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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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Petrea OC, Stanciu C, Muzica CM, Sfarti CV, Cojocariu C, Girleanu I, Huiban L, Trifan A. Idiopathic Cervical Esophageal Webs: A Case Report and Literature Review. Int J Gen Med 2020; 13:1123-1127. [PMID: 33235485 PMCID: PMC7679475 DOI: 10.2147/ijgm.s278999] [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: 08/28/2020] [Accepted: 10/16/2020] [Indexed: 02/05/2023] Open
Abstract
An esophageal web is a thin and smooth extension of normal esophageal tissue consisting of mucosa and submucosa that can occur anywhere along the length of the esophagus but is typically located in the cervical segment. The webs can be congenital or acquired, commonly associated with Plummer-Vinson syndrome and rarely with celiac disease, dermatological disorders or graft-versus-host disease. A 54-year-old man was referred to our hospital with a history of high non-progressive dysphagia to solid food, meat impaction and weight loss over last ten months. His medical history and family history were unremarkable nor was the physical examination. Complete blood count and basic biochemical tests were normal. Antigliadin and antiendomysial antibodies for celiac disease were negative. Barium swallow esophagography and upper endoscopy detected cervical esophageal webs. The treatment consisted of endoscopic balloon dilation. The patient's dysphagia resolved shortly after dilation, and the endoscope passed easily through the esophagus showing normal esophageal, gastric and duodenal mucosa. This report is consistent with a case of esophageal webs rarely documented in males and that is not related with common causes like Plummer-Vinson syndrome. Thus, the pathogenesis and treatment of esophageal webs are evolving.
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Affiliation(s)
- Oana Cristina Petrea
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Carol Stanciu
- Institute of Gastroenterology and Hepatology, Iasi, Romania
- Correspondence: Carol Stanciu Institute of Gastroenterology and Hepatology, “St Spiridon” Emergency Hospital, Iași700111, RomaniaTel +40722306020 Email
| | - Cristina Maria Muzica
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Catalin Victor Sfarti
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Camelia Cojocariu
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Irina Girleanu
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Laura Huiban
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Anca Trifan
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
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Chiesa Estomba CM, Betances Reinoso FA, Martinez Villasmil V, González Cortés MJ, Santidrian Hidalgo C. Persistent Tracheostomy after Organ Preservation Protocol in Patients Treated for Larynx and Hypopharynx Cancer. Int Arch Otorhinolaryngol 2017; 21:377-381. [PMID: 29018502 PMCID: PMC5629076 DOI: 10.1055/s-0037-1601416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/05/2017] [Indexed: 01/07/2023] Open
Abstract
Introduction Squamous cell carcinoma of the larynx is currently the second most common malignancy of the airway after lung cancer, and hypopharyngeal cancer accounts for fewer than 5% of head and neck cancers. The nonsurgical options for patients with this disease are related to significant long-term toxicities and the need for persistent tracheostomy, which adversely affects the quality of life of these patients. Objective To evaluate the need for tracheostomy, and the influence of this in the overall and specific survival rates of patients diagnosed with all stages of laryngeal carcinoma treated by chemoradiotherapy. Methods A retrospective study of patients diagnosed with laryngeal carcinoma was performed according to the criteria of the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) 7th edition, in a tertiary hospital. Results A total of 21 patients were evaluated, 8 patients required a tracheotomy (31%) during the treatment protocol, 7 (35%) men and 1 (100%) women. According to subsite 4/4 patient with glottis cancer (p ≤ 0.001), 2/10 patients with supra glottis cancer and 2/7 patients with hypopharyngeal cancer. During follow up, just in 1 patient was possible to close the tracheostomy. Conclusion Persistent tracheostomy dependence after primary chemoradiation increases significantly the morbidity, and decreases the quality of life of those patients. Patients with glottis cancer are prone to need a tracheostomy, but no statistical difference regarding the oncological stage and the need for a tracheostomy were detected. A more thorough selection of the patients is needed to improve the quality of life and reduce permanent tracheostomy dependence.
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Affiliation(s)
- Carlos Miguel Chiesa Estomba
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Frank Alberto Betances Reinoso
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Virginia Martinez Villasmil
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Maria Jesus González Cortés
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Carmelo Santidrian Hidalgo
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
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Chen XD, Tang SX, Zhang JH, Zhang LT, Wang YW. CIP2A, an oncoprotein, is associated with cell proliferation, invasion and migration in laryngeal carcinoma cells. Oncol Rep 2017; 38:1005-1012. [PMID: 28656258 DOI: 10.3892/or.2017.5759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/29/2017] [Indexed: 11/06/2022] Open
Abstract
Laryngeal carcinoma is one of the most common malignant tumors in otorhinolaryngology. Moreover, experimental investigation showed that cancerous inhibitor of protein phosphatase 2A (CIP2A) expressed highly in various cancers. Therefore, we investigated whether CIP2A can regulate the proliferation, invasion and migration by RNA interference in Hep-2 cells and AMC-NH-8 cells and further affect the activation of phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) pathway. Overexpression of CIP2A was evaluated in tumor tissue and laryngeal cancer cell lines (Hep-2 and AMC-NH-8 cells) by real-time quantitative polymerase chain reaction (RT-qPCR) and western blot assay. In a follow-up experiment, we confirmed that CIP2A siRNA effectively suppressed the cell proliferation at 48 and 72 h, and arrested cell cycle at G0/G1 in Hep-2 cells and AMC-NH-8 cells. The invasion and migration of cell in siRNA CIP2A group were markedly inhibited. Moreover, the experimental results showed that the expression levels of invasion- and migration-related genes, including E-cadherin, metastasis-associated gene 1 (MTA1) and matrix metalloproteinases-2/9 (MMP-2/9), were regulated by CIP2A siRNA. Phosphorylation levels of PI3K and AKT proteins were reduced by CIP2A siRNA. Importantly, it suggested signaling through PI3K/Akt as a critical mechanism by which CIP2A siRNA may suppress cell proliferation, invasion and migration in laryngeal carcinoma cells.
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Affiliation(s)
- Xu-Dong Chen
- Department of Otolaryngology, First Hospital of Ningbo City, Ningbo City, Zhejiang 315000, P.R. China
| | - Shi-Xiong Tang
- Department of Otolaryngology, First Hospital of Ningbo City, Ningbo City, Zhejiang 315000, P.R. China
| | - Jian-Hua Zhang
- Department of Otolaryngology, First Hospital of Ningbo City, Ningbo City, Zhejiang 315000, P.R. China
| | - Li-Tao Zhang
- Department of Otolaryngology, First Hospital of Ningbo City, Ningbo City, Zhejiang 315000, P.R. China
| | - Yao-Wen Wang
- Department of Otolaryngology, First Hospital of Ningbo City, Ningbo City, Zhejiang 315000, P.R. China
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Soares PC, Bouayed S, Dulguerov P, Frossard JL. Recurrent Complete Pharyngo-Oesophageal Stricture Treated by Multidisciplinary Anterograde-Retrograde Endoscopic Dilation. Case Rep Gastroenterol 2016; 10:560-567. [PMID: 27920642 PMCID: PMC5121545 DOI: 10.1159/000450678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/07/2016] [Indexed: 12/29/2022] Open
Abstract
Complete pharyngo-oesophageal stricture (PES) after radiotherapy for head and neck cancer is a relatively rare and difficult complication to manage. Historically this condition has been treated surgically, but endoscopic approaches are now available. We present a 61-year-old man with an epidermoid carcinoma of the supraglottic stage and a micro-invasive epidermoid carcinoma of the oropharynx treated surgically and subsequently by adjuvant radiotherapy. Eight months after the end of the radiotherapy, a complete PES was diagnosed and treated with a combined anterograde-retrograde endoscopic dilation (CARD). The procedure was performed using a transoral anterograde progression with a rigid pharyngoscope and a retrograde progression with an extra-slim nasal endoscope using the percutaneous gastrostomy already in place. Using both transillumination and direct visualisation from both sides of the complete stenosis patency was restored between the neopharynx and the oesophagus. Despite the use of an endoprosthesis, the complete PES recurred and the technique had to be performed a second time. Illustrating the complexity of the case different types of endoprosthesis and several dilations had to be performed for our patient to achieve and maintain a normal oral intake. This case report illustrates that even in complicated recurrent radiation-induced complete PES a CARD can be performed safely and successfully using different types of endoprosthesis.
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Affiliation(s)
- Paulo Castro Soares
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Salim Bouayed
- Department of Otolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Pavel Dulguerov
- Department of Otolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Jean-Louis Frossard
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
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6
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Chahla E, Cheesman A, Hammami M, Taylor JR, Poddar N, Garrett RW, Alkaade S. A unique case of a patient with rectal cancer who developed benign esophageal stenosis after localized rectal radiation and systemic chemotherapy. Case Rep Gastroenterol 2015; 9:44-8. [PMID: 25802497 PMCID: PMC4357684 DOI: 10.1159/000376608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Acute esophagitis and esophageal strictures typically occur after local radiation therapy to the thoracic field. Toxicity is usually limited to the field of radiation and potentially augmented by concomitant use of chemotherapy, however esophageal stricturing due to chemotherapy alone is exceedingly rare. Gastrointestinal toxicity has been previously reported in the setting of 5-fluorouracil (5-FU)-based chemotherapy with abnormal thymidylate synthase or dihydropyrimidine dehydrogenase activities. We present a unique case of isolated chemotherapy-induced esophageal stricture in the setting of stage IIIa rectal adenocarcinoma which presented shortly after initiation of treatment with 5-FU-based chemotherapy in a patient with normal thymidylate synthase and dihydropyrimidine dehydrogenase assays. These findings prompt further investigation of pathways and potential risk factors leading to esophageal toxicity in patients treated with 5-FU-based chemotherapy.
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Affiliation(s)
- Elie Chahla
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Antonio Cheesman
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Muhammad Hammami
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Jason R Taylor
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Nishant Poddar
- Division of Hematology and Oncology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Robert W Garrett
- Department of Radiology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Samer Alkaade
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
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Rosenthal DI, Mohamed ASR, Weber RS, Garden AS, Sevak PR, Kies MS, Morrison WH, Lewin JS, El-Naggar AK, Ginsberg LE, Kocak-Uzel E, Ang KK, Fuller CD. Long-term outcomes after surgical or nonsurgical initial therapy for patients with T4 squamous cell carcinoma of the larynx: A 3-decade survey. Cancer 2015; 121:1608-19. [PMID: 25586197 DOI: 10.1002/cncr.29241] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/20/2014] [Accepted: 11/24/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND The current study was conducted to evaluate long-term disease control, survival, and functional outcomes after surgical and nonsurgical initial treatment for patients with T4 larynx cancer. METHODS Demographics, disease stage, and treatment characteristics were reviewed for 221 sequential patients treated for T4 laryngeal squamous cell cancer at a single institution between 1983 and 2011. Survival and disease control outcomes were calculated. RESULTS The median follow-up time was 47 months (71 months for patients still alive at the time of analysis). The overall 5-year and 10-year overall survival rates were 52% and 29%, respectively, and the corresponding disease-free survival rates were 57% and 48%, respectively. Overall 5-year and 10-year locoregional control rates were 78% and 67%, respectively, and the corresponding rates for freedom from distant metastasis were 76% and 74%, respectively. On both univariate and multivariate analyses, lymph node-positive disease at the time of presentation was associated with overall mortality (P<.0001). Patients treated with laryngectomy followed by postlaryngectomy radiotherapy (161 patients) achieved better initial locoregional control than patients treated with a laryngeal preservation (LP) approach (60 patients) throughout the follow-up period (log-rank P<.007) yet the median overall survival times were equal for both groups (64 months; 95% confidence interval 47-87 months and 38-87 months, respectively [P =.7]). Patients treated with an LP approach had a tracheostomy rate of 45% and an any-event aspiration rate of 23%. Rates of high-grade dysphagia at the time of last follow-up were worse for patients treated with an LP approach (P<.01). CONCLUSIONS Surgery and postoperative radiotherapy can produce substantial long-term cancer control and survival rates for patients with T4 larynx cancer. Caution should be taken when selecting patients for initial nonsurgical treatment because of significant rates of functional impairment despite survival equivalence.
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Affiliation(s)
- David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Strozynski J, Heim J, Bunbanjerdsuk S, Wiesmann N, Zografidou L, Becker SK, Meierl AM, Gouveris H, Lüddens H, Grus F, Brieger J. Proteomic identification of the heterogeneous nuclear ribonucleoprotein K as irradiation responsive protein related to migration. J Proteomics 2014; 113:154-61. [PMID: 25281771 DOI: 10.1016/j.jprot.2014.09.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/26/2014] [Accepted: 09/20/2014] [Indexed: 01/20/2023]
Abstract
UNLABELLED Irradiation resistance is a major obstacle of head and neck squamous cell carcinoma (HNSCC) therapy, limiting treatment success and patient survival. The aim of our experiments was to identify irradiation-regulated proteins as potential drug targets. Two established HNSCC cell lines (HNSCCUM-01T and HNSCCUM-02T) were treated with a single 8Gy (Gray) fraction of irradiation. Changes in cellular protein expression were studied after 24h by means of 2D-electrophoresis and MALDI-TOF-mass spectrometry. Ninety-four differentially expressed proteins were identified. The expression levels of four proteins were regulated similarly in both cell lines after irradiation treatment, i.e., GRP78, PRDX, ACTC, and the heterogeneous nuclear ribonucleoprotein K (hnRNPK), suggesting a relevant role during irradiation response. hnRNPK as a p53 interacting protein was verified by Western blotting and immunocytochemical staining as well as functionally analyzed. Knock-down by the use of siRNA resulted in only slightly reduced viability, however, migratory activity was strongly reduced. Combined application of siRNA against hnRNPK and irradiation reduced migration almost completely. We conclude that hnRNPK is potentially implicated in the radiogenic response of HNSCC. The inhibition of hnRNPK might reduce the metastasizing potential of HNSCC especially in combination with irradiation and suggest that this molecule should be further evaluated in this context. BIOLOGICAL SIGNIFICANCE We showed completely impaired migration of irradiated hnRNPK-knock-out HNSCC cells, suggesting this molecule as a potential drug target in combined treatment schedules.
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Affiliation(s)
- Judith Strozynski
- Molecular Tumor Biology, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Julia Heim
- Molecular Tumor Biology, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sacarin Bunbanjerdsuk
- Molecular Tumor Biology, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Nadine Wiesmann
- Molecular Tumor Biology, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lea Zografidou
- Molecular Tumor Biology, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Simone Katharina Becker
- Molecular Tumor Biology, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anna-Maria Meierl
- Molecular Tumor Biology, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Haralampos Gouveris
- Molecular Tumor Biology, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hartmut Lüddens
- Molecular Psychopharmacology, Department of Psychiatry, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Franz Grus
- Experimental Ophthalmology, Dept. of Ophthalmology, University of Mainz, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jürgen Brieger
- Molecular Tumor Biology, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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9
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Silver N, Gal TJ. Endoscopic CO2 laser management of chemoradiation-related cricopharyngeal stenosis. Ann Otol Rhinol Laryngol 2014; 123:252-6. [PMID: 24595625 DOI: 10.1177/0003489414525019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Treatment of head and neck cancer with chemoradiation (CRT) can result in strictures of the cervical esophagus, often at the level of the cricopharyngeus. The objective of this study is to assess the feasibility of endoscopic CO2 laser cricopharyngeal myotomy for stricture ablation in the setting of prior CRT. METHODS A retrospective review of patients who underwent endoscopic CO2 laser cricopharyngeal myotomy for dysphagia after radiation for squamous cell carcinoma of the head and neck (SCCHN). Pre- and postoperative barium swallow and swallowing assessment were performed before and after surgery. Outcomes and complication rates were examined. RESULTS Endoscopic CO2 laser cricopharyngeal myotomy was performed in 10 patients with dysphagia secondary to cricopharyngeal stenosis/stricture, which developed following treatment for SCCHN with chemoradiation. All patients demonstrated radiographic improvement in stricture, with complete resolution of stricture in 9 of 10 patients. All patients noted improvement in dysphagia with 9 of 10 patients demonstrating significant advancement of diet by modified barium swallow. No complications were observed. CONCLUSION Endoscopic CO2 cricopharyngeal myotomy can be performed safely in the setting of prior CRT, with significant improvement in swallowing in select patients. Indications and technical considerations will be discussed.
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Affiliation(s)
- Natalie Silver
- Department of Otolaryngology, University of Kentucky, Lexington, Kentucky, USA
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Tennant PA, Cash E, Bumpous JM, Potts KL. Persistent tracheostomy after primary chemoradiation for advanced laryngeal or hypopharyngeal cancer. Head Neck 2013; 36:1628-33. [DOI: 10.1002/hed.23508] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 07/18/2013] [Accepted: 09/10/2013] [Indexed: 11/07/2022] Open
Affiliation(s)
- Paul A. Tennant
- Division of Otolaryngology, Department of Surgery, James Graham Brown Cancer Center; University of Louisville; Louisville Kentucky
| | - Elizabeth Cash
- Division of Otolaryngology, Department of Surgery, James Graham Brown Cancer Center; University of Louisville; Louisville Kentucky
| | - Jeffrey M. Bumpous
- Division of Otolaryngology, Department of Surgery, James Graham Brown Cancer Center; University of Louisville; Louisville Kentucky
| | - Kevin L. Potts
- Division of Otolaryngology, Department of Surgery, James Graham Brown Cancer Center; University of Louisville; Louisville Kentucky
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Bae WK, Hwang JE, Shim HJ, Cho SH, Lee KH, Han HS, Song EK, Yun HJ, Cho IS, Lee JK, Lim SC, Chung WK, Chung IJ. Multicenter phase II study of weekly docetaxel, cisplatin, and S-1 (TPS) induction chemotherapy for locally advanced squamous cell cancer of the head and neck. BMC Cancer 2013; 13:102. [PMID: 23497365 PMCID: PMC3599387 DOI: 10.1186/1471-2407-13-102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 02/28/2013] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this study was to evaluate the efficacy and tolerability of weekly docetaxel, cisplatin, and S-1 (weekly TPS) as induction chemotherapy for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Methods A total of 35 patients with previously untreated, locally advanced HNSCC were enrolled. Seven patients (20%) were diagnosed with stage III HNSCC and 28 patients (80%) were diagnosed with stage IV. Induction treatment included 30 mg/m2 docetaxel on day 1 and 8, 60 mg/m2 cisplatin on day 1, and 70 mg/m2 S-1 on days 1 to 14. The regimen was repeated every 21 days. After three courses of induction chemotherapy, patients received concurrent chemoradiotherapy. Results Among the 35 patients, 30 (85.7%) completed induction chemotherapy. The response to induction chemotherapy was as follows: nine patients (25.7%) achieved a complete response (CR) and the overall response rate (ORR) was 85.7%. Grades 3–4 toxicity during induction therapy included neutropenia (28.5%), neutropenic fever (8.5%), and diarrhea (17.1%). After completion of concurrent chemoradiotherapy, the CR rate was 62.8% and the partial response (PR) was 22.8%. Estimates of progression-free and overall survival at 2 years were 73.2% and 79.3%, respectively. Conclusions Weekly TPS is a promising regimen that is well-tolerated, causes minimal myelosuppression and is effective as an outpatient regimen for locally advanced HNSCC. Trial registration ClinicalTrials.gov: NCT01645748
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Affiliation(s)
- Woo Kyun Bae
- Department of Hematology-Oncology, Chonnam National University, Gwangju, Korea
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12
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Wang JJ, Goldsmith TA, Holman AS, Cianchetti M, Chan AW. Pharyngoesophageal stricture after treatment for head and neck cancer. Head Neck 2011; 34:967-73. [PMID: 21953721 DOI: 10.1002/hed.21842] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 03/17/2011] [Accepted: 05/12/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to report the risk of pharyngoesophageal stricture after treatment for head and neck cancer. METHODS Human studies on radiation therapy with or without chemotherapy for head and neck cancer published in peer-reviewed journals with assessment of pharyngoesophageal stricture with barium swallow or endoscopy were included. RESULTS A total of 4727 patients from 26 studies treated between 1989 and 2008 were eligible for analysis. The reported overall risk of stricture was 7.2%. The risks of pharyngoesophageal stricture in both conventional and intensity-modulated radiation therapy (IMRT) studies were 5.7% and 16.7%, respectively (p < .001). Use of concurrent (p < .001) and taxane (p = .01) chemotherapy was associated with the IMRT technique. Prospective studies reported a 3.3-fold increased risk of stricture compared with that of retrospective studies (odds ratio: 3.3; 95% confidence interval: 2.3-4.8; p < .001). CONCLUSIONS Pharyngoesophageal stricture after IMRT and chemotherapy treatment for head and neck cancer is not uncommon. Videofluoroscopic swallow study should be performed prospectively to evaluate swallowing function.
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Affiliation(s)
- Jing Jing Wang
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Anterograde-retrograde rendezvous approach for radiation-induced complete upper oesophageal sphincter stenosis: case report and literature review. The Journal of Laryngology & Otology 2011; 125:761-4. [PMID: 21693080 DOI: 10.1017/s0022215111001058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Strictures of the hypopharynx and oesophagus are frequently observed following (chemo)radiation. Anterograde dilatation of a complete stenosis carries a high risk of perforation. An alternative is described: a combined anterograde-retrograde approach. CASE REPORT A 75-year-old man developed complete stenosis of the oesophageal inlet after primary radiotherapy for laryngeal carcinoma and full percutaneous endoscopic gastrostomy feeding. To prevent creation of a false route into the mediastinum, a dilatation wire was introduced in a retrograde fashion into the oesophagus, through the gastrostomy opening. The wire was endoscopically identified from the proximal side and then passed through a perforation created by CO2 laser. Anterograde dilatation was safely performed, and the patient returned to a normal diet. There is consensus in the literature that blind anterograde dilatation carries a high risk of perforation; therefore, an anterograde-retrograde rendezvous technique is advisable. CONCLUSION In cases of complete obstruction of the oesophageal inlet, anterograde-retrograde dilatation represents a safe technique with which to restore enteric continuity.
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Tsai TL, Chu PY, Tai SK, Wang YF, Yang MH, Wang LW, Lirng JF, Chang SY. Promising Long-term Results with Attenuated Adverse Effects by Methotrexate-containing Sequential Chemoradiation Therapy in Locally Advanced Head and Neck Squamous Cell Carcinoma. Jpn J Clin Oncol 2011; 41:1182-93. [DOI: 10.1093/jjco/hyr124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Liu T, Peng H, Zhang M, Deng Y, Wu Z. Cucurbitacin B, a small molecule inhibitor of the Stat3 signaling pathway, enhances the chemosensitivity of laryngeal squamous cell carcinoma cells to cisplatin. Eur J Pharmacol 2010; 641:15-22. [DOI: 10.1016/j.ejphar.2010.04.062] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 03/27/2010] [Accepted: 04/28/2010] [Indexed: 12/18/2022]
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Lu W, Posner MR, Wayne P, Rosenthal DS, Haddad RI. Acupuncture for dysphagia after chemoradiation therapy in head and neck cancer: a case series report. Integr Cancer Ther 2010; 9:284-90. [PMID: 20713374 DOI: 10.1177/1534735410378856] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dysphagia is a common side effect following chemoradiation therapy (CRT) in patients with head and neck cancer (HNC). METHODS In this retrospective case series, 10 patients with HNC were treated with acupuncture for radiation-induced dysphagia and xerostomia. All patients were diagnosed with stage III/IV squamous cell carcinoma. In all, 7 of 10 patients were percutaneous endoscopic gastrostomy (PEG) tube dependent when they began acupuncture. Manual acupuncture and electroacupuncture were used once a week. RESULTS A total of 9 of 10 patients reported various degrees of subjective improvement in swallowing functions, xerostomia, pain, and fatigue levels. Overall, 6 (86%) of 7 PEG tube-dependent patients had their feeding tubes removed after acupuncture, with a median duration of 114 days (range 49 to 368 days) post CRT. One typical case is described in detail. CONCLUSIONS A relatively short PEG tube duration and reduced symptom severity following CRT were observed in these patients. Formal clinical trials are required to determine the causality of the observations.
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Affiliation(s)
- Weidong Lu
- Dana-Farber Cancer Institute, Harvard Medical School, 44 Binney Street, Boston, MA 02115, USA.
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Haigentz Jr M, Silver CE, Hartl DM, Takes RP, Rodrigo JP, Robbins KT, Rinaldo A, Ferlito A. Chemotherapy regimens and treatment protocols for laryngeal cancer. Expert Opin Pharmacother 2010; 11:1305-16. [DOI: 10.1517/14656561003749256] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Missak Haigentz Jr
- Montefiore Medical Center, Albert Einstein College of Medicine, Division of Oncology, Department of Medicine, Bronx, NY, USA
| | - Carl E Silver
- Montefiore Medical Center, Albert Einstein College of Medicine, Departments of Surgery and Otolaryngology-Head and Neck Surgery, Bronx, NY, USA
| | - Dana M Hartl
- Institut Gustave Roussy, Department of Otolaryngology-Head and Neck Surgery, Villejuif Cedex, France
- Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France
| | - Robert P Takes
- Radboud University Nijmegen Medical Center, Department of Otolaryngology-Head and Neck Surgery, Nijmegen, The Netherlands
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - K Thomas Robbins
- Southern Illinois University School of Medicine, Division of Otolaryngology-Head and Neck Surgery, Springfield, IL, USA
| | - Alessandra Rinaldo
- Department of Surgical Sciences, Professor and Chairman of the ENT Clinic, University of Udine, Azienda Ospedaliero-Universitaria, Piazzale S. Maria della Misericordia, I-33100 Udine, Italy ;
| | - Alfio Ferlito
- Department of Surgical Sciences, Professor and Chairman of the ENT Clinic, University of Udine, Azienda Ospedaliero-Universitaria, Piazzale S. Maria della Misericordia, I-33100 Udine, Italy ;
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Goguen LA, Norris CM, Jaklitsch MT, Sullivan CA, Posner MR, Haddad RI, Tishler RB, Burke E, Annino DJ. Combined antegrade and retrograde esophageal dilation for head and neck cancer-related complete esophageal stenosis. Laryngoscope 2010; 120:261-6. [PMID: 19998421 DOI: 10.1002/lary.20727] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Assess the safety and efficacy of combined antegrade and retrograde esophageal dilation (CARD) for complete esophageal stenosis following head and neck cancer (HNC) treatment. Review HNC dysphagia management. STUDY DESIGN Retrospective review of all patients undergoing CARD following HNC treatment between May 2001 and September 2008. METHODS Forty-five patients were identified for review. Parameters assessed included: ability to obtain intraoperative esophageal patency, complications, number of dilations required, diet, and gastric tube (GT) status. Factors associated with dilation failure were analyzed. RESULTS Intraoperative esophageal patency was obtained in 91% of patients. Median number of all dilations per patient was three. Median number of CARDs per patient was one. Resumption of oral intake occurred in 36/45 (80%). Diet results included: regular or soft diet 32/45 (71%), GT removal 27/45 (60%), and GT dependence with nothing by mouth 9/45 (20%). Laryngeal and pharyngeal stenosis, radionecrosis, tracheotomy dependence, and elongated stenosis were associated with dilation failure. Complications occurred in 18/63 (29%) CARD procedures: eight pneumomediastinum, seven GT site problems, two esophageal perforations, and one pharyngeal infection. All complications resolved spontaneously or with minimal interventions. CONCLUSIONS CARD was safe and effective. Intraoperative patency was achieved in 91% of patients. Eighty percent resumed oral intake. The majority of patients had their GTs removed and resumed a soft or regular diet. Dilation failure was associated with laryngeal, pharyngeal, and excessively long esophageal stenosis, often resulting from radionecrosis. Complications were minor. CARD should be considered before relegating patients with complete esophageal stenosis to chronic GT dependence or subjecting them to laryngopharyngo esophagectomy.
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Affiliation(s)
- Laura A Goguen
- Department of Surgery/Division of Otolaryngology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA.
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Organ Preservation With Concurrent Chemoradiation for Advanced Laryngeal Cancer: Are We Succeeding? Int J Radiat Oncol Biol Phys 2010; 76:398-402. [DOI: 10.1016/j.ijrobp.2009.01.058] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 01/28/2009] [Accepted: 01/29/2009] [Indexed: 11/18/2022]
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Silver CE, Beitler JJ, Shaha AR, Rinaldo A, Ferlito A. Current trends in initial management of laryngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 2009; 266:1333-52. [PMID: 19597837 DOI: 10.1007/s00405-009-1028-2] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 06/18/2009] [Indexed: 11/24/2022]
Affiliation(s)
- Carl E Silver
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Hilgers FJM. Functional outcomes and rehabilitation strategies in patients treated with chemoradiotherapy for advanced head and neck cancer: a systematic review. Eur Arch Otorhinolaryngol 2008; 266:889-900. [DOI: 10.1007/s00405-008-0817-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 08/11/2008] [Indexed: 01/23/2023]
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Organ preservation in locally advanced head and neck cancer of the larynx using induction chemotherapy followed by improved radiation schemes. Eur Arch Otorhinolaryngol 2008; 266:719-26. [DOI: 10.1007/s00405-008-0798-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Accepted: 08/20/2008] [Indexed: 10/21/2022]
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Caglar HB, Tishler RB, Othus M, Burke E, Li Y, Goguen L, Wirth LJ, Haddad RI, Norris CM, Court LE, Aninno DJ, Posner MR, Allen AM. Dose to larynx predicts for swallowing complications after intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 2008; 72:1110-8. [PMID: 18468812 DOI: 10.1016/j.ijrobp.2008.02.048] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 02/21/2008] [Accepted: 02/21/2008] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate early swallowing after intensity-modulated radiotherapy for head and neck squamous cell carcinoma and determine factors correlating with aspiration and/or stricture. METHODS AND MATERIALS Consecutive patients treated with intensity-modulated radiotherapy with or without chemotherapy between September 2004 and August 2006 at the Dana Farber Cancer Institute/Brigham and Women's Hospital were evaluated with institutional review board approval. Patients underwent swallowing evaluation after completion of therapy; including video swallow studies. The clinical- and treatment-related variables were examined for correlation with aspiration or strictures, as well as doses to the larynx, pharyngeal constrictor muscles, and cervical esophagus. The correlation was assessed with logistic regression analysis. RESULTS A total of 96 patients were evaluated. Their median age was 55 years, and 79 (82%) were men. The primary site of cancer was the oropharynx in 43, hypopharynx/larynx in 17, oral cavity in 13, nasopharynx in 11, maxillary sinus in 2, and unknown primary in 10. Of the 96 patients, 85% underwent definitive RT and 15% postoperative RT. Also, 28 patients underwent induction chemotherapy followed by concurrent chemotherapy, 59 received concurrent chemotherapy, and 9 patients underwent RT alone. The median follow-up was 10 months. Of the 96 patients, 31 (32%) had clinically significant aspiration and 36 (37%) developed a stricture. The radiation dose-volume metrics, including the volume of the larynx receiving >or=50 Gy (p = 0.04 and p = 0.03, respectively) and volume of the inferior constrictor receiving >or=50 Gy (p = 0.05 and p = 0.02, respectively) were significantly associated with both aspiration and stricture. The mean larynx dose correlated with aspiration (p = 0.003). Smoking history was the only clinical factor to correlate with stricture (p = 0.05) but not aspiration. CONCLUSION Aspiration and stricture are common side effects after intensity-modulated radiotherapy for head-and-neck squamous cell carcinoma. The dose given to the larynx and inferior constrictors correlated with these side effects.
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Affiliation(s)
- Hale B Caglar
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Abstract
PURPOSE OF REVIEW Primary treatment of many head and neck cancers is shifting to nonsurgical modalities with concomitant chemoradiation becoming increasing prevalent. With this change, surgery is moving to a role as a salvage treatment modality. As a result of this shift, it is important to understand the issues surrounding surgical salvage after chemoradiation. RECENT FINDINGS Studies have consistently found that salvage surgery after chemoradiation carries a high complication rate, higher than either primary surgery or salvage surgery after radiation alone. There are very few reports on the success rate of salvage surgery after failed primary concurrent chemoradiation, but what little data we have seems to suggest success rates approximate success rates for salvage after radiation therapy. There are also reasons to believe that efficacy of salvage surgery varies by stage and site of disease. Also, fundamental differences in the nature of cancer after failed primary therapy have been elucidated by recent studies. SUMMARY While salvage surgery is fraught with higher morbidity and lower efficacy than primary surgery, it remains the only potentially curative option available to patients who have failed 'organ preservation' primary therapy. We review issues to consider when managing these challenging patients.
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Lawson JD, Otto K, Grist W, Johnstone PA. Frequency of esophageal stenosis after simultaneous modulated accelerated radiation therapy and chemotherapy for head and neck cancer. Am J Otolaryngol 2008; 29:13-9. [PMID: 18061826 DOI: 10.1016/j.amjoto.2006.12.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Accepted: 12/13/2006] [Indexed: 10/22/2022]
Abstract
BACKGROUND Chronic esophageal toxicity after radiotherapy alone for cancer of the head and neck (HNCa) is rare: 2.6% for strictures and 0.8% for stenosis after a 60-Gy dose. With combined modality therapy, stricture rates of 22% to 37% have been reported. We report the frequency of esophageal toxicity after simultaneous modulated accelerated radiation therapy (SMART) with chemotherapy for HNCa. METHODS The records of the otolaryngology/head and neck surgery department of Emory University, Atlanta, GA, were screened for patients undergoing combined modality therapy using SMART for HNCa. Radiation Oncology records were reviewed for target and critical normal structure dosimetry, with detailed analysis of esophageal and supraglottic laryngeal dosimetry. Hospital and clinic records were reviewed for evidence of esophageal toxicity. RESULTS From January 2003 to August 2005, 99 patients underwent definitive therapy for squamous cell HNCa using SMART and chemotherapy. Follow-up was documented in all cases. Median dose to sites of gross primary or nodal disease was 70.29 Gy, at 2.13 Gy per fraction. Median dose to the ipsilateral neck was 63.03 Gy at 1.91 Gy per fraction. Median dose to the contralateral neck in 97 patients treated was 57.75 Gy at 1.75 Gy per fraction. Thirteen (13%) patients developed esophageal strictures. Five (5%) patients had complete esophageal stenosis. Four (14%) of the 29 patients with either a hypopharyngeal primary or a N2c nodal disease developed complete stenosis. A statistically larger esophageal volume of esophagus reactivity > or = 60 Gy (V(60)) was found in patients who developed stenosis/stricture when compared with a randomly selected population of N2a/b patients who did not develop those toxicities. Esophageal stenosis/stricture was also numerically more common in patients receiving taxane-based chemotherapy, developing in 23%, as opposed to 9% in patients treated with platinum-based chemotherapy. CONCLUSION The risk of esophageal stenosis may increase with SMART and chemotherapy for HNCa. Potential mechanisms to reduce this include (a) contouring the esophagus as a dose-limiting structure; (b) early flexible examination posttreatment, with early intervention with dilation; (c) improved therapy for mucositis.
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Modalidades de preservación de órgano en carcinomas de laringe e hipofaringe. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s0001-6519(07)74970-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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van den Broek GB, Wreesmann VB, van den Brekel MWM, Rasch CRN, Balm AJM, Rao PH. Genetic abnormalities associated with chemoradiation resistance of head and neck squamous cell carcinoma. Clin Cancer Res 2007; 13:4386-91. [PMID: 17671120 DOI: 10.1158/1078-0432.ccr-06-2817] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To identify reliable predictors of chemoradiation resistance of advanced head and neck squamous cell carcinoma (HNSCC). EXPERIMENTAL DESIGN We did a matched-pair analysis of 20 chemoradiation-resistant and 20 sensitive HNSCCs, identified among a series of 104 consecutively treated cases. We compared the global DNA copy number profiles derived from comparative genomic hybridization analysis of both groups to identify genetic markers associated with chemoradiation resistance. RESULTS Although sensitive and resistant case groups were characterized by a similar total number of genetic aberrations, high-level amplifications were more frequent in resistant tumors. Resistant tumors were characterized by a different profile of genetic changes. Gains of 3q11-q13, 3q21-q26.1, and 6q22-q27 and losses of 3p11-pter and 4p11-pter were significantly associated with chemoradiation resistance. High-level amplifications unique to resistant cases involved the chromosomal regions 1p32, 3q24, 7p11.1, 7p11.2-12, 8p11.1, 8p11.1-12, 12q15, 13q21, 15q12, 18p11.3, and 18q11. CONCLUSIONS Sensitive and resistant HNSCCs are characterized by divergent genomic profiles. These profiles may be valuable as predictive markers of treatment failure.
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Affiliation(s)
- Guido B van den Broek
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Specenier PM, Vermorken JB. Neoadjuvant chemotherapy in head and neck cancer: Should it be revisited? Cancer Lett 2007; 256:166-77. [PMID: 17673364 DOI: 10.1016/j.canlet.2007.06.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 06/16/2007] [Accepted: 06/20/2007] [Indexed: 11/23/2022]
Abstract
Locally advanced SCCHN (LA-SCCHN) is generally treated by a combination of chemotherapy, irradiation and/or surgery. Timing of the chemotherapy has for long been a matter of debate but concurrent chemoradiation was widely adopted as standard of care for locally advanced squamous cell carcinoma of the head and neck after the publication of a large meta-analysis which demonstrated that concurrent chemoradiation confers an absolute survival benefit of 8% at 2 and 5 years. Induction chemotherapy has some appealing advantages including the opportunity of assessing tumor response and selecting the patients who are candidates for organ preservation. The cisplatin-fluorouracil combination has been the induction regimen of choice for two decades but has recently been superseded by a combination of cisplatin, fluorouracil and a taxane which can be considered the standard regimen when induction chemotherapy is appropriate. Multiple large randomized trials designed to compare sequential induction, i.e., chemotherapy followed by CRT to CRT alone are currently underway. New challenges are the integration of targeted therapies into the current treatment strategies and the identification of prognostic biomarkers and of factors predicting the response to treatment which would help to select patients who are likely to benefit most from induction chemotherapy.
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Affiliation(s)
- Pol M Specenier
- Department of Medical Oncology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
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Ahn JS, Cho SH, Kim OK, Lee JK, Yang DH, Kim YK, Lee JJ, Lim SC, Kim HJ, Chung WK, Chung IJ. The efficacy of an induction chemotherapy combination with docetaxel, cisplatin, and 5-FU followed by concurrent chemoradiotherapy in advanced head and neck cancer. Cancer Res Treat 2007; 39:93-8. [PMID: 19746222 DOI: 10.4143/crt.2007.39.3.93] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 09/06/2007] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This study was performed to determine the feasibility and safety of the use of induction chemotherapy combined with docetaxel, cisplatin, and 5-fluorouracil (TPF) followed by concurrent chemoradiation therapy for locally advanced squamous cell carcinoma of the head and neck (SCCHN). MATERIALS AND METHODS The patients, that were initially not treated for locally advanced SCCHN, underwent three cycles of induction chemotherapy every 3 weeks at a dose of 70 mg/m(2) docetaxel D1, 75 mg/m(2) cisplatin D1, 1000 mg/m(2) 5-FU D1-4, and subsequently received concurrent chemoradiation therapy. RESULTS Forty-nine patients were enrolled in this study and forty-three of the patients completed the treatment. The median duration of follow-up was 18 months (range, 6 approximately 39 months). All of the patients had stage III (26.5%) or IV (73.5%) squamous cell carcinoma. After sequential therapy, a complete response and partial response was seen in 28 (65.2%) and 13 (30.2%) patients, respectively. The overall response rate was 95.4%. Overall survival and progression-free survival (PFS) at 2 years were 88.7% and 69.7%, respectively. Grade 3 approximately 4 neutropenia occurred in 42.2% of the patients and grade 4 thrombocytopenia in 1 cycle (0.7%). Two patients (4.1%) died during the induction chemotherapy due to pneumonia and a subdural hemorrhage, respectively. The group of patients over 65 years of age showed a significant lower dose intensity than that of patients under 65 years of age, but PFS was not significantly different between two groups (p=0.105). CONCLUSION TPF induction chemotherapy followed by concurrent chemoradiotherapy showed a high level of CR and moderate treatment-induced toxicity. Adequate dose modification in elderly patients should be considered to maintain efficacy and avoid treatment-related toxicity.
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Affiliation(s)
- Jae-Sook Ahn
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
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Rivera F, Vega-Villegas ME, López-Brea M, Isla D, Mayorga M, Galdós P, Rubio A, Del Valle A, García-Reija F, García-Montesinos B, Rodríguez-Iglesias J, Mayordomo J, Rama J, Saiz-Bustillo R, Sanz-Ortiz J. Randomized phase II study of cisplatin and 5-FU continuous infusion (PF) versus cisplatin, UFT and vinorelbine (UFTVP) as induction chemotherapy in locally advanced squamous cell head and neck cancer (LA-SCHNC). Cancer Chemother Pharmacol 2007; 62:253-61. [PMID: 17901953 DOI: 10.1007/s00280-007-0599-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 09/10/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We conducted a multicentric randomized phase II trial comparing 5-FU continuous infusion (PF) and cisplatin, UFT and vinorelbine (UFTVP) as induction chemotherapy (IC) in locally advanced squamous cell head and neck cancer (LA-SCHNC). Primary objective was complete response (CR) to IC and overall survival (OS) was a secondary objective. MATERIALS AND METHODS PF: cisplatin 100 mg/m(2) i.v. Day 1 (D1) and 5-FU 1,000 mg/m(2) per day i.v. continous infusion D1-D5, every 21 days. UFTVP: cisplatin 100 mg/m(2) i.v. D1; UFT 200 mg/m(2) per day p.o. D1-D21 and vinorelbine 25 mg/m(2) i.v. D1 and D8, every 21 days. Four IC courses were planned in both arms. RESULTS A total of 206 patients (pts) were included (PF/UFTVP: 99/107): oral cavity: 8%/10%, oropharynx: 20%/25%, hypopharynx: 17%/14%, larynx: 54%/50%. Stage (TNM, 2002): III: 41%/35%, IVA: 23%/27%, IVB: 35%/38%. Complete response to IC: PF:36%/UFTVP:31% (P: no significative (NS)). G 3-4 toxicity (PF/UFTVP): neutropenia: 52%/72%; febrile neutropenia: 3%/20% (P < 0.001); anaemia:1%/14% (P < 0.001); trombocytopenia: 5%/0% (P = 0.02); mucositis: 15%/7% (P < 0.001). Deaths during IC: 2(2%)/3(3%). IC with UFTVP was associated with a favourable OS in the Cox analysis (actuarial 5 year OS: 49% vs. 34%; HR: 0.67, 95% CI: 0.47-0.95, P: 0.03). CONCLUSIONS Although clinical response is equal in both arms, overall survival (Cox) is better in the UFTVP arm. Febrile neutropenia and anaemia were more frequent with UFTVP while mucositis and trombocytopenia were more severe with PF.
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Affiliation(s)
- Fernando Rivera
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, 39008, Santander, Spain.
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Quer M, León X. Organ Preservation in Laryngeal and Hypopharyngeal Cancer. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s2173-5735(07)70392-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nguyen NP, Moltz CC, Frank C, Vos P, Millar C, Smith HJ, Lee H, Karlsson U, Nguyen PD, Martinez T, Nguyen LM, Sallah S. Aspiration Rate following Nonsurgical Therapy for Laryngeal Cancer. ORL J Otorhinolaryngol Relat Spec 2006; 69:116-20. [PMID: 17159375 DOI: 10.1159/000097843] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Accepted: 09/21/2006] [Indexed: 11/19/2022]
Abstract
The aim of this study was to evaluate the aspiration rate following nonsurgical therapy, i.e. chemoradiation or radiation alone for laryngeal cancer. Modified barium swallow was performed in 43 patients who complained of dysphagia following chemoradiation (n = 22) or radiation alone (n = 21) for laryngeal cancer. Patients were selected if they were cancer free at the time of the swallowing study. Dysphagia severity was graded on a scale of 1-7. Patients were grouped according to the dysphagia severity: no aspiration (grade 1-4), and severe (grade 5-7). Mean and median dysphagia grades were 4.4/5 and 3.5/3 for chemoradiation and radiation, respectively. Aspiration occurred in 12 patients (54%) of the chemoradiation group and 7 (33%) of the radiation alone group (p = 0.13). There was a higher proportion of patients with large tumor (T3-T4) in the chemoradiation group (64%) compared to the radiation group (5%) (p = 0.0001). Aspiration is a significant source of morbidity in patients treated for laryngeal cancer with chemoradiation or radiation alone. Aspiration occurred in both groups. Although the observed difference in aspiration rates did not achieve statistical significance, the higher aspiration rate in the chemoradiation group may be due to a higher proportion of large tumors, to the additional toxic effect of chemotherapy, or to the small number of patients in both groups. Diagnostic studies such as modified barium swallow should be part of future laryngeal cancer prospective studies to assess the prevalence of aspiration as it may be silent.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, University of Arizona, Tucson, AZ 85124-5081, USA.
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Abstract
Since the first total laryngectomy was undertaken, efforts have been made to avoid removing the entire larynx. For a long time, partial surgery and radiotherapy were the only options that could preserve the larynx. Development of active chemotherapy regimens has prompted an era of intensive clinical research. Induction chemotherapy followed by radiotherapy in patients with objective responses has been shown to allow conservation of the larynx in nearly two-thirds of individuals, without any effect on survival; concurrent chemoradiotherapy also provides high rates of laryngeal preservation, again without affecting survival; and induction chemotherapy followed by concurrent chemoradiotherapy is under investigation. In the meantime, partial open surgery and endoscopic carbon dioxide laser procedures are feasible in selected moderately advanced laryngopharyngeal cancers as an alternative to destructive surgery. Altered fractionation radiotherapy can also be used in management of these tumours, and targeted treatments have opened a new area of clinical research. Findings of basic research and modern imaging should provide useful approaches for selection of patients for various strategies.
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Affiliation(s)
- Jean Louis Lefebvre
- Head and Neck Department, Centre Oscar Lambret, 3 rue Combemale, 59020 Lille, France.
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Rapidis AD, Trichas M, Stavrinidis E, Roupakia A, Ioannidou G, Kritselis G, Liossi P, Giannakouras G, Douzinas EE, Katsilieris I. Induction chemotherapy followed by concurrent chemoradiation in advanced squamous cell carcinoma of the head and neck: Final results from a phase II study with docetaxel, cisplatin and 5-fluorouracil with a four-year follow-up. Oral Oncol 2006; 42:675-84. [PMID: 16731029 DOI: 10.1016/j.oraloncology.2005.12.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Revised: 12/03/2005] [Accepted: 12/06/2005] [Indexed: 11/22/2022]
Abstract
Encouraging results have recently been reported in patients (pts) with locally advanced unresectable squamous cell carcinoma of the head and neck (SCCHN) when induction chemotherapy (IC) is used and followed by radiotherapy (RT). The present study assessed the therapeutic response of an aggressive regimen consisting of docetaxel (TXT), cisplatin (CDDP) and 5-fluorouracil (5-Fu) as IC and concurrent with RT in pts with locally advanced (stages III and IV) SCCHN. 42 pts (35 male and 7 female) with a mean age of 58 years suffering from stages III and IV (Mo) SCCHN were included to this organ preservation phase II clinical trial. The site of the primary tumors was the anterior mouth in 9 pts, base of tongue and oropharynx in 12, middle third of the face in 8 and larynx in 13. The performance status of the pts was 0-1 according to WHO and above 80% according to Karnofsky classification. IC consisted of TXT (40 mg/m2), CDDP (40 mg/m2) and 5-Fu (350 mg/m2) every two weeks (wks) for a total of four courses and repeated, coupled with RT (66-68 cGys total dose fractionated at 200 Gy per day, 5 days a week), for up to seven wks. In total, pts received eight courses of chemotherapy (CT) at the end of RT treatment. Pts were evaluated at the end of IC, after RT and every six wks thereafter. 41 pts were eligible for evaluation after IC (one died from myocardial infarction) and 39 after completion of treatment (two died during RT). Statistical multivariate analysis was performed using SPSS (11) package. Complications from IC and RT were evaluated according to WHO criteria and included mucositis Grade (Gr) IV in 10% of the pts, Gr III in 50%, Gr II in 20%. Anemia presented in 40% of the pts with Gr II, 40% with Gr I, neutropenia 17% with Gr IV, 20% with Gr III, 30% with Gr II, thrombocytopenia 3% with Gr III, 10% with Gr I and xerostomia up to Gr II in 70% of the pts. The response rate (RR) after IC was complete response (CR) for 10 pts (24.4%), partial response (PR) for 22 (53.7%) and no response (NR) for 9 (21.9%). At the end of the treatment the RR in the intention-to-treat population were CR for 25 pts (64.1%), and PR for 14 (35.9%). Follow up ranges from 18 to 56 months (mts). 14 pts died during follow-up time. The mean survival time is 41 mts and the median 40. 2 pts with CR developed local recurrence and two distant metastases, whereas all pts with PR developed progressive disease (PD) and all but two are dead from disease. It is evident from this phase II study that TXT-CDDP-5Fu based IC followed by the same regimen coupled with RT improves local control. Pts that showed CR after IC continued to maintain disease status during RT (P-value=0.0181). In pts with SD concurrent RT did not alter dramatically disease outcome. Patients who showed complete response after both IC and RT presented a four-year survival rate of 74% compared to a 30% to partial responders (P-value=0.0001). Results are encouraging and further study of the toxicity and follow-up is needed to validate treatment effectiveness.
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Affiliation(s)
- Alexander D Rapidis
- Department of Maxillofacial Surgery, Greek Anticancer Institute, Saint Savvas Hospital, 171 Alexandras Avenue, and Department of Critical Care Medicine, University of Athens Medical School, 115 22, Greece.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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