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Higashino M, Aihara T, Takeno S, Naonori H, Jinnin T, Nihei K, Ono K, Kawata R. Boron neutron capture therapy as a larynx-preserving treatment for locally recurrent laryngeal carcinoma after conventional radiation therapy: A preliminary report. Auris Nasus Larynx 2024; 51:792-796. [PMID: 38964028 DOI: 10.1016/j.anl.2024.06.007] [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: 11/30/2023] [Revised: 05/27/2024] [Accepted: 06/21/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE Laryngeal preservation and a radical cure are the treatment goals for laryngeal carcinoma, and larynx-preserving therapy is generally preferred for early-stage laryngeal carcinoma. When laryngeal carcinoma recurs locally, patients are often forced to undergo total laryngectomy, resulting in loss of vocal function. However, many patients with laryngeal carcinoma who have residual or recurrent disease after radiotherapy wish to preserve their voice. The purpose of this study was to investigate the possibility of using BNCT as a larynx-preserving treatment for residual or recurrent laryngeal carcinomas following radical irradiation. PATIENTS AND METHODS This study included 15 patients who underwent BNCT for residual or recurrent laryngeal carcinoma after radical laryngeal carcinoma irradiation. The number of treatment sessions for all patients was one irradiation. Before BNCT, the recurrent laryngeal carcinoma stage was rT1aN0, rT2N0, rT2N1, rT3N0, rT3N1, and rT4aN0 in one, six, one, three, one, and three patients, respectively. The median maximum tumor diameter before BNCT was 15 mm (8-22 mm). All patients underwent a tracheostomy before BNCT to mitigate the risk of upper airway stenosis due to laryngeal edema after BNCT. Treatment efficacy was evaluated retrospectively using monthly laryngoscopy after BNCT and contrast-enhanced CT scans at 3 months. The safety of treatment was evaluated based on examination findings and interviews with patients. RESULTS The median hospital stay after BNCT was 2 days (1-6). The response rate at three months after BNCT in 15 patients with locally recurrent laryngeal carcinoma was 93.3 %, and the CR rate was 73.3 %. The most frequent adverse event associated with BNCT was laryngeal edema, which occurred in nine patients the day after BNCT. The average course of laryngeal edema peaked on the second day after BNCT and almost recovered after 1 week in all patients. One patient had bilateral vocal fold movement disorders. None had dyspnea because of prophylactic tracheostomy. No grade four or higher adverse events occurred. Other grade 2 adverse events included pharyngeal mucositis, diarrhea, and sore throat. Three months after BNCT, tracheostomy tubes were removed in nine patients, retinal cannulas were placed in three patients, and voice cannulas were placed in three patients. CONCLUSIONS BNCT for locally recurrent laryngeal carcinoma can safely deliver radical irradiation to tumor tissues, even in patients undergoing radical irradiation. BNCT has shown antitumor effects against recurrent laryngeal carcinoma. However, further long-term observations of the treatment outcomes are required.
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Affiliation(s)
- Masaaki Higashino
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Japan.
| | - Teruhito Aihara
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Japan; Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, Japan
| | - Satoshi Takeno
- Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, Japan
| | - Hu Naonori
- Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, Japan
| | - Tsuyoshi Jinnin
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Japan
| | - Keiji Nihei
- Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, Japan; Department of Radiation Oncology, Osaka Medical and Pharmaceutical University, Japan
| | - Koji Ono
- Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, Japan
| | - Ryo Kawata
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Japan
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Russo E, Costantino A, Veneroni MV, Festa BM, Pellini R, Campo F, Petruzzi G, Spriano G, Mercante G, De Virgilio A. Transoral Laser Microsurgery in Recurrent Laryngeal Cancer: A Systematic Review and Meta‐analysis. Laryngoscope 2022; 133:1425-1433. [PMID: 37158265 DOI: 10.1002/lary.30332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the oncological outcomes of salvage transoral laser microsurgery (TLM) in the treatment of patients suffering from recurrent laryngeal cancer. METHODS PubMed/MEDLINE, Cochrane Library, and Scopus databases were searched. English language, original studies investigating oncological outcomes of TLM in adult patients with recurrent laryngeal cancer were included. Data were pooled using a distribution-free approach for estimating summary local control (LC), disease-specific survival (DSS), and overall survival (OS) curves with random effects. RESULTS Two hundred and thirty-five patients underwent salvage TLM after primary (chemo)radiotherapy. The mean follow-up time was 60.8 months (95% CI: 32.7-88.9). Estimated pooled LC rates (95% CI) at 1, 3 and 5 years were 74.2% (61.7-89.4), 53.9% (38.5-75.3), and 39.1% (25.2-60.8). Estimated pooled DSS rates (95% CI) at 1, 3 and 5 years were 88.4% (82.0-95.3), 67.8% (50.9-90.3), and 58.9% (42.7-81.1). Two hundred and seventy-one patients underwent TLM after primary laser treatment. The mean follow-up time was 70.9 months (95% CI: 36.9-104.9). Estimated pooled LC rates (95% CI) at 1, 3 and 5 years were 72.2% (64.7-80.6), 53.2% (42.2-66.9), and 40.4% (29.6-55.2). Estimated pooled DSS rates (95% CI) at 1, 3 and 5 years were 92.1% (85.5-99.1), 77.0% (64.4-92.0), and 67.1% (51.6-87.3). CONCLUSIONS TLM is a valuable treatment option for the management of locally recurrent laryngeal carcinoma if performed by experienced surgeons and following rigorous patients' selection criteria. Further studies should be conducted to define stage-based clinical guidelines. LEVEL OF EVIDENCE NA Laryngoscope, 133:1425-1433, 2023.
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Affiliation(s)
- Elena Russo
- Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy
- Otorhinolaryngology Unit IRCCS Humanitas Research Hospital Rozzano Italy
| | - Andrea Costantino
- Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy
- Otorhinolaryngology Unit IRCCS Humanitas Research Hospital Rozzano Italy
| | | | - Bianca Maria Festa
- Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy
- Otorhinolaryngology Unit IRCCS Humanitas Research Hospital Rozzano Italy
| | - Raul Pellini
- Department of Otolaryngology‐Head & Neck Surgery IRCCS Regina Elena National Cancer Institute Rome Italy
| | - Flaminia Campo
- Department of Otolaryngology‐Head & Neck Surgery IRCCS Regina Elena National Cancer Institute Rome Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology‐Head & Neck Surgery IRCCS Regina Elena National Cancer Institute Rome Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy
- Otorhinolaryngology Unit IRCCS Humanitas Research Hospital Rozzano Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy
- Otorhinolaryngology Unit IRCCS Humanitas Research Hospital Rozzano Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy
- Otorhinolaryngology Unit IRCCS Humanitas Research Hospital Rozzano Italy
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Salvage carbon dioxide transoral laser microsurgery for laryngeal cancer after (chemo)radiotherapy: a European Laryngological Society consensus statement. Eur Arch Otorhinolaryngol 2021; 278:4373-4381. [PMID: 34226992 PMCID: PMC8486708 DOI: 10.1007/s00405-021-06957-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/23/2021] [Indexed: 12/11/2022]
Abstract
Purpose To provide expert opinion and consensus on salvage carbon dioxide transoral laser microsurgery (CO2 TOLMS) for recurrent laryngeal squamous cell carcinoma (LSCC) after (chemo)radiotherapy [(C)RT]. Methods Expert members of the European Laryngological Society (ELS) Cancer and Dysplasia Committee were selected to create a dedicated panel on salvage CO2 TOLMS for LSCC. A series of statements regarding the critical aspects of decision-making were drafted, circulated, and modified or excluded in accordance with the Delphi process. Results The expert panel reached full consensus on 19 statements through a total of three sequential evaluation rounds. These statements were focused on different aspects of salvage CO2 TOLMS, with particular attention on preoperative diagnostic work-up, treatment indications, postoperative management, complications, functional outcomes, and follow-up. Conclusion Management of recurrent LSCC after (C)RT is challenging and is based on the need to find a balance between oncologic and functional outcomes. Salvage CO2 TOLMS is a minimally invasive approach that can be applied to selected patients with strict and careful indications. Herein, a series of statements based on an ELS expert consensus aimed at guiding the main aspects of CO2 TOLMS for LSCC in the salvage setting is presented.
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Vander Poorten V, Meulemans J, Beitler JJ, Piazza C, Kowalski LP, Mäkitie AA, Paleri V, Rinaldo A, Robbins KT, Rodrigo JP, Silver CE, Sjögren EV, Strojan P, Takes RP, Ferlito A. Salvage surgery for residual or recurrent laryngeal squamous cell carcinoma after (Chemo)radiotherapy: Oncological outcomes and prognostic factors. Eur J Surg Oncol 2021; 47:2711-2721. [PMID: 34059377 DOI: 10.1016/j.ejso.2021.05.035] [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: 02/19/2021] [Revised: 04/26/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022] Open
Abstract
Nonsurgical primary treatment of early and advanced laryngeal squamous cell carcinoma, employing radiotherapy with or without chemotherapy, is considered a standard of care in many centers throughout the world. When patients have persistent or recurrent disease after non-surgical treatment, salvage surgery is frequently the only remaining potentially curative treatment. Depending on the extent of the residual/recurrent disease, different surgical salvage options are at the surgeon's disposal. In selected cases with limited local disease, salvage transoral laser microsurgery, transoral robotic surgery and open partial laryngectomies can be employed to achieve cure while preserving laryngeal function. For more advanced cases total laryngectomy is necessary. Identifying situations with unacceptable results from surgical salvage may guide future therapies.
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Affiliation(s)
- Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
| | - Jeroen Meulemans
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Otolaryngology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil; Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki, University Hospital, FI-00029, HUS Helsinki, Finland
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, The Institute of Cancer Research, Brompton Road, London, UK
| | | | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Elisabeth V Sjögren
- Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Locatello LG, Bruno C, Gallo O. Early glottic cancer recurrence: A critical review on its current management. Crit Rev Oncol Hematol 2021; 160:103298. [PMID: 33716199 DOI: 10.1016/j.critrevonc.2021.103298] [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: 12/02/2020] [Revised: 02/03/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Recurrent early glottic cancer (rEGC) poses several issues in terms of timely diagnosis, correct re-staging, and treatment. We want to critically review the latest evidence about rEGC considering its epidemiology, biology, diagnostic challenges, and treatment strategies. METHODS A systematic search of the literature using PubMed from 1990 to October 31, 2020 was performed. RESULTS There are many different treatment options available (open surgery, transoral mini-invasive surgery, radiotherapy), and many factors related to the patient's status and previous treatments must be considered when planning the best management strategy for rEGC. While its overall prognosis remains satisfactory, it is of the utmost importance to appreciate all the clinical implications derived from the choice of the initial therapeutic modality, and from a correct primary and recurrent staging. CONCLUSION The balance between oncological and voice and swallowing functions represents the fundamental principle underlying rEGC management. Future studies should focus on molecular profiling of rEGC, and on the results of the emerging radiation delivery techniques and mini-invasive procedures.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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The investigation of salvage endoscopic laryngopharyngeal surgery after chemoradiotherapy. Wideochir Inne Tech Maloinwazyjne 2020; 15:511-518. [PMID: 32904634 PMCID: PMC7457200 DOI: 10.5114/wiitm.2020.94518] [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: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Endoscopic laryngopharyngeal surgery (ELPS) is an effective treatment for early-stage oropharyngeal and hypopharyngeal cancers. Since 2007, we have performed ELPS on 14 patients with early-stage cancer who had undergone radiation therapy (salvage ELPS). We discuss the beneficial effects and issues with salvage ELPS compared with those of fresh patients since we experienced some severe complications, such as ruptured pseudoaneurysm with salvage ELPS. Aim To our knowledge, the efficacy and safety of ELPS following radiation therapy have not yet been evaluated, and several unknown factors exist. An evaluation was performed for assessing whether ELPS following radiation therapy is safe, similar to findings in fresh cases previously reported by us, and whether this treatment method can be efficacious. Material and methods We studied the cases of 14 patients who had undergone salvage ELPS after radiation therapy for head and neck cancer at Akita University Hospital between 2007 and 2018. Results The rate of recurrence of head and neck cancer at different sites after salvage ELPS was 48.9% at 2 years. Furthermore, deformation of the pharyngolarynx made it extremely difficult to perform surgery. We also experienced extremely severe complications of ruptured pseudoaneurysms. Conclusions If salvage ELPS is performed after radiation therapy, patients should be followed up on an outpatient basis to monitor the onset of subsequent cancers. Complications may become severe; therefore, postoperative management should be performed cautiously. In particular, vulnerable sites, such as the piriform sinus, may not be indicated for surgery. At this stage, the expectation is that patients need to be methodically selected.
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Misirovs R, Gartner I, Manickavasagam J. Double pyramid technique of transoral laser partial laryngectomy for radiorecurrent laryngeal cancer. BMJ Case Rep 2018; 11:11/1/e224915. [PMID: 30567084 DOI: 10.1136/bcr-2018-224915] [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: 11/04/2022] Open
Abstract
Management of recurrent head and neck cancer is challenging. Surgical treatments for residual or radiorecurrent laryngeal cancer include total laryngectomy, open partial laryngectomy and transoral laser microsurgery (TLM). TLM has been shown to achieve good oncological and functional outcomes in radiorecurrent laryngeal cancer. We describe a case of a patient with radiorecurrent T2 (rT2) with impaired vocal cord mobility laryngeal cancer who underwent transoral laser partial laryngectomy using our proposed double pyramid technique. It encompasses two steps: resection of the superior and inferior pyramids. Full resection is achieved by staying close to the thyroid and cricoid cartilages. In this technique, the dissection principle is to remove anterior commissure in two pyramid fashions without having to actually follow the tumour. This method is easy and simple to master. Two years postoperatively, the patient has no signs of recurrence and is able to use her voice and has full swallowing ability.
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Affiliation(s)
- Rasads Misirovs
- Department of Otorhinolaryngology, Ninewells Hospital, NHS Tayside, Dundee, UK
| | | | - Jaiganesh Manickavasagam
- Department of Otorhinolaryngology, Ninewells Hospital, NHS Tayside, Dundee, UK.,Tayside Medical Science Centre, University of Dundee, Dundee, UK
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Meulemans J, Bijnens J, Delaere P, Vander Poorten V. Up-Front and Salvage Transoral Laser Microsurgery for Early Glottic Squamous Cell Carcinoma: A Single Centre Retrospective Case Series. Front Oncol 2018; 8:186. [PMID: 29892574 PMCID: PMC5985398 DOI: 10.3389/fonc.2018.00186] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 05/11/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction/aim Transoral laser microsurgery (TLM) is a minimally invasive surgical alternative for radiotherapy (RT) in the primary management of early glottic cancer. More recently, TLM emerged also as a possible salvage treatment for selected radiorecurrent cancers. We reviewed outcomes of primary and salvage TLM performed in a Belgian tertiary referral center. Patients and methods A retrospective review of records from 142 consecutive patients who underwent TLM was performed. Oncologic outcomes were evaluated by means of descriptive statistics and Kaplan-Meier estimates. Variation of estimated outcomes between different subgroups was evaluated using Log-Rank analysis. Results Of 142 patients, 109 (76.8%) underwent TLM as a primary treatment and 33 (23.2%) were treated in a salvage setting for recurrent or second primary glottic cancer. cT classification in the up-front TLM group was cT1a in 72 (66.1%), cT1b in 11 (10.1%), and cT2 in 26 (23.9%) patients. In the salvage group, patients were cT/rT classified as cT1a-rT1a in 17 (51.5%), cT1b-rT1b in 1 (3.0%), cT2-rT2 in 14 (42.4%), and cT3-rT3 in 1 (3.0%) patients. All patients were cN0. Second-look TLM was performed in 28 patients (19.7%), and RT was associated as adjuvant therapy in 5 patients (3.5%). Mean follow-up was 51.6 months (SD = 38.4 months). Three-year overall survival (OS) was 94.1% (SE = 2.2%), 3-year disease-specific survival (DSS) 100%, 3-year disease-free survival (DFS) 80.1% (SE = 3.8%), 3-year local recurrence-free survival (RFS) 81.0% (SE = 3.7%), and 3-year ultimate local control rate with laser alone 89.2% (SE = 3.0%). Upon subgroup analysis, no differences in OS, DSS, and DFS were observed between the up-front and salvage group (log rank; p = 0.306, p = 0.298, and p = 0.061 respectively). However, local RFS and ultimate local control rate with laser alone were significantly higher in the primary treated TLM group (log rank, p = 0.014 and p = 0.012). Five-year laryngeal preservation rate was 89.7% (SE = 3.5%) in the total population, 100% in the upfront group, and 64.9% (SE = 9.8%) in the salvage group, a difference which proved statistically significant (Log-Rank, p < 0.001). Conclusion This retrospective study confirms excellent oncologic outcomes of up-front TLM for early glottic cancer. In the salvage setting, TLM allows avoidance of total laryngectomy in the majority of cases.
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Affiliation(s)
- Jeroen Meulemans
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Jacqueline Bijnens
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Pierre Delaere
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
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Weiss BG, Bertlich M, Canis M, Ihler F. Transoral laser microsurgery or total laryngectomy for recurrent squamous cell carcinoma of the larynx: Retrospective analysis of 199 cases. Head Neck 2017; 39:1166-1176. [DOI: 10.1002/hed.24737] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/29/2016] [Indexed: 12/25/2022] Open
Affiliation(s)
- Bernhard G. Weiss
- Department of Otorhinolaryngology, University Medical Center Göttingen; Georg-August University Göttingen; Robert-Koch-Straße 40 Göttingen Germany
| | - Mattis Bertlich
- Department of Otorhinolaryngology, University Medical Center Göttingen; Georg-August University Göttingen; Robert-Koch-Straße 40 Göttingen Germany
| | - Martin Canis
- Department of Otorhinolaryngology, University Medical Center Göttingen; Georg-August University Göttingen; Robert-Koch-Straße 40 Göttingen Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, University Medical Center Göttingen; Georg-August University Göttingen; Robert-Koch-Straße 40 Göttingen Germany
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Ahn SH, Hong HJ, Kwon SY, Kwon KH, Roh JL, Ryu J, Park JH, Baek SK, Lee GH, Lee SY, Lee JC, Chung MK, Joo YH, Ji YB, Hah JH, Kwon M, Park YM, Song CM, Shin SC, Ryu CH, Lee DY, Lee YC, Chang JW, Jeong HM, Cho JK, Cha W, Chun BJ, Choi IJ, Choi HG, Lee KD. Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2017; 10:1-43. [PMID: 28043099 PMCID: PMC5327593 DOI: 10.21053/ceo.2016.01389] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
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Affiliation(s)
- Korean Society of Thyroid-Head and Neck Surgery Guideline Task Force
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jun Hong
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kee Hwan Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Junsun Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jun Hee Park
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Sei Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Bae Ji
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Hun Hah
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang Myeon Song
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ha Min Jeong
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Byung Joon Chun
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
| | - Ik Joon Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Kang Dae Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
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Outcomes of transoral laser microsurgical management of T1b stage glottic cancer. The Journal of Laryngology & Otology 2017; 131:433-441. [DOI: 10.1017/s0022215117000329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:This study aimed to evaluate the oncological and voice outcomes of transoral laser microsurgery for tumour stage T1b stage glottic cancer patients.Methods:A prospective cohort study in a tertiary care head and neck cancer centre included tumour–node–metastasis stage T1bN0M0 glottic cancer patients scheduled to undergo transoral laser microsurgery from January 2002 until June 2014. Kaplan–Meier five-year analyses of local control, overall survival, disease-specific survival and laryngeal preservation were performed. Voice Handicap Index-10 scores and maximum phonation times were also recorded.Results:Twenty-one participants with a mean age of 66.8 years were enrolled. The mean follow up was 56.5 months. Kaplan–Meier 5-year survival analysis illustrated a local control rate of 82 per cent, overall survival of 88 per cent, disease-specific survival of 100 per cent, and laryngeal preservation of 100 per cent. The pre-operative Voice Handicap Index-10 score was 19.1 ± 9.47 (mean ± standard deviation (SD)) and the post-operative scores were 13.5 ± 9.29 at three months, 10.44 ± 9.70 at one year and 5.83 ± 4.91 at two years. The pre-operative maximum phonation time was 16.23 ± 5.46 seconds (mean ± SD) and the post-operative values were 14.44 ± 6.73 seconds at three months, 15.27 ± 5.71 seconds at one year and 14.33 ± 6.44 seconds at two years.Conclusion:Transoral laser microsurgery yields relatively high rates of oncological control and acceptable voice outcomes, and thus shows utility as a primary treatment modality for T1b glottic cancer.
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Meulemans J, Delaere P, Nuyts S, Clement P, Hermans R, Vander Poorten V. Salvage Transoral Laser Microsurgery for Radiorecurrent Laryngeal Cancer: Indications, Limits, and Outcomes. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017; 5:83-91. [PMID: 28367362 PMCID: PMC5357496 DOI: 10.1007/s40136-017-0143-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review The aim of this report is to identify relevant literature reports on salvage transoral laser microsurgery (TLM); to consider its oncologic and functional outcomes, as well as reported complications; and to address indications and limitations of salvage TLM. Findings The weighted average of local control after first salvage TLM was 57%. Repeated TLM procedures for second or third recurrences were required in up to 41% of cases, resulting in a weighted average of local control with TLM alone of 67%. The rate of definite laryngeal preservation was 73%. The ultimate local control rate, including cases that required total laryngectomy, was 90%. The overall complication rate after salvage TLM was 14%. Summary Salvage TLM of radiorecurrent laryngeal cancer yields excellent oncologic outcomes. Serious complications are scarce, hospitalization times are short, and functional outcomes in terms of voice and swallowing are favorable when compared to open conservation laryngeal surgery. The key to success is an optimal patient selection.
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Affiliation(s)
- J. Meulemans
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - P. Delaere
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - S. Nuyts
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Experimental Radiotherapy, KU Leuven, Leuven, Belgium
| | - P.M. Clement
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
- Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - R. Hermans
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - V. Vander Poorten
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
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Tomifuji M, Araki K, Yamashita T, Shiotani A. Salvage Transoral Videolaryngoscopic Surgery for radiorecurrent hypopharyngeal and supraglottic cancer. Auris Nasus Larynx 2016; 44:464-471. [PMID: 27856033 DOI: 10.1016/j.anl.2016.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/16/2016] [Accepted: 10/19/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the feasibility of Transoral Videolaryngoscopic Surgery (TOVS) for radiorecurrent supraglottic and hypopharyngeal cancer, and to compare survival and complications between primary and radiorecurrent cases. METHODS Twelve cases of salvage TOVS for radiorecurrent cancer and 53 cases of TOVS as an initial treatment (primary cases) were evaluated. Days to resume soft diet, Functional Outcomes of Swallowing Scale (FOSS), postoperative complications, epithelization days and survival outcomes were assessed by retrospective chart review. RESULTS FOSS score was significantly worse in salvage cases compared with primary cases. Bleeding and airway compromise was slightly greater in salvage cases than in primary cases; however, this was not statistically significant. Wound healing was significantly delayed in salvage cases compared with primary cases (P<0.001). In primary cases, wounds were re-epithelized within 60 days in 83% of patients and within 90 days in almost all patients, while in salvage cases 42% of patients required more than 90 days for wound healing. In salvage cases, the 5-year overall survival, disease specific survival rate, local control rate, and laryngeal preservation rate was 85.7%, 85.7%, 62.5%, and 78.0%, respectively, and 85.7%, 98.0%, 91.3%, and 97.8%, respectively, for primary cases. Local control rate was significantly better in primary cases than in salvage cases. CONCLUSION Salvage TOVS was feasible in highly selected cases. After serial transoral surgery, the final laryngeal preservation rate was satisfactory. Swallowing function in salvage cases tended to be worse than in primary cases, and a significantly longer time was required for wound healing.
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Affiliation(s)
- Masayuki Tomifuji
- National Defense Medical College, Department of Otolaryngology - Head and Neck Surgery, Saitama, Japan.
| | - Koji Araki
- National Defense Medical College, Department of Otolaryngology - Head and Neck Surgery, Saitama, Japan
| | - Taku Yamashita
- Kitasato University School of Medicine, Department of Otorhinolaryngology - Head and Neck Surgery, Kanagawa, Japan
| | - Akihiro Shiotani
- National Defense Medical College, Department of Otolaryngology - Head and Neck Surgery, Saitama, Japan
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Fink DS, Sibley H, Kunduk M, Schexnaildre M, Sutton C, Kakade-Pawar A, McWhorter AJ. Functional Outcomes after Salvage Transoral Laser Microsurgery for Laryngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2016; 155:606-11. [PMID: 27165684 DOI: 10.1177/0194599816648111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 04/14/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Transoral laser microsurgery (TLM) has been increasingly used in lieu of total laryngectomy to treat malignancy after definitive radiation. There are few data in the literature regarding functional outcomes. We retrospectively reviewed voice and swallowing outcomes in patients who underwent TLM for recurrent laryngeal carcinoma. STUDY DESIGN Case series with chart review. SETTING Tertiary care center. SUBJECTS AND METHODS Forty-two patients were identified with recurrent squamous cell carcinoma of the larynx after definitive radiation therapy from 2001 to 2013: 28 patients with glottic recurrence and 14 with supraglottic recurrence. Swallowing outcomes were evaluated by gastrostomy tube dependence, the MD Anderson Dysphagia Inventory, and the Functional Oral Intake Scale. Voice outcomes were evaluated by the Voice Handicap Index and observer-rated perceptual analysis. RESULTS No significant difference was noted between mean pre- and postoperative MD Anderson Dysphagia Inventory scores: 78.25 and 74.9, respectively (P = .118, t = 1.6955). Mean Functional Oral Intake Scale scores after TLM for supraglottic and glottic recurrences were 6.4 and 6.6, respectively. Of 42 patients, 17 (40.5%) required a gastrostomy tube either during radiation or in conjunction with the salvage procedure. Of 17 patients, 15 resumed sufficient oral diet for tube removal. Patients' mean Voice Handicap Index score did increase from 34.3 to 51.5 (P = .047), and their mean perceptual score did decrease from 60.0 to 45.3 (P = .005). However, at 1-year follow-up, there was no significant difference in perceptual score: 61.1 to 57.1 (P = .722). CONCLUSIONS TLM is a successful surgical option for recurrent laryngeal cancer with acceptable functional outcomes.
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Affiliation(s)
- Daniel S Fink
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA Our Lady of the Lake Voice Center, Baton Rouge, Louisiana, USA
| | - Haley Sibley
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Melda Kunduk
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA Our Lady of the Lake Voice Center, Baton Rouge, Louisiana, USA Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, Louisiana, USA
| | | | - Collin Sutton
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | | | - Andrew J McWhorter
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA Our Lady of the Lake Voice Center, Baton Rouge, Louisiana, USA
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