1
|
Coviello CM, Sheehan C, Hernandez DJ, Liou NE, Sandulache VC, Haskins AD, Sturgis EM, Huang AT. Outcome Comparison of Functional Laryngectomy for the Dysfunctional Larynx to Salvage Laryngectomy. Laryngoscope 2024; 134:222-227. [PMID: 37345670 DOI: 10.1002/lary.30844] [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: 03/07/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE To compare functional outcomes of total laryngectomy (TL) with microvascular free tissue transfer (MVFTT) reconstruction in the treatment of dysfunctional larynx (DL) versus salvage therapy for locally recurrent disease in patients with a history of laryngeal squamous cell carcinoma (SCC). METHODS Retrospective review from a tertiary medical center between August 2015 and August 2022. RESULTS Sixty-nine patients underwent TL with MVFTT following primary laryngeal radiation or chemoradiation; 15 (22%) patients underwent functional laryngectomy (FL) and 54 (78%) underwent a salvage laryngectomy (SL). There were no total flap failures. Four (6%) patients developed a pharyngocutaneous fistula; one (7%) FL patient and 3 (6%) in the SL cohort. There was no significant difference in average hospital length of stay (LOS) between the cohorts (8.6 ± 3.0 days vs. 12.8 ± 10.1 days, p = 0.12). All patients (100%) in the FL cohort achieved a total oral diet compared to 41 (76%) in the SL cohort (p = 0.03). Two (13%) and 10 (19%) patients developed pharyngoesophageal stenosis in the FL and SL cohorts, respectively (p = 1.0). Nine (60%) and 23 (43%) patients in the FL and SL cohorts underwent tracheoesophageal puncture (TEP) placement, with 89% and 91% achieving fluency, respectively (p = 0.23). CONCLUSION Although the role of TL for the definitive treatment of laryngeal SCC has decreased over the past 30 years, organ-preservation protocols can impact speech, swallowing, and airway protection with life-threatening consequences. The use of elective FL with MVFTT for the treatment of DL results in similar or better functional outcomes compared to SL for recurrent disease. LEVEL OF EVIDENCE 3 Laryngoscope, 134:222-227, 2024.
Collapse
Affiliation(s)
- Caitlin M Coviello
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Cameron Sheehan
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - David J Hernandez
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - N Eddie Liou
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Vlad C Sandulache
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Angela D Haskins
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Erich M Sturgis
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Andrew T Huang
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| |
Collapse
|
2
|
Almas S, Jeffery CC. Late laryngeal dysfunction in head and neck cancer survivors. Laryngoscope Investig Otolaryngol 2023; 8:1272-1278. [PMID: 37899877 PMCID: PMC10601572 DOI: 10.1002/lio2.1128] [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: 04/30/2023] [Revised: 07/05/2023] [Accepted: 07/16/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives Head and neck cancer (HNC) survivorship issues are areas of increasing research interest. Laryngeal dysfunction in HNC patients is particularly important given the importance of the larynx in voice, swallowing, and airway protection. The objective of our study is to characterize late laryngeal dysfunction in a cohort of long-term HNC survivors. Methods HNC survivors who were at least 2 years post-treatment were recruited prospectively for standard collection of videolaryngoscopy findings, videofluoroscopic swallowing studies, and assessment of clinical outcomes. Descriptive statistics were performed and clinical presentation and outcomes were compared between survivors >10 years and <10 years post-treatment. Additional factor analysis to correlate clinical outcomes with clinical variables was performed. Results Thirty participants were analyzed with a mean age of 66 years. The majority were male (80%) patients treated for oropharyngeal squamous cell carcinoma (67%). Within the cohort, 43% underwent primary chemoradiation therapy and had 13% radiation alone. Common presenting symptoms included swallowing dysfunction (83%), voice change (67%), and chronic cough (17%). Laryngeal findings on video laryngoscopy include vocal fold motion abnormalities (VFMA) in over half of participants (61%) and mucosal changes in 20%. A weak correlation was found between time since treatment and laryngeal dysfunction (r = .182, p = .34), and no correlation was found between age, sex, time since treatment, or primary site and the presence or absence of VFMA, G-tube status, or tracheostomy-tube status. Conclusion Late laryngeal dysfunction in HNC survivors contributes to significant morbidity, is difficult to treat, and remains static decades after treatment for their original cancer. Lay Summary The voice-box, or the larynx, plays an important role in voice, swallowing and airway protection. It is particularly vulnerable to radiation-related damage and changes. This study demonstrates the sequelae of long-term damage of the larynx in head and cancer survivors. Level of Evidence IV.
Collapse
Affiliation(s)
- Sarah Almas
- Division of Otolaryngology‐Head and Neck Surgery, Department of Surgery, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - Caroline C. Jeffery
- Division of Otolaryngology‐Head and Neck Surgery, Department of Surgery, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
| |
Collapse
|
3
|
Ahmadi N, Stone D, Stokan M, Coleman H, Heller G, Smith M, Riffat F, Kudpaje A, Veness M, Palme CE. Treatment of Early Glottic cancer with Transoral Laser Microsurgery: An Australian Experience. Indian J Otolaryngol Head Neck Surg 2023; 75:661-667. [PMID: 37274960 PMCID: PMC10235397 DOI: 10.1007/s12070-022-03392-8] [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: 05/05/2022] [Accepted: 12/07/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction Early laryngeal carcinomas may be treated by transoral laser microsurgery (TLM) or external beam radiotherapy. We review our experience of surgical treatment of laryngeal pre-malignant and malignant lesions over the past 15 years in a high-volume head neck unit. Methods A review of a prospective patient database of patients with laryngeal SCC, who were treated with CO2 TLM between 2004 and 2019 was carried out. Results 83 patients with a mean age of 67.7 (SD: 10.6) years underwent primary curative TLM for T1a/b SCC. 5-year overall survival was 93.2% (95%CI 86.9-100%), disease free survival was 86.0% (95%CI 78.1-94.6%), locoregional control was 91.2% (95%CI: 85.1-97.7%) and larynx preservation rate of 95.1% at 5 years. Conclusion TLM is an excellent treatment modality for T1 early glottic SCC, with excellent locoregional control and disease-free survival. It is minimally invasive, outpatient-based, and cost-effective procedure preserving upper aerodigestive tract dysfunction for all activities of daily living.
Collapse
Affiliation(s)
- Navid Ahmadi
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW Australia
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW Australia
| | - Danielle Stone
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
| | - Murray Stokan
- Department of Anaesthetics, Westmead Hospital, Sydney, NSW Australia
| | - Hedley Coleman
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
- Douglass Hanly Moir Pathology, Sydney, NSW Australia
| | - Gillian Heller
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW Australia
| | - Mark Smith
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
| | - Faruque Riffat
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
| | - Akshay Kudpaje
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
- Cytecare Cancer Hospitals, Bangalore, India
| | - Michael Veness
- Crown Princess Cancer Care Centre, Westmead hospital, Sydney, NSW Australia
- Sydney Medical School, University of Sydney, Sydney, NSW Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW Australia
- Department of ENT, Westmead Hospital, Sydney, NSW Australia
- Sydney Medical School, University of Sydney, Sydney, NSW Australia
| |
Collapse
|
4
|
Olinde L, Evangelista L, Bewley AF. Functional laryngectomy for the dysfunctional larynx: indications and outcomes in setting of prior chemoradiotherapy. Curr Opin Otolaryngol Head Neck Surg 2021; 29:473-478. [PMID: 34535008 DOI: 10.1097/moo.0000000000000757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW To review the recent literature on indications for and functional outcomes following laryngectomy for severe laryngeal dysfunction. RECENT FINDINGS The use of functional laryngectomy as a definitive treatment for severe laryngeal dysfunction is increasing as more patients with head and neck cancer are treated with definitive chemoradiotherapy. Data are emerging on the efficacy of this technique as measured by aspiration, recurrent pneumonias, enteral tube feeding dependence, and surgical complication rates. Though most patients have marked improvement in aspiration and oral intake, difficulties in swallowing and voicing functions may persist. SUMMARY Functional laryngectomy is an effective treatment for end-stage laryngeal dysfunction. There is a clear benefit with regard to prevention of aspiration and alleviation of nothing by mouth status. However, qualitative speech and swallowing outcomes are less well studied, though available data suggest that many patients still suffer some degree of continued chronic impairment. More research is needed on these outcomes in order to appropriately counsel patients regarding long-term functional outcomes.
Collapse
Affiliation(s)
- Lindsay Olinde
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | | | | |
Collapse
|
5
|
Wu MP, Goldsmith T, Holman A, Kammer R, Parikh A, Devore EK, Emerick KS, Lin DT, Deschler DG, Richmon JD, Varvares MA, Naunheim MR. Risk Factors for Laryngectomy for Dysfunctional Larynx After Organ Preservation Protocols: A Case-Control Analysis. Otolaryngol Head Neck Surg 2020; 164:608-615. [DOI: 10.1177/0194599820947702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective (1) To identify factors associated with severe dysfunctional larynx leading to total laryngectomy after curative treatment of head and neck squamous cell carcinoma and (2) to describe swallowing and voice outcomes. Study Design Retrospective single-institution case-control study. Setting Tertiary care referral center. Methods A 10-year chart review was performed for patients who had previously undergone radiation or chemoradiation for head and neck mucosal squamous cell carcinoma and planned to undergo total laryngectomy for dysfunctional larynx, as well as a control group of matched patients. Controls were patients who had undergone radiation or chemoradiation for mucosal squamous cell carcinoma but did not have severe dysfunction warranting laryngectomy; these were matched to cases by tumor subsite, T stage, and time from last treatment to video swallow study. Main outcomes assessed were postoperative diet, alaryngeal voice, pharyngeal dilations, and complications. Results Twenty-six patients were scheduled for laryngectomy for dysfunctional larynx, of which 23 underwent surgery. Originally treated tumor subsites included the larynx, oropharynx, hypopharynx, oral cavity, and a tumor of unknown origin. The median time from end of cancer treatment to laryngectomy was 11.5 years. All cases were feeding tube or tracheostomy dependent or both prior to laryngectomy. As compared with matched controls, cases were significantly less likely to have undergone IMRT (intensity-modified radiotherapy) and more likely to have pulmonary comorbidities. Eighty-nine percent of cases with follow-up achieved functional alaryngeal voice, and all were able to have oral intake. Conclusion Non-IMRT approaches and pulmonary comorbidities are associated with laryngectomy for dysfunction after radiation or chemoradiation.
Collapse
Affiliation(s)
- Michael P. Wu
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Tessa Goldsmith
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Allison Holman
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachael Kammer
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anuraag Parikh
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Elliana K. Devore
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Kevin S. Emerick
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Derrick T. Lin
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Daniel G. Deschler
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Jeremy D. Richmon
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Mark A. Varvares
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Matthew R. Naunheim
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Farlow JL, Birkeland AC, Hardenbergh A, Lyden T, Brenner JC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Rosko AJ, Spector ME. Speech and swallowing outcomes after laryngectomy for the dysfunctional irradiated larynx. Eur Arch Otorhinolaryngol 2020; 277:1459-1465. [PMID: 31989269 DOI: 10.1007/s00405-020-05809-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/18/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize outcomes of total laryngectomy for the dysfunctional larynx after radiation. METHODS Retrospective case series of all subjects who underwent total laryngectomy for the irradiated dysfunctional larynx between 2000 and 2018 at an NCI-designated comprehensive cancer center at a single tertiary care academic medical center. Main outcomes included enteral tube feeding dependency, functional tracheoesophageal speech, and number and timing of postoperative pharyngeal dilations. RESULTS Median time from radiation to laryngectomy was 2.8 years (range 0.5-27 years). Functional outcomes were analyzed for the 32 patients with 1-year follow-up. Preoperatively, 81% required at least partial enteral tube feeding, as compared to 34% 1-year postoperatively (p = 0.0003). At 1 year, 81% had achieved functional tracheoesophageal speech, which was associated with cricopharyngeal myotomy (p = 0.04, HR 0.04, 95% CI 0.002-0.949). There were 34% of subjects who required at least one pharyngeal dilation for stricture by 1 year postoperatively. Over half (60%) of the cohort were dilated over the study period. CONCLUSIONS Laryngectomy for the dysfunctional larynx improves speech and swallowing outcomes in many patients. Cricopharyngeal myotomy is associated with improved postoperative voice. While the need for enteral feeding is decreased, persistent postoperative swallowing dysfunction is common. Careful patient selection and education regarding functional expectations are paramount.
Collapse
Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Andrew C Birkeland
- Department of Otolaryngology, Head and Neck Surgery, University of California Davis, Sacramento, CA, 98517, USA
| | - Anna Hardenbergh
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Teresa Lyden
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - J Chad Brenner
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Andrew G Shuman
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Steven B Chinn
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Chaz L Stucken
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Kelly M Malloy
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Keith A Casper
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Mark E P Prince
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Carol R Bradford
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Gregory T Wolf
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Douglas B Chepeha
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - Andrew J Rosko
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA.
| | - Matthew E Spector
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA.
| |
Collapse
|
7
|
Treatment of end-stage pharyngeal strictures after laryngectomy with fasciocutaneous microvascular reconstruction. Oral Oncol 2020; 103:104556. [PMID: 31924531 DOI: 10.1016/j.oraloncology.2019.104556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 11/24/2022]
Abstract
Pharyngeal strictures can develop after laryngectomy for larynx cancer, particularly in combination with radiation. Some patients develop intractable strictures where conservative swallowing therapy and pharyngeal dilations fail. Secondary reconstruction of these patients has not been described in the literature. We report our experience with completion pharyngectomy and fasciocutaneous free tissue reconstruction for this patient population. Five subjects who had undergone laryngectomy and radiation were successfully reconstructed with fasciocutaneous free tissue transfer using the radial forearm or anterolateral thigh with minimal post-operative complications. Following surgery, enteral tube feeding requirements were eliminated, and all diets were advanced. A few patients still required a modified diet or continued dilations. We thus demonstrate that pharyngectomy with secondary reconstruction is an effective option for end-stage pharyngeal strictures, though this should only be undertaken with careful patient selection.
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW Purpose of the present review is to revise the literature of the last 18 months, looking for novelties or new trends in diagnosis and therapeutical approaches to a very uncommon complicaton. RECENT FINDINGS Some comorbidities as well as prior surgical laryngeal treatment and lifestyle factors are known to increase tissue susceptibility to radiation injury and to complications due to endotracheal intubation. SUMMARY Chondroradionecrosis (CRN) of the larynx is a rare and severe complication of radiotherapy and endotracheal intubation which can be fatal if not managed promptly. In recent years, the trend in oncological surgery is organ preservation even in the advanced stage of laryngeal malignancies. However, in certain stages of squamous cell carcinomas, radiotherapy is necessary as a first or second line of treatment. Endotracheal intubation has also been associated with chondronecrosis and it is thought to be secondary to excessive pressure of the endotracheal tube or its cuff on the cartilage itself. Clinical diagnosis of CRN is extremely difficult and should be placed in differential diagnosis with postradiation outcomes and cancer recurrence. PET is useful, but biopsy is still required to confirm the diagnosis. The use of the laryngeal mask airway should prevent this complication and is a reasonable choice through which to administer general anesthesia in selected patients.
Collapse
|
9
|
Melo GM, Souza PD, Bastos Filho LC, Neves MC, Espirito Santo KSD, Cervantes O, Abrahão M. Condroradionecrose de laringe após radioterapia. Rev Col Bras Cir 2017; 44:374-382. [DOI: 10.1590/0100-69912017004012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/30/2017] [Indexed: 12/27/2022] Open
Abstract
RESUMO Objetivo: estudar a condroradionecrose de laringe por complicação de radio-quimioterapia para tratamento do câncer de laringe e propor um fluxograma de tratamento com a utilização de câmara hiperbárica. Métodos: estudo retrospectivo de pacientes portadores de carcinoma de laringe admitidos em dois hospitais terciários num período de cinco anos. Resultados: de 131 pacientes portadores de câncer de laringe, 28 foram submetidos à radio e quimioterapia exclusiva e destes, três evoluíram com condroradionecrose. O tratamento destes pacientes foi realizado com câmara hiperbárica e com desbridamento cirúrgico, conforme proposição do fluxograma. Todos os pacientes tiveram a laringe preservada. Conclusão: a incidência de condroradionecrose de laringe por complicação de radioterapia e quimioterapia em nossa casuística foi de 10,7% e o tratamento com oxigenoterapia hiperbárica, com base no nosso fluxograma, foi efetivo no controle desta complicação.
Collapse
Affiliation(s)
- Giulianno Molina Melo
- Universidade Federal de São Paulo, Brazil; Hospital da Beneficência Portuguesa de São Paulo, Brazil
| | - Paula Demetrio Souza
- Universidade Federal de São Paulo, Brazil; Hospital da Beneficência Portuguesa de São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
10
|
Gessert TG, Britt CJ, Maas AMW, Wieland AM, Harari PM, Hartig GK. Chondroradionecrosis of the larynx: 24-year University of Wisconsin experience. Head Neck 2017; 39:1189-1194. [PMID: 28295829 DOI: 10.1002/hed.24749] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 12/03/2016] [Accepted: 01/03/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Chondroradionecrosis (CRN) is an uncommon but significant complication of laryngeal radiotherapy that presents a diagnostic challenge to clinicians through its similarity in presentation to cancer recurrence. METHODS Two hundred ninety-four patients underwent primary, adjuvant, or salvage radiation for laryngeal cancer from 1991 to 2015 at the University of Wisconsin. Medical records were reviewed to identify and characterize patients with a diagnosis of CRN. RESULTS Of the 294 patients, 7 cases (2.4%) of CRN were identified. Development of CRN was associated with the presence of cartilage invasion by tumor (p = .038) and ongoing alcohol use postradiotherapy (p = .036). Additionally, a trend between development of CRN and ongoing smoking postradiotherapy was observed (p = .067). CONCLUSION The diagnosis of CRN is challenging, and the likelihood of successful resolution is modest. A high premium should be placed on efforts directed at prevention, such as tobacco and alcohol cessation. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1189-1194, 2017.
Collapse
Affiliation(s)
- Thomas G Gessert
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christopher J Britt
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Austin M W Maas
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Aaron M Wieland
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gregory K Hartig
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
11
|
Anti-inflammatory effects of hyperbaric oxygen on irradiated laryngeal tissues. Braz J Otorhinolaryngol 2017; 84:206-211. [PMID: 28341337 PMCID: PMC9449171 DOI: 10.1016/j.bjorl.2017.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/05/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION To manage the complications of irradiation of head and neck tissue is a challenging issue for the otolaryngologist. Definitive treatment of these complications is still controversial. Recently, hyperbaric oxygen therapy is promising option for these complications. OBJECTIVE In this study, we used biochemical and histopathological methods to investigate the efficacy of hyperbaric oxygen against the inflammatory effects of radiotherapy in blood and laryngeal tissues when radiotherapy and hyperbaric oxygen are administered on the same day. METHODS Thirty-two Wistar Albino rats were divided into four groups. The control group was given no treatment, the hyperbaric oxygen group was given only hyperbaric oxygen therapy, the radiotherapy group was given only radiotherapy, and the radiotherapy plus hyperbaric oxygen group was given both treatments on the same day. RESULTS Histopathological and biochemical evaluations of specimens were performed. Serum tumor necrosis factor-α, interleukin-1β, and tissue inflammation levels were significantly higher in the radiotherapy group than in the radiotherapy plus hyperbaric oxygen group, whereas interleukin-10 was higher in the radiotherapy plus hyperbaric oxygen group. CONCLUSION When radiotherapy and hyperbaric oxygen are administered on the same day, inflammatory cytokines and tissue inflammation can be reduced in an early period of radiation injury.
Collapse
|
12
|
Worthen M, Jusufbegovic M, Bumpous JM, Vaughn A, Cash E, Yang X, Fichandler C, Tennant P. Fungal contribution in chondroradionecrosis of the larynx. Laryngoscope 2016; 127:E159-E165. [PMID: 27666333 DOI: 10.1002/lary.26313] [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] [Accepted: 08/10/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the prevalence of invasive fungal elements in the specimens of patients who underwent salvage total laryngectomy for chondroradionecrosis (CRN) in the absence of recurrent or persistent malignancy. STUDY DESIGN Retrospective chart review. SETTING Tertiary academic medical center. METHODS One hundred fifty-nine patients were identified who underwent salvage total laryngectomy. Pathology reports were reviewed, and all laryngectomy specimens that did not contain residual malignancy were reevaluated for evidence of invasive fungal elements. RESULTS Twelve of 159 (7.5%) patients who underwent total laryngectomy after primary radiotherapy or chemoradiotherapy had no evidence of residual malignancy. Each of these specimens contained histopathologic evidence of CRN; invasive fungal elements were identified in 25%. There was no statistical difference in demographic or treatment-related variables between patients who underwent salvage total laryngectomy with evidence of persistent or recurrent malignancy in the laryngectomy specimen versus patients without evidence of tumor on final histopathologic analysis. Patients with evidence of ulceration or necrosis in the laryngectomy specimen had reduced overall survival, irrespective of the presence of persistent malignancy (hazard ratio = 2.923, 95% confidence interval = 1.023-8.352, P = .045). CONCLUSION Among salvage total laryngectomy patients, no difference was identified between patients who underwent total laryngectomy for recurrent or persistent malignancy after primary radiotherapy and those who received total laryngectomy without evidence of malignancy in their specimens. Invasive fungal elements were detected in several laryngectomy specimens that did not contain residual malignancy. Empiric antifungal therapy may therefore benefit patients diagnosed with CRN who are at risk for progression to nonfunctional larynx. Patients with evidence of ulceration or necrosis in the salvage laryngectomy specimen had worse overall survival. LEVEL OF EVIDENCE 4. Laryngoscope, 127:E159-E165, 2017.
Collapse
Affiliation(s)
- Mary Worthen
- Department of Otolaryngology-HNS and Communicative Disorders, Louisville, Kentucky, U.S.A
| | - Mia Jusufbegovic
- University of Louisville School of Medicine, Louisville, Kentucky, U.S.A
| | - Jeffrey M Bumpous
- Department of Otolaryngology-HNS and Communicative Disorders, Louisville, Kentucky, U.S.A
| | - Andrew Vaughn
- University of Louisville School of Medicine, Louisville, Kentucky, U.S.A
| | - Elizabeth Cash
- Department of Otolaryngology-HNS and Communicative Disorders, Louisville, Kentucky, U.S.A.,Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, U.S.A.,James Graham Brown Cancer Center, Louisville, Kentucky, U.S.A
| | - Xiu Yang
- Department of Pathology, University of Louisville School of Medicine, Louisville, Kentucky, U.S.A
| | - Craig Fichandler
- University of Louisville School of Medicine, Louisville, Kentucky, U.S.A
| | - Paul Tennant
- Department of Otolaryngology-HNS and Communicative Disorders, Louisville, Kentucky, U.S.A
| |
Collapse
|
13
|
Bergström L, Ward EC, Finizia C. Voice rehabilitation for laryngeal cancer patients: Functional outcomes and patient perceptions. Laryngoscope 2016; 126:2029-35. [DOI: 10.1002/lary.25919] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/04/2015] [Accepted: 01/19/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Liza Bergström
- Department of Otorhinolaryngology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Dept of Speech Pathology; School of Health & Rehabilitation Sciences; The University of Queensland; Brisbane Queensland Australia
- Center for Functioning & Health Research (CFAHR); Queensland Health; Buranda Queensland Australia
| | - Elizabeth C. Ward
- Dept of Speech Pathology; School of Health & Rehabilitation Sciences; The University of Queensland; Brisbane Queensland Australia
- Center for Functioning & Health Research (CFAHR); Queensland Health; Buranda Queensland Australia
| | - Caterina Finizia
- Department of Otorhinolaryngology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| |
Collapse
|
14
|
|
15
|
Wierzbicka M, Leszczyńska M, Szyfter W. [Re-evaluation of 191 larynx cancer surgeries according to the Open Partial Horizontal Laryngectomies classification proposed by European Laryngological Society working committee in 2014]. Otolaryngol Pol 2014; 68:281-6. [PMID: 25152380 DOI: 10.1016/j.otpol.2014.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 07/08/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
Abstract
AIM of study was to present material of open partial horizontal laryngectomies (OPHL) in T1b, T2 and T3 larynx cancer treatment in single tertiary referral institution. MATERIAL AND METHODS Retrospective analysis of operating protocols in patients treated in Poznań ENT University Department between 2000-2012 with glottis (T1b - 185, T2 - 185, T3 - 231) and supraglottis tumors (T1 - 80, T2 - 104, T3 - 206), potentially available for organ preservation treatment. Transoral laser microsurgery, OPHL, radiotherapy and total laryngectomy were treatment options in 210, 191, 271 and 326 patients respectively. OPHL was applied in glottic tumors: 21 - T1b, 103 - T2, 27 - T3 and in supraglottic tumors: 4 - T1, 29 - T2. All procedures were re-evaluated acc. to European Laryngogical Society working committee on nomenclature new classification presented in 2014. RESULTS There was no discrepancies in supraglottic laryngectomies (4 cases), classified as OPHL Typ I. All the rest: 84 transglottic, 96 supracricoid with CHEP and 7 supracricoid with CHP laryngectomies were re-classified into Typ II (172) and Type III (15) OPHL. Thus, revision of inferior incision changed classification of procedure into supratracheal laryngectomy in 15 cases. Transglottic laryngectomies, in which upper part of thyroid cartilage was preserved and crito-thyreo-pexy was performed (84 pts), have not been distinguished any more. In 7 cases superior incision included epiglottis; thus 165 patients were distinguished as Typ II a and 7 patients as Typ IIb OPHL. The most pronounced difference was stated in description of structures additionally included into surgical specimen: arytenoid (+ARY) in 24, crico-arytenoid-unit (+CAU) in 5 and piriform sinus (+PIR) in 17 cases; none had the base of tongue (+BOT) resected. CONCLUSIONS In 36/191 additional structures and in 15/191 the cricoid ring resection was re-evaluated and pointed out. All these data were available retrospectively in the operating protocols but not pronounced in surgery headlines. Thanks to the univocal, simple new classification all operation details can be included into operation title.
Collapse
Affiliation(s)
- Małgorzata Wierzbicka
- Klinika Otolaryngologii i Onkologii Laryngologicznej, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu, Kierownik: prof. dr hab. med. Witold Szyfter, Poznań, Polska.
| | - Małgorzata Leszczyńska
- Klinika Otolaryngologii i Onkologii Laryngologicznej, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu, Kierownik: prof. dr hab. med. Witold Szyfter, Poznań, Polska
| | - Witold Szyfter
- Klinika Otolaryngologii i Onkologii Laryngologicznej, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu, Kierownik: prof. dr hab. med. Witold Szyfter, Poznań, Polska
| |
Collapse
|