1
|
Ansarin M, Pietrobon G, Tagliabue M, Mossinelli C, Ruju F, Maffini F, Rocca MC, Alterio D, Simon C, Zorzi SF. Salvage transoral robotic surgery in recurrent oropharyngeal carcinoma: a single-center retrospective study. Eur Arch Otorhinolaryngol 2024; 281:3167-3177. [PMID: 38546850 DOI: 10.1007/s00405-024-08590-4] [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: 12/01/2023] [Accepted: 02/29/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE Salvage surgery is still the best therapeutic option for resectable recurrent oropharyngeal squamous cell carcinoma (rOPSCC). Transoral robotic surgery may potentially reduce the morbidity of standard open approaches. The aim of the study is to present oncological and functional outcomes of a monocentric experience in salvage transoral robotic surgery. METHODS We performed a single-center retrospective analysis of patients submitted to transoral robotic salvage surgery with or without neck dissection for cT1-3 rOPSCC. We investigated complication rate, survival outcomes (Overall Survival, Disease Specific Survival, Loco-Regional Recurrence Free Survival) and functional outcomes (tracheal tube and/or gastrostomy dependence). RESULTS Sixty-one patients were included in the analysis. No major complications or perioperative deaths were recorded. The estimated 2-year OS was 76.7%, DSS 81.8% and LRRFS 50.5%. In multivariable analysis rpT, PNI (perineural infiltration) and HPV-positivity were significantly associated with LRRFS (Hazard Ratios: T3 vs T1 6.43, PNI yes vs no 4.19, HPV+ yes vs no 2.63). At last follow up, 97% of patients were tracheal tube-free, while 93% were gastrostomy-free. CONCLUSION Transoral robotic salvage surgery is a successful treatment in selected patients affected by rOPSCC because it grants good oncologic and functional outcomes.
Collapse
Affiliation(s)
- Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Giacomo Pietrobon
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy.
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Chiara Mossinelli
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Francesca Ruju
- Division of Radiology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Fausto Maffini
- Division of Pathology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Maria Cossu Rocca
- Division of Medical Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Daniela Alterio
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Christian Simon
- Department of Otolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Stefano Filippo Zorzi
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| |
Collapse
|
2
|
Wotman M, Gold B, Takahashi M, Draper L, Posner M. Treatment of Recurrent and Metastatic HPV-Associated Squamous Cell Carcinoma. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00402-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
3
|
Chien PJ, Hung LT, Wang LW, Yang MH, Chu PY. Oncologic results and quality of life in patients with T3 glottic cancer after transoral laser microsurgery. Eur Arch Otorhinolaryngol 2021; 278:2983-2992. [PMID: 33403435 DOI: 10.1007/s00405-020-06445-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE CO2 transoral laser microsurgery (CO2 TOLMS) is an alternative approach to non-surgical organ preservation in selected T3 glottic squamous cell carcinoma (SCC). This study aimed to assess the oncologic results and quality of life (QOL) of patients with T3 glottic SCC after CO2 TOLMS. METHODS Of the 44 patients who underwent CO2 TOLMS, 38 underwent QOL evaluations. QOL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and head and neck module, Voice Handicap Index-30, and M. D. Anderson Dysphagia Inventory at least 6 months postoperatively. RESULTS The patients were predominantly male (98%), with a median age of 61 years. Cordectomy type included 1 type III, 4 type IV, 31 type V, and 8 type VI according to European Laryngological Society classification. Two patients (5%) had cervical lymph node metastasis and 21 patients (48%) underwent postoperative radiotherapy. With a mean follow-up of 65 months for all patients, 10 (23%) had tumor recurrence (9 local, 1 distant). After salvage surgery, four patients lived without disease, and the larynx was preserved in two. The 5-year local control and overall and disease-specific survival rates were 78%, 75%, and 84%, respectively. The overall laryngeal preservation rate was 82% (36/44). Most patients had satisfactory QOL. CONCLUSIONS In selected T3 glottic SCC cases, CO2 TOLMS can achieve favorable oncologic results and a satisfactory QOL.
Collapse
Affiliation(s)
- Pei-Ju Chien
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Li-Ting Hung
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Ling-Wei Wang
- Department of Oncology Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University, Taipei, Taiwan
| | - Muh-Hwa Yang
- Department of Oncology Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University, Taipei, Taiwan
| | - Pen-Yuan Chu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
| |
Collapse
|
4
|
Maruo T, Zenda S, Shinozaki T, Tomioka T, Okano W, Sakuraba M, Tahara M, Hayashi R. Comparison of salvage surgery for recurrent or residual head and neck squamous cell carcinoma. Jpn J Clin Oncol 2019; 50:288-295. [DOI: 10.1093/jjco/hyz176] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 07/24/2019] [Accepted: 10/29/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Concomitant chemoradiation therapy is a standard treatment for head and neck cancer. Thus, salvage surgery has become a necessary treatment. The aim of the study was to evaluate the results of salvage surgery by each site of the head and neck, especially the oropharynx, hypopharynx and larynx.
Methods
This was a retrospective, single-institute study. The primary endpoint was overall survival. Secondary endpoints were disease-free survival, the locoregional control rate after salvage surgery, the indication rate for salvage surgery, the reasons for contraindications to salvage surgery, the post-operative complication rate and the predictors of survival.
Results
Three-year overall survival after salvage surgery was 58.8% in the salvage surgery group and 8.59% in the other treatment group (P < 0.0001). Regarding overall survival and disease-free survival after salvage surgery, there was no difference among sites. Regarding locoregional control rate among sites, there was no significant difference. The oropharyngeal cancer group had the lowest rate of salvage primary resection. Surgical margin and local and regional recurrence or residual disease were predictors on univariate and multivariate analyses.
Conclusions
Salvage surgery is effective for recurrent or residual cases after concomitant chemoradiation therapy. For oropharyngeal cancer, local control is important, and for oropharyngeal cancer and hypopharyngeal cancer, distant metastasis is important.
Collapse
Affiliation(s)
- Takashi Maruo
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sadamoto Zenda
- Departments of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takeshi Shinozaki
- Departments of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toshifumi Tomioka
- Departments of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Wataru Okano
- Departments of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Minoru Sakuraba
- Department of Plastic and Reconstructive Surgery Iwate Medical University, Morioka, Japan
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ryuichi Hayashi
- Departments of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| |
Collapse
|
5
|
Peltenburg B, Driessen JP, Vasmel JE, Pameijer FA, Janssen LM, Terhaard CHJ, de Bree R, Philippens MEP. Pretreatment ADC is not a prognostic factor for local recurrences in head and neck squamous cell carcinoma when clinical T-stage is known. Eur Radiol 2019; 30:1228-1231. [PMID: 31529258 PMCID: PMC6957548 DOI: 10.1007/s00330-019-06426-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/26/2019] [Accepted: 08/14/2019] [Indexed: 11/24/2022]
Abstract
Objectives Pretreatment identification of radio-insensitive head and neck squamous cell carcinomas (HNSCC) would affect treatment modality selection. The apparent diffusion coefficient (ADC) of a tumor could be a predictor of local recurrence. However, little is known about its prognostic value next to known factors such as clinical T-stage. The aim of the present study is to determine the added value of pretreatment ADC to clinical T-stage as a prognostic factor for local recurrence. Methods This retrospective cohort study included 217 patients with HNSCC treated with (chemo)radiotherapy between April 2009 and December 2015. All patients underwent diffusion-weighted MRI prior to treatment. Median ADC values of all tumors were obtained using a semi-automatic delineation method. Univariate models containing ADC and T-stage were compared with a multivariable model containing both variables. Results Fifty-eight patients experienced a local recurrence within 3 years. On average, the ADC value in the group of patients with a recurrence was 1.01 versus 1.00 (10−3 mm2/s) in the group without a recurrence. Univariate analysis showed no significant association between tumor ADC and local recurrence within 3 years after (chemo)radiotherapy (p = 0.09). Cox regression showed that clinical T-stage was an independent predictor of local recurrence and adding ADC to the model did not increase its performance. Conclusion Pretreatment ADC has no added value as a prognostic factor for local recurrence to clinical T-stage. Key Points • Pretreatment identification of head and neck squamous cell carcinoma patients who do not benefit from (chemo)radiotherapy could improve personalized cancer care. • The apparent diffusion coefficient (ADC) obtained from diffusion-weighted MRI has been reported to be a prognostic factor for local recurrence. • In this study, ADC has no added value as a prognostic factor compared with clinical T-stage. Electronic supplementary material The online version of this article (10.1007/s00330-019-06426-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Boris Peltenburg
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. .,Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Juliette P Driessen
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeanine E Vasmel
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Frank A Pameijer
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luuk M Janssen
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chris H J Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marielle E P Philippens
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| |
Collapse
|
6
|
Elbers JBW, Veldhuis LI, Bhairosing PA, Smeele LE, Jóźwiak K, van den Brekel MWM, Verheij M, Al-Mamgani A, Zuur CL. Salvage surgery for advanced stage head and neck squamous cell carcinoma following radiotherapy or chemoradiation. Eur Arch Otorhinolaryngol 2019; 276:647-655. [PMID: 30673847 DOI: 10.1007/s00405-019-05292-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/12/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma (HNSCC) is known to result in poor prognosis. As there are only small and heterogeneous studies available with wide variety in outcome measures, our purpose was to select and pool literature according to specific criteria. METHODS Systematic review and meta-analysis of clinical outcome after salvage surgery for recurrent advanced stage HNSCC following primary radiotherapy or chemoradiation. RESULTS 16 of 3956 screened studies were included for analysis (729 patients). Pooled 5-year OS was 37% (95% CI 30-45%, 12 studies, 17 outcome measurements, 540 patients). Outcome was presented for larynx (6 studies, 397 patients), hypopharynx (2 studies, 47 patients), larynx and hypopharynx combined (3 studies, 69 patients) or separately (1 study, 134 patients), oral cavity (1 study, 11 patients), oropharynx (1 study, 34 patients) and multiple subsites combined (2 studies, 37 patients). There was no significant difference in survival outcome between subsites (pheterogeneity = 0.8116). The pooled tumor-positive resection margin rate was 32% and pooled re-operation rate 17%. Complication rates from the pooled data were: fistulas 33%, wound infections 24% and flap failure 3%. Treatment-related mortality rate was 1% and mean hospital stay was 23 days. CONCLUSIONS Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma after primary (chemo)radiotherapy is a good last resort curative treatment option, resulting in 37% overall survival at 5 years. As data from advanced stage non-laryngeal tumors were sparse, no solid conclusions can be drawn with regard to outcome differences between tumor subsites.
Collapse
Affiliation(s)
- Joris B W Elbers
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Lars I Veldhuis
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Patrick A Bhairosing
- Scientific Information Service, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral-Maxillofacial Surgery, AMC, Amsterdam, The Netherlands
| | - Katarzyna Jóźwiak
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral-Maxillofacial Surgery, AMC, Amsterdam, The Netherlands
| | - Marcel Verheij
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Charlotte L Zuur
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Department of Oral-Maxillofacial Surgery, AMC, Amsterdam, The Netherlands.
| |
Collapse
|
7
|
Steinbichler TB, Lichtenecker M, Anegg M, Dejaco D, Kofler B, Schartinger VH, Kasseroler MT, Forthuber B, Posch A, Riechelmann H. Persistent Head and Neck Cancer Following First-Line Treatment. Cancers (Basel) 2018; 10:cancers10110421. [PMID: 30400290 PMCID: PMC6265977 DOI: 10.3390/cancers10110421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 10/26/2018] [Accepted: 10/30/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Following first-line treatment of head and neck cancer (HNC), persistent disease may require second-line treatment. Methods: All patients with HNC treated between 2008 and 2016 were included. Second-line treatment modalities and survival of patients were analyzed. Results: After first-line therapy, 175/741 patients had persistent disease. Of these, 112 were considered eligible for second-line treatment. Second-line treatment resulted in 50% complete response. Median overall survival of patients receiving second-line therapy was 24 (95% CI: 19 to 29) months; otherwise survival was 10 (9 to 11; p < 0.0001) months. Patients receiving second-line surgery had a median overall survival of 45 (28 to 62) months, patients receiving second-line radiotherapy had a median overall survival of 37 (0 to 79; p = 0.17) months, and patients receiving systemic therapy had a median overall survival of 13 (10 to 16; p < 0.001) months. Patients with persistent HNC in the neck had a better median survival (45 months; 16 to 74 months; p = 0.001) than patients with persistence at other sites. Conclusion: Early treatment response evaluation allows early initiation of second-line treatment and offers selected patients with persistent disease a realistic chance to achieve complete response after all. If possible, surgery or radiotherapy are preferable.
Collapse
Affiliation(s)
- Teresa Bernadette Steinbichler
- Department of Otorhinolaryngology-Head & Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Madeleine Lichtenecker
- Department of Otorhinolaryngology-Head & Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Maria Anegg
- Department of Otorhinolaryngology-Head & Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Daniel Dejaco
- Department of Otorhinolaryngology-Head & Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Barbara Kofler
- Department of Otorhinolaryngology-Head & Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Volker Hans Schartinger
- Department of Otorhinolaryngology-Head & Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Maria-Therese Kasseroler
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Britta Forthuber
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Andrea Posch
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Herbert Riechelmann
- Department of Otorhinolaryngology-Head & Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| |
Collapse
|
8
|
Pantvaidya GH, Raina S, Mondal A, Deshmukh A, Nair D, Pai P, Chaturvedi P, D'Cruz A. Total laryngectomy: Surgical morbidity and outcomes - A case series. Indian J Cancer 2018; 54:621-625. [PMID: 30082546 DOI: 10.4103/ijc.ijc_463_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Total laryngectomy (TL) is a well-established procedure for laryngeal and hypopharyngeal cancers. There is an increasing number of TLs done after organ preservation strategies. AIM The aim of this study was to report 30-day morbidity and survival outcomes in patients undergoing TL at a tertiary referral center. SETTING AND DESIGN This was a retrospective review of a prospective database of TL patients operated during 2012-2013. MATERIALS AND METHODS Patient demographics and other data were captured from the database. Surgical complications were graded as per Clavien-Dindo grading system and were also divided into major and minor as per predecided criteria. Recurrence and survival data were computed using Kaplan-Meier survival curves. RESULTS A total of 169 patients underwent TL during the study period. About 34% of the patients had received prior radiation therapy. Around 18% of the patients had major complications with a pharyngocutaneous fistula rate of 22.4%. Ninety percent of these were managed conservatively. Though used in a small subset, microvascular reconstruction had the least complication rates. The 3-year disease-free survival and overall survival were 66% and 72%, respectively. There was no difference in survival between per primum and salvage surgery cohorts. CONCLUSION TL is a safe and oncologically sound procedure in patients with laryngeal and hypopharyngeal cancers. A large proportion of patients still undergo TL as a de novo procedure. This denotes that patients still present with locally advanced cancers which are not amenable to organ preservation.
Collapse
Affiliation(s)
- Gouri H Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sheetal Raina
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Arindam Mondal
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anuja Deshmukh
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Deepa Nair
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prathamesh Pai
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anil D'Cruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
9
|
Maruo T, Sakuraba M, Shinozaki T, Tomioka T, Okano W, Arahira S, Iino Y, Hayashi R. Swallowing disorder following salvage total pharyngo-laryngo-esophagectomy with free jejunum reconstruction. Oncol Lett 2018; 15:7355-7361. [PMID: 29731889 DOI: 10.3892/ol.2018.8213] [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: 10/18/2017] [Accepted: 01/25/2018] [Indexed: 11/05/2022] Open
Abstract
For recurrent cases or residual cases following concomitant chemo-radiation therapy (CCRT), salvage surgery is a frequently used treatment options. A swallowing disorder is one of the major complications of CCRT. The purpose of the present study was to evaluate the effect of CCRT on swallowing function in patients who underwent salvage total pharyngo-laryngo-esophagectomy (TPLE), and to evaluate the importance of pharyngeal constriction in patients who underwent TPLE. Between 2008 January and 2014 May, 54 patients were treated with salvage TPLE following CCRT or TPLE at the National Cancer Center Hospital East, Chiba, Japan and were included in the present study. A total of 14 patients underwent salvage TPLE following CCRT for recurrence or residual tumor (the salvage TPLE group), and 40 patients underwent TPLE as initial treatment (the TPLE group). The pharyngeal constriction score and the post-swallowing oropharyngeal residue rate were evaluated, and inadequate velopharyngeal closure was assessed by videofluorography. The pharyngeal constriction score of the salvage TPLE group was poorer than that of the TPLE group (P<0.05). The bolus residue in the oropharynx was significantly larger in the salvage TPLE group than in the TPLE group (P<0.05). With regards to inadequate velopharyngeal closure, there was no significant difference between the TPLE group and the salvage TPLE group (P>0.99). The results of the present study indicate that the swallowing function of patients who undergo salvage TPLE may be affected by CCRT.
Collapse
Affiliation(s)
- Takashi Maruo
- Department of Otorhinolaryngology, Nagoya University, Nagoya, Aichi 466-8550, Japan
| | - Minoru Sakuraba
- Department of Plastic Surgery, Iwate Medical School, Morioka, Iwate 020-8505, Japan
| | - Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Research Center Hospital East, Kashiwa, Chiba 277-0882, Japan
| | - Toshifumi Tomioka
- Department of Head and Neck Surgery, National Cancer Research Center Hospital East, Kashiwa, Chiba 277-0882, Japan
| | - Wataru Okano
- Department of Head and Neck Surgery, National Cancer Research Center Hospital East, Kashiwa, Chiba 277-0882, Japan
| | - Satoko Arahira
- Department of Radiation Oncology, National Cancer Research Center Hospital East, Kashiwa, Chiba 277-0882, Japan
| | - Yoshie Iino
- Department of Rehabilitation, National Cancer Research Center Hospital East, Kashiwa, Chiba 277-0882, Japan
| | - Ryuichi Hayashi
- Department of Head and Neck Surgery, National Cancer Research Center Hospital East, Kashiwa, Chiba 277-0882, Japan
| |
Collapse
|
10
|
Pujo K, Philouze P, Scalabre A, Céruse P, Poupart M, Buiret G. Salvage surgery for recurrence of laryngeal and hypopharyngeal squamous cell carcinoma: A retrospective study from 2005 to 2013. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:111-117. [DOI: 10.1016/j.anorl.2017.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
11
|
Kim KR, Shim HJ, Hwang JE, Cho SH, Chung IJ, Park KS, Kang SR, Kwon SY, Chung WK, Bae WK. The role of interim FDG PET-CT after induction chemotherapy as a predictor of concurrent chemoradiotherapy efficacy and prognosis for head and neck cancer. Eur J Nucl Med Mol Imaging 2017; 45:170-178. [PMID: 28940101 PMCID: PMC5745569 DOI: 10.1007/s00259-017-3836-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/14/2017] [Indexed: 02/06/2023]
Abstract
Purpose Induction chemotherapy (ICT) with docetaxel, cisplatin, and 5-fluorouracil (TPF) followed by concurrent chemoradiotherapy (CCRT) has the advantages of organ preservation and systemic control in head and neck cancer (HNC). Early prediction of CCRT efficacy may help identify patients who will benefit more from surgery than from CCRT. We investigated the role of interim 18-fluoro-2-deoxy-glucose positron emission tomography computed tomography (FDG PET-CT) after ICT to predict the efficacy of CCRT and clinical outcomes. Methods Tumor responses were retrospectively reviewed after CCRT based on the Response Evaluation Criteria in Solid Tumors. FDG PET-CT imaging was performed before and after three cycles of TPF. We examined the associations between the metabolic response (percentage decrease in the maximum standardized uptake value [SUVmax] and total metabolic tumor volume [MTV]) after ICT and complete response (CR) to CCRT, progression-free survival (PFS), and overall survival (OS). Results We studied 43 HNC patients with a median follow-up of 32.7 months. Lymph node (LN) SUVmax and total MTV decreases from baseline after ICT were greater in patients with a CR to CCRT than in non-CR patients (LN SUVmax, 88.8% vs. 62.5%, respectively; total MTV, 99.7% vs. 89.9%, respectively). Decreases in total MTV ≥ 78% and LN SUVmax ≥73% after ICT predicted CR to CCRT and longer OS and PFS. Conclusions Using interim FDG PET-CT to measure SUVmax and total MTV after three cycles of ICT may be a useful technique for identifying HNC patients who will benefit from CCRT and predicting survival outcomes. Electronic supplementary material The online version of this article (10.1007/s00259-017-3836-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ka-Rham Kim
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyun-Jeong Shim
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jun-Eul Hwang
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sang-Hee Cho
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ik-Joo Chung
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ki Seong Park
- Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sae-Ryung Kang
- Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Woong-Ki Chung
- Department of Radiation-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Woo Kyun Bae
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea. .,Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 58128, Republic of Korea.
| |
Collapse
|
12
|
Survival outcomes following salvage surgery for oropharyngeal squamous cell carcinoma: systematic review. The Journal of Laryngology & Otology 2017; 132:299-313. [DOI: 10.1017/s0022215117000998] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractBackground:Recurrent oropharyngeal squamous cell carcinoma causes great morbidity and mortality. This systematic review analyses survival outcomes following salvage surgery for recurrent oropharyngeal squamous cell carcinoma.Methods:A comprehensive search of various electronic databases was conducted. Studies included patients with recurrent or residual oropharyngeal squamous cell carcinoma treated with salvage surgery. Primary outcomes were survival rates following salvage surgery. Secondary outcomes included time to recurrence, staging at time of recurrence, post-operative complications, and factors associated with mortality and recurrence. Methodological appraisal and data extraction were conducted as per Joanna Briggs Institute methodology.Results:Eighteen articles were included. The two- and five-year survival rates of the patients were 52 per cent and 30 per cent respectively.Conclusion:Improvements in treatment modalities for recurrent oropharyngeal squamous cell carcinoma were associated with improvements in two-year overall survival rates, with minimal change to five-year overall survival rates. Various factors were identified as being associated with long-term overall survival, thus assisting clinicians in patient counselling and selection for salvage surgery.
Collapse
|
13
|
Cesium-131 brachytherapy in high risk and recurrent head and neck cancers: first report of long-term outcomes. J Contemp Brachytherapy 2015; 7:445-52. [PMID: 26816501 PMCID: PMC4716131 DOI: 10.5114/jcb.2015.56764] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/14/2015] [Indexed: 01/29/2023] Open
Abstract
Purpose The feasibility and efficacy of re-irradiation using contemporary radiation techniques to treat recurrent head and neck cancer has been demonstrated but the role of brachytherapy is unclear. Here we describe the use of 131Cs brachytherapy with concurrent salvage surgery in 18 patients. Material and methods Eligible patients underwent maximal gross resection of the tumor with implantation of brachytherapy seeds delivering a minimum dose of 80 Gy to the tumor bed. Rates of overall survival, locoregional progression free survival, disease-free survival, and radiation-induced toxicity were analyzed. Results Retrospective Kaplan-Meier analysis shows median overall survival was 15 months and disease free survival was 12 months. Two patients developed grade 3 toxicity; all other complications were grade 1-2 with no grade 4 or 5 complications. Conclusions Compared to prior literature, our study shows comparable rates of survival with a decreased rate of radiation-induced toxicity.
Collapse
|
14
|
Practice of laryngectomy rehabilitation interventions: a perspective from Australia. Curr Opin Otolaryngol Head Neck Surg 2013; 21:224-9. [PMID: 23644734 DOI: 10.1097/moo.0b013e32836118aa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide a perspective of contemporary practice in rehabilitation of speech and swallowing in patients undergoing total laryngectomy in Australia. RECENT FINDINGS In Australia, the preferred method of voice rehabilitation is by the use of tracheo-oesophageal voice prosthesis. Dysphagia is an ongoing problem and the use of adjuvant radiation and chemotherapy compounds this problem. There are difficulties associated with surgery because of the variation in disease involvement of pharyngeal mucosa and musculature, as well as difficulties associated with healing in previously chemoradiated surgical fields. SUMMARY This article demonstrates the need for careful consideration of surgical technique, particularly in closure of the neopharynx in the chemoradiated patient. It encourages further research into the problems of speech and particularly swallowing in this patient population, as these problems impact significantly on the quality of life.
Collapse
|
15
|
Harréus U. Surgical errors and risks - the head and neck cancer patient. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2013; 12:Doc04. [PMID: 24403972 PMCID: PMC3884539 DOI: 10.3205/cto000096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Head and neck surgery is one of the basic principles of head and neck cancer therapy. Surgical errors and malpractice can have fatal consequences for the treated patients. It can lead to functional impairment and has impact in future chances for disease related survival. There are many risks for head and neck surgeons that can cause errors and malpractice. To avoid surgical mistakes, thorough preoperative management of patients is mandatory. As there are ensuring operability, cautious evaluation of preoperative diagnostics and operative planning. Moreover knowledge of anatomical structures of the head and neck, of the medical studies and data as well as qualification in modern surgical techniques and the surgeons ability for critical self assessment are basic and important prerequisites for head and neck surgeons in order to make out risks and to prevent from mistakes. Additionally it is important to have profound knowledge in nutrition management of cancer patients, wound healing and to realize and to be able to deal with complications, when they occur. Despite all precaution and surgical care, errors and mistakes cannot always be avoided. For that it is important to be able to deal with mistakes and to establish an appropriate and clear communication and management for such events. The manuscript comments on recognition and prevention of risks and mistakes in the preoperative, operative and postoperative phase of head and neck cancer surgery.
Collapse
Affiliation(s)
- Ulrich Harréus
- Department of Otolaryngology/Head and Neck Surgery, University Hospital Munich, Campus Grosshadern, Munich, Germany
| |
Collapse
|
16
|
Suzuki K, Hayashi R, Ebihara M, Miyazaki M, Shinozaki T, Daiko H, Sakuraba M, Zenda S, Tahara M, Fujii S. The Effectiveness of Chemoradiation Therapy and Salvage Surgery for Hypopharyngeal Squamous Cell Carcinoma. Jpn J Clin Oncol 2013; 43:1210-7. [DOI: 10.1093/jjco/hyt136] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
|
17
|
Hu M, Ampil F, Clark C, Sonavane K, Caldito G, Nathan CAO. Comorbid predictors of poor response to chemoradiotherapy for laryngeal squamous cell carcinoma. Laryngoscope 2012; 122:565-71. [PMID: 22252981 DOI: 10.1002/lary.22489] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 10/27/2011] [Accepted: 11/14/2011] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate whether a correlation exists between medical comorbidities and disease control following primary therapy of laryngeal squamous cell carcinoma. STUDY DESIGN Retrospective medical record review. METHODS A retrospective chart review was performed on patients diagnosed with laryngeal carcinoma between 1997 and 2011. The Adult Comorbidity Evaluation 27 (ACE 27) index was used to evaluate severity of comorbid health. Ten-year disease-free survival rates and median disease-free intervals were calculated, and significant associations between disease recurrence and comorbid factors were determined using the log-rank test. Independent significant risk factors for disease recurrence were determined with the Cox proportional hazard regression model. RESULTS Of the 181 patients identified, 121 were treated nonsurgically with either primary radiotherapy (XRT) (49%) or chemoradiotherapy (CRT) (51%). Sixty patients (50%) experienced recurrence of their disease. The 10-year disease-free survival rate was 23.8%, and the median disease-free survival was 58 months (95% confidence interval, 12-108 months). Factors observed to be significantly associated with recurrence within 10 years after treatment were renal disease (P < .01), pulmonary disease (P < .01), malnutrition (P < .01), T size (P < .01), stage (P = .02), and ACE 27 Index (P < .01). Independent significant risk factors for recurrence were malnutrition (P < .01), T stage (P = .01), and ACE 27 (P < .01). Adjusted hazard ratios were 1.43 for T stage, 2.58 for ACE 27, and 2.15 for malnutrition. CONCLUSIONS The results of this study demonstrate that there is a significant association between increased comorbidity and recurrent disease in laryngeal carcinoma treated with XRT/CRT. The consideration of comorbid health in primary treatment planning may improve the success and survival of patients with laryngeal squamous cell carcinoma.
Collapse
Affiliation(s)
- Melissa Hu
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health-Shreveport, Shreveport, Louisiana 71130-3932, USA
| | | | | | | | | | | |
Collapse
|
18
|
Shin DM, Khuri FR. Advances in the management of recurrent or metastatic squamous cell carcinoma of the head and neck. Head Neck 2011; 35:443-53. [PMID: 22052826 DOI: 10.1002/hed.21910] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2011] [Indexed: 11/09/2022] Open
Abstract
Most patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) undergo definitive therapy, yet locoregional recurrence and metastasis are common. Most patients ultimately require systemic treatment. Platinum/5-fluorouracil (5-FU) has been the standard of care for patients with good performance status (median survival, 6-8 months). Cetuximab, a monoclonal antibody against epidermal growth factor receptor (EGFR), significantly improved median survival in combination with platinum/5-FU compared with chemotherapy alone, establishing it as a new standard for patients with recurrent or metastatic disease. Cetuximab is also active in platinum-refractory disease. Ongoing trials are exploring other EGFR inhibitors as well as the use of biologic agents in combination (eg, cetuximab + bevacizumab). Predictive biomarkers may help personalize therapy for SCCHN, and it is unclear whether the favorable prognostic effect of p16 or human papillomavirus in locally advanced oropharyngeal cancer is relevant for advanced disease.
Collapse
Affiliation(s)
- Dong M Shin
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
| | | |
Collapse
|
19
|
Esteller E, Vega MC, López M, Quer M, León X. Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy. Eur Arch Otorhinolaryngol 2010; 268:295-301. [DOI: 10.1007/s00405-010-1365-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 08/08/2010] [Indexed: 10/19/2022]
|
20
|
Salvage surgery for local recurrence after chemoradiotherapy or radiotherapy in hypopharyngeal cancer patients. Eur Arch Otorhinolaryngol 2010; 267:1765-9. [PMID: 20495926 DOI: 10.1007/s00405-010-1274-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2010] [Accepted: 04/30/2010] [Indexed: 10/19/2022]
Abstract
This retrospective study aimed to assess the role of salvage surgery for local recurrence in hypopharyngeal cancer (HPC) patients who had received radiotherapy (RT) or concomitant chemoradiotherapy (CRT) as an initial treatment. The local recurrence rate, salvage rate after local recurrence and overall survival rate were investigated in 104 HPC patients who received treatment between 1991 and 2005. Local recurrence in the primary site was observed in 41 patients (rate, 39.4%) of whom only 12 could undergo further salvage surgery. Disease control was achieved in seven of these patients (successful salvage rate, 17.1%). The 5-year overall survival rate was 40.6% in the RT/CRT patient group and successful salvage rates for T1, T2, T3 and T4 primary disease were 33.3% (1/3), 20.0% (4/20), 16.7% (2/12) and 0% (0/6), respectively. Severe postoperative complications such as pharyngo-cutaneous fistula were seen in six patients (50.0%). Prognosis of patients with locally recurring HPC after RT/CRT is poor at any primary T-stage and the incidence of postoperative complication is relatively high. This should be taken into consideration when the initial treatment plan is decided and the choice of salvage surgery for such recurrent cases should be carefully determined.
Collapse
|
21
|
Tan HK, Giger R, Auperin A, Bourhis J, Janot F, Temam S. Salvage surgery after concomitant chemoradiation in head and neck squamous cell carcinomas - stratification for postsalvage survival. Head Neck 2010; 32:139-47. [PMID: 19536855 DOI: 10.1002/hed.21159] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Salvage surgery after concomitant chemoradiation therapy (CCRT) for patients with head and neck squamous cell carcinomas (HNSCC) is challenging because of its associated morbidity/mortality and the poor prognoses of these patients. METHODS The outcome analysis of prospectively collected data from 93 patients with HNSCC with local and/or regional shows treatment failures but without distant metastasis after CCRT. RESULTS Thirty-eight patients underwent salvage surgery, whereas 55 underwent palliative treatment, with 2-year overall survival rates of 43.4% and 0%, respectively. Initial stage IV tumors (p = .017) and concurrent local and regional failures (p = .003) were independent predictors for decreased survival after salvage surgery. Two-year overall survival rates for patients with 2, 1, or none of these predictive factors were 0%, 49%, and 83%, respectively (p = .0005). CONCLUSION Salvage surgery after CCRT has acceptable outcomes. Initial stage IV tumors and concurrent local and regional failures were independent predictors that can stratify patients into distinct prognostic groups for postsalvage survival.
Collapse
Affiliation(s)
- Hiang Khoon Tan
- Department of Head and Neck Surgery, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | | | | | | | | | | |
Collapse
|
22
|
Haigentz M, Silver CE, Corry J, Genden EM, Takes RP, Rinaldo A, Ferlito A. Current trends in initial management of oropharyngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 2009; 266:1845-55. [DOI: 10.1007/s00405-009-1109-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
23
|
Bachar GY, Goh C, Goldstein DP, O'Sullivan B, Irish JC. Long-term outcome analysis after surgical salvage for recurrent tonsil carcinoma following radical radiotherapy. EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF OTO-RHINO-LARYNGOLOGICAL SOCIETIES (EUFOS) : AFFILIATED WITH THE GERMAN SOCIETY FOR OTO-RHINO-LARYNGOLOGY - HEAD AND NECK SURGERY 2009. [PMID: 19756684 DOI: 10.1007/s00405‐009‐1070‐0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The objective of this study is to report the longterm outcomes of salvage surgery following local and/or regional failure of tonsillar carcinoma treated with standard fractionation radiotherapy. All cases of carcinoma of the tonsil treated by radical radiotherapy at the Princess Margaret Hospital between January 1970 and December 1990 were reviewed retrospectively. Patients who underwent salvage surgery for local and/or regional recurrent squamous cell carcinoma of the tonsil following radiation therapy were included for analysis. 239 out of 640 patients with tonsillar carcinoma recurred post radiotherapy. 175 patients were deemed candidates for surgical salvage. At the time of the last follow-up, only 13 patients were alive and 162 patients had died. The majority of patients (n = 96, 59%)died with disease. The median time to death was approximately 1.3 years following salvage surgery. The 5-year overall survival rate was 23%. The 5-year cause-specific survival was 40%. The probability of death due to disease was higher than the probability of death due to other causes. Both N-classification and T-classification were found to be significant predictors of time to death. In conclusion,in spite of the fact that the patients in this study had been treated prior to the widespread introduction of altered fractionation and concurrent chemoradiation for advanced tonsil carcinoma, it demonstrates the poor prognosis of recurrent disease. Despite the poor prognosis, 20% of patients will be alive at 5 years and therefore salvage surgery should be considered when possible.
Collapse
Affiliation(s)
- Gideon Y Bachar
- Department of Otolaryngology-Head and Neck Surgery,Princess Margaret Hospital, University of Toronto, Toronto, ON M5G2M9, Canada.
| | | | | | | | | |
Collapse
|
24
|
Long-term outcome analysis after surgical salvage for recurrent tonsil carcinoma following radical radiotherapy. Eur Arch Otorhinolaryngol 2009; 267:295-301. [DOI: 10.1007/s00405-009-1070-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 08/05/2009] [Indexed: 11/27/2022]
|
25
|
Watkins JM, Shirai KS, Wahlquist AE, Stuart RK, Chaudhary UB, Garrett-Mayer E, Day TA, Gillespie MB, Sharma AK. Toxicity and survival outcomes of hyperfractionated split-course reirradiation and daily concurrent chemotherapy in locoregionally recurrent, previously irradiated head and neck cancers. Head Neck 2009; 31:493-502. [PMID: 19156831 DOI: 10.1002/hed.20986] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND : Reirradiation of locoregionally recurrent, previously irradiated head/neck cancer may be considered in situations of unresectability, medical inoperability, or adverse pathologic features found at salvage resection. METHODS : Retrospective cohort analysis of toxicity and survival outcomes in locoregionally recurrent, previously irradiated patients with head/neck cancer treated with hyperfractionated split-course radiotherapy and concurrent chemotherapy. RESULTS : Between March 1998 and September 2006, 39 patients initiated reirradiation at median of 2.3 years (range, 0.5-19) following prior radiotherapy. At median survivor follow-up of 24.5 months (range, 3-63.9), 10 patients are alive without evidence of disease. Median survival is 19.0 months, with estimated 1-, 2-, and 3-year overall survivals of 60.1%, 45.1%, and 22.7%, respectively. Locoregional failure was the predominant site of postreirradiation recurrence. Male sex, total radiotherapy dose, cycles of chemotherapy completed, and clinical response were associated with improved overall survival. CONCLUSIONS : Reirradiation can offer long-term survival for patients with recurrent, previously irradiated head/neck cancers.
Collapse
Affiliation(s)
- John M Watkins
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
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
| | | | | | | | | |
Collapse
|
27
|
Immunotherapy of head and neck cancer using tumor antigen-specific monoclonal antibodies. Curr Oncol Rep 2009; 11:156-62. [PMID: 19216848 DOI: 10.1007/s11912-009-0023-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Monoclonal antibodies (mAbs) are now commonly used therapeutic agents in cancer patients. Since US Food and Drug Administration approval of cetuximab for head and neck squamous cell carcinoma, it has been used increasingly in this disease. Several other mAbs also are in development or in clinical -trials. Recently, evidence has accumulated that mAbs induce activation of cellular immunity, including natural killer and T cells and that this may contribute to clinical response. mAbs have been shown to mediate antibody-dependent cellular cytotoxicity, complement-dependent lysis, and activation of tumor antigen-specific T cells. Various patient and tumor factors, such as polymorphisms in Fcgamma receptors expressed by immune cells, activity of T-regulatory cells, and tumor escape through downregulation of antigen-processing machinery in tumor cells, are likely to modulate the immune activation mediated by therapeutic mAbs. Understanding the interplay of these factors is likely to improve the selection of the most appropriate candidates for mAb-based immunotherapy, prediction of clinical response, and our understanding of mechanisms of tumor escape from therapeutic mAbs.
Collapse
|
28
|
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]
|