1
|
Richey LM, Shores CG, George J, Lee S, Couch MJ, Sutton DK, Weissler MC. The effectiveness of salvage surgery after the failure of primary concomitant chemoradiation in head and neck cancer. Otolaryngol Head Neck Surg 2016; 136:98-103. [PMID: 17210342 DOI: 10.1016/j.otohns.2006.06.1267] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Accepted: 06/30/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE: To determine survival outcomes and locoregional control rates in patients with locoregional head and neck squamous cell cancer (HNSCC) who failed primary concomitant chemoradiation (CRT) intended for cure and underwent attempted surgical salvage. STUDY DESIGN AND SETTING: Design was a nonrandomized retrospective cohort study. Of 204 patients with HNSCC who received primary concomitant chemoradiation intended for cure between 1995 and 2004, 38 recurred and underwent attempted salvage surgery at a tertiary care academic center. RESULTS: Among the 38 patients undergoing surgical salvage, 12- and 24-month overall survival rates were 60 percent and 27 percent. Locoregional control at 24 months was 42 percent. Lower survival was seen with initial N3 disease ( P = 0.0115). Overall surgical morbidity was 24 percent. CONCLUSION/SIGNIFICANCE: The results of salvage surgery after failed chemoradiation for HNSCC are poor. Those with N3 disease fare least well. Patients should be well informed about the realistic chances of cure and potential morbidity of surgery. © 2007 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved.
Collapse
Affiliation(s)
- Luke M Richey
- General Clinical Research Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599-7070, USA
| | | | | | | | | | | | | |
Collapse
|
2
|
Rosenthal DI, Mohamed ASR, Weber RS, Garden AS, Sevak PR, Kies MS, Morrison WH, Lewin JS, El-Naggar AK, Ginsberg LE, Kocak-Uzel E, Ang KK, Fuller CD. Long-term outcomes after surgical or nonsurgical initial therapy for patients with T4 squamous cell carcinoma of the larynx: A 3-decade survey. Cancer 2015; 121:1608-19. [PMID: 25586197 DOI: 10.1002/cncr.29241] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/20/2014] [Accepted: 11/24/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND The current study was conducted to evaluate long-term disease control, survival, and functional outcomes after surgical and nonsurgical initial treatment for patients with T4 larynx cancer. METHODS Demographics, disease stage, and treatment characteristics were reviewed for 221 sequential patients treated for T4 laryngeal squamous cell cancer at a single institution between 1983 and 2011. Survival and disease control outcomes were calculated. RESULTS The median follow-up time was 47 months (71 months for patients still alive at the time of analysis). The overall 5-year and 10-year overall survival rates were 52% and 29%, respectively, and the corresponding disease-free survival rates were 57% and 48%, respectively. Overall 5-year and 10-year locoregional control rates were 78% and 67%, respectively, and the corresponding rates for freedom from distant metastasis were 76% and 74%, respectively. On both univariate and multivariate analyses, lymph node-positive disease at the time of presentation was associated with overall mortality (P<.0001). Patients treated with laryngectomy followed by postlaryngectomy radiotherapy (161 patients) achieved better initial locoregional control than patients treated with a laryngeal preservation (LP) approach (60 patients) throughout the follow-up period (log-rank P<.007) yet the median overall survival times were equal for both groups (64 months; 95% confidence interval 47-87 months and 38-87 months, respectively [P =.7]). Patients treated with an LP approach had a tracheostomy rate of 45% and an any-event aspiration rate of 23%. Rates of high-grade dysphagia at the time of last follow-up were worse for patients treated with an LP approach (P<.01). CONCLUSIONS Surgery and postoperative radiotherapy can produce substantial long-term cancer control and survival rates for patients with T4 larynx cancer. Caution should be taken when selecting patients for initial nonsurgical treatment because of significant rates of functional impairment despite survival equivalence.
Collapse
Affiliation(s)
- David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Gendreau-Lefèvre AK, Audet N, Maltais S, Thuot F. Prophylactic pectoralis major muscle flap in prevention of pharyngocutaneous fistula in total laryngectomy after radiotherapy. Head Neck 2014; 37:1233-8. [DOI: 10.1002/hed.23742] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/20/2014] [Accepted: 05/03/2014] [Indexed: 01/12/2023] Open
Affiliation(s)
| | - Nathalie Audet
- Department of Otorhinolaryngology - Head and Neck Surgery; CHU de Québec; Québec Canada
| | - Scott Maltais
- Department of Otorhinolaryngology - Head and Neck Surgery; CHU de Québec; Québec Canada
| | - François Thuot
- Department of Otorhinolaryngology - Head and Neck Surgery; CHU de Québec; Québec Canada
| |
Collapse
|
4
|
Amit M, Hilly O, Leider-Trejo L, Popovtzer A, Gutfeld O, Shvero J, Fliss DM, Cohen JT, Bachar G, Gil Z. The role of elective neck dissection in patients undergoing salvage laryngectomy. Head Neck 2012; 35:1392-6. [PMID: 23019150 DOI: 10.1002/hed.23145] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We investigated the risk of neck metastases in patients undergoing salvage total laryngectomy in association with previous radiotherapy. METHODS The medical records of 42 patients (51 neck specimens) with clinical N0 classification who underwent salvage total laryngectomy in 2 cancer centers were reviewed. Fourteen patients had previous radiotherapy to the central neck and 28 to the central and lateral neck. RESULTS Staging before salvage total laryngectomy was similar in both groups. The risk of neck metastases in the central and central/lateral radiation groups was 12% and 18%, respectively (p = .69). Subgroup analysis revealed that 4 of 8 patients initially presenting with clinically N+ had neck metastases before surgery, versus 2 of 26 for those with clinically N0 (p = .015; relative risk [RR] = 4.67). The risk or metastases in the contralateral neck was 0 of 9. CONCLUSION The risk of neck metastases in patients who undergo either central or central/lateral neck radiotherapy is similar. Elective neck dissection seems appropriate in patients undergoing SLR.
Collapse
Affiliation(s)
- Moran Amit
- The Laboratory for Applied Cancer Research Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Sewnaik A, Keereweer S, Al-Mamgani A, Baatenburg de Jong RJ, Wieringa MH, Meeuwis CA, Kerrebijn JDF. High complication risk of salvage surgery after chemoradiation failures. Acta Otolaryngol 2012; 132:96-100. [PMID: 22026439 DOI: 10.3109/00016489.2011.617779] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
CONCLUSIONS Although organ preservation can be achieved with chemoradiation protocols for laryngeal or pharyngeal cancers, salvage surgery is accompanied by high complication rates. OBJECTIVES To determine the rate of complications associated with salvage surgery after chemoradiation for laryngeal and pharyngeal cancers. METHODS A multicenter retrospective study was performed of 24 patients treated with total laryngectomy combined with total or partial pharyngectomy between 1995 and 2004 who had previously been treated with chemoradiation. The main outcome measures were early and late complication rates. Quality of life analysis was determined by two questionnaires. RESULTS The complication rate after salvage surgery was 92% in the direct postoperative period. The most frequent complication was pharyngocutaneous fistula formation. Narrowing of the esophagus and tracheostoma were the most common late sequelae. The quality of life, measured at least 2 years after salvage surgery, showed a social dysfunctioning.
Collapse
Affiliation(s)
- Aniel Sewnaik
- Department of Otolaryngology Head and Neck Surgery, Erasmus Medical Center Rotterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
6
|
Salvage surgery after induction chemotherapy with paclitaxel/cisplatin and primary radiotherapy for advanced laryngeal and hypopharyngeal carcinomas. Eur Arch Otorhinolaryngol 2009; 266:1799-805. [DOI: 10.1007/s00405-009-0946-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 02/26/2009] [Indexed: 10/21/2022]
|
7
|
Improved Survival in Patients With Stage III-IV Head and Neck Cancer Treated With Radiotherapy as Primary Local Treatment Modality. Int J Radiat Oncol Biol Phys 2008; 72:343-50. [DOI: 10.1016/j.ijrobp.2007.12.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Revised: 12/14/2007] [Accepted: 12/14/2007] [Indexed: 11/19/2022]
|
8
|
|
9
|
Fowler BZ, Muller S, Chen AY, Johnstone PAS. Factors influencing long-term survival following salvage total laryngectomy after initial radiotherapy or conservative surgery. Head Neck 2006; 28:99-106. [PMID: 16355384 DOI: 10.1002/hed.20297] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This retrospective study investigated survival outcomes of salvage total laryngectomy (STL) after initial radiation therapy (RT) or larynx conservation surgery (CS) at an academic center. METHODS A chart review yielded 64 patients with STL: 53 with RT failures, six with CS failures, and five after RT + CS. Median potential follow-up after STL was 9.4 years (mean, 9.2 years; range, 0.3-17.4 years). RESULTS Five- and 10-year actuarial overall survival (OS) after STL was 65.2% and 37.7%, respectively. Mean survival after STL was 7.2 years (median, 6.8 years; range, 0.2-17.4 years). No significant survival difference was found between the three treatment groups (p = .50). For 21 patients with nodes assessed at STL, 9-year OS was 45.4% for patients with N0 disease versus 26.7% for patients with N+ disease (p = .25). CONCLUSION These data suggest that STL after radiation failure is associated with equivalent long-term survival as STL after RT + CS or after failure of CS alone.
Collapse
Affiliation(s)
- B Zach Fowler
- Department of Radiation Oncology, Emory University School of Medicine, 1365 Clifton Road NE, Atlanta, GA 30322, USA
| | | | | | | |
Collapse
|
10
|
Jalisi M, Jalisi S. Advanced laryngeal carcinoma: surgical and non-surgical management options. Otolaryngol Clin North Am 2005; 38:47-57, viii. [PMID: 15649498 DOI: 10.1016/j.otc.2004.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This article discusses the surgical and non-surgical management of advanced laryngeal cancers.
Collapse
Affiliation(s)
- M Jalisi
- Department of Otolaryngology, College of Physicians and Surgeons, Pakistan.
| | | |
Collapse
|
11
|
Ganly I, Patel S, Matsuo J, Singh B, Kraus D, Boyle J, Wong R, Lee N, Pfister DG, Shaha A, Shah J. Postoperative complications of salvage total laryngectomy. Cancer 2005; 103:2073-81. [PMID: 15816049 DOI: 10.1002/cncr.20974] [Citation(s) in RCA: 201] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The objectives of the current study were to report the incidence of postoperative complications for salvage total laryngectomy (STL) compared with primary total laryngectomy (PTL) and to identify patient and tumor-related factors predictive of postoperative complications. METHODS A sample of 183 patients who had received a total laryngectomy were identified from an existing database of 662 patients treated for squamous cell carcinoma of the larynx. PTL and STL were performed in 113 and 70 patients, respectively. Initial therapy in the patients who required salvage surgery included radiotherapy (RT) in 32 (46%) and chemoradiotherapy (CTRT) in 38 (54%). Postoperative complications were recorded for each group and categorized into local, swallowing, airway, and systemic complications. Postoperative complication rates for STL after RT and CTRT were compared with those after PTL by univariate analysis. Patient and tumor-related predictors of complications were identified by univariate and multivariate analyses. RESULTS The overall mortality rate was 0.5%. Forty percent of all patients developed a postoperative complication after total laryngectomy. Local complications, which were the most frequent, occurred in 52 (28%) patients. Pharyngocutaneous fistula occurred in 31 (17%) patients. Statistical analysis showed that there was a greater number of patients with local wound (45% vs. 25%, P = 0.02) and fistula complications (32% vs. 12%, P = 0.012) in the STL-CTRT group compared with the primary laryngectomy group. Multivariate analysis showed that primary CTRT was an independent predictor of local complications and pharyngocutaneous fistula. CONCLUSIONS Salvage laryngectomy was more frequently associated with postoperative complications after CTRT compared with PTL. Problems related to local wound healing, especially the development of pharyngocutaneous fistula, constituted the most common postoperative complication in these patients. Multivariate analysis showed that primary CTRT was an independent predictor of local wound complications and pharyngocutaneous fistula.
Collapse
Affiliation(s)
- Ian Ganly
- Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Righini C, Lequeux T, Cuisnier O, Morel N, Reyt E. The pectoralis myofascial flap in pharyngolaryngeal surgery after radiotherapy. Eur Arch Otorhinolaryngol 2004; 262:357-61. [PMID: 15906055 DOI: 10.1007/s00405-004-0827-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2004] [Accepted: 06/17/2004] [Indexed: 10/26/2022]
Abstract
Pharyngocutaneous fistula after total laryngectomy remains a hardly inevitable complication. The predisposing factors are not clearly identified, but prior radiotherapy seems to increase the risk of fistulae. The purpose of this retrospective study was to determine the value of the pectoralis myofascial flap in pharyngeal reconstruction in post-radiotherapy total laryngectomy in order to decrease the risk of fistula formation. The charts of 60 consecutive patients who had undergone total laryngectomy or pharyngolaryngectomy after radiotherapy were analyzed. Twenty-one variables were recorded for each patient. The overall rate of fistula formation was 38% (23% when a pectoralis myofascial flap was used to cover the pharynx and 50% when no flap was used, P = 0.06). The flap-related complications were exceptional. In the subgroup of patients with diabetes mellitus, a history of vascular disease or a poor nutritional status, the use of a flap reduced the fistula formation from 73 to 13% (P = 0.018). The pectoralis myofascial flap covering the pharyngeal sutures in postradiotherapy laryngectomy is particularly useful in a selected group of patients (with diabetes mellitus, history of vascular disease or poor nutritional status).
Collapse
Affiliation(s)
- C Righini
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Grenoble, BP 217-38043, Grenoble Cedex 9, France.
| | | | | | | | | |
Collapse
|
13
|
Machtay M, Rosenthal DI, Chalian AA, Lustig R, Hershock D, Miller L, Weinstein GS, Weber RS. Pilot study of postoperative reirradiation, chemotherapy, and amifostine after surgical salvage for recurrent head-and-neck cancer. Int J Radiat Oncol Biol Phys 2004; 59:72-7. [PMID: 15093901 DOI: 10.1016/j.ijrobp.2003.10.056] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2003] [Revised: 10/06/2003] [Accepted: 10/15/2003] [Indexed: 11/18/2022]
Abstract
PURPOSE Salvage surgery alone after radiotherapy (RT) failure for locally advanced head-and-neck cancer is frequently unsuccessful because of subsequent recurrence. We designed a prospective protocol to determine the feasibility, toxicity, and preliminary efficacy of a regimen of postoperative reirradiation, chemotherapy and the radioprotector amifostine after salvage head-and-neck surgery. METHODS AND MATERIALS Eligible patients had biopsy-proven locally advanced, but resectable, recurrence without distant metastases >6 months after previous RT. After adequate healing from surgery, patients underwent RT to 54-66 Gy within 5-5.5 weeks to the resection bed (lifetime RT dose, 100-130 Gy). The fractionation was 1.5 Gy b.i.d. within 2 weeks, followed by a 1-week break, followed by 1.5 Gy b.i.d. to a total of 54-66 Gy. Chemotherapy consisted of cisplatin 25 mg/m(2)/d three times and 5-fluorouracil 500 mg/m(2)/d continuous infusion for 4 days, for two cycles (Weeks 1 and 5). Amifostine (500 mg i.v.) was administered daily, 30 min before either the morning or the afternoon RT. RESULTS Between 1998 and 2001, 16 patients were enrolled and studied. Two patients had gross residual disease after surgery; all other patients underwent complete surgical resection but had high-risk features (rT3-T4 and/or N+ disease). Three patients (19%) had serious acute toxicity events (nonneutropenic infections) that were reversible. The median follow-up was 35 months. The actuarial locoregional control rate was 81% at 3 years. Three patients developed isolated distant metastases and one developed a fatal second primary cancer (hepatoma). The 2- and 3-year actuarial event-free survival rate was 81% and 50%, respectively. The 2- and 3-year actuarial overall survival rate was 81% and 63%, respectively. Both patients who had gross residual disease after surgery had early recurrence; if these patients were excluded from analysis, the 3-year actuarial survival and event-free survival rate was 67% and 59%, respectively. Of the 16 patients, 6 (38%) developed Grade 3+ late toxicity, including one fatal stroke and two life-threatening major vessel necrosis and/or bleeding events. CONCLUSION This regimen of postoperative reirradiation/chemotherapy plus amifostine is feasible and was well tolerated acutely, with encouraging oncologic efficacy. However, the incidence and severity of late effects was significant and suggests that modifications are necessary for future studies in this patient population.
Collapse
Affiliation(s)
- Mitchell Machtay
- Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia, PA, USA.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Rubio Suárez A, Teigeiro Núñez V, Gallo Terán J, Señaris González B, Mesuro Domínguez N. Quimioterapia de inducción con vinorelbine cisplatino y uft en carcinomas avanzados faringolaríngeos: resultados de un estudio fase II. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2003; 54:697-703. [PMID: 15164709 DOI: 10.1016/s0001-6519(03)78469-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the results of an induction chemotherapy protocol with Vinorelbine, UFT and Cisplatin (UFTVP). METHODS 93 patients with laryngo-pharyngeal squamous cell carcinoma in stage III or IV were prospectively entered into a protocol to receive four cycles of UFTVP. Responders followed definitive radiation therapy. Nonresponders underwent conventional surgery with postoperative radiation. RESULTS Following chemotherapy nodal response (complete in 28% and partial in 33%) was less than that the primary site (complete in 60% and partial in 30%), p = 0.002. With a median follow-up of 62 months, the Kaplan-Meier 5-year survival was 45%. Successful larynx preservation was achieved in 50% of patients with laryngeal cancer and in 29% of patients with hypopharyngeal cancer. Lymph node metastases and pharyngeal localization were found to be significant negative factors with regards to survival. CONCLUSIONS UFTVP is an active regime of chemotherapy in advanced squamous cell carcinoma of the pharynx and larynx. Results differ according to the localization, having significantly better rates of survival and organ preservation in the laryngeal cancers that in those of the pharynx.
Collapse
Affiliation(s)
- A Rubio Suárez
- Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, 39008 Santander.
| | | | | | | | | |
Collapse
|
15
|
Ferlito A, Shaha AR, Lefebvre JL, Silver CE, Rinaldo A. Organ and voice preservation in advanced laryngeal cancer. Acta Otolaryngol 2002; 122:438-42. [PMID: 12126004 DOI: 10.1080/00016480260000166] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Alfio Ferlito
- Department of Otolaryngology-Head and Neck Surgery, University of Udine, Policlinico Universitario, Italy.
| | | | | | | | | |
Collapse
|
16
|
León X, Quer M, Orús C, López M, Gras JR, Vega M. Results of salvage surgery for local or regional recurrence after larynx preservation with induction chemotherapy and radiotherapy. Head Neck 2001; 23:733-8. [PMID: 11505482 DOI: 10.1002/hed.1104] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND After treatment of locally advanced laryngeal carcinomas with induction chemotherapy and radiotherapy, some patients suffer a local or regional failure of the tumor, and salvage surgery is required. The aim of this study was to review the results of such salvage surgery in this group of patients. METHODS A retrospective study of a cohort of 110 patients diagnosed between 1989 and 1996 with a locally advanced laryngeal carcinoma (T3-T4) treated with induction chemotherapy and radiotherapy was performed. The results of salvage surgery in patients with a local and/or regional failure of the treatment were analyzed. RESULTS Forty-two patients presented a local and/or a regional recurrence of the tumor: 26 patients in the larynx, eight in the neck, and a further eight in both in the larynx and the neck. Salvage surgery was carried out in 28 patients (67%), consisting of total laryngectomies with neck dissections (24 cases), endoscopic resection of the tumor (one case), and radical neck dissections (three cases). Five-year adjusted survival for the 42 patients was 38%. Five-year survival for the 28 patients treated with salvage surgery was 57%. Five patients had postoperative complications: four had pharyngo-cutaneous fistulas and one had wound infection. CONCLUSIONS After a local and/or regional recurrence, 67% of patients with advanced laryngeal carcinoma treated with induction chemotherapy and radiotherapy were candidates to salvage surgery. Five-year adjusted survival for this group of patients was 57%.
Collapse
Affiliation(s)
- X León
- Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau, Avda. San Antoni M(a) Claret, 167, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
17
|
Gokhale AS, Lavertu P. Surgical salvage after chemoradiation of head and neck cancer: complications and outcomes. Curr Oncol Rep 2001; 3:72-6. [PMID: 11123873 DOI: 10.1007/s11912-001-0046-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The treatment of advanced squamous cell carcinoma involves a multidisciplinary approach among various physicians and ancillary personnel. The role of the head and neck surgeon continues to change, as concurrent chemotherapy and radiotherapy protocols have evolved in the initial management of this challenging patient population. More and more, the surgeon is called upon to operate on those patients with persistent or recurrent disease despite initial treatment with chemotherapy and radiotherapy. The purpose of this article is to analyze complications and outcomes of surgery in patients who have already received radiotherapy and chemotherapy.
Collapse
Affiliation(s)
- A S Gokhale
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals of Cleveland, Cleveland, OH 44106-5045, USA.
| | | |
Collapse
|
18
|
León X, Quer M, Burgués J. Montgomery salivary bypass tube in the reconstruction of the hypopharynx. Cost-benefit study. Ann Otol Rhinol Laryngol 1999; 108:864-8. [PMID: 10527277 DOI: 10.1177/000348949910800908] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study analyzes the postoperative complications and the functional results in 61 patients who underwent total laryngectomy with partial or total (circumferential) pharyngectomy reconstructed with a pectoralis major myocutaneous flap, in relation to the use of the Montgomery Salivary Bypass Tube (MSBPT). There were no significant differences regarding frequency of postoperative cervical complications in relation to the use of the MSBPT. The median hospital stay for patients without the MSBPT (36 days) was significantly higher than that for patients with the MSBPT (25 days). Although the MSBPT did not modify the rate of complications at the cervical level, it did reduce their severity. A financial study showed the cost-effectiveness of using the MSBPT. Systematic use of the MSBPT is recommended after total laryngectomy with partial or total pharyngectomy reconstructed with a pectoralis major myocutaneous flap.
Collapse
Affiliation(s)
- X León
- Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma Barcelona, Spain
| | | | | |
Collapse
|
19
|
Redaelli de Zinis LO, Ferrari L, Tomenzoli D, Premoli G, Parrinello G, Nicolai P. Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy. Head Neck 1999; 21:131-8. [PMID: 10091981 DOI: 10.1002/(sici)1097-0347(199903)21:2<131::aid-hed6>3.0.co;2-f] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Pharyngocutaneous fistula is the most common complication following total laryngectomy. The present study was designed to determine the incidence and predisposing factors and to describe the management of the complication. METHODS The records of 246 consecutive patients who underwent total laryngectomy for squamous cell carcinoma were reviewed. We evaluated 23 factors potentially predisposing to fistula formation (age, sex, smoking and drinking habits, hypertension, diabetes, chronic bronchitis, chronic congestive heart failure, anesthesiologic risk, cholinesterase level, pre- and postoperative hemoglobin and albumin levels, previous treatment, previous tracheotomy, site of origin of the tumor, surgical procedure, concurrent neck dissection, suture material, status of surgical margins, clinical stage, and histologic grade) using the chi-squared test and logistic regression analysis. RESULTS A pharyngocutaneous fistula developed in 16% of patients within a mean time of 11 days from surgery. Spontaneous closure with local wound care was achieved in 70% of cases. Ten patients required surgical closure by direct suture of the pharyngeal mucosa; a deltopectoral flap and a pectoralis major myocutaneous flap were used in one case each. The mean healing time was 39+/-46 days in the group of patients requiring surgical closure, compared with 19+/-12 days in the group in which spontaneous closure occurred. The definitive model of logistic regression analysis showed that pharyngolaryngectomy, chronic congestive heart failure, and postoperative hemoglobin level lower than 12.5 g/dL carried respectively a two-, five-, and ninefold increase in the risk of fistula development. The model, with a specificity of 81%, is fairly good in identifying patients with a low risk of fistula. CONCLUSIONS The results observed in the group of patients under analysis corroborated the relevance of factors such as the extension of laryngectomy and postoperative hemoglobin level on fistula occurrence. However, chronic congestive heart failure, which is an expression of disturbance of the organism, emerged for the first time as an additional statistically significant risk factor for pharyngocutaneous fistula formation. Our experience confirmed that most fistulas can be successfully managed with conservative treatment. Except for the rare cases in which large defects are present, direct suture is appropriate when conservative treatment has failed.
Collapse
|
20
|
Wilson LD, Chung JY, Haffty BG, Cahow EC, Sasaki CT, Son YH. Intraoperative brachytherapy, laryngopharyngoesophagectomy, and gastric transposition for patients with recurrent hypopharyngeal and cervical esophageal carcinoma. Laryngoscope 1998; 108:1504-8. [PMID: 9778290 DOI: 10.1097/00005537-199810000-00014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the role of laryngopharyngoesophagectomy (LPE), intraoperative 125I brachytherapy (IOBT), and gastric transposition (GT) in patients with recurrent carcinoma involving the hypopharynx, or cervical esophagus. METHODS Between 1988 and 1994 a total of 21 patients were managed with LPE/IOBT/GT. All patients had documentation of recurrent disease at the hypopharynx or cervical esophagus and had previously been treated with external-beam radiation (EBRT) to a total median dose of 60 Gy. Median age was 67 years, with 17 male patients and four female. IOBT was performed in all cases with permanent 125I implantation. Medical records were retrospectively reviewed. Overall survival, local control, and complications were evaluated. Median follow-up was 6 months. RESULTS The median activity of 125I was 36 mCi, with a median dose of 80 Gy to the region at risk. Fifteen patients had lymph node dissections performed in conjunction with LPE, and 10 patients had nodal involvement on pathologic examination. Margins were microscopically positive in nine patients, and lymphvascular space invasion noted in 13. Actuarial survival at 1 and 3 years was 32% and 14%, respectively, with patients alive and with local control at 6, 24, 36, and 48 months (negative margins). Actuarial local control at 1 and 3 years was 63%. Complications included fistula in five patients, facial edema in four, protracted facial pain in two, cervical abscess in one, and mucosal hemorrhage in one. CONCLUSION Patients with recurrent carcinoma of the hypopharynx or cervical esophagus after EBRT have an extremely poor prognosis. LPE, IOBT, and GT may provide very good local control for all candidates and prolonged survival for a small percentage of patients with an acceptable risk profile.
Collapse
Affiliation(s)
- L D Wilson
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | | | | | | | | | | |
Collapse
|