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Sato M, Hirose K. Efficacy and safety of boron neutron capture therapy for Hypopharyngeal/Laryngeal cancer patients with previous head and neck irradiation in Japan. Radiother Oncol 2024; 198:110382. [PMID: 38880413 DOI: 10.1016/j.radonc.2024.110382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/02/2024] [Accepted: 06/09/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND AND PURPOSE Patients with hypopharyngeal cancer (HPC)/laryngeal cancer (LCA) with a history of head and neck irradiation are often difficult to treat with conventional radiotherapy. This study aimed to clarify the efficacy and safety of boron neutron capture therapy (BNCT) for HPC/LCA. MATERIALS AND METHODS In this retrospective study, HPC/LCA with local lesions were analyzed, including both recurrent cases after treatment and second primary cases. The primary endpoints were tumor response and incidence of adverse events (AEs) after BNCT. The secondary endpoints were local control (LC), progression-free survival (PFS), and overall survival (OS). Evaluation of tumor response was terminated when any additional treatment was administered, and only survival data were collected. RESULTS The analysis included 25 and 11 cases of HPC and LCA, respectively. All had a history of head and neck irradiation, and median dose of prior radiotherapy was 70 Gy. The complete response (CR) rate was 72%, overall response rate was 84%, and the 1-year LC and PFS were 63.1% and 53.7%, respectively. The median survival time was 15.5 months, and the 2-year OS was 79.8%. Of the 27 patients with CR, 11 cases recurred at a median of 6.0 months. The acute G3 AEs were oral mucositis (6%), pharyngeal mucositis (3%), and soft tissue infection (3%). Acutely, there were no G4-5 AEs, except hyperamylasemia, and in the late phase, there were no G3 or higher AEs. CONCLUSION BNCT can be achieve good tumor response while preserving the larynx without severe AEs.
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Affiliation(s)
- Mariko Sato
- Department of Radiation Oncology, Southern Tohoku BNCT Research Center, 7-10 Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan; Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Katsumi Hirose
- Department of Radiation Oncology, Southern Tohoku BNCT Research Center, 7-10 Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan; Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
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Entezami P, Tritter A, Shaha M, Ware E, Chang B. A systematic review and meta-analysis on the outcomes of type I thyroplasty in the irradiated neck. Am J Otolaryngol 2023; 44:103769. [PMID: 36640533 DOI: 10.1016/j.amjoto.2022.103769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Type I thyroplasty has been well-documented as a safe and effective treatment modality for vocal fold motion impairment, as well as other select cases of persistent glottic insufficiency. However, history of prior radiation to the neck has traditionally been viewed as a relative, if not formal contra-indication to this procedure. The objective of this systematic review was to analyze all available data in the literature on type I thyroplasty in previously irradiated patients and perform a meta-analysis assessing whether complications and revision rates are significantly different between radiated and non-irradiated patients. Secondary outcomes were to compare voice outcomes between these cohorts. METHODS Several databases were screened for relevant citations using the PICO process. The quality of studies and risk of bias were evaluated using the MINORS scoring system. Main endpoints for analysis in this study were complication rate and revision rate. Secondary endpoint was reported voice outcome. RESULTS Three articles were included in the analysis. Zero major complications were reported, including no instances of implant extrusion or explantation. There was an 11.8 % rate of minor complications. There were similar rates of revision between radiation and control groups. There was no significant difference in voice outcomes between groups. The average MINORS score of the studies suggested a high risk of bias. CONCLUSIONS Based on limited quality evidence, this review suggests that type I thyroplasty is safe and feasible in carefully selected irradiated patients, with comparable complication and success rates as their non-irradiated cohorts. Further large-scale studies are warranted.
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Affiliation(s)
- Payam Entezami
- Department of Otolaryngology/Head & Neck Surgery, LSU Health Shreveport, Shreveport, LA, USA
| | - Andrew Tritter
- Department of Otorhinolaryngology - Head & Neck Surgery, UTHealth Houston, Houston, TX, USA
| | - Manish Shaha
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erin Ware
- Medical Library, LSU Health Shreveport, Shreveport, LA, USA
| | - Brent Chang
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
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McCarter SJ, Mansukhani MP, Herold DL, Kolla BP. Delayed onset sleep-related stridor due to radiation for thyroid cancer. J Clin Sleep Med 2022; 18:2327-2329. [PMID: 35713170 PMCID: PMC9435334 DOI: 10.5664/jcsm.10128] [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: 03/09/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022]
Abstract
Radiation therapy is the mainstay of treatment for head and neck cancers with both acute and delayed complications. While obstructive sleep apnea is common in the few series of patients undergoing radiation therapy to the neck, the development of sleep-related stridor is exceedingly rare and has typically been reported in the acute treatment setting. We describe a 65-year-old female with 1 year of nocturnal groaning beginning 2 years after radiation therapy for thyroid carcinoma. Polysomnography revealed mild obstructive sleep apnea and sleep-related stridor responsive to nasal continuous positive airway pressure. Our case highlights the importance of screening patients with a history of head and neck radiation for sleep-related breathing complaints at each follow-up visit and consideration of both obstructive sleep apnea and stridor in these patients. Identification of sleep-disordered breathing in these patients may lead to timely treatment and improvement in quality of life. CITATION McCarter SJ, Mansukhani MP, Herold DL, Kolla BP. Delayed onset sleep-related stridor due to radiation for thyroid cancer. J Clin Sleep Med. 2022;18(9):2327-2329.
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Affiliation(s)
| | | | | | - Bhanu Prakash Kolla
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
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Reduction of Elective Radiotherapy Treatment Volume in Definitive Treatment of Locally Advanced Head and Neck Cancer-Comparison of a Prospective Trial with a Revised Simulated Contouring Approach. J Clin Med 2021; 10:jcm10204653. [PMID: 34682782 PMCID: PMC8537676 DOI: 10.3390/jcm10204653] [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: 09/03/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Definitive radiochemotherapy of locally advanced head and neck squamous cell cancer (HNSCC) achieves high locoregional tumor control rates; but is frequently associated with long-term toxicity. A future direction could be a de-escalation strategy focusing on treated volume rather than radiotherapy dose. This analysis evaluates radiotherapy dose and volume parameters of patients treated with a standard contouring approach in a clinical trial context compared with a revised volume-reduced contouring approach. In this case, 30 consecutive patients from the CheckRad-CD8 trial treated at a single study center were included in this analysis. Treatment toxicity and quality of life were assessed at the end of radiotherapy. Standard treatment plans (ST) following state of the art contouring guidelines that were used for patient treatment and volume reduced treatment plans (VRT) according to a revised simulated approach were calculated for each patient. Planning target volumes (PTV) and mean doses to 38 organs-at-risk structures were compared. At the end of radiotherapy patients reported high rates of mucositis; dysphagia and xerostomia. In addition; patient reported quality of life as assessed by the EORTC QLQ-HN35 questionnaire deteriorated. Comparing the two contouring approaches; the elective PTV_56 Gy and the high risk PTV_63 Gy (shrinking field) were significantly smaller in the VRT group. Significant reduction of mean dose to structures of the oral cavity; the larynx as well as part of the swallowing muscles and the submandibular glands was achieved in the simulated VRT-plan. Treatment de-intensification by reduction of the irradiated volume could potentially reduce treatment volume and mean doses to organs at risk. The proposed contouring approach should be studied further in the context of a clinical trial.
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Hamdan AL, Abou Rizk S, Ghanem A, El Natout T. Irradiation-Induced Vocal Fold Paralysis: A Delayed Complication. EAR, NOSE & THROAT JOURNAL 2019; 100:NP274-NP275. [PMID: 31578105 DOI: 10.1177/0145561319872164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology-Head and Neck Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Samer Abou Rizk
- Department of Otolaryngology-Head and Neck Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Anthony Ghanem
- Department of Otolaryngology-Head and Neck Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Tamer El Natout
- Department of Otolaryngology-Head and Neck Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
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Jaggi S, Balachandran DD, Bashoura L, Faiz SA. Severe sleep disordered breathing in head and neck cancer survivor. Postgrad Med J 2018; 95:110-111. [PMID: 30425134 DOI: 10.1136/postgradmedj-2018-136075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/01/2018] [Accepted: 10/17/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Sonam Jaggi
- Divisions of Pulmonary, Critical Care Medicine and Sleep Medicine, McGovern Medical School at University of Texas Health, Houston, Texas, USA
| | - Diwakar D Balachandran
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lara Bashoura
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Saadia A Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Wiegand S, Teymoortash A, Hanschmann H. Endo-extralaryngeal Laterofixation of the Vocal Folds in Patients with Bilateral Vocal Fold Immobility. In Vivo 2017; 31:1159-1162. [PMID: 29102939 DOI: 10.21873/invivo.11183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Bilateral vocal fold paralysis can result in shortness of breath and severe dyspnea which can be life-threatening. PATIENTS AND METHODS Thirty-five patients with bilateral vocal fold paralysis who underwent endo-extralaryngeal laterofixation according to Lichtenberger were retrospectively analyzed regarding etiology, symptoms, treatment and complications. RESULTS In 27 patients, laterofixation of the vocal cord alone was performed. Eight patients underwent laterofixation and additional posterior chordectomy of the opposite vocal cord according to Dennis and Kashima. The time of intervention ranged from 1 day to 38 years after the onset of bilateral vocal cord immobility. The intraoperative course was uneventful in all patients. None of the patients had postoperative aspiration. Postoperative voice function was acceptable in all patients. Complications of suture laterofixation were laryngeal edema, formation of fibrin, and malposition of the suture. CONCLUSION Laterofixation of the vocal cords according to Lichtenberger is a safe and easy method that can be used as a first-stage treatment of vocal cord paralysis.
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Affiliation(s)
- Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig, Leipzig, Germany
| | - Afshin Teymoortash
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Holger Hanschmann
- Private Practice for Otorhinolaryngology, Allergology, Phoniatrics and Pedaudiology, Frankfurt am Main, Germany
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Kubik M, Rosen C. Laryngeal Framework Surgery in the Irradiated Neck: A Retrospective Matched Cohort Study. Ann Otol Rhinol Laryngol 2016; 125:823-8. [PMID: 27357974 DOI: 10.1177/0003489416656203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Laryngeal framework surgery (LFS) remains a cornerstone treatment in the management of glottic insufficiency. Traditionally, a history of radiation to the neck has been considered a relative contraindication to LFS. METHODS A retrospective matched cohort study was performed to study LFS outcomes in patients with and without a history of radiation. Variables studied included radiation specifics, surgical time, operative difficulty, complications, need for revision surgery, and Voice Handicap Index-10 (VHI-10) scores. RESULTS A total of 298 patients were studied. Fourteen patients with a history of neck irradiation were matched with 14 nonirradiated controls. No complications were encountered in the nonirradiated cohort. In the irradiated cohort, there were 2 minor wound complications and 1 admission for stridor treated medically. No cases of implant extrusion were observed. The VHI-10 scores were improved in both cohorts relative to preoperative baseline (P = .001). Posttreatment VHI-10 scores were better in the nonirradiated cohort (P = .03). There was no difference between cohorts with respect to complication rates, surgical time, surgical difficulty, length of stay, use of a surgical drain, or need for revision surgery. CONCLUSION Laryngeal framework surgery is safe and associated with improved voice outcomes in patients with a history of neck irradiation.
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Affiliation(s)
- Mark Kubik
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Clark Rosen
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Mor N, Wu G, Aylward A, Christos PJ, Sulica L. Predictors for Permanent Medialization Laryngoplasty in Unilateral Vocal Fold Paralysis. Otolaryngol Head Neck Surg 2016; 155:443-53. [PMID: 27143710 DOI: 10.1177/0194599816644716] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 03/25/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Early differentiation of patients with unilateral vocal fold paralysis (VFP) who recover from those who do not and consequently require permanent medialization laryngoplasty (ML) remains a challenge. The goal of this study is to identify factors that predict the need for ML. STUDY DESIGN Case series with chart review. SETTING Academic center. SUBJECTS AND METHODS A total of 507 records of patients with VFP were analyzed, of which 252 met criteria and were stratified according to whether or not they obtained ML. Demographic information and clinical features were analyzed to determine predictors of ML. A nomogram was generated according to the significance and utility of these parameters. RESULTS Of 252 patients, 86 underwent ML, and 166 did not. No differences in age or sex were observed between the ML and non-ML patients (P = .27 and P = .35, respectively). The most common cause of VFP was iatrogenic injury (62.79%, ML; 49.40%, non-ML). ML correlated with VFP secondary to neoplastic disease (odds ratio [OR], 2.14; 95% confidence interval [95% CI], 1.01-4.53) and iatrogenic injury (OR 1.73; 95% CI 1.01-2.94). ML had an inverse correlation with idiopathic VFP (OR, 0.40; 95% CI, 0.20-0.79). Patients in the ML group were more likely to have left-sided VFP, to have a history of aspiration, and to present ≥90 days from onset and less likely to have had temporary injection augmentation. CONCLUSION Clinical features may be used to predict the likelihood of a patient obtaining ML. Nomograms may be useful to counsel patients who would benefit from early definitive surgery.
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Affiliation(s)
- Niv Mor
- Voice and Swallowing Disorders, Division of Otolaryngology-Head and Neck Surgery, Maimonides Medical Center, Brooklyn, New York, USA Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, USA
| | - Guojiao Wu
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Alana Aylward
- College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Lucian Sulica
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, USA
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Unilateral Cervical Polyneuropathies following Concurrent Bortezomib, Cetuximab, and Radiotherapy for Head and Neck Cancer. Case Rep Otolaryngol 2016; 2016:2313714. [PMID: 27088023 PMCID: PMC4818816 DOI: 10.1155/2016/2313714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/11/2016] [Indexed: 12/25/2022] Open
Abstract
We report a constellation of cervical polyneuropathies in a patient treated with concurrent bortezomib, cetuximab, and cisplatin alongside intensity modulated radiotherapy for carcinoma of the tonsil with neck metastasis. The described deficits include brachial plexopathy, cervical sensory neuropathy, and oculosympathetic, recurrent laryngeal, and phrenic nerve palsies within the ipsilateral radiation field. Radiation neuropathy involving the brachial plexus is typically associated with treatment of breast or lung cancer; however, increased awareness of this entity in the context of investigational agents with potential neuropathic effects in head and neck cancer has recently emerged. With this report, we highlight radiation neuropathy in the setting of investigational therapy for head and neck cancer, particularly since these sequelae may present years after therapy and entail significant and often irreversible morbidity.
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Krouse JH. Highlights from the Current Issue: August 2015. Otolaryngol Head Neck Surg 2015; 153:159-160. [PMID: 29135349 DOI: 10.1177/0194599815591145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- John H Krouse
- 1 Department of Otolaryngology/Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania, USA
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