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Yang Y, Wang YL, Wei LZ, Wang JX, Huang FT, Huang GW. Is CO 2 laser microsurgery better than radiotherapy in early glottic cancer: a meta-analysis. Lasers Med Sci 2023; 38:223. [PMID: 37758965 PMCID: PMC10533611 DOI: 10.1007/s10103-023-03890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
The choice between radiotherapy (RT) and CO2 laser surgery (CO2-LS) for early glottic cancer remains controversial. We systematically examined electronic databases in order to identify prospective trials comparing patients who had undergone CO2-LS or RT to treat early glottic cancer. Eleven studies involving 1053 patients were included. In the selected literature, the parameter setting of CO2 laser equipment can be summarized as wavelength 10.6 µm, superpulsed mode, continuous setting, power tailored on target structures (1-3 W for subtle resections and 4-15 W for cutting a larger tumor), and approximately 2080-3900 W/cm2 of laser energy. Using RevMan 5.3, we estimated pooled odds ratios (ORs) for dichotomous variables and pooled mean differences (MDs) for continuous variables, along with associated 95% confidence intervals (CIs). The heterogeneity in the treatment variables was measured using Higgins' inconsistency test and expressed as I2 values. The continuous variables were then depicted as histograms developed using PlotDigitizer 2.6.8. Compared to patients treated with CO2-LS, those treated with RT had better jitter (MD 1.27%, 95% CI 1.21 ~ 1.32, P < 0.001), and high scores on the "Grade (MD 6.54, 95% CI 5.31 ~ 7.76, P < 0.001), Breathiness (MD 9.08, 95% CI 4.02 ~ 14.13, P < 0.001), Asthenia (MD 2.13, 95% CI 0.29 ~ 3.98, P = 0.02), and Strain (MD 3.32, 95% CI 0.57 ~ 6.07, P = 0.02)" scale. Patients treated with CO2-LS had worse local control rates (OR 3.14, 95% CI 1.52 ~ 6.48, P = 0.002) while lower incidence of second primary tumor (OR 0.30, 95% CI 0.15 ~ 0.61, P < 0.001). It is hoped that retrospective analysis can provide suggestions for early glottis patients to choose personalized treatment.
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Affiliation(s)
- Yong Yang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, No.6 of Shuangyong Road, Nanning, 530021, Guangxi, China
- Department of Otolaryngology-Head and Neck Surgery, The First People's Hospital of Nanning, Nanning, 530021, Guangxi, China
| | - Yong-Li Wang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, No.6 of Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Li-Zhi Wei
- Department of Otolaryngology-Head and Neck Surgery, The First People's Hospital of Nanning, Nanning, 530021, Guangxi, China
| | - Ju-Xin Wang
- Department of Otolaryngology-Head and Neck Surgery, The First People's Hospital of Nanning, Nanning, 530021, Guangxi, China
| | - Fang-Ting Huang
- Department of Otolaryngology-Head and Neck Surgery, The First People's Hospital of Nanning, Nanning, 530021, Guangxi, China
| | - Guang-Wu Huang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, No.6 of Shuangyong Road, Nanning, 530021, Guangxi, China.
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2
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Kanamori K, Kurita D, Hirano Y, Ishiyama K, Oguma J, Masutomi K, Daiko H. Does synchronous early head and neck cancer with esophageal cancer need treatment after preoperative chemotherapy? Gen Thorac Cardiovasc Surg 2021; 70:280-284. [PMID: 34837129 DOI: 10.1007/s11748-021-01744-9] [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: 09/01/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Treatment options for patients with resectable thoracic esophageal squamous cell cancer (ESCC) and synchronous head and neck cancer (HNC) are unclear. Little has been reported about the effects of chemotherapy on early HNC. The aim of this study was to investigate the treatment outcomes of resectable thoracic ESCC with synchronous early HNC. METHODS We retrospectively reviewed 37 patients undergoing esophagectomy for thoracic ESCC with synchronous early HNC from January 2008 to December 2018. RESULTS Among 37 patients who had synchronous early HNC, 27 patients received preoperative therapy for ESCC before HNC treatment, and 16 of 27 patients achieved a complete response for HNC by preoperative chemotherapy. Fifteen of 16 patients did not receive additional treatment, and regional recurrence of HNC was not observed. In one other case, an oral excision was performed, but no cancer cell remnants were found pathologically. No significant difference in overall survival and disease-free survival was observed between 15 patients with follow-up and 22 patients with surgery or radiation. CONCLUSION Our results indicate that early HNC with comorbid ESCC could be followed up without additional treatment if preoperative chemotherapy is successful.
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Affiliation(s)
- Kohei Kanamori
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-5-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Japan
| | - Daisuke Kurita
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-5-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yuki Hirano
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-5-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Koshiro Ishiyama
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-5-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Junya Oguma
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-5-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kenkichi Masutomi
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Japan.,Division of Cancer Stem Cell, National Cancer Research Institute, 5-5-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hiroyuki Daiko
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-5-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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Laccourreye O, Marret G, Rubin F, Fabre E, Badoual C, Oudard S, Bonfils P, Lisan Q. Ten‐year outcome of curative “exclusive” chemotherapy in N0M0 squamous cell carcinoma of the larynx and pharynx with complete clinical response. Head Neck 2019; 41:2190-2196. [DOI: 10.1002/hed.25674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ollivier Laccourreye
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryUniversité Paris Descartes Sorbonne Paris Cité, Hôpital Européen Georges Pompidou Paris France
| | - Grégoire Marret
- Department of Medical OncologyUniversité Paris Descartes Sorbonne Paris Cité, Hôpital Européen Georges Pompidou Paris France
| | | | - Elizabeth Fabre
- Department of Medical OncologyUniversité Paris Descartes Sorbonne Paris Cité, Hôpital Européen Georges Pompidou Paris France
| | - Cécile Badoual
- Department of PathologyUniversité Paris Descartes Sorbonne Paris Cité, Hôpital Européen Georges Pompidou Paris France
| | - Stéphane Oudard
- Department of Medical OncologyUniversité Paris Descartes Sorbonne Paris Cité, Hôpital Européen Georges Pompidou Paris France
| | - Pierre Bonfils
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryUniversité Paris Descartes Sorbonne Paris Cité, Hôpital Européen Georges Pompidou Paris France
| | - Quentin Lisan
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryUniversité Paris Descartes Sorbonne Paris Cité, Hôpital Européen Georges Pompidou Paris France
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4
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Weiss JM, Grilley-Olson JE, Deal AM, Zevallos JP, Chera BS, Paul J, Knowles MF, Usenko D, Weissler MC, Patel S, Hayes DN, Hackman T. Phase 2 trial of neoadjuvant chemotherapy and transoral endoscopic surgery with risk-adapted adjuvant therapy for squamous cell carcinoma of the head and neck. Cancer 2018; 124:2986-2992. [PMID: 29741773 DOI: 10.1002/cncr.31526] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/14/2018] [Accepted: 03/17/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND The objective of this study was to demonstrate the feasibility and efficacy of induction chemotherapy, surgery, and pathology-guided adjuvant therapy to treat transorally resectable squamous head and neck cancer. METHODS Patients had squamous head and neck cancer that was resectable by the transoral route and advanced-stage disease (American Joint Committee on Cancer stage III-IV, T3-T4 tumors, and/or positive lymph nodes). They received treatment with weekly carboplatin at an area under the curve of 2, plus paclitaxel 135 mg/m2 , and daily lapatinib 1000mg for 6 weeks followed by surgical resection. Pathology that revealed margins <5 mm, extracapsular extension, N2a of N2b lymph node status, perineural invasion, or lymphovascular space invasion resulted in adjuvant radiotherapy concurrent with weekly cisplatin. Pathology with N2c/N3 lymph node status or positive margins resulted in radiation with bolus cisplatin. The primary endpoint was the clinical response rate to induction chemotherapy, and a key secondary endpoint was feasibility. RESULTS Toxicity was modest, and 37 of 40 patients completed study procedures as planned. The clinical response rate was 93%, the pathologic complete response rate was 36%, and the clinical response did not predict for a pathologic complete response. No patient on study follow-up has recurred or died. Twenty-nine of 39 patients who underwent surgery avoided radiation. Speech and swallowing function were well preserved. CONCLUSIONS The study met both its primary efficacy endpoint and the secondary feasibility endpoint. Neoadjuvant, systemic therapy and surgical resection followed by risk-adapted adjuvant therapy resulted in high response rates and excellent long-term outcomes and should be further studied. Cancer 2018;124:2986-92. © 2018 American Cancer Society.
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Affiliation(s)
- Jared M Weiss
- Department of Hematology and Oncology, Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, North Carolina
| | - Juneko E Grilley-Olson
- Department of Hematology and Oncology, Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, North Carolina
| | - Allison Mary Deal
- Lineberger Cancer Center at the University of North Carolina, Chapel Hill, North Carolina
| | - Jose P Zevallos
- Head and Neck Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Bhishamjit S Chera
- Department of Radiation Oncology, Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer Paul
- Department of Hematology and Oncology, Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, North Carolina
| | - Mary Fleming Knowles
- Department of Radiation Oncology, Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, North Carolina
| | - Dmitriy Usenko
- Department of Hematology and Oncology, Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, North Carolina
| | - Mark C Weissler
- Division of Head and Neck Surgery, Department of Otolaryngology, Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, North Carolina
| | - Samip Patel
- Division of Head and Neck Surgery, Department of Otolaryngology, Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, North Carolina
| | | | - Trevor Hackman
- Division of Head and Neck Surgery, Department of Otolaryngology, Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, North Carolina
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5
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Ko HC, Harari PM, Chen S, Wieland AM, Yu M, Baschnagel AM, Kimple RJ, Witek ME. Survival Outcomes for Patients With T3N0M0 Squamous Cell Carcinoma of the Glottic Larynx. JAMA Otolaryngol Head Neck Surg 2017; 143:1126-1133. [PMID: 29049434 DOI: 10.1001/jamaoto.2017.1756] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Radiotherapy (RT)-based organ preservation approaches for patients with advanced laryngeal cancer have been established stepwise through prospective randomized clinical trials. However, broad adoption of these approaches has stimulated discussion about long-term results challenging their applicability in a heterogeneous patient population, most recently for patients with T3 disease. Objective To define outcomes in patients with clinical T3N0M0 glottic laryngeal cancer treated with definitive surgical and RT-based approaches. Design, Setting, and Participants This retrospective cohort study included patients treated from January 1, 2004, through December 31, 2013, with a median follow-up time of 58 months (range, 0-126.6 months) in the National Cancer Database. Of the 4003 patients with T3N0M0 disease, 2622 received definitive therapy defined by the study protocol. Data were obtained from the clinical oncology database sourced from hospital registry data that are collected from more than 1500 Commission on Cancer-accredited facilities. Data were analyzed from September 14, 2016, through April 24, 2017. Interventions Radiotherapy, chemoradiotherapy, surgery, surgery and RT, or surgery and chemoradiotherapy. Main Outcomes and Measures Five-year overall survival (OS). Results A total of 2622 patients (2251 men [85.9%] and 371 women [14.1%]; median age, 64 years [range, 19-90 years]) were included in the analytic cohort. In the overall patient cohort, the adjusted 5-year survival probability was 53%. No statistical differences were observed between the primary surgery (53%; 95% CI, 48%-57%) and primary RT (54%; 95% CI, 52%-57%) cohorts. In multivariate analysis, patient factors associated with decreased OS included age (hazard ratio [HR], 1.04; 95% CI, 1.03-1.04), insurance status (HR, 1.26; 95% CI, 1.06-1.50), and increasing comorbidity (HR, 1.20; 95% CI, 1.02-1.42). Conclusions and Relevance Current management of T3N0M0 glottic laryngeal cancer relies largely on RT-based organ preservation approaches. The present study substantiates randomized clinical trial data supporting the use of RT-based organ preservation approaches for patients with T3N0M0 glottic laryngeal cancer without compromising OS.
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Affiliation(s)
- Huaising C Ko
- Department of Human Oncology, Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison
| | - Paul M Harari
- Department of Human Oncology, Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison
| | - Shuai Chen
- Department of Biostatistics and Medical Informatics, Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison
| | - Aaron M Wieland
- Division of Otolaryngology and Head and Neck Surgery, Department of Surgery, Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison
| | - Menggang Yu
- Department of Biostatistics and Medical Informatics, Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison
| | - Andrew M Baschnagel
- Department of Human Oncology, Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison
| | - Randall J Kimple
- Department of Human Oncology, Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison
| | - Matthew E Witek
- Department of Human Oncology, Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison
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6
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D'Souza AM, Mark J, Demarcantonio M, Leino D, Sisson R, Geller JI. Pediatric laryngeal carcinoma in a heterozygous carrier of Fanconi anemia. Pediatr Blood Cancer 2017; 64. [PMID: 28139070 DOI: 10.1002/pbc.26463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 11/14/2016] [Accepted: 12/09/2016] [Indexed: 11/10/2022]
Abstract
A case of invasive, keratinizing squamous cell carcinoma of the larynx in an 8-year-old female treated with laryngectomy is presented. Perinatal exposure to human papilloma virus and constitutional heterozygosity for a FANCC mutation were identified, though FANCC heterozygosity is not known to be cancer predisposing. An additional tumor-associated mutation in NOTCH1 was also identified potentially contributing to oncogenesis. This case illustrates an exceedingly rare type of cancer in the pediatric population and discusses diagnostic workup, evaluation of risk factors for head and neck cancer, and treatment options.
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Affiliation(s)
- A M D'Souza
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - J Mark
- Department of Otolaryngology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - M Demarcantonio
- Department of Otolaryngology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - D Leino
- Department of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - R Sisson
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - J I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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7
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Abstract
Squamous cell carcinomas of larynx and hypopharynx can be treated by surgery and/or radiotherapy according to tumor size. For small tumors, the results are similar. For locally advanced tumors, the surgical approach is mutilating and requires a total (pharyngo)laryngectomy. Exclusive chemoradiotherapy has shown its interest at the cost of late sequelae. In order to reduce these effects and mutilation, induction chemotherapy with cisplatin, docetaxel and 5FU for organ preservation becomes the standard treatment but there are no solid studies comparing this approach with the exclusive chemoradiotherapy. And it is not possible to conclude as to the superiority of a scheme in terms of overall survival. When chemotherapy is chosen, the modalities of any potentiation of radiation have not been yet established.
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8
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Vainshtein JM, Wu VF, Spector ME, Bradford CR, Wolf GT, Worden FP. Chemoselection: a paradigm for optimization of organ preservation in locally advanced larynx cancer. Expert Rev Anticancer Ther 2014; 13:1053-64. [PMID: 24053204 DOI: 10.1586/14737140.2013.829646] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Definitive chemoradiation (CRT) and laryngectomy followed by postoperative radiotherapy (RT) are both considered standard-of-care options for the management of advanced laryngeal cancer. While organ preservation with chemoradiotherapy is often the preferred up-front approach for appropriately selected candidates, the functional benefits of organ preservation must be carefully balanced against the considerable morbidity of salvage laryngectomy in patients who fail primary chemoradiation. Up-front identification of patients who are likely to require surgical salvage, therefore, is an important aim of any organ preserving approach in order to minimize morbidity while maximizing organ preservation. To this end, a strategy of 'chemoselection', using the primary tumor's response after 1 cycle of induction chemotherapy as an in vivo method of selecting responders for definitive chemoradiation while reserving primary surgical management for non-responders, has been employed extensively at our institution. The rationale, treatment results and future directions of this approach are discussed.
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Affiliation(s)
- Jeffrey M Vainshtein
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI, USA
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9
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When is chemotherapy in head and neck squamous cell carcinoma not indicated? Eur Arch Otorhinolaryngol 2014; 272:781-787. [PMID: 24525999 DOI: 10.1007/s00405-014-2894-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 01/16/2014] [Indexed: 01/30/2023]
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10
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Gold KA, Neskey M, William WN. The role of systemic treatment before, during, and after definitive treatment. Otolaryngol Clin North Am 2013; 46:645-56. [PMID: 23910475 DOI: 10.1016/j.otc.2013.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In locoregionally advanced head and neck squamous cell carcinomas, outcomes using single-modality therapy are usually poor. Although chemotherapy alone is not considered a curative therapy, the addition of chemotherapy to other modalities can lead to improved outcomes. Discussed here is the use of chemotherapy for oropharyngeal and/or oral cavity squamous cell carcinomas in 3 settings: in combination with radiation as definitive therapy, as induction treatment before definitive therapy, and in combination with radiation therapy as adjuvant treatment following surgical resection. The role of the targeted agent cetuximab in combination with radiation therapy for locally advanced disease is also discussed.
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Affiliation(s)
- Kathryn A Gold
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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11
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Forastiere AA, Zhang Q, Weber RS, Maor MH, Goepfert H, Pajak TF, Morrison W, Glisson B, Trotti A, Ridge JA, Thorstad W, Wagner H, Ensley JF, Cooper JS. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol 2013; 31:845-52. [PMID: 23182993 PMCID: PMC3577950 DOI: 10.1200/jco.2012.43.6097] [Citation(s) in RCA: 817] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To report the long-term results of the Intergroup Radiation Therapy Oncology Group 91-11 study evaluating the contribution of chemotherapy added to radiation therapy (RT) for larynx preservation. PATIENTS AND METHODS Patients with stage III or IV glottic or supraglottic squamous cell cancer were randomly assigned to induction cisplatin/fluorouracil (PF) followed by RT (control arm), concomitant cisplatin/RT, or RT alone. The composite end point of laryngectomy-free survival (LFS) was the primary end point. RESULTS Five hundred twenty patients were analyzed. Median follow-up for surviving patients is 10.8 years. Both chemotherapy regimens significantly improved LFS compared with RT alone (induction chemotherapy v RT alone: hazard ratio [HR], 0.75; 95% CI, 0.59 to 0.95; P = .02; concomitant chemotherapy v RT alone: HR, 0.78; 95% CI, 0.78 to 0.98; P = .03). Overall survival did not differ significantly, although there was a possibility of worse outcome with concomitant relative to induction chemotherapy (HR, 1.25; 95% CI, 0.98 to 1.61; P = .08). Concomitant cisplatin/RT significantly improved the larynx preservation rate over induction PF followed by RT (HR, 0.58; 95% CI, 0.37 to 0.89; P = .0050) and over RT alone (P < .001), whereas induction PF followed by RT was not better than treatment with RT alone (HR, 1.26; 95% CI, 0.88 to 1.82; P = .35). No difference in late effects was detected, but deaths not attributed to larynx cancer or treatment were higher with concomitant chemotherapy (30.8% v 20.8% with induction chemotherapy and 16.9% with RT alone). CONCLUSION These 10-year results show that induction PF followed by RT and concomitant cisplatin/RT show similar efficacy for the composite end point of LFS. Locoregional control and larynx preservation were significantly improved with concomitant cisplatin/RT compared with the induction arm or RT alone. New strategies that improve organ preservation and function with less morbidity are needed.
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Affiliation(s)
- Arlene A Forastiere
- Sydney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
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12
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Hoffmann TK. Systemic therapy strategies for head-neck carcinomas: Current status. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc03. [PMID: 23320055 PMCID: PMC3544206 DOI: 10.3205/cto000085] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Head and neck cancers, most of which are squamous cell tumours, have an unsatisfactory prognosis despite intensive local treatment. This can be attributed, among other factors, to tumour recurrences inside or outside the treated area, and metastases at more distal locations. These tumours therefore require not only the standard surgical and radiation treatments, but also effective systemic modalities. The main option here is antineoplastic chemotherapy, which is firmly established in the palliative treatment of recurrent or metastatic stages of disease, and is used with curative intent in the form of combined simultaneous or adjuvant chemoradiotherapy in patients with inoperable or advanced tumour stages. Neoadjuvant treatment strategies for tumour reduction before surgery have yet to gain acceptance. Induction chemotherapy protocols before radiotherapy have to date been used in patients at high risk of distant metastases or as an aid for decision-making ("chemoselection") in those with extensive laryngeal cancers, prior to definitive chemoradiotherapy or laryngectomy. Triple-combination induction therapy (taxanes, cisplatin, 5-fluorouracil) shows high remission rates with significant toxicity and, in combination with (chemo-)radiotherapy, is currently being compared with simultaneous chemoradiotherapy; the current gold standard with regards to efficacy and long-term toxicity.A further systemic treatment strategy, called "targeted therapy", has been developed to help increase specificity and reduce toxicity. An example of targeted therapy, EGFR-specific antibodies, can be used in palliative settings and, in combination with radiotherapy, to treat advanced head and neck cancers. A series of other novel biologicals such as signal cascade inhibitors, genetic agents, or immunotherapies, are currently being evaluated in large-scale clinical studies, and could prove useful in patients with advanced, recurring or metastatic head and neck cancers. When developing a lasting, individualised systemic tumour therapy, the critical evaluation criteria are not only efficacy and acute toxicity but also (long-term) quality-of-life and the identification of dedicated predictive biomarkers.
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13
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Strojan P, Haigentz M, Bradford CR, Wolf GT, Hartl DM, Langendijk JA, Rinaldo A, Eisbruch A, Mendenhall WM, Forastiere AA, Takes RP, Ferlito A. Chemoradiotherapy vs. total laryngectomy for primary treatment of advanced laryngeal squamous cell carcinoma. Oral Oncol 2012; 49:283-6. [PMID: 23219843 DOI: 10.1016/j.oraloncology.2012.11.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 11/08/2012] [Accepted: 11/11/2012] [Indexed: 10/27/2022]
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14
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Haigentz M, Cohen EEW, Wolf GT, Strojan P, Eisbruch A, Ferlito A. The future of induction chemotherapy for head and neck squamous cell carcinoma. Oral Oncol 2012; 48:1065-7. [PMID: 22981388 DOI: 10.1016/j.oraloncology.2012.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 08/17/2012] [Indexed: 11/15/2022]
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15
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Induction chemotherapy in locally advanced pharyngolaryngeal cancers with stridor: is it feasible and safe? CHEMOTHERAPY RESEARCH AND PRACTICE 2012; 2012:549170. [PMID: 22924129 PMCID: PMC3424664 DOI: 10.1155/2012/549170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 07/05/2012] [Accepted: 07/06/2012] [Indexed: 11/25/2022]
Abstract
Background. The standard initial management of patients with locally advanced pharyngolaryngeal presenting with stridor is tracheostomy. Tracheostomy has been shown to negatively impact cancer-related outcomes. Methods. Retrospective analysis of prospectively collected data of 9 patients, who underwent induction chemotherapy with the aim of prevention of tracheostomy. Presenting features, time to resolution of stridor, and further management are reported. Results. Eight out of 9 patient received chemotherapy within 12 hours of presentation with stridor. There were 4 patients each with primary hypopharynx and larynx. The stage was IVA in 6 patients and IVB in 2 patients. In all patients receiving immediate chemotherapy, clinical stridor resolved within 48 hours. The radiological response rate was 62.5%. The median reduction in size of tumor was 37%.
Conclusion. Immediate neoadjuvant chemotherapy is a feasible and safe option for patients presenting with early stridor and helps in resolution of stridor and avoiding tracheostomy.
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16
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Abstract
The main issue in the management of glottic squamous cell carcinoma, as for all cancers, is adequate disease control while optimizing functional outcomes and minimizing morbidity. This is true for early-stage disease as for advanced tumors. This article evaluates the current evidence for the diagnostic and pretherapeutic workup for glottic squamous cell carcinoma and the evidence concerning different treatment options for glottic carcinoma, from early-stage to advanced-stage disease.
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Affiliation(s)
- Dana M Hartl
- Department of Head and Neck Oncology, Institut Gustave Roussy, Villejuif, France.
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Haigentz M, Hartl DM, Silver CE, Langendijk JA, Strojan P, Paleri V, de Bree R, Machiels JP, Hamoir M, Rinaldo A, Paccagnella D, Shaha AR, Takes RP, Ferlito A. Distant metastases from head and neck squamous cell carcinoma. Part III. Treatment. Oral Oncol 2012; 48:787-93. [PMID: 22516376 DOI: 10.1016/j.oraloncology.2012.03.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 03/08/2012] [Indexed: 12/14/2022]
Abstract
Distant metastases from head and neck squamous cell carcinoma (HNSCC), though rare at initial presentation, remain an important manifestation of cancer recurrence and mortality. Although generally considered incurable with a dismal prognosis despite palliative therapy, highly selected patients with distant metastases may have a long term survival benefit from aggressive surgery or radiotherapy. Advances in systemic treatments also may improve patient survival. This article reviews the current state of management of HNSCC patients with distant metastases.
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Affiliation(s)
- Missak Haigentz
- Department of Medicine (Oncology), Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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The anti-tumour effect of cisplatin and ifosfamide on xenografted squamous cell carcinoma of the head and neck is schedule-dependent. Oral Oncol 2012; 48:61-6. [DOI: 10.1016/j.oraloncology.2011.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 09/07/2011] [Accepted: 09/08/2011] [Indexed: 11/19/2022]
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Kies MS, Boatright DH, Li G, Blumenschein G, El-Naggar AK, Brandon Gunn G, Lewin JS, Steinhaus GD, Sturgis EM. Phase II trial of induction chemotherapy followed by surgery for squamous cell carcinoma of the oral tongue in young adults. Head Neck 2011; 34:1255-62. [PMID: 22009800 DOI: 10.1002/hed.21906] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We conducted a phase II clinical trial of induction chemotherapy followed by surgery ± radiotherapy for squamous cell carcinoma of the oral tongue (SCCOT) in young adults. METHODS From September 2001 to October 2004, 23 patients aged 18 to 49 years with clinical T2-3 N0-2 M0 SCCOT and no prior radiotherapy, chemotherapy, or neck dissection underwent induction chemotherapy (paclitaxel, ifosfamide, and carboplatin) followed by glossectomy and neck dissection ± radiotherapy and chemotherapy. RESULTS On final surgical pathology, 9 patients (39%) had a complete/major (2 complete) histologic response at the primary tumor site; 8 patients (35%) had no response or progression. Similarly, 9 patients (39%) had a complete response in the neck or remained node negative; 6 patients (26%) had an increase in nodal category. No treatment-associated deaths occurred, and toxicity was modest. At a median follow-up from the end of treatment of 52 months (minimum, 23 months), 10 patients (43%) developed recurrence, and all 10 died of cancer. Crude recurrence/cancer death rates were associated with ≤ a partial response at the tongue (p = .029), poor histologic differentiation (p = .012), and multiple adverse features on final surgical pathology (p = .040). CONCLUSION Response rates and overall survival with this induction chemotherapy regimen were limited, but complete/major response at the tongue was associated with excellent prognosis. Additionally, improved patient selection and predictive tumor biomarkers will be needed for induction chemotherapy to be routinely incorporated into the treatment of oral tongue cancer in young adults.
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Affiliation(s)
- Merrill S Kies
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Torrente MC, Rodrigo JP, Haigentz M, Dikkers FG, Rinaldo A, Takes RP, Olofsson J, Ferlito A. Human papillomavirus infections in laryngeal cancer. Head Neck 2011; 33:581-6. [PMID: 20848441 DOI: 10.1002/hed.21421] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although the association and clinical significance of human papillomavirus (HPV) infections with a subset of head and neck cancers, particularly for oropharyngeal carcinoma, has recently been well documented, the involvement of HPV in laryngeal cancer has been inadequately evaluated. Herein we review the currently known associations of HPV infections in diseases of the larynx and their potential for oncogenicity. Using several methods of detection, HPV DNA has been detected in benign (papillomatosis), indolent (verrucous carcinoma), and malignant (squamous cell carcinoma) lesions of the larynx. Consistent with the known oncogenic risk of HPV infections, common HPV types associated with laryngeal papillomatosis include low-risk HPV types 6 and 11, with high-risk HPV types 16 and 18 more commonly present in neoplastic lesions (verrucous carcinoma and squamous cell carcinoma). Although a broad range of prevalence has been noted in individual studies, approximately 25% of laryngeal squamous cell carcinomas harbor HPV infections on meta-analysis, with common involvement of high-risk HPV types 16 (highest frequency) and 18. Preliminary results suggest that these high-risk HPV infections seem to be biologically relevant in laryngeal carcinogenesis, manifested as having viral DNA integration in the cancer cell genome and increased expression of the p16 protein. Despite this knowledge, the clinical significance of these infections and the implications on disease prevention and treatment are unclear and require further investigation.
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Affiliation(s)
- Mariela C Torrente
- Departamento de Otorrinolaringologia, Universidad de Chile, Santiago de Chile, Chile
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Divi V, Worden FP, Prince ME, Eisbruch A, Lee JS, Bradford CR, Chepeha DB, Teknos TN, Hogikyan ND, Moyer JS, Tsien CI, Urba SG, Wolf GT. Chemotherapy alone for organ preservation in advanced laryngeal cancer. Head Neck 2010; 32:1040-7. [PMID: 19953609 DOI: 10.1002/hed.21285] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND For patients with advanced laryngeal cancer, a trial was designed to determine if chemotherapy alone, in patients achieving a complete histologic complete response after a single neoadjuvant cycle, was an effective treatment with less morbidity than concurrent chemoradiotherapy. METHODS Thirty-two patients with advanced laryngeal or hypopharyngeal cancer received 1 cycle of induction chemotherapy, and subsequent treatment was decided based on response. RESULTS A histologic complete response was achieved in 4 patients and were treated with chemotherapy alone. All 4 patients' cancer relapsed in the neck and required surgery and postoperative radiotherapy (RT). Twenty-five patients were treated with concomitant chemoradiation. Three patients were treated with surgery. Overall survival and disease-specific survival at 3 years were 68% and 78%, respectively. CONCLUSION Chemotherapy alone is not feasible for long-term control of regional disease in patients with advanced laryngeal cancer even when they achieve a histologic complete response at the primary site.
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Affiliation(s)
- Vasu Divi
- Department of Otolaryngology-Head and Neck Surgery, Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI, USA
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Haigentz Jr M, Silver CE, Hartl DM, Takes RP, Rodrigo JP, Robbins KT, Rinaldo A, Ferlito A. Chemotherapy regimens and treatment protocols for laryngeal cancer. Expert Opin Pharmacother 2010; 11:1305-16. [DOI: 10.1517/14656561003749256] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Missak Haigentz Jr
- Montefiore Medical Center, Albert Einstein College of Medicine, Division of Oncology, Department of Medicine, Bronx, NY, USA
| | - Carl E Silver
- Montefiore Medical Center, Albert Einstein College of Medicine, Departments of Surgery and Otolaryngology-Head and Neck Surgery, Bronx, NY, USA
| | - Dana M Hartl
- Institut Gustave Roussy, Department of Otolaryngology-Head and Neck Surgery, Villejuif Cedex, France
- Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France
| | - Robert P Takes
- Radboud University Nijmegen Medical Center, Department of Otolaryngology-Head and Neck Surgery, Nijmegen, The Netherlands
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - K Thomas Robbins
- Southern Illinois University School of Medicine, Division of Otolaryngology-Head and Neck Surgery, Springfield, IL, USA
| | - Alessandra Rinaldo
- Department of Surgical Sciences, Professor and Chairman of the ENT Clinic, University of Udine, Azienda Ospedaliero-Universitaria, Piazzale S. Maria della Misericordia, I-33100 Udine, Italy ;
| | - Alfio Ferlito
- Department of Surgical Sciences, Professor and Chairman of the ENT Clinic, University of Udine, Azienda Ospedaliero-Universitaria, Piazzale S. Maria della Misericordia, I-33100 Udine, Italy ;
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:134-45. [PMID: 20234215 DOI: 10.1097/moo.0b013e3283383ef9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hartl DM, Brasnu DF. Chemotherapy alone for glottic carcinoma: a need for higher-level evidence. Ann Otol Rhinol Laryngol 2009; 118:543-5. [PMID: 19746749 DOI: 10.1177/000348940911800801] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Haigentz M, Silver CE, Corry J, Genden EM, Takes RP, Rinaldo A, Ferlito A. Current trends in initial management of oropharyngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 2009; 266:1845-55. [DOI: 10.1007/s00405-009-1109-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Haigentz M, Silver CE, Rinaldo A, Ferlito A. Definitive chemotherapy: a new frontier in the fight against laryngeal cancer. Eur Arch Otorhinolaryngol 2009; 267:1-4. [DOI: 10.1007/s00405-009-1105-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 08/31/2009] [Indexed: 11/28/2022]
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Holsinger FC, Lin HY, Bassot V, Laccourreye O. Platin-based exclusive chemotherapy for selected patients with squamous cell carcinoma of the larynx and pharynx. Cancer 2009; 115:3909-18. [PMID: 19551883 PMCID: PMC3851301 DOI: 10.1002/cncr.24477] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The current study was conducted to determine the long-term outcomes of patients with squamous cell carcinoma of the larynx and pharynx who were treated with platin-based exclusive chemotherapy (EC) after they achieved a complete clinical response (CCR) to induction chemotherapy. METHODS One hundred forty-two who achieved a CCR after platin-based induction chemotherapy were treated exclusively with additional chemotherapy, and 98.6% were followed for a minimum of 3 years or until death. Thirty-five patients had >10 years of follow-up. RESULTS The survival rates at 1 year and 5 years were 95.8% and 61.2%, respectively. The main causes of death were metachronous second primary tumors (n = 27) and intercurrent disease (n = 21). Death related to EC was not encountered, and only 2 patients (1.4%) had grade 4 toxicity. In multivariate analysis, primary tumor arising outside the glottic larynx (P = .0001) and a Charlson comorbidity index >1 (P = .0001) were associated with a statistically significant reduction in survival. The 1-year and 5-year Kaplan-Meier local control estimates were 76.1% and 50.7%, respectively. Salvage treatment resulted in an observed final local control rate of 93% that varied from 97.2% in patients who had glottic cancer to 88.7% in patients who had tumor originating from other sites (P = .097). Combined chemotherapy with cisplatin and 5-fluorouracil (PF) allowed for the successful modulation of local therapy in 54.9% of patients. CONCLUSIONS For selected patients, EC may provide long-term, durable disease control. For patients who developed recurrent disease after EC, this approach did not diminish survival and maintained function in the majority of patients. Future work should be directed toward select markers of response to PF chemotherapy with which to identify those patients who are suited optimally for this approach.
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Affiliation(s)
- F Christopher Holsinger
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
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Silver CE, Beitler JJ, Shaha AR, Rinaldo A, Ferlito A. Current trends in initial management of laryngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 2009; 266:1333-52. [PMID: 19597837 DOI: 10.1007/s00405-009-1028-2] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 06/18/2009] [Indexed: 11/24/2022]
Affiliation(s)
- Carl E Silver
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Forastiere AA, Shaha AR. Chemotherapy alone for laryngeal preservation--is it possible? J Clin Oncol 2009; 27:1933-4. [PMID: 19289612 DOI: 10.1200/jco.2008.20.9445] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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