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Ramsey T, Tikhtman R, Tang AL. Laryngeal Preservation Strategies. Surg Oncol Clin N Am 2024; 33:761-773. [PMID: 39244293 DOI: 10.1016/j.soc.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
Over the last 2 decades, the paradigm of laryngeal cancer management has pivoted toward preserving laryngeal function without sacrificing oncologic outcomes. Transoral laser microsurgery has diminished the role of open laryngeal surgery. For early-stage laryngeal cancer, the common primary modalities are endoscopic laryngeal surgery and narrow field radiation. Total laryngectomy followed by either radiation or chemoradiation is option for advanced laryngeal cancer. In experienced hands and following meticulous patient selection, supracricoid laryngectomy may serve as a viable alternative to total laryngectomy to preserve laryngeal function. Total laryngectomy is still the recommended treatment in those with airway compromise and/or laryngeal dysfunction.
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Affiliation(s)
- Tam Ramsey
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati, College of Medicine, 3151 Bellevue Avenue, Cincinnati, OH 45219, USA
| | - Raisa Tikhtman
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati, College of Medicine, 3151 Bellevue Avenue, Cincinnati, OH 45219, USA
| | - Alice L Tang
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati, College of Medicine, 3151 Bellevue Avenue, Cincinnati, OH 45219, USA.
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Wald T, Koppe TJ, Pirlich M, Zebralla V, Kunz V, Dietz A, Stoehr M, Wichmann G. Outcome Disparities in Patients with Early-Stage Laryngeal Cancer Depending on Localization, Tobacco Consumption, and Treatment Modality. Biomedicines 2024; 12:2136. [PMID: 39335649 PMCID: PMC11428932 DOI: 10.3390/biomedicines12092136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 09/13/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
Background/Objectives: Laryngeal squamous cell carcinoma (LSCC) is among most frequent malignancies of the head and neck. Recent oncologic research focusses on advanced rather than on early stages. Thus, we aimed to improve the knowledge concerning prognostic factors and survival in early glottic (GC) and supraglottic cancer (SGC). Methods: We retrospectively investigated patients diagnosed in 2007 to 2020 with stage I or II GC (ICD-10-C32.0) or SGC (ICD-10-C32.1, C32.8 or C32.9). For precise discrimination of GC and SGC, pathology reports about biopsy and definitive excision were closely examined and information on clinical characteristics and risk factors were collected before analyzing patterns of risk factors for overall survival (OS) in multivariate Cox regression analyses (mvCox). Results: The cohort included 220 patients with early GC (n = 183) and SGC (n = 37). The GC patients showed significantly improved 5-year OS compared to SGC patients (83.6% vs. 64.9%; p = 0.004), whereas survival according to UICC stage (I vs. II) was not different (p = 0.177). Surgical resection was superior to definitive radiotherapy (RT) for 5-year OS (p < 0.001). Cumulative tobacco consumption of greater than 10 pack years drastically impaired OS (p = 0.024), especially in patients receiving RT (p < 0.001). Supraglottic localization, smoking, and re-resection after initial R1 status consistently were independent prognostic factors in mvCox. Conclusions: Our cohort of early LSCC patients demonstrates significant negative impact of supraglottic localization, older age, tobacco consumption, poor tumor differentiation, and re-resection on OS. Further research is required as there is still lack of evidence on optimal decision-making and therapeutic strategies.
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Affiliation(s)
- Theresa Wald
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10–14, 04103 Leipzig, Germany; (T.-J.K.); (M.P.); (V.Z.); (V.K.); (A.D.); (M.S.); (G.W.)
- The Comprehensive Cancer Center Central Germany, Leipzig University Hospital, Liebigstr. 10–14, 04103 Leipzig, Germany
| | - Tim-Jonathan Koppe
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10–14, 04103 Leipzig, Germany; (T.-J.K.); (M.P.); (V.Z.); (V.K.); (A.D.); (M.S.); (G.W.)
| | - Markus Pirlich
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10–14, 04103 Leipzig, Germany; (T.-J.K.); (M.P.); (V.Z.); (V.K.); (A.D.); (M.S.); (G.W.)
- The Comprehensive Cancer Center Central Germany, Leipzig University Hospital, Liebigstr. 10–14, 04103 Leipzig, Germany
| | - Veit Zebralla
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10–14, 04103 Leipzig, Germany; (T.-J.K.); (M.P.); (V.Z.); (V.K.); (A.D.); (M.S.); (G.W.)
- The Comprehensive Cancer Center Central Germany, Leipzig University Hospital, Liebigstr. 10–14, 04103 Leipzig, Germany
| | - Viktor Kunz
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10–14, 04103 Leipzig, Germany; (T.-J.K.); (M.P.); (V.Z.); (V.K.); (A.D.); (M.S.); (G.W.)
- The Comprehensive Cancer Center Central Germany, Leipzig University Hospital, Liebigstr. 10–14, 04103 Leipzig, Germany
| | - Andreas Dietz
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10–14, 04103 Leipzig, Germany; (T.-J.K.); (M.P.); (V.Z.); (V.K.); (A.D.); (M.S.); (G.W.)
- The Comprehensive Cancer Center Central Germany, Leipzig University Hospital, Liebigstr. 10–14, 04103 Leipzig, Germany
| | - Matthaeus Stoehr
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10–14, 04103 Leipzig, Germany; (T.-J.K.); (M.P.); (V.Z.); (V.K.); (A.D.); (M.S.); (G.W.)
- The Comprehensive Cancer Center Central Germany, Leipzig University Hospital, Liebigstr. 10–14, 04103 Leipzig, Germany
| | - Gunnar Wichmann
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10–14, 04103 Leipzig, Germany; (T.-J.K.); (M.P.); (V.Z.); (V.K.); (A.D.); (M.S.); (G.W.)
- The Comprehensive Cancer Center Central Germany, Leipzig University Hospital, Liebigstr. 10–14, 04103 Leipzig, Germany
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3
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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 2024; 38:1227-1236. [PMID: 35422356 DOI: 10.1016/j.jvoice.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Shneyderman M, Shen S, Tanavde V, Kut C, Kiess AP, Naunheim MR, Akst LM. Factors Impacting Provider Treatment Decision-Making in Early Glottic Cancer. Laryngoscope 2024; 134:3686-3694. [PMID: 38727258 DOI: 10.1002/lary.31494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/17/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES Transoral laser microsurgery (TLMS) and radiotherapy (XRT) are mainstays of treatment for early glottic carcinoma (EGC). Here, we investigated case-dependent provider treatment preferences and identify factors which impact decision-making in EGC. METHODS This cross-sectional survey of laryngologists, head-and-neck surgeons, and radiation oncologists presented five diagrammatic cases of progressively advanced EGC (T1/2, N0). Respondents indicated preference for TLMS or XRT and ranked factors which influenced their recommendation for each case. Analysis utilized descriptive statistics, Fischer's exact tests, and Kruskal-Wallis tests for nonparametric data. RESULTS A total of 141 complete responses (69.5% laryngologists) were received. Most respondents practiced in academic settings (93.5%) and within multidisciplinary teams (94.0%). Anterior commissure involvement was the most important a priori tumor factor for case-independent treatment recommendation (Likert Scale: 4.22/5), followed by Laterality (Likert Scale: 4.02/5). Across all specialties, TLMS was recommended for unilateral T1a lesions. Laryngologists continued recommending TLMS in T2 lesions (41.0%) more than head-and-neck surgeons (5.0%) and radiation oncologists (0.0%). Across all cases, survival and voice outcomes were the most important clinical factors impacting treatment decisions. Radiation oncologists weighed voice more heavily than laryngologists in more complex presentations of EGC (rank: 1.6 vs. 2.7, Kruskall-Wallis: p < 0.05). CONCLUSIONS In more complex clinical presentations of EGC, preference for TLMS compared to XRT differed across specialists, despite similar rankings of factors driving these treatment recommendations. This may be driven by differing experiences and viewpoints on case-dependent voice outcomes following TLMS versus XRT, suggesting a need for increased understanding of how tumor location and depth impact voice outcomes. LEVEL OF EVIDENCE 5 Laryngoscope, 134:3686-3694, 2024.
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Affiliation(s)
- Matthew Shneyderman
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sarek Shen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Ved Tanavde
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Carmen Kut
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Ana P Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Matthew R Naunheim
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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5
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Razavian NB, D'Agostino RB, Shenker RF, Hughes RT. Intensity-Modulated Radiation Therapy for Early-Stage Squamous Cell Carcinoma of the Glottic Larynx: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2023; 117:652-663. [PMID: 37150263 DOI: 10.1016/j.ijrobp.2023.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 04/03/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE Early-stage squamous cell carcinoma of the glottic larynx is commonly treated with 2-dimensional or 3-dimensional conventional radiation therapy (CRT). Despite its use in other head and neck cancers, intensity-modulated radiation therapy (IMRT) remains controversial in this patient population. METHODS AND MATERIALS A systematic review was performed by querying 3 databases (Pubmed, Embase, Web of Science) for articles published between December 1, 2000 and September 2, 2022. Included studies reported outcomes in at least 10 patients treated with IMRT for early-stage glottic cancer. Data were extracted and reported following PRISMA standards. Pooled outcomes were estimated using random-effects models. Primary outcome was the rate of local failure (LF) following IMRT. Secondary outcomes included rates of regional failure (RF) following IMRT and rates of LF and RF following CRT. RESULTS A total of 15 studies (14 retrospective, 1 prospective) consisting of 2083 patients were identified. IMRT was used in 873 patients (64% T1, 28% T2). Multiple treatment (partial larynx, single vocal cord carotid sparing) and image-guided radiation therapy techniques were used. The pooled crude rate of LF was 7.6% (95% confidence inverval [CI], 3.6%-11.5%) and actuarial LF rates at 3 and 5 years were 6.3% (95% CI, 2.2%-10.3%) and 9.0% (95% CI, 4.4%-13.5%), respectively. The pooled crude rate of RF after IMRT was 1.5% (95% CI, 0.5%-2.5%). On metaregression analysis, increased rate of LF was significantly associated with T2 disease (P < .001) and grade 2 to 3 histology (P < .001). Treatment with CRT was reported in 738 patients (76% T1, 22% T2). Among the studies reporting outcomes of both modalities, there was no significant difference in LF (log odds ratio; P = .12) or RF (log odds ratio; P = .58) between IMRT or CRT. CONCLUSIONS In patients with early-stage glottic cancer, retrospective data suggests local and regional control are similar for patients treated with IMRT and CRT. Additional prospective studies with uniform methods of volume delineation and image guidance are needed to confirm the efficacy of IMRT.
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Affiliation(s)
- Niema B Razavian
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Ralph B D'Agostino
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Rachel F Shenker
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, North Carolina.
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Wise-Draper T. Platinum-Level Care. Int J Radiat Oncol Biol Phys 2023; 117:9-10. [PMID: 37574249 DOI: 10.1016/j.ijrobp.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/01/2022] [Indexed: 08/15/2023]
Affiliation(s)
- Trisha Wise-Draper
- Division of Hematology/Oncology, University of Cincinnati, Cincinnati, Ohio
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Arboleda LPA, Neves AB, Kohler HF, Vartanian JG, Candelária LM, Borges MF, Fernandes GA, de Carvalho GB, Kowalski LP, Brennan P, Santos‐Silva AR, Curado MP. Overview of glottic laryngeal cancer treatment recommendation changes in the NCCN guidelines from 2011 to 2022. Cancer Rep (Hoboken) 2023; 6:e1837. [PMID: 37288471 PMCID: PMC10432469 DOI: 10.1002/cnr2.1837] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The treatment of glottic cancer remains challenging, especially with regard to morbidity reduction and larynx preservation rates. The National Comprehensive Cancer Network (NCCN) has published guidelines to aid decision-making about this treatment according to the tumor site, clinical stage, and patient medical status. AIM The present review was conducted to identify changes in the NCCN guidelines for glottic cancer treatment made between 2011 and 2022 and to describe the published evidence concerning glottic cancer treatment and oncological outcomes in the same time period. METHODS AND RESULTS Clinical practice guidelines for head and neck cancer published from 2011 up to 2022 were obtained from the NCCN website (www.NCCN.org). Data on glottic cancer treatment recommendations were extracted, and descriptive analysis was performed. In addition, a review of literature registered in the PubMed database was performed to obtain data on glottic cancer management protocols and treatment outcomes from randomized controlled trials, systematic reviews, and meta-analyses published from 2011 to 2022. In total, 24 NCCN guidelines and updates and 68 relevant studies included in the PubMed database were identified. The main guideline changes made pertained to surgical and systemic therapies, the consideration of adverse features, and new options for the treatment of metastatic disease at initial presentation. Early-stage glottic cancer received the most research attention, with transoral endoscopic laser surgery and radiotherapy assessed and compared as the main treatment modalities. Reported associations between treatment types and survival rates for this stage of glottic cancer appear to be similar, but functional outcomes can be highly compromised. CONCLUSION NCCN panel members provide updated recommendations based on currently accepted treatment approaches for glottic cancer, constantly reviewing new surgical and non-surgical techniques. The guidelines support decision-making about glottic cancer treatment that should be individualized and prioritize patients' quality of life, functionality, and preferences.
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Affiliation(s)
| | | | - Hugo Fontan Kohler
- Head and Neck Surgery and Otorhinolaryngology DepartmentA.C. Camargo Cancer CenterSão PauloBrazil
| | - José Guilherme Vartanian
- Head and Neck Surgery and Otorhinolaryngology DepartmentA.C. Camargo Cancer CenterSão PauloBrazil
| | | | - Matheus Ferraz Borges
- Group of Epidemiology and Statistics on CancerA.C. Camargo Cancer CenterSão PauloSPBrazil
| | | | | | - Luiz Paulo Kowalski
- Head and Neck Surgery and Otorhinolaryngology DepartmentA.C. Camargo Cancer CenterSão PauloBrazil
- Head and Neck Surgery Department, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Paul Brennan
- International Agency for Research on CancerGenomic Epidemiology BranchLyonFrance
| | | | - Maria Paula Curado
- Group of Epidemiology and Statistics on CancerA.C. Camargo Cancer CenterSão PauloSPBrazil
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Friedman AD, Gengler I, Altaye M, Tabangin ME. Early-Stage Glottic Carcinoma in the United States: Demographics and Treatment Choice. Laryngoscope 2023; 133:901-907. [PMID: 35852500 DOI: 10.1002/lary.30305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/10/2022] [Accepted: 07/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Limited investigation of factors potentially contributing to treatment choice in early-stage glottic carcinoma (EGC) has been performed with large-scale data. The National Cancer Database (NCDB) represents >72% of all new cancer cases in the United States. We hypothesized that NCDB variables may lend insight into treatment decisions between surgery and radiation for EGC. METHODS The NCDB was queried for all cases of T1-2 N0 M0 glottic carcinoma from 2004 to 2016. We used multivariable logistic regression analysis to examine factors associated with first-line treatment modality: radiation therapy (RT) versus surgery. All reported odds ratios (OR) were adjusted for age, gender, race, insurance, residence in a metropolitan area, region, and facility volume. RESULTS 34,991 EGC patients received treatment: 6,687 (19%) surgery; 20,289 (58%) RT; and 8,015 (23%) surgery and RT. OR for receiving RT (vs. surgery alone) were >2 for: more advanced T stage cancers (OR 2.5 [95%CI: 2.3, 2.7]), treatment at non-academic facilities (OR 2.8, [95%CI: 2.6, 3.0]), and shorter travel distances to treatment centers (OR 2.2, [95%CI: 2.0, 2.4]). Surgery was more likely with treatment in the western US, higher income, private insurance, living in a metropolitan (vs. non-metropolitan) area, female gender, older age, and low facility volume. Hispanic ethnicity, education level, and race were not associated with treatment type in the multivariable model. CONCLUSION Most patients in the NCDB receive first-line treatment with radiation for EGC, and this decision is associated with various tumor, patient, and treatment facility characteristics. LEVEL OF EVIDENCE 4 Laryngoscope, 133:901-907, 2023.
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Affiliation(s)
- Aaron D Friedman
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, U.S.A
| | - Isabelle Gengler
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, U.S.A
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Meredith E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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Blomkvist R, Marklund L, Hammarstedt‐Nordenvall L, Gottlieb‐Vedi E, Mäkitie A, Palmgren B. Treatment and outcome among patients with laryngeal squamous cell carcinoma in Stockholm-A population-based study. Laryngoscope Investig Otolaryngol 2023; 8:441-449. [PMID: 37090883 PMCID: PMC10116984 DOI: 10.1002/lio2.1034] [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: 12/12/2022] [Revised: 01/30/2023] [Accepted: 02/19/2023] [Indexed: 03/08/2023] Open
Abstract
Objective Survival of patients with advanced laryngeal squamous cell carcinoma (LSCC) remains poor and management protocols warrant further development. We thus investigated treatment and outcome-related factors for LSCC in Stockholm, Sweden. Methods In a retrospective setting, 520 patients with LSCC diagnosed during 2000-2014, were included. Data on stage, treatment, and outcome were correlated with recurrence-free and overall survival (RFS and OS, respectively). Results Five-year OS for all patients was 65%. Five-year RFS for T1a, T1b, T2, T3, and T4 glottic LSCC was 90%, 91%, 77%, 47%, and 80%, respectively. The corresponding figures for T1, T2, T3, and T4 supraglottic LSCC were 64%, 66%, 64%, and 86%. Conclusion Patients with a T3 glottic LSCC had unexpectedly poor survival, especially when compared with patients with a T4 tumor. Patients with T4 disease were primarily treated with laryngectomy and postoperative radiotherapy (RT)/chemoradiotherapy (CRT), while most patients with T3 LSCC were treated with RT/CRT.
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Affiliation(s)
- Rasmus Blomkvist
- Division of ENT Diseases, Department of Clinical ScienceIntervention and Technology, Karolinska InstitutetStockholmSweden
- Department of OtorhinolaryngologyKarolinska University HospitalStockholmSweden
| | - Linda Marklund
- Division of ENT Diseases, Department of Clinical ScienceIntervention and Technology, Karolinska InstitutetStockholmSweden
- Medical Unit, Head Neck, Lung and Skin CancerKarolinska University HospitalStockholmSweden
| | - Lalle Hammarstedt‐Nordenvall
- Division of ENT Diseases, Department of Clinical ScienceIntervention and Technology, Karolinska InstitutetStockholmSweden
- Medical Unit, Head Neck, Lung and Skin CancerKarolinska University HospitalStockholmSweden
| | - Eivind Gottlieb‐Vedi
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and SurgeryKarolinska Institutet and Karolinska University HospitalStockholmSweden
| | - Antti Mäkitie
- Division of ENT Diseases, Department of Clinical ScienceIntervention and Technology, Karolinska InstitutetStockholmSweden
- Department of Otorhinolaryngology – Head and Neck SurgeryUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Björn Palmgren
- Division of ENT Diseases, Department of Clinical ScienceIntervention and Technology, Karolinska InstitutetStockholmSweden
- Medical Unit, Head Neck, Lung and Skin CancerKarolinska University HospitalStockholmSweden
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10
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Silver JA, Turkdogan S, Roy CF, Kost KM. Surgical Treatment of Early Glottic Cancer. Otolaryngol Clin North Am 2023; 56:259-273. [PMID: 37030939 DOI: 10.1016/j.otc.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
The incidence of all head and neck malignancies is rising worldwide, with carcinoma of the larynx constituting approximately 1% of all cancers. Early glottic cancer responds quite favorably to surgical intervention due to its early presentation, coupled with the low rate of regional and distant metastases. This article focuses on various approaches to the surgical treatment of early glottic cancer. Details include the clinical and radiological evaluation of laryngeal cancer, the goals of treatment, current surgical options for early disease, approach to surgical resection margins and management of nodal disease, and complications associated with each treatment modality.
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11
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Kienle LL, Schild LR, Böhm F, Grässlin R, Greve J, Hoffmann TK, Schuler PJ. A novel 3D-printed laryngoscope with integrated working channels for laryngeal surgery. Front Surg 2023; 10:906151. [PMID: 36998594 PMCID: PMC10043209 DOI: 10.3389/fsurg.2023.906151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
BackgroundFor the surgical treatment of early-stage laryngeal cancer, the use of transoral laser microsurgery (TLM) has emerged as the gold standard. However, this procedure requires a straight line of sight to the operating field. Therefore, the patient's neck needs to be brought into a hyperextended position. In a considerable number of patients, this is not possible due to anomalies in the cervical spine anatomy or soft tissue scarring, e.g., after radiation. In these cases, adequate visualization of relevant laryngeal structures cannot be ensured using a conventional rigid operating laryngoscope, which may negatively affect the outcome of these patients.MethodsWe present a system based on a 3D-printed prototype of a curved laryngoscope with three integrated working channels (sMAC). The curved profile of the sMAC-laryngoscope is specifically adapted to the nonlinear anatomy of the upper airway structures. The central working channel provides access for flexible video endoscope imaging of the operating field while the two remaining channels provide access for flexible instrumentation. In a user study (n = 11), visualization and reachability of relevant laryngeal landmarks as well as the feasibility of basic surgical procedures with the proposed system were examined in a patient simulator. In a second setup, the system was evaluated for its applicability in a human body donor.ResultsAll participants of the user study were able to visualize, reach and manipulate the relevant laryngeal landmarks. Reaching those took significantly less time in the second attempt compared to the first one (27.5 s ± 5.2 s vs. 39.7 s ± 16.5 s, p = 0.008) indicating a significant learning curve for handling the system. Instrument changes were performed quickly and reliably by all participants (10.9 s ± 1.7 s). All participants were able to bring the bimanual instruments into position for a vocal fold incision. Relevant laryngeal landmarks could be visualized and reached in the human body donor setup.ConclusionPossibly, the proposed system may develop into an alternative treatment option for patients with early-stage laryngeal cancer and restricted mobility of the cervical spine in the future. Further improvements of the system could include finer end effectors and a flexible instrument with a laser cutting tool.
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Affiliation(s)
- Linus L. Kienle
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Leon R. Schild
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Felix Böhm
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Rene Grässlin
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Thomas K. Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Patrick J. Schuler
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
- Correspondence: Patrick J. Schuler
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12
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Li N, Yin G, Guo W, Huang Z. Relationship between dysphagia and surgical treatment for supraglottic laryngeal carcinoma: A meta-analysis. Am J Otolaryngol 2023; 44:103788. [PMID: 36706715 DOI: 10.1016/j.amjoto.2023.103788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To systematically evaluate differences in swallowing disorder-related manifestations in patients with supraglottic laryngeal cancer, who underwent traditional open partial horizontal laryngectomy (OPHL) and endoscopic supraglottic laryngectomy (ESL). METHODS A systematic review of the literature and a meta-analysis were performed. The CNKI, Wan Fang, PubMed, EMBASE, Cochrane Library, Web of Science, and Clinical Trials databases for clinical studies data sources were investigated. The efficiency of recovery, postoperative swallowing function, and complications related to dysphagia were investigated to compare the effects of surgical procedures. RESULTS The meta-analysis included 8 studies with 281 patients. ESL surgery played a positive role in the recovery of patients. Preservation of the anterior epiglottic space, ventricular band, and arytenoid cartilage without destroying the external framework of the larynx can effectively reduce the risk of aspiration pneumonia in patients. CONCLUSIONS ESL has advantages in postoperative recovery and retention of swallowing function in patients with supraglottic laryngeal cancer.
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Affiliation(s)
- Nuan Li
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Gaofei Yin
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Guo
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhigang Huang
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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de Leo AN, Dagan R, Morris CG, Holtzman AL, Hitchcock KE, Bryant CM, Amdur RJ, Mendenhall WM. Early-stage vocal cord cancer treated with hypofractionated radiotherapy to the larynx with or without concurrent chemotherapy. Head Neck 2022; 44:2513-2521. [PMID: 35950338 DOI: 10.1002/hed.27165] [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: 04/18/2022] [Revised: 06/17/2022] [Accepted: 07/15/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND We report outcomes among patients with T2 and select T3 glottic squamous cell carcinoma (SCC) treated with radiotherapy. METHODS We reviewed T2 and T3 (only paraglottic space invasion) N0 M0 glottic SCC patients treated with curative-intent hypofractionated larynx radiotherapy, with or without concurrent systemic therapy. RESULTS Of 71 patients, those who received concurrent chemotherapy (23/71; 32%) had worse prognostic factors, including impaired cord mobility (70% vs. 40%, p = 0.02) and larger median gross tumor volume (3.0 vs. 1.6 cm3 , p = 0.003). Over a median follow-up of 3.8 years, 2-year local control among patients with impaired cord mobility appeared higher for those who received chemotherapy (88% vs. 61%, p = 0.12), but the difference was not statistically significant. Acute and late toxicity rates were not higher among patients who received chemotherapy. CONCLUSIONS The addition of concurrent platinum-based chemotherapy to hypofractionated larynx radiotherapy among patients with early-stage glottic SCC with impaired cord mobility appears safe and worthy of additional investigation.
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Affiliation(s)
- Alexandra N de Leo
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, USA
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, USA
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, USA
| | - Adam L Holtzman
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, USA
| | - Kathryn E Hitchcock
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, USA
| | - Curtis M Bryant
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, USA
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, USA
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, USA
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14
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Gong H, Huang Q, Shi Y, Gao C, Hsueh CY, Wu C, Tao L, Zhang M, Zhou J, Cao P, Zhou L. Oncologic outcomes of transoral laser microsurgery versus open partial laryngectomies in the management of early stage glottic carcinoma. Am J Otolaryngol 2022; 43:103551. [DOI: 10.1016/j.amjoto.2022.103551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/24/2022] [Indexed: 11/29/2022]
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15
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Heng Y, Xu C, Lin H, Zhu X, Zhou L, Zhang M, Wu C, Tao L. Management of clinically node-negative glottic squamous cell carcinoma patients according to risk-scoring model for occult lymph node metastases. Laryngoscope Investig Otolaryngol 2022; 7:715-722. [PMID: 35734062 PMCID: PMC9195031 DOI: 10.1002/lio2.762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 11/07/2022] Open
Abstract
Background Glottic squamous cell carcinoma (GSCC) is the most prevalent type of laryngeal carcinoma. The value of prophylactic lymph node dissection (LND) in resected GSCC remains controversial. This study aims to quantitatively assess the probability of occult lymph node metastasis (LNM) for GSCC patients and devise individualized postoperative radiotherapy strategies. Methods A total of 1319 patients with GSCC were retrospectively analyzed. Results GSCC patients with T1-T2 stages showed significantly lower LNM rate than those with T3-T4 stages. For patients with T3-T4 GSCC, multivariate logistic analyses indicated that three factors-maximum tumor diameter (MTD) of more than 2.0 cm, relatively low differentiation, and tumor invasive depth of no less than 1.0 cm-were independent risk factors for the existence of LNM. A predictive nomogram was established based on these factors. The accuracy and validity of our model were verified by 0.716 and remained at 0.717 after 1000 bootstrapping. The calibration curve was also plotted and showed a favorable agreement. The patients were stratified into two groups based on their individual LNM risk points. Possible LNM rates for low-risk and high-risk subgroups were 4.7% and 25.2%, respectively. Conclusions A new post-operative strategy selection flow chart was established based on our newly created nomogram which can effectively predict the individualized possibility of occult LNM for GSCC patients. For clinical T3-4N0 patients in the high-risk subgroup, prophylactic dose post-operative radiation therapy is recommended. However, for all those clinically diagnosed as T1-2N0 stage, regular follow-up is sufficient in view of the low occult LNM rate.Level of Evidence: 2a.
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Affiliation(s)
- Yu Heng
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
| | - Chengzhi Xu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
| | - Hanqing Lin
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
| | - Xiaoke Zhu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
| | - Liang Zhou
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
| | - Ming Zhang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
| | - Chunping Wu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
| | - Lei Tao
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT HospitalFudan UniversityShanghaiChina
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Kozhanov AL, Kozhanov LG, Kravtsov SA, Sdvizhkov AM. [Modern aspects of organ-preserving surgery for laryngeal cancer]. Vestn Otorinolaringol 2022; 87:44-50. [PMID: 35605271 DOI: 10.17116/otorino20228702144] [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: 11/17/2022]
Abstract
A review of the literature on modern aspects of organ-preserving surgery for laryngeal cancer - endolaryngeal and open resections - is presented. The indications for these operations are determined depending on the location and extent of the tumor, as well as on the anatomical features. The advantages and disadvantages of each method, complications, functional and oncological results are shown.
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Affiliation(s)
- A L Kozhanov
- Clinical Oncological Hospital No. 1 Department of Healthcare of the City of Moscow, Moscow, Russia
| | - L G Kozhanov
- Clinical Oncological Hospital No. 1 Department of Healthcare of the City of Moscow, Moscow, Russia.,N.I. Pirogov Russian National Research Medical University, Moscow, Russia
| | - S A Kravtsov
- Clinical Oncological Hospital No. 1 Department of Healthcare of the City of Moscow, Moscow, Russia.,Peoples' Friendship University, Moscow, Russia
| | - A M Sdvizhkov
- Clinical Oncological Hospital No. 1 Department of Healthcare of the City of Moscow, Moscow, Russia
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Bicakci BC, Mustafayev TZ, Cetinayak O, Igdem S, Birgi SD, Meydan D, Demircioglu F, Atalar B, Ozyar E, Akman F. Outcomes of carotid sparing intensity-modulated radiotherapy for early stage glottic cancer in 201 patients: Multicenter study of Turkish Radiation Oncology Society/TROD-01-007. Head Neck 2022; 44:1825-1832. [PMID: 35596585 DOI: 10.1002/hed.27101] [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: 06/02/2021] [Revised: 03/22/2022] [Accepted: 05/05/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To assess and report clinical outcomes after carotid sparing intensity-modulated radiotherapy for early stage laryngeal cancer. METHODS We retrospectively analyzed 201 patients with early stage glottic laryngeal cancer treated with carotid sparing intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) techniques in six TROD centers. RESULTS After a median follow-up of 31 months the actuarial 1- and 3-year local and locoregional control rates were 99.4% and 94.7%, 98.4% and 93%, respectively. T classification, anterior commissure involvement, IMRT technique, and type of fractionation were not found to be prognostic for local control. Overall, eight patients had lost their organ function due to recurrence or toxicity. Grade 3 and 4 acute laryngeal edema was seen in eight (4%) and one (0.5%) of patients, respectively. Grade 3 and 4 late laryngeal edema developed in two (1%) and one patient (0.5%), respectively. CONCLUSION Oncologic outcomes of patients treated with carotid sparing IMRT were excellent; comparable with historical series, with acceptable side effects. Longer follow-up is needed to estimate long term effect on stroke.
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Affiliation(s)
- Beyhan Ceylaner Bicakci
- Department of Radiation Oncology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Oguz Cetinayak
- Department of Radiation Oncology, Medical School, Dokuz Eylul University, Izmir, Turkey
| | - Sefik Igdem
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Sumerya Duru Birgi
- Department of Radiation Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Deniz Meydan
- Department of Radiation Oncology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Fatih Demircioglu
- Department of Radiation Oncology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Fadime Akman
- Department of Radiation Oncology, Medical School, Dokuz Eylul University, Izmir, Turkey
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Comparison of Oncologic Outcomes Between Radiation Therapy and Transoral Laser Microsurgery for Early Glottic and Supraglottic Squamous Cell Carcinoma; a Retrospective Cohort Study with Literature Review. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-117504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Laryngeal cancer is known as the second most common airway cancer. These tumors are usually diagnosed early; thus, it is important to choose the optimal treatment modality. Several studies are comparing transoral laser microsurgery (TLM) and radiotherapy in early-stage laryngeal cancer. Due to a paucity of high-quality research and the lack of conclusive randomized prospective studies, standard care for early glottic cancer is still a matter of controversy. Methods: In this retrospective cohort study, T1-T2N0M0 laryngeal cancer patients who underwent TLM or radiotherapy were compared with statistical methods in terms of Recurrence Rate, Organ (Larynx) Preservation Rate, Mortality Rate, and Overall Survival. Results: A total of 123 patients were evaluated in this study, 65 of whom underwent TLM and 58 underwent radiotherapy. There was no significant difference in demographic and medical characteristics of patients. The rate of recurrence was 27.3% in the TLM group and 43.6% in the radiotherapy group. There was no significant difference between the two groups (P = 0.114). Overall mortality rate (5.4% vs 39.6%, P = 0.001), Disease-specific mortality rate (5.5% vs 39.9%, P = 0.001), and aorgan preservation rate (98.5%vs 89.7%, P = 0.035) were all in favor of TLM. Conclusions: TLM appears to be the treatment of choice in patients with early laryngeal cancer due to a better overall survival rate, lower disease-specific mortality rate, and better organ preservation rate than definitive radiotherapy.
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Wang WL, Zheng HW, Zhang LH, Yu LS. Effect of treatment modality on the long-term survival of patients with early glottic squamous cancer: a retrospective cohort study based on the SEER database. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:440. [PMID: 35571433 PMCID: PMC9096410 DOI: 10.21037/atm-21-5288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/14/2022] [Indexed: 11/06/2022]
Abstract
Background The optimal treatment strategy for patients with early glottic (T1-2N0M0) squamous cancer remains unclear. Methods A retrospective population-based analysis was performed using the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was used to balance treatment arms, and Cox regression analysis was used to determine prognostic factors for survival. Kaplan-Meier analysis, log-rank tests, and competing risk analysis were used to compare survival outcomes between treatment modalities (surgery vs. radiotherapy). Results Among the 3,994 eligible patients in this study, surgery was associated with improved cancer-specific survival (CSS) and overall survival (OS) compared with radiotherapy (log-rank test, P<0.05). This survival trend favoring surgery was consistent in the T1a, well/moderately differentiated grade, male, and all age subgroups. However, after the baseline characteristics were balanced with PSM, the survival outcomes (CSS and OS) did not differ significantly between the surgery and radiotherapy groups. Interestingly, surgery was associated with a 39% reduced risk of cancer-related death compared with radiotherapy in patients aged ≥70 years (hazard ratio 0.61; 95% CI: 0.43-0.87; P=0.006). However, this survival trend favoring surgery was not observed in younger patients (age <70 years), T stage subgroups, male or female subgroups, or in any of the pathological grade subgroups. Conclusions In patients with early glottic squamous cell carcinoma undergoing surgery or radiotherapy, there is no sufficient evidence favoring one method over another in terms of survival. However, surgery is recommended in patients aged ≥70 years because, in this group, it was associated with improved survival outcomes compared with radiotherapy.
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Affiliation(s)
- Wen-Lun Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Hong-Wei Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Li-Hong Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Li-Sheng Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China
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Liu CH, Chien PJ, Hung LT, Wang LM, Kao YC, Tsai YJ, Chu PY. Long-term Oncologic Results and Voice Outcomes in Patients With Glottic Cancer After Modified Type III Cordectomy. Otolaryngol Head Neck Surg 2022; 167:839-845. [PMID: 35167384 DOI: 10.1177/01945998221075317] [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: 12/24/2022]
Abstract
OBJECTIVE Transoral laser microsurgery and radiotherapy provide high and comparable cure rates for the treatment of early glottic cancer. However, the voice outcomes after treatment remain controversial. A modified type III cordectomy technique was proposed in 2006, and preliminary results showed it to be an oncologically safe method with satisfactory voice outcomes. This study aimed to evaluate oncologic and voice outcomes after long-term follow-up of these patients. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care academic center. METHODS Between 2006 and 2018, 42 patients with glottic cancer underwent a modified type III cordectomy. This technique resected the tumor and upper part of the vocal folds and preserved the lower part of the vocalis muscle as a scaffold to improve glottis closure. The oncologic results and voice outcomes were evaluated at a median follow-up of 68 months. RESULTS The primary tumor stages included 13 T1 (31%), 26 T2 (64%), and 3 T3 (7%). Eight patients (19%) had local recurrence, and 6 underwent successful salvage with transoral laser microsurgery with or without postoperative radiotherapy with laryngeal preservation. The 5-year rate of local control was 80%; laryngeal preservation, 95%; overall survival, 89%; and disease-specific survival, 97%. The final laryngeal preservation rate was 95% (40/42). The voice outcomes were satisfactory and comparable to those of patients who underwent type I and II cordectomies. CONCLUSION The modified type III cordectomy has been proven to be an oncologically safe method with satisfactory voice outcomes after long-term follow-up in selected cases of early glottic cancer.
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Affiliation(s)
- Chin-Hsuan Liu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Pei-Ju Chien
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Li-Ting Hung
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Li-Mei Wang
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Ya-Chuan Kao
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Yueh-Ju Tsai
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Pen-Yuan Chu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei.,National Yang Ming Chiao Tung University, Taipei
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de Vincentiis M, Greco A, Campo F, Candelori F, Ralli M, Di Traglia M, Colizza A, Cambria F, Zocchi J, Manciocco V, Spriano G, Pellini R. Open partial horizontal laryngectomy for T2-T3-T4a laryngeal cancer: oncological outcomes and prognostic factors of two Italian hospitals. Eur Arch Otorhinolaryngol 2022; 279:2997-3004. [PMID: 34978589 DOI: 10.1007/s00405-021-07238-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to analyse the oncologic results of open partial horizontal laryngectomy (OPHL) and to assess the prognostic factors that could affect the survival of patients affected by T2, T3 and T4a laryngeal cancer. Using this data, we aim to identify clinical criteria to select patients amenable to conservative surgery, and to facilitate a more targeted approach in the management of advanced laryngeal cancer. METHODS A retrospective study was performed in patients who underwent OPHL type II for laryngeal squamous cell carcinoma from January 2005 to December 2018. We analysed a total of 170 patients; 21(12.36%) cases were staged as pT2, 116 (68.23%) as pT3 and 33 (19.41%) as pT4a. RESULTS Five-year overall survival (OS) was 80.9%, 79.3%, 70.4% for T2, T3 and T4 respectively. Disease-specific survival (DSS) was 90.4%, 85.3% and 77.4%. Posterior tumour extension, perineural invasion and N status showed to considerably influence survival in both uni- and multivariate analyses. CONCLUSION The oncological outcomes from our study show that OPHL for advanced laryngeal cancer can guarantee a high percentage of success. Accurate patient selection is of utmost importance to differentiate advanced disease amenable to conservative surgery, and treatment options should consider selected criteria based on tumour and patient features.
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Affiliation(s)
- Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Flaminia Campo
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.,Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Candelori
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Mario Di Traglia
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
| | - Francesca Cambria
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Jacopo Zocchi
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Valentina Manciocco
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Spriano
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Tan C, Fang J, Wang R, Zhong Q, Hou L, Ma H, Feng L, He S, Lian M, Yang Y. Risk factors for local recurrence of early bilateral vocal cord carcinoma treated with transoral CO 2 laser microsurgery. Acta Otolaryngol 2021; 141:860-864. [PMID: 34565304 DOI: 10.1080/00016489.2021.1925958] [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: 10/20/2022]
Abstract
BACKGROUND The incidence of local recurrence after transoral CO2 laser microsurgery for T1b-T2 glottic carcinoma is relatively low. Multiple risk factors have been described for the development of local recurrence after treatment. However, to date, there is no analysis or systematic review investigating the relationships between clinical and histopathological factors and the appearance of local recurrence after transoral CO2 laser microsurgery in T1b-T2 glottic carcinoma patients. AIMS/OBJECTIVE To investigate risk factors for local recurrence after CO2 laser surgery in T1b-T2 glottic carcinoma involving bilateral vocal cords. MATERIAL AND METHODS We retrospectively studied patients undergoing CO2 laser surgery for T1b-T2 glottic carcinoma involving bilateral vocal cords. Multiple follow-up laryngoscopies and computed tomographies were performed. Main outcome measures: survival rate, local recurrence rate, and independent risk factors for recurrence. RESULTS All 85 patients (83 male; age, 63.33 ± 10.59 years; 36 T1b and 49 T2 lesions; 28 cases with and 57 without anterior commissure (AC) involvement) survived; 15 exhibited postoperative local recurrence. Recurrence rates differed between the following groups: patients without (6/57) versus patients with AC involvement (9/28) (p = .007); patients with negative (11/77) versus positive resection margins (4/8) (p = .014); p53-negative (5/51) versus p53-positive patients (10/34) (p = .0132). AC involvement, positive resection margins, and p53 expression were independent risk factors for recurrence. CONCLUSIONS Patients with stage T1b and T2 glottic carcinoma with AC involvement, positive resection margins, and p53 expression should be followed up at shorter intervals. SIGNIFICANCE This article provided valid clinical data for risk factors for local recurrence after CO2 laser surgery for T1b-T2 glottic carcinoma involving bilateral vocal cords.
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Affiliation(s)
- Chen Tan
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education of China, Beijing Institute of Otolaryngology, Beijing, China
| | - Jugao Fang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education of China, Beijing Institute of Otolaryngology, Beijing, China
| | - Ru Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education of China, Beijing Institute of Otolaryngology, Beijing, China
| | - Qi Zhong
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education of China, Beijing Institute of Otolaryngology, Beijing, China
| | - Lizhen Hou
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education of China, Beijing Institute of Otolaryngology, Beijing, China
| | - Hongzhi Ma
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education of China, Beijing Institute of Otolaryngology, Beijing, China
| | - Ling Feng
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education of China, Beijing Institute of Otolaryngology, Beijing, China
| | - Shizhi He
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education of China, Beijing Institute of Otolaryngology, Beijing, China
| | - Meng Lian
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education of China, Beijing Institute of Otolaryngology, Beijing, China
| | - Yifan Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education of China, Beijing Institute of Otolaryngology, Beijing, China
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Voora RS, Panuganti B, Flagg M, Kumar A, Qian AS, Kotha NV, Qiao EM, Weissbrod PA, Rose B, Orosco RK. Salvage Following Transoral Laser Microsurgery for Early Glottic Cancer in National Veteran Database. Laryngoscope 2021; 131:2766-2772. [PMID: 34296772 DOI: 10.1002/lary.29740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/07/2021] [Accepted: 06/28/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Transoral laser microsurgery (TLM) is commonly utilized for early glottic cancer and offers favorable oncologic and functional outcomes. However, the survival implications of salvage therapy for recurrent or persistent disease have not been definitively characterized. STUDY DESIGN Retrospective, national database cohort study. METHODS Data were extracted from Veterans Health Affairs (VHA) Informatics and Computing Infrastructure (VINCI) concerning the TLM-based management of T1-T2 glottic squamous cell carcinoma patients between 2000 and 2017. Patients were characterized as either requiring TLM-only, or in cases of persistent or recurrent local disease, TLM plus change in treatment modality (radiotherapy, chemoradiotherapy, or open surgery). Predictors of overall survival (OS), cancer-specific survival (CSS), and salvage-free survival were evaluated via Cox and Fine-Gray models. RESULTS About 553 patients (70.9% T1a, 13.4% T1b, 15.7% T2) were included, with a median follow-up time of 74.5 months. The need for non-TLM salvage increased along with more advanced disease (11.7% T1a, 29.7% T1b, 32.2% T2). Compared to patients with T1a disease, those with T1b and T2 tumors initially treated with TLM had a significantly higher probability of receiving non-TLM salvage (T1b: HR 2.70, 95% CI: 1.61-4.54; T2: HR 3.02, 95% CI: 1.88-4.84). In a multivariable model, receipt of non-TLM salvage was not a significant predictor of either OS (HR = 0.91, 95% CI: 0.62-1.33, P = .624) or CSS (HR 1.21 95% CI 0.51-2.86, P = .667). CONCLUSION The majority of patients with early glottic cancer that are managed with TLM do not require additional salvage therapy. When non-TLM salvage was required, there was no decrement in OS or CSS. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Rohith S Voora
- University of California, San Diego School of Medicine, La Jolla, California, U.S.A.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A.,Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A
| | - Bharat Panuganti
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A.,Moores Cancer Center, La Jolla, California, U.S.A
| | - Mitchell Flagg
- University of California, San Diego School of Medicine, La Jolla, California, U.S.A.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A
| | - Abhishek Kumar
- Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, U.S.A
| | - Alexander S Qian
- University of California, San Diego School of Medicine, La Jolla, California, U.S.A.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, U.S.A
| | - Nikhil V Kotha
- University of California, San Diego School of Medicine, La Jolla, California, U.S.A.,Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, U.S.A
| | - Edmund M Qiao
- University of California, San Diego School of Medicine, La Jolla, California, U.S.A.,Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, U.S.A
| | - Philip A Weissbrod
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A.,Moores Cancer Center, La Jolla, California, U.S.A
| | - Brent Rose
- Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A.,Moores Cancer Center, La Jolla, California, U.S.A.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, U.S.A
| | - Ryan K Orosco
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A.,Veterans Affairs San Diego Healthcare System, San Diego, California, U.S.A.,Moores Cancer Center, La Jolla, California, U.S.A
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Abstract
OBJECTIVES To investigate the utilisation of different treatment modalities for patients with laryngeal cancer (LC) during last decade in Poland. SETTING Retrospective population-based study. PARTICIPANTS Patients with LC treated between January 2009 and December 2018. PRIMARY AND SECONDARY OUTCOME MEASURES The contemporary utilisation of treatment modalities of LC: surgery with intent of radical resection (total or partial laryngectomy), radiotherapy (RT) and chemoradiotherapy (CRT). RESULTS There was determined the overall number of 22 957 new diagnosis of LC from 2010 to 2018 and confirmed the steady decrease in the incidence rate of LC in the following years from 7.7 to 6.03. The mean age of patients with LC was raising by an average of 0.3832 of year per year. There was observed decrease in number of total laryngectomies (TLs) in subsequent years (from 1122 in 2009 to 776 in 2018). The number of procedures involving partial laryngeal resection was within stable ranges however the upward trend was observed separately for vocal cordectomy. There was established decreased involvement of surgery in LC treatment from 52.8% in 2009 to 24.3% in 2016 with the subsequent rise to 33.7% in 2018. The percentage of patients receiving RT increased from 23.8% in 2009 to 42.1% in 2013 with the next decrease to 25.7% in 2018. The utilisation of CRT in LC treatment was progressively increasing over analysed years from 23.4% in 2009 reaching 40.6% in 2018. CONCLUSIONS The presented data revealed an increase in total number of organs preserving treatment modality with CRT in subsequent years with decreasing number of TLs in Polish patients with LC.
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Affiliation(s)
- Anna Rzepakowska
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Warszawa, Poland
| | - Michał Żurek
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Warszawa, Poland
- Department of Analyses and Strategies, Polish Ministry of Health, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Warszawa, Poland
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Could Primary Chemoradiotherapy in T2 Glottic Cancers Yield Results Comparable to Primary Radiotherapy in T1? Considerations from 531 German Early Stage Patients. Cancers (Basel) 2021; 13:cancers13071601. [PMID: 33807125 PMCID: PMC8037641 DOI: 10.3390/cancers13071601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 02/07/2023] Open
Abstract
T1 glottic cancer is a highly treatable disease with local control (LC) rates over 90% by either primary radiotherapy (pRT) or transoral laser microsurgery (TLM). LC of T2 glottic cancers is 15 percent points poorer on average. However, salvage after pRT entails more than 50% total laryngectomy. Therefore, there is a need for enhanced LC. Altered fractionation regimens improved LC in T1 but not in T2. For this reason, for T2, alternative strategies must be considered. In a large observational cohort study including 531 early-stage laryngeal cancers, a small number of patients were treated with primary chemoradiotherapy (pCRT). In multivariable analysis, factors associated with significantly poorer outcomes included age, comorbidities, supraglottic localization, and T category. While there was a significant difference between pRT and surgery (HR 1.79; 95%-CI: 1.15-2.79), there was none between pCRT and surgery (HR 0.70; 95%-CI: 0.33-1.51). There is evidence from the literature that pCRT in early glottic cancers could yield results that surpass the limits so far experienced in radiotherapy alone with acceptable toxicity. Thus, prospective randomized studies with larger numbers of patients are warranted.
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Li X, Li J, Cui X, Hu X, Yu P, Sun G. The Thermal Damage of Canine Vocal Fold by CO 2 Laser Under Different Laser Emission Mode. EAR, NOSE & THROAT JOURNAL 2021; 101:17S-23S. [PMID: 33719628 DOI: 10.1177/0145561321999262] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this study is to review the differences between continuous wave (CW) and UltraPulse (UP) on thermal damage of the laser with different power. METHODS Four adult beagle dogs underwent transoral laser microsurgery (TLM) using CO2 laser. The laser emission mode and power was CW (3 W, 5 W, and 8 W) and UP (3 W and 5 W), respectively. The tissue from 4 animals was evaluated histologically on postoperative days 1 and 3. The thermal damage of the laser was measured using slide scan system via SlideViewer version 1.5.5.2 software. RESULTS All dogs underwent TLM uneventfully. Under microscope examined, the laser damage area was composed of 2 parts: the vaporized zone (VPZ) and thermal damage area. The thermal damage area can be divided into thermal coagulative necrosis area (TCN) and hydropic degeneration area. The width of VPZ and TCN in UP mode was less than that in CW mode (P < .01). The data indicate that lower laser power created less thermal damage (P < .01). In addition, the width of VPZ on postoperative day 3 was less than that on postoperative day 1 (P < .01). CONCLUSION CO2 laser with UP and lower power could decrease the laser thermal damage and may offer more prompt wound healing.
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Affiliation(s)
- Xumao Li
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jiaying Li
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xidong Cui
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xinqi Hu
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Pengcheng Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Guangbin Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
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Piazza C, Paderno A, Del Bon F, Lancini D, Fior M, Berretti G, Bosio P, Deganello A, Peretti G. Long-term Oncologic Outcomes of 1188 Tis-T2 Glottic Cancers Treated by Transoral Laser Microsurgery. Otolaryngol Head Neck Surg 2021; 165:321-328. [PMID: 33400625 DOI: 10.1177/0194599820983727] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate long-term disease-specific survival (DSS) and organ preservation (OP) rates in patients affected by Tis-T2 glottic squamous cell carcinoma (SCC) treated by carbon dioxide transoral laser microsurgery (CO2 TOLMS). STUDY DESIGN Single-center retrospective cohort study. SETTING Tertiary academic hospital. METHODS The study included patients treated by CO2 TOLMS for Tis-T2 glottic SCC at the Department of Otorhinolaryngology-Head and Neck Surgery of the University of Brescia, Italy, from 1988 to 2018. The male:female ratio was 11.2:1, and the mean age was 64 years (range, 31-95). T categories were distributed as follows: 124 (10%) Tis, 646 (54%) T1a, 172 (15%) T1b, and 246 (21%) T2. RESULTS Ten- and 20-year DSS rates were 97.6% and 96.3%, respectively, and 10- and 20-year OP rates were 94.7% and 93%. During the follow-up, 91% of patients were treated by CO2 TOLMS alone, while the remaining needed adjunctive treatments. Assessing the impact of multiple sessions of CO2 TOLMS, DSS showed no significant difference in terms of patients treated by 1, 2, or >2 procedures. Conversely, patients treated by >2 sessions of CO2 TOLMS showed a significantly worse OP rate. CONCLUSIONS Our series validates CO2 TOLMS as a long-term treatment strategy for early glottic SCC. Salvage CO2 TOLMS provided optimal results in terms of DSS and OP in patients with recurrence after previous transoral surgery.
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Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Davide Lancini
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Milena Fior
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Giulia Berretti
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Paolo Bosio
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Deganello
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Huang GJ, Yang BB. Prognostic risk factors for initially diagnosed T2N0M0 glottic cancer: competing risk analysis and propensity-score matched cohort analysis. Eur Arch Otorhinolaryngol 2021; 278:3921-3931. [PMID: 33388990 DOI: 10.1007/s00405-020-06557-9] [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: 09/05/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prognostic risk factors of patients with initially diagnosed T2N0M0 glottic cancer remain unclear. This study was aimed to conduct a comprehensive analysis to identify valuable prognostic risk factors for initially diagnosed T2N0M0 glottic cancer. METHODS Data of patients with initially diagnosed T2N0M0 glottic cancer were extracted from the Surveillance, Epidemiology, and End Results database. Survival analyses and Cox regression analyses were conducted to evaluate overall survival (OS) and cancer-specific survival (CSS). In consideration of competing events, the competing risk (CR) analysis was applied. Furthermore, propensity-score matching (PSM) was applied to mimic randomized-controlled trials and reduce selection bias. RESULTS A total of 923 eligible patients met the inclusion criteria. Survival analyses showed that age, marital status, primary site surgery, and radiation were independent predictors of OS. Besides, age, marital status, primary site surgery, radiation, and chemotherapy were independent predictors of CSS. Cox regression analyses and the CR analysis were basically consistent with this result. In addition, an internal validation and PSM were performed to explore the role of chemotherapy. CONCLUSION We conducted a comprehensive analysis to prove that age, marital status, primary site surgery, radiation, and chemotherapy may be valuable prognostic risk factors for initially diagnosed T2N0M0 glottic cancer. Primary site surgery and radiation should be recommended, whereas chemotherapy was likely not suitable so far. Furthermore, we constructed a CR nomogram to predict survival rates.
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Affiliation(s)
- Guan-Jiang Huang
- Department of Otorhinolaryngology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Bei-Bei Yang
- Department of Otorhinolaryngology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
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29
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Lois-Ortega Y, García-Curdi F, Sebastián-Cortés JM, De Miguel-García F, Vallés-Varela H, Muniesa-del Campo A. Radiotherapy versus laser microsurgery in the treatment of early glottic cancer. Acta Otolaryngol 2020; 140:954-958. [PMID: 32677497 DOI: 10.1080/00016489.2020.1788723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Glottic squamous cell carcinoma (SCC) in stages I or II can be treated by transoral CO2 laser microsurgery (TLM) or exclusive radiotherapy (RT). OBJECTIVES To compare the oncological results of patients treated with TLM, to those treated with RT, in a tertiary hospital. MATERIAL AND METHODS Data from patients diagnosed with glottic SCC in stages I and II between 2004 and 2018 were analyzed. Response to treatment was studied in terms of recurrence, local control and laryngeal preservation. RESULTS Of 164 patients, 63.41% received treatment with TLM and 36.58% with RT. 26.21% presented a recurrence or progression of the tumor. Both treatments obtained good local control rates (84.15% in the case of TLM and 89.6% in the case of RT) and no significant association was found between tumor recurrence and type of treatment, nor with the involvement of the anterior commissure. However, treatment with RT obtained worse laryngeal preservation rate compared to TLM (81.6% and 100% respectively) (p < .001LR). Conclusions and significance: Both treatments obtained good oncological results. There were no significant differences regarding local control. However, TLM obtained a better laryngeal preservation rate. The involvement of the anterior commissure was not a poor prognosis factor for tumor recurrence.
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Affiliation(s)
| | | | | | | | - Héctor Vallés-Varela
- Department of Otorhinolaryngology, Lozano Blesa University Clinical Hospital, Zaragoza, Spain
| | - Ana Muniesa-del Campo
- Faculty of Veterinary Sciences, Department of Animal Pathology, University of Zaragoza, Zaragoza, Spain
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Patel TR, Eggerstedt M, Toor J, Tajudeen BA, Husain I, Stenson K, Al-Khudari S. Occult Lymph Node Metastasis in Early-Stage Glottic Cancer in the National Cancer Database. Laryngoscope 2020; 131:E1139-E1146. [PMID: 32809243 DOI: 10.1002/lary.28995] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Early-stage glottic cancer (cT1-T2 cN0) may be treated by primary surgery or radiation. Elective treatment of the neck in clinically N0 disease is usually not performed due to low rates of regional lymph node metastasis. This study examines the role of elective neck dissection (END) and rate of occult nodal metastasis in cT1-T2 cN0 glottic cancer treated with primary surgery. STUDY DESIGN Retrospective cohort study. METHODS The National Cancer Database was used to identify patients treated for early-stage glottic cancer. Demographic variables, disease characteristics, and overall survival were compared between the subgroups of patients who did and did not receive END. Factors predictive of occult lymph node metastasis were also identified using a multivariate logistic regression model. RESULTS Thirty-eight percent of the 991 patients in this cohort underwent END. Younger age, treatment at an academic facility, advanced T-stage, and higher tumor grade were associated with receiving END. Sixteen percent of the 372 patients undergoing END had occult nodal metastasis. Higher tumor histopathologic grade was associated with occult metastasis (P = .004). While undergoing END did not affect significantly survival, those with occult metastasis had poorer survival (P < .001). CONCLUSIONS END should be considered in cT1-T2 N0 glottic cancers with poorly differentiated or undifferentiated tumor histopathology. While END itself may not improve overall survival, identification of occult nodal metastasis is an important finding for prognostication. LEVEL OF EVIDENCE Level 3 Laryngoscope, 131:E1139-E1146, 2021.
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Affiliation(s)
- Tirth R Patel
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Michael Eggerstedt
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | - Bobby A Tajudeen
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Inna Husain
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Kerstin Stenson
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Samer Al-Khudari
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Early Glottic Cancer Treated by Transoral Laser Surgery Using Toluidine Blue for the Definition of the Surgical Margins: A Pilot Study. ACTA ACUST UNITED AC 2020; 56:medicina56070334. [PMID: 32635245 PMCID: PMC7404472 DOI: 10.3390/medicina56070334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022]
Abstract
Background and objectives: Transoral laser microsurgery (TLM) is widely accepted for its advantages, which consist of a brief hospital stay, rapid functional recovery, low management costs and the fact that it can be easily repeated in cases of recurrence. However, a high incidence of positive or narrow surgical margins has been reported in the literature, even if controversy still exists on the prognostic significance of positive resection margins. The aim of the study was to evaluate the utility of toluidine blue staining in defining the resection margins of early glottic cancer (T1a–T2) treated with TLM. Materials and Methods: This retrospective study was conducted on patients with early glottic cancer (T1a–T2) managed by TLM. A group of patients treated between 2010 and 2014 underwent toluidine blue staining (TB group) of the lesions before starting the cordectomy by TLM, and a group of patients treated by TLM between 2006 and 2009 was considered the control group. Results: A total of 44 subjects were included in this study: 41 were men, and 3 were women. The mean age was 58 ± 9.0 years (median 59.0, range 41–77). Twenty-three of the 44 patients were included in the TB group and 21 in the case control group. In the TB group, only the positivity of the deep margin was a predictor of local recurrence (p = 0.037), while in the control group, positive or close margins and the type of cordectomy were predictive factors of local recurrence (p = 0.049). Considering the TB group and control cases, the 5-year local recurrence-free survival was 95.6% and 80.9%, respectively (p = 0.14). Conclusions: From this first study, toluidine blue staining seems to be a useful modality to improve the rate of the negative resection margins of early glottic cancer (T1a–T2) treated by TLM.
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Campo F, Zocchi J, Ralli M, De Seta D, Russo FY, Angeletti D, Minni A, Greco A, Pellini R, de Vincentiis M. Laser Microsurgery Versus Radiotherapy Versus Open Partial Laryngectomy for T2 Laryngeal Carcinoma: A Systematic Review of Oncological Outcomes. EAR, NOSE & THROAT JOURNAL 2020; 100:51S-58S. [PMID: 32511005 DOI: 10.1177/0145561320928198] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The aim of the current systematic review is to update the pooled survival outcome of patients with T2 glottic carcinoma treated with either laser surgery (CO2 transoral laser microsurgery [CO2 TOLMS]), radiotherapy (RT), or open partial laryngectomy (OPL). METHODS A systematic search was performed using the MEDLINE database, Scopus, and Google scholar. The inclusion criteria were studies of patients with T2N0 glottic tumor, treated with either primary CO2 TOLMS, definitive curative RT, or primary OPL, and with reported oncological outcome at 5 years calculated with a Kaplan-Meier or Cox regression method. RESULTS The results of the current review show that local control (LC) is higher with OPL 94.4%, while there are no differences in LC at 5-year posttreatment for patients treated with RT, compared to those treated with CO2 TOLMS (respectively, 75.6% and 75.4%). Primary treatment with OPL and CO2 TOLMS results in higher laryngeal preservation than primary treatment with RT (respectively 95.8%, 86.9%, and 82.4%). CONCLUSION First-line treatment with OPL and CO2 TOLMS should be encouraged in selected T2 patients, because it results in higher laryngeal preservation and similar LC compared to primary treatment with RT. The involvement of the anterior commissure in the craniocaudal plane and T2b impaired vocal cord mobility have a poorer prognosis and LC compared to patients with T2a tumors for both CO2 TOLMS and RT.
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Affiliation(s)
- Flaminia Campo
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Jacopo Zocchi
- Department of Otolaryngology and Head & Neck Surgery, IRCCS "18658Regina Elena" National Cancer Institute, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Daniele De Seta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria Di Cagliari, 3111University of Cagliari, Cagliari, Italy
| | | | - Diletta Angeletti
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Antonio Minni
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Raul Pellini
- Department of Otolaryngology and Head & Neck Surgery, IRCCS "18658Regina Elena" National Cancer Institute, Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, 9311Sapienza University of Rome, Rome, Italy
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Jayakrishnan TT, White RJ, Greenberg L, Colonias A, Wegner RE. Predictors of chemotherapy and its effects in early stage squamous cell carcinoma of the larynx. Laryngoscope Investig Otolaryngol 2020; 5:445-452. [PMID: 32596486 PMCID: PMC7314463 DOI: 10.1002/lio2.327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 10/21/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Squamous cell carcinoma (SCC) of larynx is a common head and neck cancer. For cases that are node negative, the role of definitive concurrent chemoradiation is unclear and not supported by guidelines but used at provider discretion. To address this knowledge gap, we examined the oncological outcomes with additional chemotherapy and factors correlated with the chemotherapy administration. METHODS We queried the National Cancer Database for patients with early stage (T2N0M0) laryngeal SCC treated nonsurgically. Multivariable logistic regression identified predictors of chemotherapy. Multivariable Cox regression evaluated predictors of survival. Propensity matching accounted for indication biases. RESULTS We identified 7181 patients meeting the eligibility criteria, of which 1568 (22%) patients received chemotherapy in addition to radiation. Predictors of chemotherapy use included younger age, Caucasian race, more remote year of treatment, higher grade, sites other than glottis, treatment at a community cancer center, and use of intensity-modulated radiation therapy. Median overall survival was not significantly different in the two arms analyzed-65 months (95% confidence interval [CI] 60, 72months) with chemotherapy compared to 70 months without chemotherapy (95% CI 66, 75 months, P<.37). Predictors for survival on propensity-matched multivariable analysis were increased age, male sex, less education, lower income, higher comorbidity score, receipt of treatment at a community center, and nonglottic sites. CONCLUSIONS This study shows no clear survival benefit with chemotherapy in early stage disease. Although this implies that chemotherapy should not be routinely delivered, individualized judgment and prospective studies are recommended as the biology behind this interesting finding is undefined. LEVEL OF EVIDENCE 2C (Outcomes Research).
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Affiliation(s)
| | - Richard J. White
- Department of Internal MedicineAllegheny Health NetworkPittsburghPA
| | - Larisa Greenberg
- Division of Medical OncologyAllegheny Health Network Cancer InstitutePittsburghPA
| | - Athanasios Colonias
- Division of Radiation OncologyAllegheny Health Network Cancer Institute, Allegheny General HospitalPittsburghPA
| | - Rodney E. Wegner
- Division of Radiation OncologyAllegheny Health Network Cancer Institute, Allegheny General HospitalPittsburghPA
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De Seta D, Campo F, D'Aguanno V, Ralli M, Greco A, Russo FY, de Vincentiis M. Transoral laser microsurgery for Tis, T1, and T2 glottic carcinoma: 5-year follow-up. Lasers Med Sci 2020; 36:507-512. [PMID: 32472425 DOI: 10.1007/s10103-020-03049-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/22/2020] [Indexed: 02/07/2023]
Abstract
The aim of this retrospective study is to evaluate the results obtained with CO2 TOLMS in patients with Tis, T1, and T2 glottic tumors at our Department from 2004 to 2016 treated with CO2 TOLMS. One hundred eighty-five patients having a median age of 67 years (range 42-88) were included in the present analysis. The tumor stages of the patients included 134 pTis-T1a, 12 pT1b, and 39 pT2 cases. Median duration of follow-up for the whole study cohort was 55 months (range 24-108 months). At 5-year follow-up, local control was 91%, 83%, and 79.4% for T1a, T1b, and T2 respectively. Disease-specific survival was 95.5%, 91.6%, and 92.3%. Overall survival was 73.8%, 91.6%, and 82%, and larynx preservation was 96.2%, 83%, and 84.6%. This study confirms that CO2 TOLMS is a safe and standard therapy for selected T1 and T2 glottic carcinoma, and our review on T2 glottic cancer suggests that CO2 TOLMS represents a reliable option in terms of overall survival, disease-specific survival, and laryngeal preservation. However, patients with anterior commissure involvement and T2 cancer should be evaluated with a preoperative MRI in order to exclude the infiltration of the laryngeal framework and to quantify the neoplastic involvement of para-glottic space.
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Affiliation(s)
- D De Seta
- Department of Surgery, Unit of Otolaryngology, University of Cagliari, Cagliari, Italy
| | - Flaminia Campo
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università, 33, 00186, Rome, Italy.
| | - V D'Aguanno
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università, 33, 00186, Rome, Italy
| | - M Ralli
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università, 33, 00186, Rome, Italy
| | - A Greco
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università, 33, 00186, Rome, Italy
| | - F Y Russo
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università, 33, 00186, Rome, Italy
| | - M de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00186, Rome, Italy
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Martinez-Monedero R, Danielian A, Angajala V, Dinalo JE, Kezirian EJ. Methodological Quality of Systematic Reviews and Meta-analyses Published in High-Impact Otolaryngology Journals. Otolaryngol Head Neck Surg 2020; 163:892-905. [PMID: 32450783 DOI: 10.1177/0194599820924621] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the methodological quality of intervention-focused systematic reviews (SRs) and meta-analyses (MAs) published in high-impact otolaryngology journals. DATA SOURCES Ovid Medline, Embase, and Cochrane Library. REVIEW METHODS A comprehensive search was performed for SR and MA citations from 2012 to 2017 in the 10 highest impact factor otolaryngology journals. Abstracts were screened to identify published manuscripts in which the authors indicated clearly that they were performing an SR or MA. Applying a modified typology of reviews, 4 reviewers characterized the review type as SR, MA, or another review type. A simplified version of the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2) tool was used to assess the reporting and methodological quality of the SRs and MAs that were focused on interventions. RESULTS Search and abstract screening generated 499 manuscripts that identified themselves as performing an SR or MA. A substantial number (85/499, 17%) were review types other than SRs or MAs, including 34 (7%) that were literature reviews. In total, 236 SRs and MAs focused on interventions. Over 50% of these SRs and MAs had weaknesses in at least 3 of the 16 items in the AMSTAR 2, and over 40% had weaknesses in at least 2 of the 7 critical domains. Ninety-nine percent of SRs and MAs provided critically low confidence in the results of the reviews. CONCLUSION Intervention-focused SRs and MAs published in high-impact otolaryngology journals have important methodological limitations that diminish confidence in the results of these reviews.
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Affiliation(s)
- Rodrigo Martinez-Monedero
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
| | - Arman Danielian
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Varun Angajala
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Jennifer E Dinalo
- Health Sciences Libraries, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Eric J Kezirian
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
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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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Elicin O, Giger R. Comparison of Current Surgical and Non-Surgical Treatment Strategies for Early and Locally Advanced Stage Glottic Laryngeal Cancer and Their Outcome. Cancers (Basel) 2020; 12:cancers12030732. [PMID: 32244899 PMCID: PMC7140062 DOI: 10.3390/cancers12030732] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/05/2020] [Accepted: 03/16/2020] [Indexed: 12/27/2022] Open
Abstract
For the treatment of early and locally advanced glottic laryngeal cancer, multiple strategies are available. These are pursued and supported by different levels of evidence, but also by national and institutional traditions. The purpose of this review article is to compare and discuss the current evidence supporting different loco-regional treatment approaches in early and locally advanced glottic laryngeal cancer. The focus is kept on randomized controlled trials, meta-analyses, and comparative retrospective studies including the treatment period within the last twenty years (≥ 1999) with at least one reported five-year oncologic and/or functional outcome measure. Based on the equipoise in oncologic and functional outcome after transoral laser surgery and radiotherapy, informed and shared decision-making with and not just about the patient poses a paramount importance for T1-2N0M0 glottic laryngeal cancer. For T3-4aN0-3M0 glottic laryngeal cancer, there is an equipoise regarding the partial/total laryngectomy and non-surgical modalities for T3 glottic laryngeal cancer. Patients with extensive and/or poorly functioning T4a laryngeal cancer should not be offered organ-preserving chemoradiotherapy with salvage surgery as a back-up plan, but total laryngectomy and adjuvant (chemo) radiation. The lack of high-level evidence comparing contemporary open or transoral robotic organ-preserving surgical and non-surgical modalities does not allow any concrete conclusions in terms of oncological and functional outcome. Unnecessary tri-modality treatments should be avoided. Instead of offering one-size-fits-all approaches and over-standardized rigid institutional strategies, patient-centered informed and shared decision-making should be favored.
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Affiliation(s)
- Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland;
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
- Correspondence:
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Lei L, Zhong D, Zou J, Wang H, Yang H, Zhao Y, Liu J, Cheng D, Wu F. Oncological outcomes of early stage glottic squamous cell carcinoma treated with transoral laser microsurgery. Am J Otolaryngol 2020; 41:102364. [PMID: 31924412 DOI: 10.1016/j.amjoto.2019.102364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 02/05/2023]
Abstract
MATERIALS AND METHODS The records of patients treated with TLM with previously untreated early stage glottic squamous cell carcinoma were reviewed. RESULTS A total of 201 patients were enrolled: 191 men (95.0%) and 10 women (4.98%). The anterior commissure (AC) was involved in 94 (47.8%) patients. The 3- and 5-year overall survival rates of all patients were 94.5% and 90.9%. The local recurrence rates were 30.8% in the AC involvement (AC+) group and 16.0% in the group without AC involvement (AC-). The mortality rates were 18.1% and 3.7% in the AC+ and AC- groups. The 3- and 5-year disease-free survival rates were lower in the AC+ group (89.1%, 82.5%) than that in AC- group (99.0%, 96.5%). Local recurrence rates were 25%, 22.7%, 23.4%, and 22.1% for Tis, T1a, T1b, and T2 lesions. The mortality rates were 0.0%, 4.6%, 12.8%, and 15.3%. Three- and 5-year disease-free survival rates did not differ significantly between the tumor stage subgroups. The mortality for patients with local recurrence was 22.2%, which was higher than that for those without recurrence. The organ preservation rate was 98.5%. PURPOSE This study was to assess the rates of oncological outcomes in patients with early stage glottic squamous cell carcinoma treated with transoral laser microsurgery (TLM). CONCLUSION AC involvement was a predictor of local recurrence, and its presence was associated with a reduced survival rate and increased mortality after TLM. TLM got high survival rate and low recurrence rate. The staging and oncological outcomes did not differ between tumor stage subgroups.
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Affiliation(s)
- Lei Lei
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Daling Zhong
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Jian Zou
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China.
| | - Haiyang Wang
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Hui Yang
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Yu Zhao
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Jun Liu
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Danni Cheng
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Fumei Wu
- The Department of Traditional Chinese Medicine Hospital, Section 2, Huayuan Road, Shuangliu District, Chengdu, Sichuan, China
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Forner D, Rigby MH, Corsten M, Trites JR, Pyne J, Taylor SM. Oncological and functional outcomes after repeat transoral laser microsurgery for the treatment of recurrent early glottic cancer. J Laryngol Otol 2020; 134:1-5. [PMID: 32079549 DOI: 10.1017/s0022215120000407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transoral laser microsurgery for glottic squamous cell carcinoma is the standard of care at many institutions. Repeat transoral laser microsurgery for recurrence may avoid the need for radiotherapy and total laryngectomy. This study aimed to identify oncological and functional outcomes in a cohort of patients who had undergone repeat transoral laser microsurgery procedures. METHOD A retrospective review of prospectively collected data of patients treated with transoral laser microsurgery for carcinoma in situ or tumour stages T1 or T2 glottic cancer, from 2003 to 2018. RESULTS Twenty patients were identified. Additional treatment was not needed in 45 per cent of patients. The five-year overall survival rate was 90 per cent. The disease-specific survival rate was 100 per cent. The laryngeal preservation rate was 85 per cent. There was improvement in mean Voice Handicap Index-10 scores following repeat transoral laser microsurgery treatment, when comparing the pre- and post-operative periods (mean scores = 15.5 vs 11.5, p = 0.373). CONCLUSION Repeat transoral laser microsurgery can be an oncologically safe alternative to other salvage therapies for glottic squamous cell carcinoma recurrence, without sacrificing functional outcomes.
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Affiliation(s)
- D Forner
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
| | - M H Rigby
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
| | - M Corsten
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
| | - J R Trites
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
| | - J Pyne
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - S M Taylor
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
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Moore A, Den RB, Popovtzer A, Goldvaser H, Gordon N, Goldstein DA. Fractionation scheme and treatment planning method for early glottic cancer in the United States: Economic impact of different medical decisions. Head Neck 2020; 42:1713-1720. [PMID: 31976607 DOI: 10.1002/hed.26082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/01/2020] [Accepted: 01/10/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Early glottic cancers are often treated with radiotherapy (RT). We assessed the economic impact of fractionation scheme and planning method for payers in the United States. METHODS A population-based analysis of the total cost of RT for early glottic cancers in the United States was performed annually. The target population was calculated using the Surveillance, Epidemiology, and End Results database. RT costs were based on 2019 pricing by Medicare. RESULTS We estimate that 3794 patients with early glottic cancers are treated with RT annually. The cost of RT per patient ranges between US $13 964 and $26 599 by fractionation and planning method. Hypofractionation reduces costs by 9% to 14%, while Intensity-modulated radiotherapy (IMRT) increases costs by 65% to 72%. IMRT-based standard fractionation leads to an excess cost of $47 937 076 compared with 3D-based hypofractionation. CONCLUSIONS 3D-based hypofractionated RT is the current standard of care. It would be reasonable for public and private payers to consider evidence-based policies for radiation reimbursement.
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Affiliation(s)
- Assaf Moore
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert B Den
- Department of Radiation Oncology, Sindey Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Aaron Popovtzer
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Goldvaser
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Gordon
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Israel
| | - Daniel A Goldstein
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina
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41
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Survival and Prognostic Factors for Outcome after Radiotherapy for T2 Glottic Carcinoma. Cancers (Basel) 2019; 11:cancers11091319. [PMID: 31500162 PMCID: PMC6770714 DOI: 10.3390/cancers11091319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Local recurrence after radiotherapy for T2 glottic carcinoma remains an issue and identifying patients at risk for relapse is, therefore, important. This study aimed to assess the oncological outcomes and prognostic factors in a consecutive series of patients treated with radiotherapy for T2N0 glottic carcinoma. Methods: Patients with T2N0 glottic carcinoma treated with radiotherapy were included in this retrospective study. Five- and ten-year local control (LC), overall survival (OS), disease-specific survival (DSS), and laryngeal preservation (LP) rates were calculated with the Kaplan–Meier method. The impact of prognostic variables was evaluated with the log-rank test. Results: Ninety-four patients were included for analysis. LC, OS, DSS, and LP rates were 70.5, 63.7, 86.0, and 74.7%, respectively at five years and 65.8, 41.0, 75.6, and 72.4% at 10 years. In total, 46 scans were included in the analyses. Vertical involvement of the anterior commissure on imaging showed a significant impact on LC. Conclusions: In accordance with previously described surgical risk factors, we identified vertical involvement of the anterior commissure on imaging as a prognostic factor for radiation failure.
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42
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Fullmer TM, Shi J, Skinner HD, Hernandez DJ, Huang AT, Mai W, Parke RB, Donovan DT, Sandulache VC. Early glottic cancer in a veteran population: Impact of race on management and outcomes. Laryngoscope 2019; 130:1733-1739. [PMID: 31461171 DOI: 10.1002/lary.28262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/03/2019] [Accepted: 08/12/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Multiple population studies have shown racial discrepancies in head and neck cancer treatment and outcomes. We sought to characterize the impact of race on clinical outcomes for patients with early glottic squamous cell carcinoma (SCC) in a tertiary institution which provides equivalent access to care. METHODS We retrospectively reviewed all early glottic (T1-T2) squamous cell carcinoma at a single institution, the Michael E. DeBakey Veterans' Administration Medical Center (MEDVAMC). Data collected included demographic information, primary and adjuvant treatment modalities, time to diagnosis, time to treatment, recurrences, recurrence treatment modality, secondary malignancies, recurrence-free survival (RFS), and overall survival (OS). RESULTS One hundred seventeen patients with a primary diagnosis of T1-T2 glottic squamous cell carcinoma were included. Black and white patients demonstrated equivalent rates of recurrence, RFS, and OS. There was no significant difference in treatment delivery by race for all recorded parameters. T1b tumors were associated with an increased risk of recurrence which did not translate into a statistically significant decrease in RFS or OS. Surgical treatment was associated with increased recurrence but similar RFS and OS compared to radiation-based treatment. Secondary malignancies were common; 12% of patients were diagnosed with a second primary lung cancer during the study period. CONCLUSION At our institution, race did not impact survival when access to care, treatment selection, and delivery are equivalent for early glottic SCC. Secondary lung cancer is a critical risk factor for mortality in this patient group and requires long-term surveillance and monitoring. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1733-1739, 2020.
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Affiliation(s)
- Tanner M Fullmer
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Justin Shi
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Heath D Skinner
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - David J Hernandez
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Andrew T Huang
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Weiyuan Mai
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Robert B Parke
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Donald T Donovan
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
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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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Liang F, Xiao Z, Chen R, Han P, Lin P, Huang Y, Huang X. Transoral 980-nm/1470-nm dual-wavelength fiber laser microsurgery for early-stage glottic carcinoma. Oral Oncol 2019; 96:66-70. [PMID: 31422215 DOI: 10.1016/j.oraloncology.2019.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/31/2019] [Accepted: 07/05/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate the effective and safety of transoral 980-nm/1470-nm dual-wavelength fiber laser microsurgery for early-stage glottic carcinoma by compared with CO2 laser surgery. MATERIALS AND METHODS From September 2015 to July 2018, 44 patients with early glottic carcinoma underwent transoral microsurgery were divided into 980-nm/1470-nm dual-wavelength fiber laser surgery (Dual-wavelength fiber laser group) and CO2 laser surgery (CO2 laser group). The operative time, number of other hemostatic devices used, postoperative blood loss, surgical complications and postoperative length of hospital stay The time of mucosal epithelialization and Voice Handicap Index-10(VHI-10) in pre-operation, 1-month postoperation and 6-month postoperation in both two groupswere retrospectively analyzed. RESULTS All the patients underwent successful operation and all the tumors received en-bloc resection with negative margins. The median operative time in Dual-wavelength laser group was faster than CO2 laser group (32.00 min vs 37.50 min, p = 0.014). There was no statistically significant difference between the two groups in the median postoperative hospital stay and the median time of mucosal epithelialization. No patient need feeding tubes place temporarily or permanently in both two groups. Tongue numbness, tear of the palatal arch, postoperative vocal cord adhesion, VHI-10 score in Pre-operation, 1-month postoperation and 6-month postoperation were similar in both two group. No recurrence was reported in both groups during follow-up. CONCLUSION Compared to the CO2 laser surgery, transoral 980-nm/1470-nm dual-wavelength fiber laser microsurgery is a safe and feasible procedure for early-stage glottic carcinoma. It can provide clearer surgical field without hemorrhage and make the operation simpler, smoother and faster.
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Affiliation(s)
- Faya Liang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Department of Otorhinolaryngology-Head&Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Zhiwen Xiao
- Department of Otorhinolaryngology-Head&Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, China
| | - Renhui Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Department of Otorhinolaryngology-Head&Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Pin Han
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Department of Otorhinolaryngology-Head&Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Peiliang Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Department of Otorhinolaryngology-Head&Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Yuzhang Huang
- Department of Otorhinolaryngology-Head&Neck Surgery, Beijing United Family Hospital, Beijing 100015, China.
| | - Xiaoming Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Department of Otorhinolaryngology-Head&Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, Guangdong 510120, China.
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45
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Osuch-Wójcikiewicz E, Rzepakowska A, Sobol M, Bruzgielewicz A, Niemczyk K. Oncological outcomes of CO 2 laser cordectomies for glottic squamous cell carcinoma with respect to anterior commissure involvement and margin status. Lasers Surg Med 2019; 51:874-881. [PMID: 31286558 DOI: 10.1002/lsm.23130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Controversial prognostic factors of primary CO2 laser cordectomy are anterior commissure involvement (ACI) and status of margin. STUDY DESIGN/MATERIALS AND METHODS Retrospective analysis of oncological outcomes in 102 patients with early glottic cancer undergoing laser cordectomy between 2013 and 2015. RESULTS The T stages distribution included: 72.6% T1a, 14.7% T1b, and 12.7% T2. The ACI was diagnosed in 26 patients. The primary cordectomy was radical in 72 patients. The 2- and 5-year disease free survival (DFS) for all patients were, respectively, 83.3% and 77.3%.The 2-year DFS rates for T1a, T1b, T2 were, respectively, 91.7%, 66.7%, and 53.9% and the differences were statistically significant (P < 0.001). The 2-year DFS rates according to the ACI and free anterior commissure tumors were, respectively, 65.4% and 89.2%, and the ACI indicated worse prognosis (P = 0.057). The 2-year DFS rates according to margins status were higher for patients with close or positive margins, who had second resection (88.9%) compared with those of negative margins (80.9%) (P = 0.340). Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Ewa Osuch-Wójcikiewicz
- Department of Otolaryngology, Medical University of Warsaw, Banacha Street 1a, Warsaw, 02-097, Poland
| | - Anna Rzepakowska
- Department of Otolaryngology, Medical University of Warsaw, Banacha Street 1a, Warsaw, 02-097, Poland
| | - Maria Sobol
- Department of Biophysics and Human Physiology, Medical University of Warsaw, Chałubińskiego Street 5, Warsaw, 02-004, Poland
| | - Antoni Bruzgielewicz
- Department of Otolaryngology, Medical University of Warsaw, Banacha Street 1a, Warsaw, 02-097, Poland
| | - Kazimierz Niemczyk
- Department of Otolaryngology, Medical University of Warsaw, Banacha Street 1a, Warsaw, 02-097, Poland
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46
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Forner D, Rigby MH, Hart RD, Trites JR, Taylor SM. Oncological and functional outcomes following transoral laser microsurgery in patients with T2a vs T2b glottic squamous cell carcinoma. J Otolaryngol Head Neck Surg 2019; 48:27. [PMID: 31174618 PMCID: PMC6556033 DOI: 10.1186/s40463-019-0346-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 05/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background There is a paucity of evidence comparing oncological and voice outcomes between T2a and T2b glottic squamous cell carcinoma (SCC) patients treated with transoral laser microsurgery (TLM). This study identified functional and oncological outcomes in this cohort. Methods Retrospective review of prospectively collected data of patients treated with TLM for T2 glottic SCC from 2003 to 2017. Results In total, 75 patients were included. Five-year local control rates were significantly different between T2a and T2b patients (75.2% vs 57.0%, p = 0.022). There was no difference in five-year survival between patients with T2a disease and T2b disease (69.5% vs 73.4%, p = 0.627). There was no significant difference in mean VHI-10 scores in the pre-operative period (18.3 vs 21.4, p = 0.409). However, patients with T2b disease had significantly worse perceived voice outcomes post-operatively (6.6 vs 21.3 p = 0.001). Patients with T2a disease saw significant improvements in mean VHI-10 scores following surgery (18.3 vs 6.6, p = 0.000), while T2b patients did not (21.4 vs 21.3, p = 0.979). The overall laryngeal preservation rate was 94.7%, with 11.5% of T2b patients requiring salvage organ sacrifice. Conclusions This study highlights positive functional outcomes for T2a glottic SCC. Patients with T2b disease appear to have significantly worse oncological and functional outcomes, including worse voice quality following surgery and higher rates of salvage laryngectomy.
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Affiliation(s)
- David Forner
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave., 3rd Floor Dickson Bldg, Halifax, Nova Scotia, B3H 2Y9, Canada.
| | - Matthew H Rigby
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave., 3rd Floor Dickson Bldg, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Robert D Hart
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave., 3rd Floor Dickson Bldg, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Jonathan R Trites
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave., 3rd Floor Dickson Bldg, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - S Mark Taylor
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave., 3rd Floor Dickson Bldg, Halifax, Nova Scotia, B3H 2Y9, Canada
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Altered-fractionation radiotherapy improves local control in early-stage glottic carcinoma: A systematic review and meta-analysis of 1762 patients. Oral Oncol 2019; 93:8-14. [DOI: 10.1016/j.oraloncology.2019.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/26/2019] [Accepted: 04/05/2019] [Indexed: 12/25/2022]
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48
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Oncological outcomes of early glottic carcinoma treated with transoral robotic surgery. Auris Nasus Larynx 2019; 46:285-293. [DOI: 10.1016/j.anl.2018.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 11/22/2022]
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49
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Hendriksma M, van Loon Y, Klop WMC, Hakkesteegt MM, Heijnen BJ, El Hasnaoui I, de Jong M, Langeveld TPM, van Benthem PPG, Baatenburg de Jong RJ, Sjögren EV. Quality of life and voice outcome of patients treated with transoral CO 2 laser microsurgery for early glottic carcinoma (T1-T2): a 2-year follow-up study. Eur Arch Otorhinolaryngol 2019; 276:805-814. [PMID: 30810819 PMCID: PMC6411677 DOI: 10.1007/s00405-019-05348-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/13/2019] [Indexed: 02/06/2023]
Abstract
Purpose Longitudinal studies in laryngeal cancer can provide clinicians information about short-term and long-term functional outcomes, like quality of life (QoL) and voice outcome. This information is important when counseling patients or choosing a primary treatment modality. The present study assessed long-term (2 years) QoL and voice outcome in patients with extended T1 and limited T2 glottic carcinoma treated with transoral CO2 laser microsurgery (TLM) (unilateral type III or bilateral type II resections). Methods Three questionnaires were administered: the Voice Handicap Index (VHI), the European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaire (QLQ)-C30, the EORTC QLQ-HN35. A perceptual voice evaluation at six different time points was conducted: preoperatively, and postoperatively at 6 weeks, 3 months, 6 months, 1 year, and 2 years. Fluctuations over time were investigated. Results Sixty-one patients were included in the analysis. Patients reported high-level functioning and low symptom scores 2 years postoperatively. Gender significantly affected the VHI scores at 2 years (mean VHI scores: female 8.7 vs. male, 23.9; p = 0.023). The major improvement in VHI scores was observed within the first 6 months. The tumor stage (T1a, T1b, and T2) significantly impacted the grade (mean scores at 2 years: 1.0, 1.9, and 1.7; p = 0.001). These scores stabilized at 6 months. Conclusions Patients show good long-term QoL with low symptom scores, a low voice handicap, and mild to moderate dysphonia, 2 years postoperatively. Scores stabilize at 6 months and provide a clear indication of status at 1 and 2 years.
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Affiliation(s)
- Martine Hendriksma
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Yda van Loon
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - W Martin C Klop
- Department of Head and Neck Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Marieke M Hakkesteegt
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Bas J Heijnen
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ibtissam El Hasnaoui
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin de Jong
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Ton P M Langeveld
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Elisabeth V Sjögren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
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50
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Rodrigo JP, García‐Velasco F, Ambrosch P, Vander Poorten V, Suárez C, Coca‐Pelaz A, Strojan P, Hutcheson K, Folz BJ, Bernal‐Sprekelsen M, Rinaldo A, Silver CE, Ferlito A. Transoral laser microsurgery for glottic cancer in the elderly: Efficacy and safety. Head Neck 2019; 41:1816-1823. [DOI: 10.1002/hed.25616] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/25/2018] [Accepted: 12/11/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de AsturiasUniversity of Oviedo, ISPA, IUOPA, CIBERONC Oviedo Spain
| | - Fabian García‐Velasco
- Department of Otolaryngology, Hospital Universitario Central de AsturiasUniversity of Oviedo, ISPA, IUOPA, CIBERONC Oviedo Spain
| | - Petra Ambrosch
- Department of Otorhinolaryngology, Head and Neck SurgeryChristian‐Albrechts‐University of Kiel Kiel Germany
| | - Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck SurgeryUniversity Hospitals Leuven Leuven Belgium
- Department of Oncology, Section Head and Neck OncologyKU Leuven Leuven Belgium
| | - Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de AsturiasUniversity of Oviedo, ISPA, IUOPA, CIBERONC Oviedo Spain
| | - Andrés Coca‐Pelaz
- Department of Otolaryngology, Hospital Universitario Central de AsturiasUniversity of Oviedo, ISPA, IUOPA, CIBERONC Oviedo Spain
| | - Primoz Strojan
- Department of Radiation OncologyInstitute of Oncology Ljubljana Slovenia
| | - Kate Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology and AudiologyMD Anderson Cancer Center Houston Texas
| | | | | | - Alessandra Rinaldo
- Otorhinolaryngology‐Head and neck surgery, University of Udine School of Medicine Udine Italy
| | - Carl E. Silver
- Department of SurgeryUniversity of Arizona College of Medicine Phoenix Arizona
| | - Alfio Ferlito
- International Head and Neck Scientific Group Padua Italy
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