatric comorbidities, and the role of social care and its substantial influence on disease-related quality of life are discussed. At the forefront are the results of the central German head and neck oncology social-medical studies.

Pathological validation of supracricoid partial laryngectomy in laryngeal cancer

OBJECTIVES

To validate pathologically whether supracricoid partial laryngectomy is an oncologically sound procedure in cases with invasion of the thyroid cartilage, paraglottic space, pre-epiglottic space, anterior commissure, or subglottis.

DESIGN

A retrospective review of case notes was performed.

SETTING

Patients treated at a single institute in the Republic of Korea.

PARTICIPANTS

Sixty-three patients who underwent supracricoid partial laryngectomy for laryngeal squamous cell carcinoma between June 1994 and May 2005 who were followed for at least 2 years.

MAIN OUTCOME MEASURES

Local control and overall survival rates. Pathological invasion of the thyroid cartilage, anterior commissure, pre-epiglottic space, paraglottic space, or subglottis was also investigated as a cause of recurrence. Prognostic factors for local control and survival were evaluated with univariate and multivariate models.

RESULTS

Invasion of the anterior commissure, paraglottic space, thyroid cartilage, pre-epiglottic space, or subglottis had no significant impact on the recurrence or overall survival rates. The presence of a positive resection margin was significantly associated with recurrence in the univariate and multivariate analyses (P = 0.026, 0.028, respectively). When considering the prognostic factors influencing survival, the univariate analysis showed that N stage, a positive resection margin and recurrence had significant influences on the overall survival rate (P = 0.010, 0.0004 and 0.000 respectively). In the multivariate analysis, only recurrence affected the survival rate (P = 0.002).

CONCLUSION

Supracricoid partial laryngectomy can be used with oncological safety in selected cases of laryngeal cancer with invasion of the anterior commissure, thyroid cartilage, pre-epiglottic space, paraglottic space, or subglottis.