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Zhou J, Heng Y, Yang Y, Zhu X, Zhou L, Gong H, Xu C, Tao L. Survival outcomes in patients with T3-4aN0M0 glottic laryngeal squamous cell carcinoma and evaluation of postoperative radiotherapy. Oncol Lett 2022; 24:434. [PMID: 36311684 PMCID: PMC9608082 DOI: 10.3892/ol.2022.13554] [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: 06/23/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
This study aimed to evaluate the clinical outcomes of patients with T3-4aN0M0 glottic laryngeal squamous cell carcinoma (LSCC) treated with laryngectomy, and to assess the postoperative radiotherapy (PORT) results in terms of the survival of T3-T4aN0M0 patients with negative margins. This was a retrospective review of 369 T3-4aN0M0 glottic LSCC cases. The 5-year cancer-specific survival (CSS) and overall survival (OS) rates were 67.5 and 66.7%, respectively. Patients who received total laryngectomy had worse survival [5-year CSS, 62.5%; disease-free survival (DFS), 56.2%] than those who underwent partial laryngectomy (5-year CSS, 79.3%; DFS, 65.4%). More advanced-stage cancer is a predictor of poor survival. There was no significant difference in CSS or DFS between patients with positive margins following rescue therapy and those with negative margins. Furthermore, no difference in the survival rates was observed between patients with negative margins who received PORT and those who did not (5-year DFS: 59.1 vs. 63.8%, P=0.057 and CSS: 62.5 vs. 69.5%, P=0.074). For T3-4aN0M0 glottic LSCC patients, surgical treatment remained a good option, as it can achieve satisfactory oncological outcomes. However, PORT did not increase survival in surgically managed pT3-4aN0M0 LSCC patients with negative margins.
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Affiliation(s)
- Jian Zhou
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Yu Heng
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Yue Yang
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Xiaoke Zhu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Liang Zhou
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Hongli Gong
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Chengzhi Xu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Lei Tao
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
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Postoperative results and the effects of extended partial laryngectomy on the quality of life. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.834031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mendenhall WM, Strojan P, Lee AWM, Rinaldo A, Eisbruch A, Ng WT, Smee R, Ferlito A. Radiotherapy in the management of glottic squamous cell carcinoma. Head Neck 2020; 42:3558-3567. [PMID: 32896071 DOI: 10.1002/hed.26419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/01/2020] [Accepted: 07/28/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Our purpose is to review the role radiotherapy (RT) in the treatment of glottic squamous cell carcinoma (SCC). METHODS A concise review of the pertinent literature. RESULTS RT cure rates are Tis- T1N0, 90% to 95%; T2N0, 70% to 80%; low-volume T3-T4a, 65% to 70%. Concomitant cisplatin is given for T3-T4a SCCs. Severe complications occur in 1% to 2% for Tis-T2N0 and 10% for T3-T4a SCCs. Patients with high-volume T3-T4 SCCs undergo total laryngectomy, neck dissection, and postoperative RT. Those with positive margins and/or extranodal extension receive concomitant cisplatin. The likelihood of local-regional control at 5 years is 85% to 90%. Severe complications occur in 5% to 10%. CONCLUSIONS RT is a good treatment option for patients with Tis-T2N0 and low-volume T3-T4a glottic SCCs. Patients with higher volume T3-T4 cancers are best treated with surgery and postoperative RT.
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Affiliation(s)
- William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Anne W M Lee
- Department of Clinical Oncology, University of Hong Kong Shenzhen Hospital, University of Hong Kong, Hong Kong, China
| | | | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Wai Tong Ng
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, New South Wales, Australia
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Heng Y, Zhu X, Zhou L, Zhang M, Zhou H, Tao L. The presence of risk factors and corresponding treatment strategies post-surgical resection in stage IV hypopharyngeal squamous cell carcinoma patients: a retrospective cohort study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:189. [PMID: 32309336 PMCID: PMC7154423 DOI: 10.21037/atm.2020.01.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background This study aims to explore the adverse features and determine whether adjuvant chemoradiation after surgical resection can benefit stage IV hypopharyngeal squamous cell carcinoma (HSCC) patients. Methods We conducted a retrospective review covering 267 patients with stage IV HSCC. Propensity score-matched analysis was employed to reduce selection bias. Results T3–T4 or N2c–N3 stage, positive surgical margin, extracapsular spread and lymphovascular invasion were adverse features for overall survival (OS) in stage IV HSCC patients. For patients possessing these adverse features, those who received postoperative adjuvant treatment (PAT) had significantly better OS and recurrence-free survival (RFS) than patients who did not (P value =0.000 and 0.007, respectively). In addition, adjuvant chemoradiation demonstrated better OS and RFS compared to adjuvant radiation (P value =0.030 and 0.017, respectively). However, PAT showed no significant impact on OS and RFS (P value =0.776 and 0.847, respectively) in patients without adverse features. Conclusions Adjuvant treatments are recommended for stage IV HSCC patients that possess adverse features of pT3 and pT4 stages, N2c and N3 stages, positive surgical margin, extracapsular spread and lymphovascular invasion. For these patients, postoperative adjuvant chemoradiotherapy (CRT) is preferred. For patients without adverse features, observation and regular re-examination is sufficient post tumour resection.
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Affiliation(s)
- Yu Heng
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai 200031, China
| | - Xiaoke Zhu
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai 200031, China
| | - Liang Zhou
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai 200031, China
| | - Ming Zhang
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai 200031, China
| | - Hong Zhou
- Department of Otolaryngology, Fudan University Pudong Medical Center, Shanghai 200031, China
| | - Lei Tao
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai 200031, China
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Kadletz L, Kenner L, Wiebringhaus R, Jank B, Mayer C, Gurnhofer E, Konrad S, Heiduschka G. Evaluation of the cancer stem cell marker DCLK1 in patients with lymph node metastases of head and neck cancer. Pathol Res Pract 2019; 215:152698. [PMID: 31706685 DOI: 10.1016/j.prp.2019.152698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Lymph node metastases are frequently detected in head and neck squamous cell carcinoma (HNSCC) patients. Little is known about biomarkers expressed in lymph node metastases or their influence on clinical outcome. Doublecortin-like kinase 1 (DCLK1) is one marker that might be associated with outcome, owing to its correlation with stem cell-like characteristics. METHODS We assessed the expression of DCLK1 in 74 postoperatively irradiated patients in histologically confirmed HNSCC lymph node metastases. Statistical analysis of the association with DCLK1 on clinical outcomes was performed. RESULTS DCLK1 was expressed in 63.5% of our patient cohort. DCLK1(+) HNSCC patients, compared with those without DCLK1 expression, showed a significantly poorer time to recurrence. Moreover, we observed a significantly poorer time to recurrence in HPV(-) HNSCC patients, and significantly shorter overall and disease-free survival rates in HPV(-) oropharyngeal cancer patients, compared with HPV(+) patients with these cancers. HPV(+) patients showed no significant differences in survival time according to DCLK1 expression. However, recurrent disease occurred in only DCLK1(+) patients. Mulitivariate analysis showed that DCLK1 expression in lymph node metastases is an independent marker for recurrence. CONCLUSION DCLK1 expression might be associated with poorer clinical outcomes in HNSCC patients, specifically in HPV(-) move patients. However, larger studies are required to verify our results.
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Affiliation(s)
- Lorenz Kadletz
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria.
| | - Lukas Kenner
- Institute of Pathology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria; Department of Experimental Pathology and Laboratory Animal Pathology, University of Veterinary Medicine, Vienna, Austria.
| | | | - Bernhard Jank
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Christina Mayer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Stefan Konrad
- Department of Radiotherapy and -Oncology, Medical University of Vienna, Vienna, Austria
| | - Gregor Heiduschka
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
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Zhou J, Zhou L, Tao L, Zhang M, Wu H, Chen X, Li X, Li C, Gong H. Oncological outcomes of surgical treatment for T3 supraglottic laryngeal squamous cell carcinoma patients. Acta Otolaryngol 2018; 138:1028-1034. [PMID: 30735065 DOI: 10.1080/00016489.2018.1490031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND T3 supraglottic laryngeal carcinoma (LC) is a common advanced laryngeal cancer. OBJECTIVE This study was conducted to assess the clinical results of pathological T3 (pT3) supraglottic LC patients who were amenable to laryngectomy treated with primary surgery and postoperative therapy. METHODS Retrospective review of 202 pT3 cases of supraglottic laryngeal squamous cell carcinoma. RESULTS The five-year cancer specific survival (CSS) rate was 63.7% and the overall survival rate (OS) was 62.8%. For T3 supraglottic patients who underwent total laryngectomy, the five-year disease-free survival (DFS) was 51.8%, and the CSS was 62.5%. For patients who underwent partial laryngectomy, the five-year DFS was 72.2%, and the CSS was 79.0%. High lymph node and stage status are predictors of mortality for these patients. No difference was found in the DFS and CSS rates between patients with negative margins and those with positive margins following postoperative radiotherapy and chemotherapy. CONCLUSION Surgical treatment of T3 supraglottic LC patients achieved satisfactory results. Postoperative radiotherapy and chemotherapy are an effective method of treatment for T3 supraglottic LC patients, especially for those with a positive margin.
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Affiliation(s)
- Jian Zhou
- Department of Otorhinolaryngology, Fudan University, Eye Ear Nose and Throat Hospital, Shanghai, China
| | - Liang Zhou
- Department of Otolaryngology, Fudan University, Eye, Ear, Nose and Throat Hospital, Shanghai, China
| | - Lei Tao
- Department of Otorhinolaryngology, Fudan University, Eye Ear Nose and Throat Hospital, Shanghai, China
| | - Ming Zhang
- Department of Otolaryngology-Head and Neck Surgery, Fudan University affiliated Eye, Ear, Nose and Throat Hospital, Shanghai, China
| | - Haitao Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Xiaoling Chen
- Department of Otorhinolaryngology, Fudan University, Eye Ear Nose and Throat Hospital, Shanghai, China
| | - Xiaoming Li
- Department of Otorhinolaryngology, Fudan University, Eye Ear Nose and Throat Hospital, Shanghai, China
| | - Cai Li
- Department of Otolaryngology-Head and Neck Surgery, Fudan University affiliated Eye, Ear, Nose and Throat Hospital, Shanghai, China
| | - Hongli Gong
- Department of Otorhinolaryngology, Fudan University, Eye Ear Nose and Throat Hospital, Shanghai, China
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Zhou J, Zhou L, Tao L, Zhang M, Wu H, Chen X, Li X, Li C, Gong H. Oncologic outcomes of surgical treatment for T3 glottic laryngeal squamous cell carcinoma. Head Neck 2018; 40:1734-1742. [PMID: 29601122 DOI: 10.1002/hed.25144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/01/2017] [Accepted: 02/05/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the clinical results of patients with T3 glottic laryngeal carcinoma treated with total laryngectomy or partial laryngectomy. METHODS We conducted a retrospectively review of 307 patients with T3 glottic laryngeal squamous cell carcinoma (SCC). RESULTS The 5-year cancer-specific survival (CSS) rate was 71.5% and the overall survival (OS) rate was 70.6%. For patients who underwent total laryngectomy, the 5-year disease-free survival (DFS) rate was 59.8%, and the CSS rate was 67.9%. For partial laryngectomy, the 5-year DFS rate was 64.8%, and the CSS rate was 78.0%. High lymph node and stage status are predictors of mortality for these patients. No difference was found in DFS and CSS rates between patients with negative margins and those with positive margins after postoperative radiotherapy and chemotherapy. CONCLUSION Postoperative radiotherapy and chemotherapy are effective treatments for patients with T3 glottic laryngeal carcinoma, especially with a positive margin. For selected patients with T3 glottic laryngeal carcinoma, partial laryngectomy is a good choice because it can achieve satisfactory oncologic results while preserving laryngeal function.
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Affiliation(s)
- Jian Zhou
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Liang Zhou
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Lei Tao
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Ming Zhang
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Haitao Wu
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Xiaoling Chen
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Xiaoming Li
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Cai Li
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Hongli Gong
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
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Kadletz L, Heiduschka G, Wolf A, Haug-Lettenbichler A, Poyntner L, Primosch T, Rogatsch H, Formanek M, Stadler M, Kenner L, Eckel HE, Brunner M. Effect of postoperative radiotherapy in pT1pN1cM0 and pT2p/cN0cM0 oropharyngeal squamous cell carcinoma. Laryngoscope 2017; 128:1075-1082. [DOI: 10.1002/lary.26815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/23/2017] [Accepted: 06/30/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Lorenz Kadletz
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| | - Gregor Heiduschka
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| | - Axel Wolf
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical University of Graz; Graz Austria
| | - Anna Haug-Lettenbichler
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical University of Innsbruck; Innsbruck Austria
| | - Lukas Poyntner
- Department of Otorhinolaryngology; Hospital Feldkirch; Feldkirch Austria
| | - Thomas Primosch
- Department of Otorhinolaryngology; Klinikum Klagenfurt; Klagenfurt Austria
| | | | - Michael Formanek
- Department of Otorhinolaryngology, Hospital of St. John of God, Department of Otolaryngology and Phonetics; Sigmund Freud University, Medical School; Vienna Austria
| | - Matthias Stadler
- Department of Otorhinolaryngology; Hospital Barmherzige Schwestern; Linz Austria
| | - Lukas Kenner
- Institute of Pathology; Medical University of Vienna; Vienna Austria
| | - Hans E. Eckel
- Department of Otorhinolaryngology; Klinikum Klagenfurt; Klagenfurt Austria
| | - Markus Brunner
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical University of Vienna; Vienna Austria
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Clinical and histopathological prognostic factors in locoregional advanced laryngeal cancer. The Journal of Laryngology & Otology 2016; 130:948-953. [DOI: 10.1017/s002221511600880x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To evaluate the clinical and histopathological factors affecting the prognosis of patients with squamous cell locoregional advanced laryngeal cancer.Methods:A retrospective chart review was conducted of 121 patients with locoregional advanced laryngeal cancer, primarily treated with surgery from 2007 to 2011. Disease-free survival and overall survival rates were analysed as oncological outcomes. Prognostic variables, namely gender, pharyngeal invasion, pathological assessment of tumour and nodal stage, adjuvant therapy, margin status, nodal extracapsular extension, tumour differentiation, lymphovascular and perineural invasion, and predominant growth pattern, were also analysed.Results:One-year and three-year disease-free survival rates were 81.3 per cent and 63.5 per cent, respectively. One-year and three-year overall survival rates were 88.3 per cent and 61.4 per cent, respectively. Multivariate analysis showed that nodal extracapsular extension (p < 0.05) and an infiltrative growth pattern (p < 0.05) were associated with disease progression. Nodal extracapsular extension (p < 0.05) was associated with higher mortality.Conclusion:Nodal extracapsular extension and an infiltrative growth pattern were the main prognostic factors in locoregional advanced laryngeal cancer. The presence of pharyngeal invasion, pathologically confirmed node-positive stage 2–3 disease, close or microscopic positive margins, and lymphovascular and perineural invasion have a negative impact on prognosis.
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Iizuka Y, Yoshimura M, Inokuchi H, Matsuo Y, Nakamura A, Mizowaki T, Hirano S, Kitamura M, Tateya I, Hiraoka M. Recurrence patterns after postoperative radiotherapy for squamous cell carcinoma of the pharynx and larynx. Acta Otolaryngol 2015; 135:96-102. [PMID: 25351439 DOI: 10.3109/00016489.2014.949848] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
CONCLUSIONS Distant metastasis was a major pattern of recurrence after postoperative radiotherapy (PORT) for squamous cell carcinoma (SCC) of the oropharynx, hypopharynx, and larynx. PORT provided good loco-regional control, with tolerable toxicities. Advanced pT and pN were unfavorable prognostic factors. OBJECTIVE To determine the clinical outcomes, and the patterns and risk factors for recurrence of SCCs of the oropharynx, hypopharynx, and larynx treated with surgery and PORT. METHODS We retrospectively reviewed 84 patients who received PORT after definitive surgery for SCC of the oropharynx, hypopharynx, or larynx between 2000 and 2010. The primary sites were the oropharynx in 25 patients, hypopharynx in 47 patients, and larynx in 12 patients. RESULTS The 3-year overall survival (OS), progression-free survival (PFS), and loco-regional control (LRC) rates were 64.9%, 56.7%, and 92.1%, respectively. Recurrences were observed in 27 patients: 6 patients had loco-regional recurrence and 23 patients developed distant metastasis. On multivariate analysis, pT4 and pN2c-N3 displayed significantly worse effects on OS (p = 0.02 and p < 0.01, respectively) and PFS (p = 0.02 and p < 0.001, respectively). In the acute phase, 12 patients experienced grade 3 or 4 toxicities. There were no grade 5 toxicities. Late grade 3 toxicity developed in six patients and no grade 4 or 5 toxicities were observed.
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Affiliation(s)
- Yusuke Iizuka
- Departments of Radiation Oncology and Image-applied Therapy
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Skóra T, Nowak-Sadzikowska J, Mucha-Małecka A, Szyszka-Charewicz B, Jakubowicz J, Gliński B. Postoperative irradiation in patients with pT3-4N0 laryngeal cancer: results and prognostic factors. Eur Arch Otorhinolaryngol 2014; 272:673-9. [PMID: 25432639 PMCID: PMC4335092 DOI: 10.1007/s00405-014-3333-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 10/11/2014] [Indexed: 11/04/2022]
Abstract
Approximately 60 % of patients with locally advanced laryngeal cancer (LALC) treated primarily with surgery require adjuvant radiotherapy. In the available literature predominate series of patients were with pathologically confirmed node-positive status. Subgroups of pN0 patients with LALC are scarce. The aim of the study is to evaluate the efficacy of postoperative radiotherapy in patients with pathological stage T3-4N0M0 and identification of prognostic factors in this group. Between 1975 and 2005, 138 patients with squamous pT3-4N0 laryngeal cancer were irradiated postoperatively. Primary surgical treatment consisted of total laryngectomy and cervical lymphadenectomy. The median time between surgery and the implementation of radiotherapy was 56 days. The median total dose was 60 Gy (range 40–70 Gy). Five-year disease-free survival (DFS5) was achieved in 76 % of patients. Cancer recurrence was observed in 34 patients. In 28 (82 %) cases it was locoregional failure. DFS5 rates for pT3 and pT4 were 92 and 69 %, for margin status R0, R1 and R2 were 82, 72 and 67 %, respectively. The pharyngeal invasion was related to a decrease in DFS5 from 80 to 59 %. Postoperative irradiation in patients with pT3-4N0 LALC is an effective treatment method. The main reason of the failure is local recurrence. The following independent prognostic factors were identified in this group of patients: pT stage, surgical margin status and pharyngeal invasion.
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Affiliation(s)
- Tomasz Skóra
- Oncology Department, Maria Skłodowska-Curie Memorial Institute of Oncology, ul. Garncarska 11, 31-115, Kraków, Poland,
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Song M, Chen SW, Zhang Q, Yang AK, Zhuang SM, Wang LP, Chen WK, Guo ZM. External monitoring of buried radial forearm free flaps in hypopharyngeal reconstruction. Acta Otolaryngol 2011; 131:204-9. [PMID: 21034173 DOI: 10.3109/00016489.2010.518157] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The radial forearm free flap (RFFF) is one of the optimal choices for hypopharyngeal reconstruction. Our series demonstrates that the technique of an indicator flap for the monitoring of the buried flap is simple, reliable, and inexpensive. The condition of the indicator flap can be easily interpreted by the physicians and the nursing staff. Therefore, the success rate of this microsurgical reconstruction may be improved. OBJECTIVES The RFFF is increasingly applied in reconstruction of the hypopharynx after radical resection for advanced hypopharyngeal cancer. However, postoperative monitoring of the buried free flap is extremely difficult. We designed a small external component as an indicator flap to monitor the perfusion of the buried vascular pedicle. METHODS Eight consecutive patients with hypopharyngeal cancer underwent radical surgery and hypopharyngeal reconstruction using RFFF at the Sun Yat-sen University Cancer Center between January 2005 and January 2007. The indicator flap was sutured to the surface of the neck for postoperative monitoring. RESULTS All of the indicator flaps remained viable. One patient experienced vascular compromise and was successfully salvaged. The success rate of the buried flaps was 100%. Pharyngocutaneous fistula occurred in one patient. All patients resumed an oral diet eventually.
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Affiliation(s)
- Ming Song
- Department of Head and Neck Surgery and State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
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Supracricoid laryngectomy: oncologic validity and functional safety. Eur Arch Otorhinolaryngol 2010; 267:1919-25. [PMID: 20490818 DOI: 10.1007/s00405-010-1279-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 05/05/2010] [Indexed: 10/19/2022]
Abstract
The objectives of this study are to elucidate the oncologic validity of the supracricoid laryngectomy (SCL) for locally advanced endolaryngeal cancers and as a salvage procedure, and to determine its safety in maintaining laryngeal physiology. The medical records of 114 patients that underwent SCL were reviewed. We examined whether the extended procedures, salvage procedure, adjuvant treatment, and type of reconstruction were associated with patient survival and the mean time of decannulation and nasogastric tube removal. Postoperative complications were investigated. There was no significant difference in survival according to the extent of the resection of the primary tumors and the presence or absence of previous treatment. However, the survival of patients that received radiation or concurrent chemoradiation after SCL was significantly lower than that of patients without any adjuvant treatment. Decannulation and nasogastric tube removal was possible for all except for two patients, and the mean time required was 18.4 and 26.1 days, respectively. The interval to starting oral feeding was significantly increased in cases that underwent cricohyoidopexy, an extended procedure, and salvage surgery compared to their counterparts. Pulmonary complications, particularly aspiration pneumonia, were the most common postoperative complications. The results of this study suggest that SCL was feasible for locally advanced laryngeal cancers and as a salvage procedure. Active and effective postoperative swallowing rehabilitation, particularly in cases that underwent cricohyoidopexy, an extended procedure, and salvage surgery, is needed to prevent aspiration pneumonia.
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Wang R, Li B, Wang X, Lin F, Gao P, Cheng SY, Zhang HZ. Inhibiting XIAP expression by RNAi to inhibit proliferation and enhance radiosensitivity in laryngeal cancer cell line. Auris Nasus Larynx 2008; 36:332-9. [PMID: 19013033 DOI: 10.1016/j.anl.2008.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 07/31/2008] [Accepted: 08/13/2008] [Indexed: 12/27/2022]
Abstract
OBJECTIVES X-linked inhibitor of apoptosis protein (XIAP) is a novel member of the inhibitors of apoptosis (IAPs) family. The overexpression of XIAP is asscociated with radioresistance of human malignancies. The purpose of the present study was to investigate the effect of shRNA-targeted XIAP on the proliferation, apoptosis and radiosensitivity of human laryngeal carcinoma cells (Hep-2). METHODS A siRNA expression vector (pSilencer4.1-XIAPshRNA) was constructed and stably transfected into human laryngeal carcinoma cells (Hep-2). The downregulation of XIAP expression was evaluated by RT-PCR and Western blot analyses. Then, we investigated the effect of XIAP-shRNA on the proliferation, cell cycle changes and apoptosis in vitro of Hep-2 cells. Finally, the radiosensitivity of Hep-2 cells was investigated by clonogenic cell survival assay. RESULTS We established stably transfected cell line (Hep-2/XIAPshRNA) in which the expression of XIAP gene was downregulated. The cell viability of Hep-2/XIAP-RNA cells was obviously decreased compared with that of untransfected Hep-2 cells. Morever, XIAP-shRNA induced cell arrest in the G(0)/G(1) phase of cell cycle by flow cytometry analysis. Results of TUNEL assay indicated that Hep-2 cells stably transfected pSilencer4.1-XIAP-shRNA showed obvious apoptosis characters. Furthermore, the downregulation of XIAP expression could lead to significant radiosensitivity enhancement in laryngeal carcinoma cells. CONCLUSIONS RNAi-mediated downregulation of XIAP expression can inhibit proliferation, induce apoptosis and diminish the radioresistance of laryngeal carcinoma cells, so combined therapy with XIAP inhibition and radiation may be a potential strategy for the treatment of laryngeal carcinoma.
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Affiliation(s)
- Rui Wang
- Clinical Laboratory Department, Tangdu Hospital, Fourth Military Medical University, Xinsi Road, 710038 Xi'an, Shaanxi Province, PR China
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Cabanillas R, Llorente JL. The Stem Cell Network model: clinical implications in cancer. Eur Arch Otorhinolaryngol 2008; 266:161-70. [DOI: 10.1007/s00405-008-0809-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Accepted: 09/03/2008] [Indexed: 01/22/2023]
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Ferreiro-Argüelles C, Jiménez-Juan L, Martínez-Salazar JM, Cervera-Rodilla JL, Martínez-Pérez MM, Cubero-Carralero J, González-Cabestreros S, López-Pino MA, Fernández-Gallardo JM. CT Findings after Laryngectomy. Radiographics 2008; 28:869-82; quiz 914. [DOI: 10.1148/rg.283075091] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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