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Eckel HNC, Nolte A, Otte MS, Shabli S, Lang-Roth R, Klußmann JP, Hansen KK. 3D-exoscopic microlaryngoscopy in phonosurgery for glottic insufficiency. Eur Arch Otorhinolaryngol 2024; 281:855-861. [PMID: 38105362 PMCID: PMC10796486 DOI: 10.1007/s00405-023-08345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE We hypothesized that using a 3D-exoscope (3Dex) in microlaryngoscopic phonosurgery is non-inferior to using a standard operating microscope (OM). To compare the above, we utilized a 3Dex and an OM for microlaryngoscopic vocal fold augmentation with autologous fat in patients with glottic insufficiency and compared the procedure itself and the long-term impact of vocal fold augmentation on subjective and objective voice parameters in both groups. METHODS 36 patients with glottic insufficiency received microlaryngoscopic laryngeal augmentation with autologous fat. A 3Dex was utilized in 24 cases for visualization and compared to twelve cases in which an OM was used. Voice parameters were evaluated over a period of twelve months. RESULTS Comparison of operation time and voice parameters between the 3Dex and OM groups did not reveal significant differences. Significant improvement of mean voice quality in all parameters excluding roughness was observed at 3 and 6 months followed then by a slight decrease of voice quality parameters between the 6 and 12 months interval in both groups. CONCLUSION Our findings indicate no difference concerning operation time and outcome between the use of a 3Dex and an OM in phonosurgery. Our results highlight a significant voice improvement after vocal fold augmentation with autologous fat in glottic insufficiency mediated dysphonia. The smaller viewing system, better ergonomics for the primary surgeon and the assistant and a direct view for the entire surgical team make a 3Dex an interesting alternative for visualization in microlaryngoscopic phonosurgery.
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Affiliation(s)
- Hans N C Eckel
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany.
| | - Antonia Nolte
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Martin S Otte
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Sami Shabli
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Ruth Lang-Roth
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Jens P Klußmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Kevin K Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
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Ahmadi N, Stone D, Stokan M, Coleman H, Heller G, Smith M, Riffat F, Kudpaje A, Veness M, Palme CE. Treatment of Early Glottic cancer with Transoral Laser Microsurgery: An Australian Experience. Indian J Otolaryngol Head Neck Surg 2023; 75:661-667. [PMID: 37274960 PMCID: PMC10235397 DOI: 10.1007/s12070-022-03392-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/07/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction Early laryngeal carcinomas may be treated by transoral laser microsurgery (TLM) or external beam radiotherapy. We review our experience of surgical treatment of laryngeal pre-malignant and malignant lesions over the past 15 years in a high-volume head neck unit. Methods A review of a prospective patient database of patients with laryngeal SCC, who were treated with CO2 TLM between 2004 and 2019 was carried out. Results 83 patients with a mean age of 67.7 (SD: 10.6) years underwent primary curative TLM for T1a/b SCC. 5-year overall survival was 93.2% (95%CI 86.9-100%), disease free survival was 86.0% (95%CI 78.1-94.6%), locoregional control was 91.2% (95%CI: 85.1-97.7%) and larynx preservation rate of 95.1% at 5 years. Conclusion TLM is an excellent treatment modality for T1 early glottic SCC, with excellent locoregional control and disease-free survival. It is minimally invasive, outpatient-based, and cost-effective procedure preserving upper aerodigestive tract dysfunction for all activities of daily living.
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Affiliation(s)
- Navid Ahmadi
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW Australia
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW Australia
| | - Danielle Stone
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
| | - Murray Stokan
- Department of Anaesthetics, Westmead Hospital, Sydney, NSW Australia
| | - Hedley Coleman
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
- Douglass Hanly Moir Pathology, Sydney, NSW Australia
| | - Gillian Heller
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW Australia
| | - Mark Smith
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
| | - Faruque Riffat
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
| | - Akshay Kudpaje
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
- Cytecare Cancer Hospitals, Bangalore, India
| | - Michael Veness
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
- Sydney Medical School, University of Sydney, Sydney, NSW Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW Australia
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
- Sydney Medical School, University of Sydney, Sydney, NSW Australia
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Dorr MC, Sewnaik A, Andrinopoulou E, Berzenji D, Dronkers EAC, Bernard SE, Hoesseini A, Tans L, Rizopoulos D, Baatenburg de Jong RJ, Offerman MPJ. Longitudinal Patient-Reported Voice Quality in Early-Stage Glottic Cancer. Otolaryngol Head Neck Surg 2023; 168:1463-1471. [PMID: 36939474 DOI: 10.1002/ohn.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/18/2022] [Accepted: 12/24/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Patient-reported voice quality is an important outcome during counseling in early-stage glottic cancer. However, there is a paucity of adequate longitudinal studies concerning voice outcomes. This study aimed to investigate longitudinal trajectories for patient-reported voice quality and associated risk factors for treatment modalities such as transoral CO2 laser microsurgery, single vocal cord irradiation, and local radiotherapy. STUDY DESIGN A longitudinal observational cohort study. SETTING Tertiary cancer center. METHODS Patients treated for Tcis-T1b, N0M0 glottic cancer were included in this study (N = 294). The Voice Handicap Index was obtained at baseline and during follow-up (N = 1944). Mixed-effects models were used for investigating the different trajectories for patient-reported voice quality. RESULTS The mean follow-up duration was 43.4 (SD 21.5) months. Patients received transoral CO2 laser microsurgery (57.8%), single vocal cord irradiation (24.5%), or local radiotherapy (17.5%). A steeper improvement during the first year after treatment for single vocal cord irradiation (-15.7) and local radiotherapy (-12.4) was seen, compared with a more stable trajectory for laser surgery (-6.1). All treatment modalities showed equivalent outcomes during long-term follow-up. Associated risk factors for different longitudinal trajectories were age, tumor stage, and comorbidity. CONCLUSION Longitudinal patient-reported voice quality after treatment for early-stage glottic cancer is heterogeneous and nonlinear. Most improvement is seen during the first year of follow-up and differs between treatment modalities. No clinically significant differences in long-term trajectories were found. Insight into longitudinal trajectories can enhance individual patient counseling and provide the foundation for an individualized dynamic prediction model.
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Affiliation(s)
- Maarten C Dorr
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Elrozy Andrinopoulou
- Department of Biostatistics and Epidemiology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Diako Berzenji
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Emilie A C Dronkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Simone E Bernard
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arta Hoesseini
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lisa Tans
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics and Epidemiology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marinella P J Offerman
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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Bertholet J, Mackeprang PH, Mueller S, Guyer G, Loebner HA, Wyss Y, Frei D, Volken W, Elicin O, Aebersold DM, Fix MK, Manser P. Organ-at-risk sparing with dynamic trajectory radiotherapy for head and neck cancer: comparison with volumetric arc therapy on a publicly available library of cases. Radiat Oncol 2022; 17:122. [PMID: 35841098 PMCID: PMC9284789 DOI: 10.1186/s13014-022-02092-5] [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: 12/18/2021] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dynamic trajectory radiotherapy (DTRT) extends volumetric modulated arc therapy (VMAT) with dynamic table and collimator rotation during beam-on. The aim of the study is to establish DTRT path-finding strategies, demonstrate deliverability and dosimetric accuracy and compare DTRT to state-of-the-art VMAT for common head and neck (HN) cancer cases. Methods A publicly available library of seven HN cases was created on an anthropomorphic phantom with all relevant organs-at-risk (OARs) delineated. DTRT plans were generated with beam incidences minimizing fractional target/OAR volume overlap and compared to VMAT. Deliverability and dosimetric validation was carried out on the phantom. Results DTRT and VMAT had similar target coverage. For three locoregionally advanced oropharyngeal carcinomas and one adenoid cystic carcinoma, mean dose to the contralateral salivary glands, pharynx and oral cavity was reduced by 2.5, 1.7 and 3.1 Gy respectively on average with DTRT compared to VMAT. For a locally recurrent nasopharyngeal carcinoma, D0.03 cc to the ipsilateral optic nerve was above tolerance (54.0 Gy) for VMAT (54.8 Gy) but within tolerance for DTRT (53.3 Gy). For a laryngeal carcinoma, DTRT resulted in higher dose than VMAT to the pharynx and brachial plexus but lower dose to the upper oesophagus, thyroid gland and contralateral carotid artery. For a single vocal cord irradiation case, DTRT spared most OARs better than VMAT. All plans were delivered successfully on the phantom and dosimetric validation resulted in gamma passing rates of 93.9% and 95.8% (2%/2 mm criteria, 10% dose threshold). Conclusions This study provides a proof of principle of DTRT for common HN cases with plans that were deliverable on a C-arm linac with high accuracy. The comparison with VMAT indicates substantial OAR sparing could be achieved. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02092-5.
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Affiliation(s)
- Jenny Bertholet
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland.
| | - Paul-Henry Mackeprang
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Silvan Mueller
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Gian Guyer
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Hannes A Loebner
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Yanick Wyss
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland.,Department of Physics, ETH Zurich, Zurich, Switzerland
| | - Daniel Frei
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Werner Volken
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Olgun Elicin
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Daniel M Aebersold
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Michael K Fix
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Peter Manser
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
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Sjogren E, Hendriksma M, Piazza C, Hartl DM, Suarez C, Cohen O, de Bree R, Quer M, Poorten VV, Rodrigo JP, Civantos F, Genden E, Kowalski LP, Makitie A, Shaha A, Takes RP, Sanabria A, Guntinas-Lichius O, Rinaldo A, Ferlito A. Voice Outcome After Carbon Dioxide Transoral Laser Microsurgery for Glottic Cancer According to the European Laryngological Society Classification of Cordectomy Types - A Systematic Review. J Voice 2022:S0892-1997(22)00069-8. [PMID: 35422356 DOI: 10.1016/j.jvoice.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Voice outcome after carbon dioxide transoral laser microsurgery (CO2TOLMS) for glottic cancer is of prime importance. However, a comprehensive overview according to the European Laryngological Society (ELS) classification of cordectomies is still lacking. The aim of this systematic review is to summarize data on voice outcome associated with individual types of ELS glottic cordectomy after CO2TOLMS. MATERIALS AND METHODS A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The initial search identified 936 records of which 25 publications were then included. Voice outcome data (Voice Handicap Index [VHI] version 30, grade of dysphonia [G] and maximum phonation time [MPT]) were extracted per resection type. Weighted averages were calculated. RESULTS Data show a gradual increase in the VHI scores although they were still similar for all cordectomy types (range 14.2 to 21.5). The grade of dysphonia showed a gradual increase with increasing resection depth (range 1.0 to 1.9). There was a gradual decrease in the MPT (range 15.2 to 7.2). CONCLUSION Voice outcome is related to cordectomy type with mild dysphonia characterizing ELS type I, II and III cordectomies, while more extended cordectomies (ELS type IV, V and VI) result in moderate dysphonia and shortness of breath during phonation. The voice handicap experienced by patients is limited even in the more extended cordectomies.
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Affiliation(s)
- Elisabeth Sjogren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Martine Hendriksma
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Cesare Piazza
- Department of Otorhinolaryngology- Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Dana M Hartl
- Department of Otolaryngology Head and Neck Surgery, Institut Gustave Roussy and University Paris-Sud, Villejuif Cedex, France
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Oded Cohen
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Miquel Quer
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium; Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Juan Pablo Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA, University of Oviedo, Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Oviedo, Spain
| | - Francisco Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Eric Genden
- Ear, Nose, Throat / Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolarynglology Department, A C Camargo Cancer Center, and Head and Neck Surgery Department, University of São Paulo Medical School
| | - Antti Makitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia.; CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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6
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Survival and Larynx Preservation in Early Glottic Cancer: A Randomized Trial Comparing Laser Surgery and Radiation Therapy. Int J Radiat Oncol Biol Phys 2022; 113:96-100. [DOI: 10.1016/j.ijrobp.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/19/2021] [Accepted: 01/09/2022] [Indexed: 01/17/2023]
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Bahig H, Rosenthal DI, Nguyen-Tan FP, Fuller DC, Yuan Y, Hutcheson KA, Christopoulos A, Nichols AC, Fung K, Ballivy O, Filion E, Ng SP, Lambert L, Dorth J, Hu KS, Palma D. Vocal-cord Only vs. Complete Laryngeal radiation (VOCAL): a randomized multicentric Bayesian phase II trial. BMC Cancer 2021; 21:446. [PMID: 33888069 PMCID: PMC8061218 DOI: 10.1186/s12885-021-08195-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 04/14/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Radiotherapy, along with laser surgery, is considered a standard treatment option for patients with early glottic squamous cell cancer (SCC). Historically, patients have received complete larynx radiotherapy (CL-RT) due to fear of swallowing and respiratory laryngeal motion and this remains the standard approach in many academic institutions. Local control (LC) rates with CL-RT have been excellent, however this treatment can carry significant toxicities include adverse voice and swallowing outcomes, along with increased long-term risk of cerebrovascular morbidity. A recent retrospective study reported improved voice quality and similar local control outcomes with focused vocal cord radiotherapy (VC-RT) compared to CL-RT. There is currently no prospective evidence on the safety of VC-RT. The primary objective of this Bayesian Phase II trial is to compare the LC of VC-RT to that of CL-RT in patients with T1N0 glottic SCC. METHODS One hundred and fifty-five patients with T1a-b N0 SCC of the true vocal cords that are n ot candidate or declined laser surgery, will be randomized in a 1:3 ratio the control arm (CL-RT) and the experimental arm (VC-RT). Randomisation will be stratified by tumor stage (T1a/T1b) and by site (each site will be allowed to select one preferred radiation dose regimen, to be used in both arms). CL-RT volumes will correspond to the conventional RT volumes, with the planning target volume extending from the top of thyroid cartilage lamina superiorly to the bottom of the cricoid inferiorly. VC-RT volumes will include the involved vocal cord(s) and a margin accounting for respiration and set-up uncertainty. The primary endpoint will be LC at 2-years, while secondary endpoints will include patient-reported outcomes (voice impairment, dysphagia and symptom burden), acute and late toxicity radiation-induced toxicity, overall survival, progression free survival, as well as an optional component of acoustic and objective measures of voice analysis using the Consensus Auditory-Perceptual Evaluation of Voice. DISCUSSION This study would constitute the first prospective evidence on the efficacy and safety of VC-RT in early glottic cancer. If positive, this study would result in the adoption of VC-RT as standard approach in early glottic cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03759431 Registration date: November 30, 2018.
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Affiliation(s)
- Houda Bahig
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - David I. Rosenthal
- grid.240145.60000 0001 2291 4776Radiation Oncology Department, University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030 USA
| | - Félix-Phuc Nguyen-Tan
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - David C. Fuller
- grid.240145.60000 0001 2291 4776Radiation Oncology Department, University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030 USA
| | - Ying Yuan
- grid.240145.60000 0001 2291 4776Biostatistics Department, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Katherine A. Hutcheson
- grid.240145.60000 0001 2291 4776Head and Neck Surgery Department, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Apostolos Christopoulos
- grid.410559.c0000 0001 0743 2111Head and Neck Surgery Department, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
| | - Anthony C. Nichols
- grid.39381.300000 0004 1936 8884Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario Canada
| | - Kevin Fung
- grid.39381.300000 0004 1936 8884Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario Canada
| | - Olivier Ballivy
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - Edith Filion
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - Sweet Ping Ng
- grid.1055.10000000403978434Radiation Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Louise Lambert
- Radiation Oncology Department, Centre Intégré de Cancérologie de Laval, Laval, Canada
| | - Jennifer Dorth
- grid.67105.350000 0001 2164 3847Radiation Oncology Department, Case Western Reserve University, Cleveland, USA
| | - Kenneth S. Hu
- Radiation Oncology Department, NYU Langone Health, Newyork, USA
| | - David Palma
- grid.39381.300000 0004 1936 8884Radiation Oncology Department, Western University, London, Ontario Canada
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Convolutional Neural Network Classifies Pathological Voice Change in Laryngeal Cancer with High Accuracy. J Clin Med 2020; 9:jcm9113415. [PMID: 33113785 PMCID: PMC7692693 DOI: 10.3390/jcm9113415] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022] Open
Abstract
Voice changes may be the earliest signs in laryngeal cancer. We investigated whether automated voice signal analysis can be used to distinguish patients with laryngeal cancer from healthy subjects. We extracted features using the software package for speech analysis in phonetics (PRAAT) and calculated the Mel-frequency cepstral coefficients (MFCCs) from voice samples of a vowel sound of /a:/. The proposed method was tested with six algorithms: support vector machine (SVM), extreme gradient boosting (XGBoost), light gradient boosted machine (LGBM), artificial neural network (ANN), one-dimensional convolutional neural network (1D-CNN) and two-dimensional convolutional neural network (2D-CNN). Their performances were evaluated in terms of accuracy, sensitivity, and specificity. The result was compared with human performance. A total of four volunteers, two of whom were trained laryngologists, rated the same files. The 1D-CNN showed the highest accuracy of 85% and sensitivity and sensitivity and specificity levels of 78% and 93%. The two laryngologists achieved accuracy of 69.9% but sensitivity levels of 44%. Automated analysis of voice signals could differentiate subjects with laryngeal cancer from those of healthy subjects with higher diagnostic properties than those performed by the four volunteers.
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Chatelet F, Wagner I, Bizard A, Hans S, Chabolle F, Bach CA. Does advanced age affect treatment of early glottic carcinoma? Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:68-72. [PMID: 32654987 DOI: 10.1016/j.anorl.2020.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Early glottic carcinoma is currently managed by radiation therapy or endoscopic surgery. Both are effective in elderly patients, but their respective indications are poorly determined. The present study assessed our management of very elderly patients with early glottic carcinoma. MATERIAL AND METHODS A retrospective single-center study included all patients aged 75 years and older at diagnosis, treated by radiation therapy or endoscopic surgery with curative intent for T1 or T2 glottic carcinoma between 2004 and 2018. RESULTS Records of 33 patients (27 men and 6 women; mean age, 82.2 years (range, 76.1-93.1 years)) were reviewed. 24 patients received radiation therapy and 9 endoscopic resection. The only factor for choice of treatment was anterior commissure involvement. Overall survival was 87% at 2 years and 62% at 5 years. 19% of patients relapsed within 5 years and had to undergo further treatment. There were no treatment-related deaths. Radiation therapy was associated with more acute local complications, with two temporary treatment interruptions and one uncompleted treatment. Surgical treatment was more likely to result in dysphonia, found in 80% of cases. CONCLUSION Treatment of early glottic cancer in elderly subjects can consist in either radiotherapy or endoscopic surgery. Age should not affect management. Surgical treatment is shorter and better tolerated, although with poorer vocal outcome, and may be preferred in the most comorbid patients.
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Affiliation(s)
- F Chatelet
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Foch, 92150 Suresnes, France
| | - I Wagner
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Foch, 92150 Suresnes, France
| | - A Bizard
- Service de Gériatrie, Hôpital Foch, 92150 Suresnes, France
| | - S Hans
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Foch, 92150 Suresnes, France; Université de Versailles Saint-Quentin en Yvelines, UFR de Médecine Paris Ouest Saint-Quentin en Yvelines, Guyancourt 78280, France
| | - F Chabolle
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Foch, 92150 Suresnes, France; Université de Versailles Saint-Quentin en Yvelines, UFR de Médecine Paris Ouest Saint-Quentin en Yvelines, Guyancourt 78280, France
| | - C-A Bach
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Foch, 92150 Suresnes, France.
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Bozec A, Culié D, Poissonnet G, Dassonville O. Current role of primary surgical treatment in patients with head and neck squamous cell carcinoma. Curr Opin Oncol 2020; 31:138-145. [PMID: 30865132 DOI: 10.1097/cco.0000000000000531] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW The objective of this review article is to discuss the current role of surgery as the primary treatment modality in patients with head and neck squamous cell carcinoma (HNSCC). RECENT FINDINGS HNSCC represents one of the cancer locations where the primary treatment modality is the most under discussion. Indeed, the respective roles of primary surgical resection followed, as necessary, by adjuvant radiotherapy or definitive chemoradiotherapy remain controversial. The results of organ preservation trials and the drastic rise in the incidence of human papillomavirus-induced oropharyngeal tumors, which are known to be highly radiosensitive, have led to an increasing use of chemoradiation-based therapies in HNSCC patients. However, no chemoradiation-based protocol has shown better oncologic outcomes than radical primary surgery. Moreover, development of minimally invasive surgical techniques, such as transoral robotic surgery, and advances in head and neck microvascular reconstruction have considerably improved the clinical outcomes of the patients and have led to a reconsideration of the role of primary surgery in HNSCC patients. SUMMARY Surgery should be the primary treatment modality for most resectable oral cavity cancers and for T4a laryngeal/hypopharyngeal cancers. Primary surgery could also be the preferred modality of treatment for most early (T1-T2, N0) laryngeal and hypo/oropharyngeal carcinomas when this strategy offers an opportunity to reserve radiotherapy for a potential recurrence or second primary tumor. Primary surgery should also be considered in patients with locally advanced human papillomavirus-negative oropharyngeal carcinoma.
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Affiliation(s)
- Alexandre Bozec
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
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Park JJ, Won S. Voice Outcomes After Transoral Laser Microsurgery or Radiotherapy in Early Glottic Cancer: Factors to Consider. Clin Exp Otorhinolaryngol 2019; 12:233-234. [PMID: 31295992 PMCID: PMC6635711 DOI: 10.21053/ceo.2019.00787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/24/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jung Je Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Gyeongsang National University Hospital, Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - Seongjun Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Gyeongsang National University Hospital, Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Korea
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Naunheim MR, Garneau J, Park C, Carroll L, Goldberg L, Woo P. Voice Outcomes After Radiation for Early-Stage Laryngeal Cancer. J Voice 2019; 34:460-464. [PMID: 30611594 DOI: 10.1016/j.jvoice.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Radiation treatment for laryngeal cancer has been shown to cause tissue changes to the vocal folds, which can result in degradation of voice. Our objective in this study was to investigate changes in perceptual, acoustic, and patient-reported outcomes over an extended period of follow-up after radiation. DESIGN Retrospective review. METHODS All patients treated with radiation for early-stage laryngeal carcinoma (in situ, T1, or T2) by a single surgeon from 2011-2018 were reviewed. Demographics and treatment information were recorded. Only patients with at least two dates of follow-up with acoustic data (cepstral spectral index of dysphonia [CSID]) and patient-reported surveys (voice handicap index-10 [VHI-10]) were included. Voice samples were rated by two senior speech-language pathologists on the grade, roughness, breathiness, asthenia, and strain scale. RESULTS Of 115 patients with early-stage laryngeal cancer, 31 patients met inclusion criteria. The average follow-up from time of treatment was 9.6 years (range 3.0-20.3 years), and the average time in between the first and last voice recordings was 2.6 years (range 0.3-5.5 years). The lesions represented were carcinoma in situ (n = 4), T1 (n = 22), and T2 (n = 5). The VHI-10 scores worsened slightly (mean increase +0.27, median +1) from first to last measurements as did the CSID score (median increase +7.0, median +7.4), though neither reached statistical significance when correlated with time since radiation (P = 0.269 and P = 0.0850). Perceptual analysis as rated by two speech-language pathologists raters showed excellent inter-rater reliability (Cronbach's alpha = 0.84), with no significant change over time (mean +0.39, median, with P = 0.347). Grade, roughness, breathiness, asthenia, and strain, VHI-10, and CSID were all correlated (all pairwise comparisons P < 0.001). CONCLUSION Perceptual, acoustic, and patient-reported outcomes years after radiation for early-stage laryngeal cancer do not show voice degradation over time in this preliminary analysis. Further research with a larger cohort may elucidate voice changes in this population.
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Affiliation(s)
- Matthew R Naunheim
- Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
| | | | - Chris Park
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Peak Woo
- Icahn School of Medicine at Mount Sinai, New York, New York
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Locatello LG, Cannavicci A, Gallo O. Prognostic impact of initial treatment in surgically salvaged recurrences of early glottic cancer. Laryngoscope 2018; 129:2328-2333. [DOI: 10.1002/lary.27702] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2018] [Indexed: 12/15/2022]
Affiliation(s)
| | - Angelo Cannavicci
- Department of OtorhinolaryngologyCareggi University Hospital Florence Italy
| | - Oreste Gallo
- Department of OtorhinolaryngologyCareggi University Hospital Florence Italy
- Department of Surgery and Translational MedicineUniversity of Florence, all in Florence Italy
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