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Matos LL, Kowalski LP, Chaves ALF, de Oliveira TB, Marta GN, Curado MP, de Castro Junior G, Farias TP, Bardales GS, Cabrera MA, Capuzzo RDC, de Carvalho GB, Cernea CR, Dedivitis RA, Dias FL, Estefan AM, Falco AH, Ferraris GA, Gonzalez-Motta A, Gouveia AG, Jacinto AA, Kulcsar MAV, Leite AK, Lira RB, Mak MP, De Marchi P, de Mello ES, de Matos FCM, Montero PH, de Moraes ED, de Moraes FY, Morais DCR, Poenitz FM, Poitevin A, Riveros HO, Sanabria Á, Ticona-Castro M, Vartanian JG, Viani G, Vines EF, William Junior WN, Conway D, Virani S, Brennan P. Latin American Consensus on the Treatment of Head and Neck Cancer. JCO Glob Oncol 2024; 10:e2300343. [PMID: 38603656 DOI: 10.1200/go.23.00343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 04/13/2024] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.
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Affiliation(s)
- Leandro Luongo Matos
- Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | - Gilberto de Castro Junior
- Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Andrés Munyo Estefan
- Profesor Adjunto Catedra de Otorrinolaringologia del Hospital de Clínicas, Montevidéu, Uruguay
| | | | | | | | - Andre Guimarães Gouveia
- Juravinski Cancer Centre, Department of Oncology, Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | | | - Marco Aurelio Vamondes Kulcsar
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Ana Kober Leite
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Renan Bezerra Lira
- AC Camargo Cancer Center and Hospital Albert Einstein, São Paulo, Brazil
| | - Milena Perez Mak
- 3Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | | | | | | | - Pablo H Montero
- Department of Surgical Oncology and Head and Neck Surgery, Division of Surgery, P. Universidad Católica de Chile, Santiago, Chile
| | | | | | | | | | | | | | - Álvaro Sanabria
- 4Department of Surgery, Universidad de Antioquia, Hospital Alma Mater, Medellin, Colombia
| | - Miguel Ticona-Castro
- 5ESMO Member, Peruvian Society of Medical Oncology (S.P.O.M.) Member, La Molina, Peru
| | - José Guilherme Vartanian
- 6Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Gustavo Viani
- 7Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Eugenio F Vines
- Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | | | - Shama Virani
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| | - Paul Brennan
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
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Sievert M, Koch M, Mantsopoulos K, Traxdorf M, Mueller SK, Iro H, Scherl C. Failure of pedicled flap reconstruction in the head and neck area: A case report of a bilateral subclavian artery stenosis. Int J Surg Case Rep 2020; 76:381-385. [PMID: 33086164 PMCID: PMC7575643 DOI: 10.1016/j.ijscr.2020.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Pedicled flap reconstruction still plays an essential role in head and neck surgery as an alternative to free grafts. Two standard methods are the pectoralis major and the deltopectoral flap, which are generally characterized by their reliable perfusion. This case describes bilateral arteriosclerosis of the subclavian artery as a possible cause of flap failure. PRESENTATION OF CASE We report on a 65-year-old patient with a multilevel carcinoma of the right pharynx. Due to the unique patient history, a free flap reconstruction was not possible. After resection of the primary, we performed reconstruction with a pedicled pectoralis major flap. DISCUSSION Postoperatively, we observed necrosis of the pectoralis major flap. Secondary defect reconstructions were performed with a deltopectoral flap first from the right and then, in the case of necrosis, from the left side. Stenosing arteriosclerotic plaques of the subclavian artery on both sides were the cause of flap failure. CONCLUSION Preoperative angiography of the subclavian artery is not a standard diagnostic procedure in the surgical planning of pedicled flap reconstruction in the head and neck region. In exceptional cases, we recommend angiographic imaging of the supplying vessels to make a more precise flap selection and avoid complications.
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Affiliation(s)
- Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Waldstrasse 1, 91054 Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Waldstrasse 1, 91054 Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Waldstrasse 1, 91054 Erlangen, Germany
| | - Maximilian Traxdorf
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Waldstrasse 1, 91054 Erlangen, Germany
| | - Sarina K Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Waldstrasse 1, 91054 Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Waldstrasse 1, 91054 Erlangen, Germany
| | - Claudia Scherl
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Waldstrasse 1, 91054 Erlangen, Germany.
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Zhao X, Jiang M, Wang Z, Chen X, Wang H, Yue W, Cai C. CCNY Accelerates Cylcin E Expression to Regulate the Proliferation of Laryngeal Carcinoma Cells via MEK/ERK Signaling Pathway. Cancer Manag Res 2020; 12:4889-4898. [PMID: 32606977 PMCID: PMC7320751 DOI: 10.2147/cmar.s241620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background Laryngeal carcinoma is a common cancer among head and neck tumors, accounting for 0.5–1% new cancer cases or deaths of all tumors throughout the body. Despite improvements in diagnostic and therapy, the prognosis of laryngeal carcinoma patients still remains poor. Thus, it is very important to identify the biomarkers involved in the molecular pathogenesis of laryngeal carcinoma. Cyclin Y (CCNY) is a conserved cell cycle regulator that acts as a growth factor in many cancers. The clinical significance of CCNY in laryngeal carcinoma remains unknown. The function of CCNY in laryngocarcinoma was studied in this paper. Materials and Methods CCNY knock-out cells were constructed by CRISPR/CAS9 technique. CCNY overexpression cells were also constructed based on CCNY knock-out cells. Cell growth ability was detected by MTS assay, high-content cell analysis, colony formation assays, and anchorage-independent growth assays. The protein levels in laryngocarcinoma cells were determined by Western blot. The role of CCNY in cell cycle progression was evaluated by flow cytometry. Results CCNY knock-out cells and CCNY up-regulation cell models were obtained successfully. Suppression of CCNY expression inhibited Hep2 cell growth. Cell growth was enhanced by the up-regulation of CCNY. The percentage of cells in G1 phase was altered when CCNY expression was down-regulated or up-regulated. The phosphorylation level of MEK and ERK as well as cyclin E protein level was also regulated by the expression level of CCNY. Conclusion In laryngocarcinoma cell line Hep2 cells, cell proliferation was controlled by CCNY. The expression of CCNY was involved in the cell cycle progress of Hep2 cells. It indicated that CCNY could promote cell growth by activating MEK/ERK/cyclin E signaling pathway.
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Affiliation(s)
- Xiaoting Zhao
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Cellular and Molecular Biology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Tongzhou, Beijing, People's Republic of China
| | - Mei Jiang
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Cellular and Molecular Biology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Tongzhou, Beijing, People's Republic of China
| | - Ziyu Wang
- Department of Cellular and Molecular Biology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Tongzhou, Beijing, People's Republic of China
| | - Xiaohong Chen
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hongzhen Wang
- Department of Oncology, Rizhao City Hospital of Traditional Chinese Medicine, Rizhao, Shandong, People's Republic of China
| | - Wentao Yue
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chao Cai
- Beijing YouAn Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Tongzhou, Beijing, People's Republic of China
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Garcia AM, Dias FL, Gonçalves AJ, Cernea CR, Freitas EQ, Menezes MB, Kulcsar MAV. Supratracheal laryngectomy: a multi-institutional study. Braz J Otorhinolaryngol 2019; 86:609-616. [PMID: 31175040 PMCID: PMC9422495 DOI: 10.1016/j.bjorl.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 04/07/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Supratracheal laryngectomy has been described as a surgical procedure for glottic or supraglottic cancer extending to the subglottic region and/or involving the cricoarytenoid joint, aiming to preserve laryngeal function (breathing, phonation and swallowing), without diminishing locoregional cancer control. The choice of supracricoid laryngectomy in these cases could result in a high risk of compromised resection margins. Objective To determine the safety, viability, adequacy of surgical margins and the supratracheal laryngectomy results for intermediate and advanced laryngeal cancer by reviewing the results at three different institutions in Brazil. Methods This is a retrospective study that analyzed the charts of 29 patients submitted to supratracheal laryngectomy from October 1997 to June 2017. The type of laryngectomy performed was classified according to the European Laryngological Society classification for horizontal laryngectomies. Early and late results were evaluated. Survival rates (overall, specific, disease-free and total laryngectomy-free survival) were calculated. The mean follow-up time was 44 months. Results Of the 29 patients submitted to supratracheal laryngectomy, 25 had no previous treatment. One patient (3.4%) had compromised margins. Four patients (13.8%) had recurrence. Of these, three had local recurrence and one had regional recurrence. Five patients (17.2%) required a total laryngectomy, two due to ruptured pexy and three due to local recurrence. Four of these patients (80%) achieved a successful total procedure. Four patients (13.8%) died, two due to postoperative complications and two due to recurrence. Overall, specific, disease-free and total laryngectomy-free survival at 5 years were, respectively, 82.1%; 88.2%; 83.0% and 80.2%. Conclusion Selected patients with intermediate and advanced laryngeal cancer may benefit from supratracheal laryngectomy, that resulted in total laryngectomy-free survival and specific survival of 80.2% and 88.2%, respectively.
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Affiliation(s)
- Ariana M Garcia
- Instituto Nacional de Câncer (INCA), Serviço de Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brazil.
| | - Fernando L Dias
- Instituto Nacional de Câncer (INCA), Serviço de Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brazil
| | - Antônio J Gonçalves
- Irmandade Santa Casa de Misericórdia de São Paulo (ISCMSP), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Claudio R Cernea
- Universidade de São Paulo (USP), Hospital das Clínicas (HC), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Emilson Q Freitas
- Instituto Nacional de Câncer (INCA), Serviço de Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brazil
| | - Marcelo B Menezes
- Irmandade Santa Casa de Misericórdia de São Paulo (ISCMSP), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Marco Aurélio V Kulcsar
- Universidade de São Paulo (USP), Hospital das Clínicas (HC), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
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Organ preservation vs primary surgery in the management of T3 laryngeal and hypopharyngeal cancers. Eur Arch Otorhinolaryngol 2018; 275:2311-2316. [PMID: 29959566 DOI: 10.1007/s00405-018-5047-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The main objective is to compare the oncologic outcomes of patients with T3 laryngeal cancers who underwent total laryngectomy or organ preservation protocol (OPP) as the initial plan of management. MATERIALS AND METHODS This is a retrospective study on 120 patients treated for T3 laryngeal and hypopharyngeal cancers. Patients with functional larynx underwent OPP and dysfunctional larynx underwent upfront laryngectomy. Median follow-up of the patients was 4.6 years. RESULTS There was a significant difference in 3 year disease-free survival (DFS) between upfront laryngectomy and OPP (73.2 vs. 55.7%; P = 0.028) group but not in 3 year overall survival (73.2 vs. 68.7%, P = 0.8). The rate laryngeal preservation was 65% in CCRT and 44% in only radiotherapy group. At 3 years, the laryngectomy-free survival was 57.2% and the laryngo-esophageal dysfunction-free survival (LEDS) was 53.0%. CONCLUSION T3 laryngeal cancers treated with upfront laryngectomy have an improved DFS when compared to those treated with non-surgical modalities. Primary surgery should be offered as an option for selected patients especially when CCRT is not feasible.
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6
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Kardasz-Ziomek M, Ścierski W, Namysłowski G. [Operation treatment results of laryngeal cancer in different types of partial laryngectomy based on own material]. Otolaryngol Pol 2014; 68:233-8. [PMID: 25283319 DOI: 10.1016/j.otpol.2013.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 11/19/2013] [Accepted: 11/27/2013] [Indexed: 11/17/2022]
Abstract
THE AIM of the study was to evaluate the oncological results of laryngeal cancer treatment performed in the Laryngology University Ward in Zabrze in the years 1990-2000, depending on the type of partial surgery applied. MATERIALS AND METHODS Retrospective clinical material includes 209 patients in whom surgery was a primary treatment method. No distant metastases (M1) or another malignant cancer were found. In all 209 patients the squamous cell carcinoma of various degree of malignancy (G1-G3) was found. The most common operation in the analyzed group was a chordectomy - 83 surgeries (40%), next, vertical partial laryngectomies - 38 (18%), horizontal glottis surgeries - 28 (13%). In 79 patients (38%) partial laryngectomy was complemented with a nodal operation. The median of the observation period was 9 years. Local recurrence, nodal recurrence and distant metastasis are rated as treatment failure. Treatment effectiveness was evaluated with relation to overall survival, disease-free survival, cause specific survival and local control. All the above-mentioned parameters were analyzed with the updated percentages method. The level of statistical significance was assumed to be p≤0.05. RESULTS The best oncological results were observed after vertical operations. In the vertical operations group the most favourable oncological results were noted after chordectomy. 83% overall survivals, 82% disease-free survivals, 93% cause specific survivals and 96% local controls in the 5-year observation. On the other hand, the least favourable treatment results were observed after ¾ subtotal partial operation, after horizontal supraglottic operation and after reconstruction operation with CHP. Statistically significant differences in treatment results between the groups of patients after various types of partial operations were found in relation to local controls and disease-free survivals.
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Affiliation(s)
- Małgorzata Kardasz-Ziomek
- Katedra i Oddział Kliniczny Laryngologii w Zabrzu Śląskiego Uniwersytetu Medycznego w Katowicach, Kierownik: prof. dr hab. med. Grzegorz Namysłowski, Zabrze, Poland.
| | - Wojciech Ścierski
- Katedra i Oddział Kliniczny Laryngologii w Zabrzu Śląskiego Uniwersytetu Medycznego w Katowicach, Kierownik: prof. dr hab. med. Grzegorz Namysłowski, Zabrze, Poland
| | - Grzegorz Namysłowski
- Katedra i Oddział Kliniczny Laryngologii w Zabrzu Śląskiego Uniwersytetu Medycznego w Katowicach, Kierownik: prof. dr hab. med. Grzegorz Namysłowski, Zabrze, Poland
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Preservation of laryngeal function improves outcomes of patients with hypopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2014; 272:1785-91. [PMID: 24913624 PMCID: PMC4438222 DOI: 10.1007/s00405-014-3115-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/20/2014] [Indexed: 10/27/2022]
Abstract
This study compares clinical characteristics and survival between patients with and without laryngeal function (LF) preservation during surgical treatment for hypopharyngeal carcinoma. We retrospectively reviewed 485 cases of hypopharyngeal carcinoma treated at a single institution for analysis. There were 337 cases with and 148 cases without LF preservation after surgery. Preservation of LF was complete in 237 patients and partial in 100 patients. There were significant statistical differences between the preservation group and the group without preservation in T-stage (P < 0.001), overall staging (P < 0.001), and tumor sites (P < 0.001) except the N-stage (P = 0.240). The patients with LF preservation had significantly better overall survival (log-rank, P = 0.005) and a lower risk of death than those without LF preservation (HR 0.62, 95% CI 0.43-0.97), after multivariable adjustment. Treatment with surgery in combination with radiotherapy is still the favorable choice for patients with hypopharyngeal carcinoma. The maximal restoration of pharyngoesophageal continuity and function improves survival for patients whose tumors are excised completely for the preservation of LF and laryngeal and pharyngeal reconstruction.
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Li XZ, Jin T, Cai XL, Pan XL. Preservation of laryngeal functions in surgical treatment of pyriform sinus carcinoma. Acta Otolaryngol 2011; 131:316-22. [PMID: 21133828 DOI: 10.3109/00016489.2010.526635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The tumor's grade, rather than the tumor's location, was related to the opportunity of preserving laryngeal functions in patients with pyriform sinus cancer. The survival rate decreased significantly with the increase of tumor grade or node grade. Preservation of laryngeal functions is a safe and promising method without compromising the survival rate of patients with pyriform sinus cancer. OBJECTIVE Surgical resection of pyriform sinus carcinoma has a profound influence on the preservation of laryngeal functions. The purpose of this study was to assess the safety and efficacy of the surgical treatment of pyriform sinus carcinoma in the preservation of laryngeal functions without compromising the survival rate. METHODS Two hundred and thirty patients with pyriform sinus cancer had been operated from March 1978 to December 2002. Of them, 158 cases had been operated with the preservation of laryngeal functions and 72 cases had been undergone total laryngectomy. In addition, 216 cases had received adjuvant postoperative radiotherapy. All cases were followed up for 6-12 months (mean 51 ± 26) after surgery. The survival rate was calculated on the basis of Kaplan-Meier analysis, and the factors that influenced the survival rate of patients with and without preservation of laryngeal functions were analyzed with the log-rank test. RESULTS Laryngeal functions were preserved completely (speech, respiration, and deglutition) in 70.9% (112/158) cases, and partially (speech and deglutition) in 29.1% (46/158) cases. The 3- and 5-year survival rates were 75.4% and 59.0%, respectively, for the group with laryngeal function preservation, and 58.6% and 41.5%, respectively, for the group without preservation. There was no statistically significant difference in the survival rate between the two groups within the follow-up period (p > 0.05). Increase in the tumor grade resulted in a proportional decrease of patients with preservation of laryngeal function (p < 0.05). Increase in the tumor grade (p < 0.05) or node grade (p < 0.05) also led to significant decrease in the survival rate. The location of the primary lesions (the lateral wall or medial wall of the pyriform sinus) showed no significant influence on either the opportunity for preserving laryngeal functions (p > 0.05) or survival rate of patients (p > 0.05).
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Affiliation(s)
- Xue-Zhong Li
- Department of Otolaryngology, Qilu Hospital, Shandong University, Ji'nan, China
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Radical surgery and postoperative radiotherapy in patients with advanced squamous cell carcinoma of the larynx. ARCHIVE OF ONCOLOGY 2011. [DOI: 10.2298/aoo1102017k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: The aim of this study is to analyze the results of radical
surgery followed by postoperative radiotherapy in patients with advanced
laryngeal cancer. Methods: Seventy-seven patients with advanced laryngeal
cancer were treated with postoperative radiotherapy following total
laryngectomy with or without neck dissection. Median age of patients at the
diagnosis was 57 years (range, 43-76). The median follow-up was 41 months
(range, 11-70). Radiotherapy was performed using three-dimensional conformal
technique. Results: Median duration of overall radiation treatment time was
5.9 weeks (range, 5.4-7.6). Median total dose delivered was 60 Gy (range,
50-66). Locoregional relapse was the most frequent pattern of failure. A
5-year locoregional control (LRC) and overall survival (OS) rates were 72.3%
and 66.2%, respectively. A 5-year LRC and OS rates were significantly higher
in patients without nodal disease (N0) as compared to patients with
metastatic involvement of the neck lymph nodes (N+) (p=0.009 and p=0.002,
respectively). Confluent mucositis was developed in 16 patients (20.8%). Late
toxicity most frequently occurred in the skin as well as in the mucous
membrane and in the subcutaneous tissue and was grade 1 reaction (74.0%,
67.5%, and 72.7%, respectively). Conclusion: In order to improve treatment
results in terms of LRC and OS and following evidence-based treatment
recommendations for patients with advanced laryngeal cancer whose initial
treatment was radical surgery, we strongly advocate the acceptance of
postoperative concurrent chemoradiotherapy in cases with surgical specimen
demonstrating high-risk pathological features.
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Genden EM, Ferlito A, Silver CE, Jacobson AS, Werner JA, Suárez C, Leemans CR, Bradley PJ, Rinaldo A. Evolution of the management of laryngeal cancer. Oral Oncol 2006; 43:431-9. [PMID: 17112771 DOI: 10.1016/j.oraloncology.2006.08.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 08/09/2006] [Accepted: 08/14/2006] [Indexed: 11/20/2022]
Abstract
The treatment of laryngeal cancer has evolved through several phases, starting with wide extirpative surgical resection, and evolving through an era of conservation surgery and, finally, planned treatment using modalities of irradiation, chemotherapy and surgery in various combinations. Attempts to extirpate laryngeal cancer date to the nineteenth century, but only by the mid-twentieth century did advances in anesthesia, blood transfusion and antibiotics, make this surgery safe and reliable. Techniques of partial laryngectomy by external approach developed in the second half of the twentieth century, and endoscopic use of the laser refined the concept and provided a new paradigm for surgical treatment, particularly for early lesions. During most of this era, radiation was employed as an alternative method of treatment, with surgery reserved for salvage of radiation failure. By the last decade of the twentieth century, and to the present time, the value of combined modality therapy, using planned combinations of irradiation, chemotherapy and surgery became the standard of care for advanced laryngeal cancer, permitting maximal laryngeal preservation with the highest attainable cure rates.
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Affiliation(s)
- Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, The Mount Sinai Medical Center, New York, NY, USA
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