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Filauro M, Caprioli S, Lovino Camerino P, Sampieri C, Conforti C, Iandelli A, Benzi P, Gabella G, Bellini E, Mora F, Cittadini G, Peretti G, Marchi F. Depth of Invasion Assessment in Laryngeal Glottic Carcinoma: A Preoperative Imaging Approach for Prognostication. Laryngoscope 2024; 134:3230-3237. [PMID: 38407326 DOI: 10.1002/lary.31369] [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: 10/30/2023] [Revised: 01/26/2024] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The prognostic value of depth of invasion (DOI) in oral squamous cell cancer carcinoma and cutaneous melanoma is well established, while there is a lack of reports investigating the role of DOI in laryngeal cancer. This study aims to explore the association of glottic cancer DOI with other established pathological risk factors and nodal metastasis and evaluate the feasibility of measuring DOI preoperatively using tomographic imaging. METHODS The medical records of glottic cancer patients treated between 2015 and 2020 in a single tertiary referral center were screened retrospectively. Pathologically measured DOI (pDOI) value was also reviewed and registered. Preoperative computer tomography (CT) was used to obtain the radiological DOI (rDOI) measured by two dedicated radiologists. Their inter-rated agreement was assessed and the correlation between pDOI and rDOI was calculated. pDOI association with the main pathology report features was assessed with univariable analysis. Cox univariable and multivariable models were used to explore the role of pDOI on survival. RESULTS Ninety-one patients had pDOI data available, of which 59 also had rDOI data. A strong concordance between the two radiologists was found (concordance correlation coefficient = 0.96); rDOI and pDOI were highly and significantly correlated (R = 0.85; p < 0.001). pDOI was significantly higher in patients with perineural invasion (PNI; p < 0.001), lymphovascular invasion (LVI; p < 0.001), and nodal metastasis (p < 0.001). pDOI was associated with disease-free survival at univariable analysis (p = 0.04) while it did not show a significant impact (p = 0.10) at multivariable analysis. CONCLUSION Glottic carcinoma DOI correlates with PNI, LVI, and nodal metastasis and it can be reliably assessed in a preoperative setting using CT imaging. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3230-3237, 2024.
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Affiliation(s)
- Marta Filauro
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Caprioli
- Unit of Oncological and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine (DIMI), University of Genova, Genoa, Italy
| | - Paola Lovino Camerino
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Department of Otorhinolaryngology, Ospedale S. Paolo, Savona, Italy
| | - Claudio Sampieri
- Department of Experimental Medicine (DIMES), University of Genova, Genoa, Italy
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
- Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
| | - Cristina Conforti
- Unit of Oncological and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Iandelli
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Benzi
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Giulia Gabella
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Elisa Bellini
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Francesco Mora
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Giuseppe Cittadini
- Unit of Oncological and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgio Peretti
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Filippo Marchi
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
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2
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Iandelli A, Gabella G, Marchi F, Campagnari V, Filauro M, Sampieri C, Tsai TY, Vilaseca I, Peretti G. The impact of margins in laryngeal cancer patients treated with transoral laser microsurgery: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08610-3. [PMID: 38564009 DOI: 10.1007/s00405-024-08610-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE In laryngeal squamous cell carcinoma (LSCC) treated with transoral laser microsurgery (TOLMS), the status of margins significantly affected local control. When a positive or close margin is present, there is no ubiquitous consensus regarding further treatments. The rationale of the present systematic review and meta-analysis is to investigate the survival impact of the status of the margins in patients affected by LSCC treated with TOLMS. DATA SOURCES PubMed, EMBASE, and Cochrane Library. METHODS We performed a systematic search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were: patients affected by LSCC, staged according to the American Joint Committee on Cancer Staging System and treated by TOLMS without any previous treatment; margins status (close, positive, negative) and the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of overall survival, disease-specific survival, and disease-free survival has to be reported. RESULTS Nine studies were deemed eligible for the qualitative analysis, and 3 for the quantitative analysis to investigate the association between margin status and OS. The cumulative number of patients was 3130. The sample size ranged from 96 to 747 patients. The follow-up period ranged from 0 to 201 months. The meta-analysis results show that positive margins have an aHR of 1.30 yet with CI range (0.56 to 2.97). CONCLUSIONS Our current meta-analysis results are unable to definitively assess the real impact of resection margins on OS. Few authors provide accurate data regarding position and types of margins. Further prospective or high-quality studies are required.
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Affiliation(s)
- Andrea Iandelli
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Giulia Gabella
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy
| | - Filippo Marchi
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy.
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy.
| | - Valentina Campagnari
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy.
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy.
| | - Marta Filauro
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Claudio Sampieri
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy
- Otolaryngology and Head and Neck Surgery Unit, Hospital Clinic, Barcellona, Spain
- Department of Experimental Medicine (DIMES), University of Genova, Genoa, Italy
| | - Tsung-You Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taoyuan, Taiwan
| | - Isabel Vilaseca
- Otolaryngology and Head and Neck Surgery Unit, Hospital Clinic, Barcellona, Spain
- Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Catalunya, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Giorgio Peretti
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy
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3
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Crosetti E, Succo G, Sapino S, Bertotto I, Cirillo S, Petracchini M, Fondello G, Arrigoni G, Tascone M, Piazza C, Farina D, Ravanelli M. Twenty questions from the surgeon to the radiologist to better plan an open partial horizontal laryngectomy. Front Oncol 2024; 13:1305889. [PMID: 38328437 PMCID: PMC10847842 DOI: 10.3389/fonc.2023.1305889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Open partial horizontal laryngectomies (OPHLs) represent a valuable therapeutic option for tumors of the intermediate T-category and, in selected cases, for locally advanced tumors with low-volume extra-laryngeal extension. The eligibility of patients treated with this type of surgery has increased with the introduction of the modular approach to OPHL planning. This strategy follows the introduction of the classification proposed by the European Laryngological Society, based on the extent of horizontal resection. Optimization of the selection is the result of a meticulous work-up process involving close cooperation between experienced surgeons and radiologists, followed by final quality control by pathologists. Computed tomography and magnetic resonance imaging are study methods whose pearls and pitfalls are well known, especially when performed at a high level of expertise. In this paper, based on the experience of two high-volume centers, a checklist of 20 questions addressed by the surgeon to the radiologist before planning an OPHL was proposed. Considerations regarding case selection are reported for each of the questioned parameters. A very simple question-and-answer process is easy to understand and mainly addressed by less experienced colleagues who wish to increase their knowledge and skills in performing this type of surgery.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Giovanni Succo
- Oncology Department, University of Turin, Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Silvia Sapino
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Ilaria Bertotto
- Radiology Service, Candiolo Cancer Institute, Candiolo, Italy
| | - Stefano Cirillo
- Radiology Service, Mauriziano Umberto I Hospital, Turin, Italy
| | | | | | - Giulia Arrigoni
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Martina Tascone
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology—Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Farina
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Department of Radiology, University of Brescia, Brescia, Italy
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Priya SR, Dandekar M, Paul P, Dravid CS, Anand A, Keshri S. Imaging for Laryngeal Malignancies: Guidelines for Clinicians. Indian J Otolaryngol Head Neck Surg 2023; 75:3386-3395. [PMID: 37974698 PMCID: PMC10645718 DOI: 10.1007/s12070-023-03986-w] [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: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 11/19/2023] Open
Abstract
Radiology has always been an important component in the evaluation of patients with head and neck cancers. Images that are appropriately acquired and systematically interpreted provide comprehensive information on local, regional, and distant disease extent. This impacts treatment decisions for primary or recurrent disease, and aids in prognostication and patient counselling. The recent significant advances in technology and instrumentation for treatment of head neck cancers have taken place in parallel with an increasing sophistication in radiodiagnostic systems. This is especially true for laryngeal neoplasms where there is now greater focus on functional outcomes and personalised treatment, thus expanding the scope and value of imaging. PURPOSE To formulate evidence-based guidelines on imaging for cancers of the larynx, from diagnosis and staging to monitoring of disease control after completion of treatment. METHODS AND MATERIALS A multidisciplinary analysis of current guidelines and published studies on the topic was performed. RESULTS On the basis of evidence gathered, guidelines were drawn up; optimal suggestions were included for low-resource situations. CONCLUSION These guidelines are intended as an aid to all clinicians dealing with patients of laryngeal cancers. It is hoped that these will be instrumental in facilitating patient care, and in improving outcomes.
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Affiliation(s)
- S. R. Priya
- Head Neck Surgeon, Independent, Visakhapatnam, India
| | - Mitali Dandekar
- Department of Surgical Oncology (Head Neck), Paras Cancer Centre, Patna, India
| | - Peter Paul
- Department of Radiology, Maria Theresa Hospital, Thrissur, Kerala India
| | | | - Abhishek Anand
- Department of Medical Oncology, Paras Cancer Centre, Patna, India
| | - Shekhar Keshri
- Department of Radiation Oncology, Paras Cancer Centre, Patna, India
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5
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Laryngeal function-preserving of frontolateral vertical partial laryngectomy (FLVPL) for selected T4a glottic cancer with thyroid cartilage invasion adherence to the anterior commissure: an innovative attempt. Eur Arch Otorhinolaryngol 2022; 279:5735-5740. [PMID: 35680654 PMCID: PMC9649462 DOI: 10.1007/s00405-022-07459-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/18/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the feasibility and efficacy in selected T4a glottic cancer (thyroid cartilage invasion adherence to the anterior commissure) treated with frontolateral vertical partial laryngectomy (FLVPL) and laryngeal framework reconstruction using titanium mesh. METHODS Six patients with the limited T4a glottic cancer with thyroid cartilage destruction adherence to the anterior commissure, underwent FLVPL from 2009 to 2016 in Sun Yat-Sen University Cancer Center. All patients were followed up postoperatively. RESULTS All patients comprised radical tumor resection and favorable functional outcomes, and no aspiration and laryngeal stenosis were observed. According to postoperative pathology, four patients should go through postsurgical radiotherapy with a mean dose of 66 Gy. But one of them refused to undergo postoperative radiotherapy, who observed local recurrence in postcricoid area underwent total laryngectomy (TL) and ipsilateral selected neck dissection in post-surgery two year. During follow-up period, all patients were still alive, and five patients without local recurrence and distant metastases. CONCLUSION FLVPL and laryngeal framework reconstruction using titanium mesh is one viable surgical procedure to obtain adequate oncologic and functional outcomes.
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6
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Vilaseca I, Aviles-Jurado FX, Valduvieco I, Berenguer J, Grau JJ, Baste N, Muxí Á, Castillo P, Lehrer E, Jordana M, Ramírez-Ruiz RD, Costa JM, Oleaga L, Bernal-Sprekelsen M. Transoral laser microsurgery in locally advanced laryngeal cancer: Prognostic impact of anterior versus posterior compartments. Head Neck 2021; 43:3832-3842. [PMID: 34569120 DOI: 10.1002/hed.26878] [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: 05/14/2021] [Revised: 08/09/2021] [Accepted: 09/08/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To evaluate the importance of larynx compartments in the prognosis of T3-T4a laryngeal cancer treated with transoral laser microsurgery. METHODS Two hundred and two consecutive pT3-T4a larynx carcinomas. Pre-epiglottic space involvement, anterior and posterior paraglottic space (PGS) involvement, vocal cord, and arytenoid mobility were determined. Local control with laser (LC), overall survival (OS), disease-specific survival (DSS), and laryngectomy-free survival (LFS) were evaluated. RESULTS The lowest LC was found in tumors with fixed arytenoid. In the multivariate analysis, positive margins (hazard ratio [HR] = 0.289 [0.085-0.979]) and anterior (HR = 0.278 [0.128-0.605]) and posterior (HR = 0.269 [0.115-0.630]) PGS invasion were independent factors of a reduced LC. Anterior (HR = 3.613 [1.537-8.495]) and posterior (HR = 5.195 [2.167-12.455]) PGS involvement were independent factors of total laryngectomy. Five-year OS, DSS, and LFS rates were 63.9%, 77.5%, and 77.5%, respectively. Patients with posterior PGS presented a reduced 5-year LFS. CONCLUSIONS Tumor classification according to laryngeal compartmentalization depicts strong correlation with LC and LFS.
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Affiliation(s)
- Isabel Vilaseca
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain
| | - Francesc Xavier Aviles-Jurado
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain
| | - Izaskun Valduvieco
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain.,Radiation Oncology Department, Hospital Clínic, Barcelona, Spain
| | - Joan Berenguer
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Radiology Department, Hospital Clínic, Barcelona, Spain
| | - Juan José Grau
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain.,Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | - Neus Baste
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | - África Muxí
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain
| | - Paola Castillo
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Pathology Department, Hospital Clínic, Barcelona, Spain
| | - Eduardo Lehrer
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain
| | - Marta Jordana
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,Rehabilitation Department, Hospital Clínic, Barcelona, Spain
| | | | - José Miguel Costa
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain
| | - Laura Oleaga
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Radiology Department, Hospital Clínic, Barcelona, Spain
| | - Manuel Bernal-Sprekelsen
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
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7
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Salvage carbon dioxide transoral laser microsurgery for laryngeal cancer after (chemo)radiotherapy: a European Laryngological Society consensus statement. Eur Arch Otorhinolaryngol 2021; 278:4373-4381. [PMID: 34226992 PMCID: PMC8486708 DOI: 10.1007/s00405-021-06957-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/23/2021] [Indexed: 12/11/2022]
Abstract
Purpose To provide expert opinion and consensus on salvage carbon dioxide transoral laser microsurgery (CO2 TOLMS) for recurrent laryngeal squamous cell carcinoma (LSCC) after (chemo)radiotherapy [(C)RT]. Methods Expert members of the European Laryngological Society (ELS) Cancer and Dysplasia Committee were selected to create a dedicated panel on salvage CO2 TOLMS for LSCC. A series of statements regarding the critical aspects of decision-making were drafted, circulated, and modified or excluded in accordance with the Delphi process. Results The expert panel reached full consensus on 19 statements through a total of three sequential evaluation rounds. These statements were focused on different aspects of salvage CO2 TOLMS, with particular attention on preoperative diagnostic work-up, treatment indications, postoperative management, complications, functional outcomes, and follow-up. Conclusion Management of recurrent LSCC after (C)RT is challenging and is based on the need to find a balance between oncologic and functional outcomes. Salvage CO2 TOLMS is a minimally invasive approach that can be applied to selected patients with strict and careful indications. Herein, a series of statements based on an ELS expert consensus aimed at guiding the main aspects of CO2 TOLMS for LSCC in the salvage setting is presented.
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Meulemans J, Narimani S, Hauben E, Nuyts S, Laenen A, Delaere P, Vander Poorten V. Introduction of a New Pathology Workup Protocol for Glottic Cancer Treated With Transoral Laser Microsurgery (TLM): Prospective Analysis of Oncological Outcomes and Matched Case-Control Study. Front Oncol 2021; 11:685255. [PMID: 34017690 PMCID: PMC8130557 DOI: 10.3389/fonc.2021.685255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023] Open
Abstract
Background/Purpose The value of margin status after TLM for glottic cancer is debatable, due to difficulties in specimen orientation and margin analysis. To reduce these difficulties, we recently introduced a standardized protocol of oriented fixation of TLM specimens. This proved feasible and resulted in high margin evaluability rates and a decreased rate of false positive deep margins, when compared to a historical TLM cohort. For the patients whose specimens were processed according to this protocol, we prospectively analyzed oncological outcomes, identified prognostic factors and assessed the influence of the protocol introduction on outcomes compared with a historical TLM cohort. Methods Ninety-six patients with glottic malignancies treated with TLM were included. Resection specimens were processed according to the new protocol. Descriptive statistics and survival analyses were used to determine oncological outcomes. To assess the effect of the protocol introduction on outcomes, a matched-case-control analysis was performed, using a historical TLM-cohort as controls. The Cox proportional hazards model was used to analyze prognostic effects of patient and treatment characteristics, including the pathology protocol introduction, on overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS) and local recurrence-free survival (LRFS). Results Two-year outcomes were favorable: 88.5% OS, 97.0% DSS, and 87.6% LRFS. At multivariable analysis, the presence of multiple positive superficial margins was a negative prognosticator for OS (HR 4.102) and increasing cT classification proved a negative prognosticator for DFS (HR 2.828) and LRFS (HR 2.676). Matched case-control analysis did not reveal a significant difference in oncological outcomes between cohorts. Deep margin status had a strong differential effect for DFS (p-value for interaction = 0.0205) and for LRFS (p-value for interaction = 0.0176) between cohorts, indicating a prognostic effect of deep margin status on both outcomes in the current cohort, but not in the historical cohort. Discussion/Conclusion The introduction of a new standardized technique of oriented fixation of TLM specimens did not affect oncological outcomes when compared to a historical TLM cohort, but assigned a significant prognostic effect to deep margin status for DFS and LRFS, facilitating the decision making process with regards to planning of second-look procedures, administration of adjuvant radiotherapy or determination of follow-up intensity.
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Affiliation(s)
- Jeroen Meulemans
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Sara Narimani
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Esther Hauben
- Pathology, University Hospitals Leuven, Leuven, Belgium.,Department of Pathology and Imaging, KU Leuven, Leuven, Belgium
| | - Sandra Nuyts
- Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Experimental Radiotherapy, KU Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Leuven, Belgium
| | - Pierre Delaere
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
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9
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Zhou J, Wen Q, Wang H, Li B, Liu J, Hu J, Liu S, Zou J. Prognostic comparison of transoral laser microsurgery for early glottic cancer with or without anterior commissure involvement: A meta-analysis. Am J Otolaryngol 2021; 42:102787. [PMID: 33316724 DOI: 10.1016/j.amjoto.2020.102787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/10/2020] [Accepted: 10/18/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Transoral laser microsurgery (TLM) has gradually gained approval in the treatment of early glottic cancer. However, the oncological outcomes of TLM for glottic cancer with anterior commissure (AC) involvement are still a controversial topic. We aimed to systematically review the literature on glottic cancer (Tis-T2) with patients who received TLM as first choice therapy and to evaluate several prognostic outcomes in patients with or without AC involvement. METHODS A systematic literature retrieval was conducted in PubMed, Medline (Ovid) and Web of Science. Risk ratio (RR) between AC involvement (AC+) or without AC involvement (AC-) was assessed and 95% confidence interval(95%CI) was calculated, which was performed on RevMan 5.3. RESULTS A total of 20 literatures were included when comparing the local recurrence (LR) rate of patients with or without AC involvement, and the results suggested LR matters in group AC+ over group AC- (RR = 2.39, 95%CI = 1.99-2.86, p < 0.00001). The 5-year overall survival(5yOS) rate included 10 studies, and there was no significant difference between AC+ and AC- (RR = 0.98, 95%CI = 0.93-1.02, p = 0.35). The laryngeal preservation rate (LPR) of AC+ was lower than that of AC- (RR = 0.97, 95%CI = 0.94-1.00, p = 0.04). CONCLUSION The results indicate that the prognosis of early glottic cancer with AC involvement is more likely to have higher local recurrence and lower LPR but no statistical difference in 5yOS rate.
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Saraniti C, Montana F, Chianetta E, Greco G, Verro B. Impact of resection margin status and revision transoral laser microsurgery in early glottic cancer: analysis of organ preservation and local disease control on a cohort of 153 patients. Braz J Otorhinolaryngol 2020; 88:669-674. [PMID: 33272837 PMCID: PMC9483927 DOI: 10.1016/j.bjorl.2020.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/03/2020] [Accepted: 09/14/2020] [Indexed: 01/12/2023] Open
Abstract
Introduction Transoral laser microsurgery represents the treatment of choice for early glottic cancer. Its use and effectiveness are mainly related to laryngeal exposure and deep extension of tumor. Histopathologic assessment of surgical margin presents a main issue about transoral laser microsurgery and complete oncological excision. Objective The aim was to analyze the impact of revision surgery on organ preservation and local disease control in patients with early glottic cancer treated by transoral laser microsurgery. Methods We carried out a retrospective study on a cohort of 153 patients with early glottic cancer (Tis, T1, T2) treated by transoral laser microsurgery. Resection margins were classified as follows: “free” if macroscopic margin-tumor distance was at least 2 mm, as “close” if it was less than 2 mm and “positive” if the margin was involved by carcinoma. Patients were divided into two groups: patients with free resection margins (Group A) and patients with positive, close or not-evaluable resection margins (Group B). Group A (36) underwent periodic followup. Group B (117) underwent a second look laser CO2 2 months after surgery. Fifteen patients of Group A with suspected persistence of carcinoma during followup underwent a second laser resection after a time interval of 4–8 months after first surgery. Overall survival, disease-free survival, disease-specific survival, ultimate local control with laser alone and organ preservation rates were estimated. Results Five-year overall survival rate and 5-year disease-specific survival were 100% in both groups. The five-year laryngeal preservation rate was 100% in Group A and 95.2% in Group B. Five-year disease-free survival was 92.15% and 5-year ultimate local control with laser alone in 92.15% of patients. Conclusion This study has demonstrated that revision Transoral Laser Microsurgery is able to confirm the oncological radicality in most cases, even in the case of positive, close or non-evaluable margins. Considering our results, according to our experience, the second look with CO2 laser is a therapeutic strategy to consider, even in the case of close or non-evaluable as well as positive margins.
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Affiliation(s)
- Carmelo Saraniti
- Università degli Studi di Palermo, Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BiND), Sezione di Otorinolaringoiatria, Palermo, Italy.
| | - Francesca Montana
- Università degli Studi di Palermo, Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BiND), Sezione di Otorinolaringoiatria, Palermo, Italy
| | - Enzo Chianetta
- Università degli Studi di Palermo, Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BiND), Sezione di Otorinolaringoiatria, Palermo, Italy
| | - Giuseppe Greco
- Università degli Studi di Palermo, Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BiND), Sezione di Otorinolaringoiatria, Palermo, Italy
| | - Barbara Verro
- Università degli Studi di Palermo, Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BiND), Sezione di Otorinolaringoiatria, Palermo, Italy
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Marchi F, Missale F, Sampieri C, Filauro M, Iandelli A, Parrinello G, Incandela F, Smeele LE, van den Brekel MWM, Del Bon F, Nicolai P, Piazza C, Peretti G. Laryngeal Compartmentalization Does Not Affect the Prognosis of T3-T4 Laryngeal Cancer Treated by Upfront Total Laryngectomy. Cancers (Basel) 2020; 12:cancers12082241. [PMID: 32796540 PMCID: PMC7463701 DOI: 10.3390/cancers12082241] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 01/15/2023] Open
Abstract
A picture is emerging in which advanced laryngeal cancers (LCs) are potentially not homogeneous and may be characterized by subpopulations which, if identified, could allow selection of patients amenable to organ preservation treatments in contrast to those to be treated with total laryngectomy (TL). This work aims to analyze a multicentric cohort of T3-T4a LCs treated by upfront TL, investigating the clinical and pathological features that can best predict oncologic outcomes. A total of 149 previously untreated patients who underwent TL for T3-T4a LC at four institutions were analyzed. Survival and disease-control were considered as the main outcomes. A secondary end-point was the identification of covariates associated with nodal status, investigating also the tumor thickness. T and N categories were significantly associated with both overall and disease-specific survival. The number of positive nodes and tracheal involvement were associated with loco-regional failure; post-cricoid area invasion and extra-nodal extension with distant failure. Posterior laryngeal compartment involvement was not a significant prognostic feature, by either univariable and multivariable analyses. These results support the conclusion that laryngeal compartmentalization has no impact on survival in patients treated by upfront TL and the current TNM staging system remains a robust prognosticator in advanced LC.
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Affiliation(s)
- Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.M.); (F.M.); (M.F.); (A.I.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei 33305, Taiwan
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.M.); (F.M.); (M.F.); (A.I.); (G.P.); (G.P.)
- Department of Molecular and Translational Medicine, University of Brescia, 25100 Brescia, Italy
| | - Claudio Sampieri
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.M.); (F.M.); (M.F.); (A.I.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
- Correspondence:
| | - Marta Filauro
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.M.); (F.M.); (M.F.); (A.I.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy
| | - Andrea Iandelli
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.M.); (F.M.); (M.F.); (A.I.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
- Department of Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Taoyuan 33305, Taiwan
| | - Giampiero Parrinello
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.M.); (F.M.); (M.F.); (A.I.); (G.P.); (G.P.)
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, 20133 Milan, Italy; (F.I.); (C.P.)
| | - Ludwig E. Smeele
- Department of Head & Neck Oncology & Surgery Otorhinolaryngology, Antoni Van Leeuwenhoek, Nederlands Kanker Instituut, 1066 Amsterdam, The Netherlands; (L.E.S.); (M.W.M.v.d.B.)
| | - Michiel W. M. van den Brekel
- Department of Head & Neck Oncology & Surgery Otorhinolaryngology, Antoni Van Leeuwenhoek, Nederlands Kanker Instituut, 1066 Amsterdam, The Netherlands; (L.E.S.); (M.W.M.v.d.B.)
| | - Francesca Del Bon
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Brescia, 25123 Brescia, Italy;
| | - Piero Nicolai
- Section of Otorhinolaryngology—Head and Neck Surgery, Department of Neurosciences, University of Padua, Via Giustiniani, 2-35128 Padua, Italy;
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, 20133 Milan, Italy; (F.I.); (C.P.)
- Department of Oncology and Oncohematology, University of Milan, 20122 Milan, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.M.); (F.M.); (M.F.); (A.I.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
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12
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Cabrera-Sarmiento JA, Vázquez-Barro JC, González-Botas JH, Chiesa-Estomba C, Mayo-Yáñez M. T1b Glottic Tumor and Anterior Commissure Involvement: Is the Transoral CO 2 Laser Microsurgery a Safe Option? EAR, NOSE & THROAT JOURNAL 2020; 100:68S-72S. [PMID: 32627619 DOI: 10.1177/0145561320937238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Transoral CO2 laser therapy represents the treatment of choice for early-stage laryngeal tumors. The anterior commissure involvement (ACI) is related to a worse local control and a lower rates of organ preservation. The objective of this study is to analyze the differences in survival, local control, and organ preservation in T1b glottic patients according to the presence of ACI. METHODS Observational prospective study in pT1b treated with transoral CO2 laser between 2009 and 2014. RESULTS Forty patients (37 male and 3 female) with a mean age of 66.43 ± 8.16 years were recruited. Anterior commissure involvement was present in 70% of the patients. The 5-year specific cause survival was 91.66%, with 32.50% of local recurrences. Laryngeal preservation was 80%, being lower in the group with local recurrence (P < .000). The involvement of the anterior commissure does not influence the organ preservation (P = .548), the appearance of local recurrences (P = .391), or the survival (P = .33). CONCLUSIONS Transoral CO2 laser therapy is an effective and reproducible treatment for early-stage laryngeal tumors. The results obtained are similar to previous studies, although they present discrepancies in relation to the role of the ACI. Prospective randomized trials are required focusing also on the patients' quality of life and functional outcome in order to clarify the role of the ACI and the need to implement changes in its evaluation, staging, and evolution.
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Affiliation(s)
- Juan Antonio Cabrera-Sarmiento
- Otorhinolaryngology-Head and Neck Surgery Department, 16811Complexo Hospitalario Universitario A Coruña (CHUAC), Galicia, Spain
| | - Juan Carlos Vázquez-Barro
- Otorhinolaryngology-Head and Neck Surgery Department, 16811Complexo Hospitalario Universitario A Coruña (CHUAC), Galicia, Spain.,School of Educational Sciences and Speech Therapy, Universidade da Coruña (UDC), A Coruña, Galicia, Spain
| | - Jesús Herranz González-Botas
- Otorhinolaryngology-Head and Neck Surgery Department, 16811Complexo Hospitalario Universitario A Coruña (CHUAC), Galicia, Spain.,School of Medicine and Odontology, Universidade de Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain
| | - Carlos Chiesa-Estomba
- Otorhinolaryngology-Head and Neck Surgery Department, 16650Hospital Universitario Donostia, Euskadi, Spain
| | - Miguel Mayo-Yáñez
- Otorhinolaryngology-Head and Neck Surgery Department, 16811Complexo Hospitalario Universitario A Coruña (CHUAC), Galicia, Spain.,Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain
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13
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T1 Glottic Cancer: Does Anterior Commissure Involvement Worsen Prognosis? Cancers (Basel) 2020; 12:cancers12061485. [PMID: 32517265 PMCID: PMC7352716 DOI: 10.3390/cancers12061485] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 11/17/2022] Open
Abstract
Radiotherapy (RT) and transoral laser microsurgery (TLM) represent the main treatment modalities for early glottic carcinoma. Local failure is notoriously more frequent in T1b glottic cancer in comparison to T1a and T2 tumors. In this scenario, the role of anterior commissure (AC) involvement is still controversial. The aim of the present study was therefore to determine its potential prognostic power in worsening patients’ survival and outcomes. We categorized different tumor glottic fold locations with respect to the involvement of one (T1a) or both vocal cords, with or without AC involvement. We analyzed a retrospective cohort of 74 patients affected by Stage I glottic cancer, treated between 2011 and 2018 by TLM or RT at a single academic institution. There were 22 T1a (30%) and 52 T1b (70%) cases. The median follow-up period was 30 months (mean, 32.09 ± 18.738 months; range, 12–79). Three-year overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), and laryngectomy-free survival (LFS) were compared according to tumor location, extension, and cT category. According to both uni- and multivariate analyses, an increased risk for recurrence in T1b with AC involvement and T1a tumors was 7.31 and 9.45 times, respectively (p-values of 0.054 and 0.030, respectively). Among the 17 recurrences, T1b with AC involvement experienced 15 tumor relapses (88.2%), thus significantly affecting both the RFS and LFS in comparison to the other two tumor subcategories (T1a, p = 0.028 and T1b without AC involvement, p = 0.043). The deteriorating prognosis in the presence of AC involvement likely reflects the need to power the hazard consistency and discrimination of the T1b category when associated with such a risk factor, thus deserving an independent T category.
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14
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Benazzo M, Sovardi F, Preda L, Mauramati S, Carnevale S, Bertino G, Berton F, Meroni M, Herman I, Trisolini G, Morbini P. Imaging Accuracy in Preoperative Staging of T3-T4 Laryngeal Cancers. Cancers (Basel) 2020; 12:cancers12051074. [PMID: 32357419 PMCID: PMC7281313 DOI: 10.3390/cancers12051074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Preoperative imaging impacts treatment planning and prognosis in laryngeal cancers. We investigated the accuracy of standard computed tomography (CT) in evaluating tumor invasions at critical glottic areas. Methods: CT scans of glottic cancers treated by partial or total laryngectomy between Jan 2015 and Aug 2019 were reviewed to assess levels of tumor invasion at critical glottic subsites. CT accuracy in the identification of tumor extensions was determined against the gold standard of histopathological analysis of surgical samples. Results: This study included 64 patients. In the anterior commissure, CT showed high rates of false positives at all levels (sensitivity 56.2–70%, specificity 87.8–92.3%); in the anterior vocal fold, it overestimated the deep invasion (19.5% specificity, 90.3% sensitivity), while it underestimated the extralaryngeal spread (63.6% sensitivity, 98.1% specificity). In the posterior paraglottic space (pPGS), false negative results were more frequent for superficial extensions (25% sensitivity, 95.8% specificity) and deep invasions (58.8% sensitivity, 82.3% specificity). Shorter disease-specific and disease-free survivals were associated with pStage IV (p: 0.045 and 0.008) and with the pathological involvement of pPGS (p: 0.045 and 0.015). Conclusions: Negative prognostic correlation of pPGS involvement was confirmed on histopathological data. CT staging did not provide a satisfactory prognostic stratification and should be complemented with magnetic resonance imaging.
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Affiliation(s)
- Marco Benazzo
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Fabio Sovardi
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
- Correspondence: ; Tel.: +39-331-229-2171
| | - Lorenzo Preda
- Radiology Department, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.P.); (F.B.)
| | - Simone Mauramati
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Sergio Carnevale
- Section of Anatomic Pathology, Cerba Healthcare Italia, 20139 Milan, Italy;
| | - Giulia Bertino
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Francesca Berton
- Radiology Department, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.P.); (F.B.)
| | - Matteo Meroni
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Irene Herman
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Giuseppe Trisolini
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Patrizia Morbini
- Unit of Pathology, Department of Molecular Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy;
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15
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Tulli M, Re M, Bondi S, Ferrante L, Dajko M, Giordano L, Gioacchini FM, Galli A, Bussi M. The prognostic value of anterior commissure involvement in T1 glottic cancer: A systematic review and meta-analysis. Laryngoscope 2019; 130:1932-1940. [PMID: 31721216 DOI: 10.1002/lary.28395] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/29/2019] [Accepted: 10/10/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The anterior commissure is considered a laryngeal subsite, but it is not taken into account in the current T-staging system. The impact of anterior commissure involvement (ACI) on the oncologic outcomes of T1 glottic tumors has not been well defined and remains controversial. The aim of this study was to assess the influence of ACI in the prognosis of T1 glottic tumors. METHODS A systematic review and meta-analysis of observational studies was performed by including studies published up to July 2019. Studies were selected if they had investigated the local control rate (LCR) at 5 years of clinical stage I (T1 and N0) glottic squamous cell carcinoma with and without ACI. The difference in LCR at 5 years between T1 glottic tumors without and with ACI was evaluated. RESULTS The meta-analysis showed that the difference in LCR at 5 years between T1 glottic tumors without and with ACI is 12% (95% confidence interval: 8%-16%, p < 0,0001, I2 = 34.81%). CONCLUSIONS Our study pointed out that the anterior commissure involvement is a negative prognostic factor in LCR at 5 years for T1 glottic tumors. Our results suggest the need to consider ACI in the T staging of glottic tumors. Laryngoscope, 130:1932-1940, 2020.
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Affiliation(s)
- Michele Tulli
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institutes of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Massimo Re
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Stefano Bondi
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institutes of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Luigi Ferrante
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Science and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Marianxhela Dajko
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Science and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Leone Giordano
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institutes of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Federico M Gioacchini
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Galli
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institutes of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Mario Bussi
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institutes of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
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16
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Survival and Prognostic Factors for Outcome after Radiotherapy for T2 Glottic Carcinoma. Cancers (Basel) 2019; 11:cancers11091319. [PMID: 31500162 PMCID: PMC6770714 DOI: 10.3390/cancers11091319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Local recurrence after radiotherapy for T2 glottic carcinoma remains an issue and identifying patients at risk for relapse is, therefore, important. This study aimed to assess the oncological outcomes and prognostic factors in a consecutive series of patients treated with radiotherapy for T2N0 glottic carcinoma. Methods: Patients with T2N0 glottic carcinoma treated with radiotherapy were included in this retrospective study. Five- and ten-year local control (LC), overall survival (OS), disease-specific survival (DSS), and laryngeal preservation (LP) rates were calculated with the Kaplan–Meier method. The impact of prognostic variables was evaluated with the log-rank test. Results: Ninety-four patients were included for analysis. LC, OS, DSS, and LP rates were 70.5, 63.7, 86.0, and 74.7%, respectively at five years and 65.8, 41.0, 75.6, and 72.4% at 10 years. In total, 46 scans were included in the analyses. Vertical involvement of the anterior commissure on imaging showed a significant impact on LC. Conclusions: In accordance with previously described surgical risk factors, we identified vertical involvement of the anterior commissure on imaging as a prognostic factor for radiation failure.
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Involvement of the Anterior Commissure in Early Glottic Cancer (Tis-T2): A Review of the Literature. Cancers (Basel) 2019; 11:cancers11091234. [PMID: 31450795 PMCID: PMC6769981 DOI: 10.3390/cancers11091234] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 12/17/2022] Open
Abstract
Background: The impact of the anterior commissure (AC) involvement on prognosis in laryngeal cancer remains a topic of discussion with inconsistent results in the literature. This review examines AC involvement as a prognostic factor in patients with early glottic cancer (Tis-T2) treated with radiotherapy or transoral laser microsurgery (TLM). Methods: A systematic literature search was performed. Due to the heterogeneity of the data, no meta-analysis was implemented. Weighted averages were calculated if the appropriate data were extractable. Results: Thirty-four studies on radiotherapy and 23 on TLM fit the inclusion criteria. The majority of studies for both radiotherapy (67.7%) and TLM (75.0%) did not report a significant impact on oncological outcomes. Weighted averages were slightly lower in patients with AC involvement. The two studies that applied a more detailed classification showed a significant impact on the amount of AC involvement. Conclusions: Binary variables (yes/no) for AC involvement lead to inconsistent results. Studies that use more detailed classifications of the AC show that there is a significant impact on the outcome. To further elucidate the role of the AC, detailed stratification of tumors involving the AC need to be investigated in further studies for both treatment modalities.
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18
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Lionello M, Bertolin A, Nardello E, Giacomelli L, Canal F, Rizzotto G, Marioni G, Lucioni M. Could the infiltration of the thyroarytenoid muscle define the pT2 glottic carcinoma? Head Neck 2019; 41:3639-3646. [PMID: 31385412 DOI: 10.1002/hed.25893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The involvement of the thyroarytenoid (TA) muscle by glottic cancer may be related to an impaired vocal cord mobility, which is classified as cT2 disease. The primary endpoint was to evaluate the prognostic significance of TA muscle involvement in early glottic cancer treated with transoral laser microsurgery (TLM). METHODS A review was conducted on a cohort of 209 patients consecutively treated with TLM for early glottic carcinoma. Univariate analysis was used to examine the prognostic meaning of clinical and pathological parameters. RESULTS The statistical analysis showed that TA muscle infiltration correlated significantly with a worse prognosis in terms of recurrence rate and disease-free survival, and this was confirmed even in the subcohort with pT1a glottic cancer. CONCLUSIONS Our preliminary findings suggest that it could be considered as a criterion for upstaging a glottic cancer from pT1 to pT2.
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Affiliation(s)
- Marco Lionello
- Otolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - Andy Bertolin
- Otolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - Ennio Nardello
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | | | - Fabio Canal
- Pathology Unit, Vittorio Veneto - Conegliano Hospital, Treviso, Italy
| | | | - Gino Marioni
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - Marco Lucioni
- Otolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
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19
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CO 2 Transoral Laser Microsurgery in Benign, Premalignant and Malignant (Tis, T1, T2) Lesion of the Glottis. A Literature Review. MEDICINES 2019; 6:medicines6030077. [PMID: 31336581 PMCID: PMC6789531 DOI: 10.3390/medicines6030077] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022]
Abstract
Carbon Dioxide transoral laser microsurgery represents a reliable option for the treatment of early glottic carcinoma (Tis–T2), with good functional and oncological outcomes, nowadays representing one of the main options in larynx preservation protocols. The development and improvement of laser devices means surgeons are able to use more precise instruments compared with classic cold dissection in laser-assisted phonosurgery. Secondary effects on voice, swallowing, or quality of life as well as complications have been well documented. Also, with the introduction of a new proposal for staging systems following the principle of the three-dimensional map of isoprognostic zones, the use of narrow-band imaging in clinical evaluation and intraoperative, and the implementation of diffusion-weighted magnetic resonance during preoperative evaluation, the development of new tools to improve surgical quality and preliminary reports regarding the use of carbon dioxide laser in transoral robotic surgery suggests an exciting future for this technique.
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20
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Marchi F, Filauro M, Missale F, Parrinello G, Incandela F, Bacigalupo A, Vecchio S, Piazza C, Peretti G. A Multidisciplinary Team Guided Approach to the Management of cT3 Laryngeal Cancer: A Retrospective Analysis of 104 Cases. Cancers (Basel) 2019; 11:E717. [PMID: 31137671 PMCID: PMC6562846 DOI: 10.3390/cancers11050717] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022] Open
Abstract
The optimal treatment for T3 laryngeal carcinoma (LC) is still a matter of debate. Different therapeutic options are available: Transoral laser microsurgery (TLM), open partial horizontal laryngectomies (OPHLs), total laryngectomy (TL), and organ preservation protocols (radiation therapy (RT) or chemo-radiation (CRT)). This study aimed to retrospectively evaluate oncologic outcomes of 104 T3 LCs treated by surgery or non-surgical approaches from January 2011 to December 2016 at a single academic tertiary referral center. Each case was evaluated by a multidisciplinary team (MDT) devoted to the management of head and neck cancers. We divided the cohort into two subgroups: Group A, surgical treatment (TLM, OPHLs, TL) and Group B, non-surgical treatment (RT, CRT). For the entire cohort, two- and five-year overall survival (OS) rates were 83% and 56%, respectively. The two- and five-year disease-free survival (DFS) rates were 75% and 65%, and disease-specific survival rates were 93% and 70%, respectively. The N category was a significant independent prognosticator for OS (p = 0.02), whereas Group B was significantly and independently associated with DFS (HR 4.10, p = 0.006). Analyzing laryngo-esophageal dysfunction-free survival as an outcome, it was found that this was significantly lower in higher N categories (p = 0.04) and in cases that underwent non-surgical treatments (p = 0.002). Optimization of oncologic outcomes in T3 LCs may be obtained only by a comprehensive MDT approach, considering that different treatment options have heterogenous toxicity profiles and indications.
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Affiliation(s)
- Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Marta Filauro
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Giampiero Parrinello
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Almalina Bacigalupo
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Radiation Oncology, University of Genoa, 16132 Genoa, Italy.
| | - Stefania Vecchio
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Oncology, University of Genoa, 16132 Genoa, Italy.
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
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21
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Succo G, Crosetti E. Limitations and Opportunities in Open Laryngeal Organ Preservation Surgery: Current Role of OPHLs. Front Oncol 2019; 9:408. [PMID: 31192120 PMCID: PMC6540733 DOI: 10.3389/fonc.2019.00408] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/30/2019] [Indexed: 11/29/2022] Open
Abstract
The current trend for treatment of intermediate-early advanced laryngeal cancer is essentially oriented toward preservation of organ and laryngeal function, and with a good potential for treating the disease. This goal can be achieved by adopting open laryngeal organ preservation surgery (OLOPS), at present mainly represented by open partial horizontal laryngectomies (OPHLs). An approach using rigorous selection criteria based on both the general condition of the patient and the local and regional extent of the disease gives excellent oncological and functional results in untreated patients. Similar outcomes, albeit slightly worse, are also obtainable in radio-recurrent and laser-recurrent patients. Troublesome postoperative management and the inconsistency of functional recovery are the main limitations for extensive application of this therapeutic strategy. The future direction is represented by simplification of the indications identifying iso-prognostic sub-categories within the T-stage, wider consensus on rehabilitation protocols, hybrid approaches to the larynx, and open minimally invasive access.
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Affiliation(s)
- Giovanni Succo
- Oncology Department, University of Turin, Turin, Italy.,Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Turin, Italy
| | - Erika Crosetti
- Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Turin, Italy
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22
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Jacobi C, Freundorfer R, Reiter M. Transoral laser microsurgery in early glottic cancer involving the anterior commissure. Eur Arch Otorhinolaryngol 2019; 276:837-845. [DOI: 10.1007/s00405-018-5261-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/18/2018] [Indexed: 12/19/2022]
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