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Bang J, Lee OH, Kim GJ, Sun DI, Kim SY. The Role of Open Conservation Surgery in the Era of Minimally Invasive Surgery for Hypopharyngeal Cancer. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1873. [PMID: 37893591 PMCID: PMC10608416 DOI: 10.3390/medicina59101873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Total laryngectomy with partial pharyngectomy is traditionally the principal curative treatment for hypopharyngeal cancer; however, conservative surgical approaches that minimize functional disability are attracting increasing interest. Thus, we evaluated the appropriateness and oncological outcomes of open conservation surgery for such patients. Materials and Methods: We reviewed the medical records of 49 patients who underwent vertical hemipharyngolaryngectomy from 1998 to 2018 at a single institution. Results: Locoregional recurrences developed in 19 patients (38.8%) and distant metastases in 6 (12.2%). Histopathologically, paraglottic space invasion was apparent in 13 patients (26.5%), pre-epiglottic space invasion in 4 (8.2%), thyroid cartilage invasion in 9 (18.4%), thyroid gland invasion in 2, perineural invasion in 11 (22.4%), and lymphovascular invasion in 35 (71.4%). The 5-year overall survival of patients who underwent open conservation surgery was comparable to that of patients who underwent total laryngectomy with partial pharyngectomy (68.7% vs. 48.4%, p = 0.14). Pre-epiglottic space invasion significantly decreased the 5-year disease-free survival rate after open conservation surgery (69.7% vs. 17.9%, p = 0.01). Conclusions: We found that pre-epiglottic space invasion negatively impacted disease control after open conservation surgery, emphasizing the crucial role played by a preoperative evaluation during patient selection.
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Affiliation(s)
- Jooin Bang
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Oh-Hyeong Lee
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Geun-Jeon Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Dong-Il Sun
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sang-Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Antala D, Mohamed K, Kim L, Bhatti S, Adhikari P, Oliff I. Pericardial Metastasis From Recurrent Squamous Cell Carcinoma of Hypopharynx in a Living Patient. Cureus 2022; 14:e24216. [PMID: 35602822 PMCID: PMC9113610 DOI: 10.7759/cureus.24216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2022] [Indexed: 12/03/2022] Open
Abstract
Cardiac metastatic disease is a rare finding and is usually diagnosed incidentally postmortem; it has been commonly reported in patients with cancers of lung, esophagus, breast, and melanoma. We present a case of a 62-year-old male with a history of squamous cell carcinoma of the pyriform sinus who presented with shortness of breath for one day. He underwent tumor resection followed by chemotherapy and radiotherapy seven months before this presentation. Computed tomography (CT) of the chest revealed pericardial nodular soft tissue that was consistent with the diagnosis of metastatic carcinomatosis. Further imaging with a transthoracic echocardiogram (TTE) showed a likely metastatic pericardial mass. The patient had presented with shortness of breath three months prior to this admission and TTE had demonstrated pericardial effusion. However, pericardial fluid cytology was negative for malignancy, and the repeat TTE had revealed resolution of the pericardial effusion. On the current admission, CT of the neck demonstrated local recurrence of the tumor in the resection bed with scattered regional lymph nodes enlargement. Thus, we report a case of a recurrent laryngopharyngeal tumor with very rarely reported pericardial metastasis.
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Wang Q, Liu Y, Wu K, Zhao Y, Gao C, Tong B, Zhang M. Options of medical treatment and laryngeal function preservation in elderly patients with medial wall pyriform sinus cancer. Onco Targets Ther 2018; 11:7441-7446. [PMID: 30464497 PMCID: PMC6219120 DOI: 10.2147/ott.s171873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To retrospectively investigate the clinical efficacy and larynx preservation of two different treatments: radiotherapy followed by surgery (R+S) and surgery followed by radiotherapy (S+R), in elderly patients with medial wall pyriform sinus cancer. Materials and methods Medical records from 48 patients over 70 years old with medial wall pyriform sinus cancer who underwent different treatments between 2001 and 2010 were analyzed. Twenty-one patients underwent radiotherapy first followed by surgery (R+S), and the other 27 patients underwent surgery first followed by radiotherapy (S+R). A Kaplan–Meier method was used to calculate the survival rate. Results Overall 3-year and 5-year survival rates were 60.4% and 35.4%, respectively. The 5-year survival rates in R+S group and S+R group were 38.1% and 33.3%, respectively, without a statistically significant difference between the two groups (P>0.05). Also, comparisons of the decannulation rates (64.3% for R+S group vs 50.0% for S+R group) and postoperative complication rates (42.9% for R+S group vs 37.0% for S+R group) between the two groups of patients did not show obvious differences. However, the laryngeal preservation rates in R+S group and S+R group were 66.7% and 37.0%, respectively, with significantly statistical difference between the two groups (P<0.05). Conclusion Based on the data analysis of 48 patients, the survival rates of elderly patients who underwent R+S or S+R were comparable, but R+S treatment could improve the laryngeal preservation rate of patients. Further study on large-scale sample pool should be performed to confirm this conclusion.
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Affiliation(s)
- Qin Wang
- Department of Otolaryngology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China, .,Department of Otolaryngology, Hefei Second People's Hospital, Hefei, People's Republic of China
| | - Yehai Liu
- Department of Otolaryngology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China,
| | - Kaile Wu
- Department of Otolaryngology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China,
| | - Yi Zhao
- Department of Otolaryngology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China,
| | - Chaobing Gao
- Department of Otolaryngology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China,
| | - Busheng Tong
- Department of Otolaryngology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China,
| | - Ming Zhang
- Department of Anatomy, Anhui Medical University, Hefei, People's Republic of China.,Department of Anatomy, University of Otago, Dunedin, New Zealand
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Kostev K, Lasrich M, Schüller L, Diogo I, Sesterhenn A, Jacob L. Diagnoses of suspected cancer in otolaryngology practices in Germany. Mol Clin Oncol 2018; 9:459-463. [PMID: 30233798 DOI: 10.3892/mco.2018.1694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/09/2018] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to estimate the prevalence of suspected head and neck cancer (HNC) diagnoses made by otolaryngologists in a population with subsequently confirmed cancer diagnoses in Germany. This study included patients with an initial documentation of confirmed cancer diagnosis made in 137 otolaryngology practices between January 2012 and December 2016 (index date). The main outcome of the study was the prevalence of diagnoses of suspected cancer in otolaryngology practices within one year prior to the first documentation of a confirmed cancer diagnosis. The association between the defined demographic and clinical variables with diagnoses of suspected cancer was analyzed using a logistic regression model. A total of 6,446 patients received a confirmed cancer diagnosis. A total of 23.1% of the population received a diagnosis of suspected cancer within 12 months prior to the first documentation of a confirmed cancer diagnosis. Patients over the age of 50 (ORs ranging from 1.44 to 1.55) and men (OR=1.52) were more likely to receive a diagnosis of suspected cancer compared with patients aged 50 or under and women. Cancer of the pyriform sinus (OR=3.00) and cancer of the thyroid gland (OR=0.27) were associated with increased and decreased odds of a diagnosis of suspected cancer compared to laryngeal cancer respectively. Overall, approximately 23% of individuals received a diagnosis of suspected cancer within a year prior to the first documentation of confirmed HNC.
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Affiliation(s)
- Karel Kostev
- Department of Epidemiology, IQVIA, D-60598 Frankfurt am Main, Germany
| | - Maike Lasrich
- Department of Otorhinolaryngology, Head and Neck Surgery, Solingen Municipal Hospital, D-42653 Solingen, Germany
| | - Lisa Schüller
- Department of Otorhinolaryngology, Head and Neck Surgery, Solingen Municipal Hospital, D-42653 Solingen, Germany
| | - Isabel Diogo
- Department of Otorhinolaryngology, Head and Neck Surgery, Solingen Municipal Hospital, D-42653 Solingen, Germany
| | - Andreas Sesterhenn
- Department of Otorhinolaryngology, Head and Neck Surgery, Solingen Municipal Hospital, D-42653 Solingen, Germany
| | - Louis Jacob
- Faculty of Medicine, University of Paris V, 75270 Paris, France
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Kim N, Lee J, Kim KH, Park JW, Lee CG, Keum KC. Early hypopharyngeal cancer treated with different therapeutic approaches: a single-institution cohort analysis. Radiat Oncol J 2016; 34:280-289. [PMID: 28030898 PMCID: PMC5207370 DOI: 10.3857/roj.2016.01711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/06/2016] [Accepted: 09/01/2016] [Indexed: 12/12/2022] Open
Abstract
Purpose Early hypopharyngeal squamous cell carcinoma (HPSCC) is a rarely diagnosed disease, for which the optimal treatment has not been defined yet. We assessed patterns of failure and outcomes in early HPSCC treated with various therapeutic approaches to identify its optimal treatment. Materials and Methods Thirty-six patients with stage I (n = 10) and II (n = 26) treated between January 1992 and March 2014 were reviewed. Patients received definitive radiotherapy (RT) (R group, n = 10), surgery only (S group, n = 19), or postoperative RT (PORT group, n = 7). All patients in both the R and PORT groups received elective bilateral neck irradiation. In the S group, 7 patients had ipsilateral and 8 had bilateral dissection, while 4 patients had no elective dissection. Results At a median follow-up of 48 months, the 5-year locoregional control (LRC) rate was 65%. Six patients had local failure, 1 regional failure (RF), 3 combined locoregional failures, and 2 distant failures. There was no difference in 5-year LRC among the R, S, and PORT groups (p = 0.17). The presence with a pyriform sinus apex extension was a prognosticator related to LRC (p = 0.01) in the multivariate analysis. Patients with a bilaterally treated neck showed a trend toward a lower RF rate (p = 0.08). Conclusion This study shows that patients with early stage HPSCC involving the pyriform sinus apex might need a tailored approach to improve LRC. Additionally, our study confirms elective neck treatment might have an efficacious role in regional control.
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Affiliation(s)
- Nalee Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Jeongshim Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Won Park
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
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Mendenhall WM, Amdur RJ, Morris CG, Kirwan J, Dziegielewski PT, Werning JW. Primary radiotherapy for squamous cell carcinoma of the pyriform sinus. Eur Arch Otorhinolaryngol 2015; 273:1857-62. [PMID: 26071621 DOI: 10.1007/s00405-015-3658-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/18/2015] [Indexed: 11/28/2022]
Abstract
The objective of this study is to report the long-term outcomes of primary radiotherapy (RT) for patients with T1-T2 squamous cell carcinomas (SCC) of the pyriform sinus. Between November 1964 and March 2008, 135 patients with T1-T2 pyriform sinus SCC were treated with primary RT at the University of Florida. Adjuvant chemotherapy was employed in 21 patients (16 %) and 62 patients (46 %) underwent a planned neck dissection. Median follow-up was 3.5 years (range 0.2-24.7 years); median follow-up on living patients was 8.3 years (range 3.8-24.0 years). The 5-year outcomes were as follows: local control, 85 %; regional control, 81 %; local-regional control, 71 %; distant metastasis-free survival, 76 %; cause-specific survival, 62 %; and overall survival, 38 %. The 5-year local control rate was 88 % for T1 cancers and 84 % for those with T2 SCCs (p = 0.5429). Sixteen patients (12 %) experienced severe late complications. Primary RT results in a high probability of cure with a relatively modest risk of severe late complications for patients with T1-T2 SCCs of the pyriform sinus.
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Affiliation(s)
- William M Mendenhall
- Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL, 32610-0385, USA.
| | - Robert J Amdur
- Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL, 32610-0385, USA
| | - Christopher G Morris
- Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL, 32610-0385, USA
| | - Jessica Kirwan
- Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL, 32610-0385, USA
| | | | - John W Werning
- Otolaryngology, University of Florida College of Medicine, Gainesville, FL, USA
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Joo YH, Lee YS, Cho KJ, Park JO, Nam IC, Kim CS, Kim SY, Kim MS. Characteristics and prognostic implications of high-risk HPV-associated hypopharyngeal cancers. PLoS One 2013; 8:e78718. [PMID: 24244346 PMCID: PMC3823884 DOI: 10.1371/journal.pone.0078718] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/18/2013] [Indexed: 12/01/2022] Open
Abstract
Background High-risk human papillomavirus (HPV) is an oncogenic virus that causes oropharyngeal cancers, and it has a favorable outcome after the treatment. Unlike in oropharyngeal cancer, the prevalence and role of high-risk HPV in the etiology of hypopharyngeal squamous cell carcinoma (HPSCC) is uncertain. Objective The aim of the present study was to evaluate the effect and prognostic significance of high-risk HPV in patients with HPSCC. Methods The study included 64 subjects with HPSCC who underwent radical surgery with or without radiation-based adjuvant therapy. Primary tumor sites were the pyriform sinus in 42 patients, posterior pharyngeal wall in 19 patients, and postcricoid area in 3 patients. High-risk HPV in situ hybridization was performed to detect HPV infection. Results The positive rate of high-risk HPV in situ hybridization was 10.9% (7/64). There was a significant difference in the fraction of positive high-risk HPV among pyriform sinus cancer (16.7%), posterior pharyngeal wall cancer (0%), and postcricoid area cancer (0%) (p = 0.042). The laryngoscopic examination revealed a granulomatous and exophytic appearance in 85.7% (6/7) of patients with high-risk HPV-positive pyriform sinus cancer, but in only 31.4% (11/35) of patients with high-risk HPV-negative pyriform sinus cancer (p = 0.012). Significant correlations were found between positive high-risk HPV and younger age (p = 0.050) and non-smoking status (p = 0.017). HPV-positive patients had a significantly better disease-free survival (p = 0.026) and disease-specific survival (p = 0.047) than HPV-negative patients. Conclusions High-risk HPV infection is significantly related to pyriform sinus cancer in patients with HPSCC.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn-Soo Lee
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwang-Jae Cho
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun-Ook Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In-Chul Nam
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chung-Soo Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Sik Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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