Minimally Invasive Procedures for Laryngeal Carcinoma: Transoral Endoscopic Laser and Transoral Robotic Surgery

Machine learning in personalized laryngeal cancer management: insights into clinical characteristics, therapeutic options, and survival predictions

PURPOSE

Over the last 40 years, there has been an unusual trend where, even though there are more varied treatments, survival rates have not improved much. Our study used survival analysis and machine learning (ML) to investigate this odd situation and to improve prediction methods for treating non-metastatic LSCC.

METHODS

The surveillance, epidemiology and end results (SEER) database provided the data used for this study's analysis. To identify the prognostic variables for patients with non-metastatic LSCC, we conducted Cox regression analysis and constructed prognostic models using five ML algorithms to predict 5-year survival. A method of validation that incorporated the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was employed to validate the accuracy and reliability of the ML models. We also investigated the role of multiple therapeutic options using Kaplan Meier (K-M) survival analysis.

RESULTS

The study included 63,324 patients, of whom 40,824 were diagnosed with glottic cancer (GC), 21,774 with supraglottic (SuGC) and 726 with subglottic (SC). ML models identified age, stage, and tumor size as the most important factors that affect survival. For SuGC, age, stage, and sex and stage and race for SC. In terms of treatment, best survival therapeutic options for GC and SC were surgery and radiotherapy (RT), whereas SuGC surgery only.

CONCLUSION

This study underscores the critical role of individualized factors in non-metastatic LSCC management, with surgery often combined with radiotherapy as the optimal treatment for early stage tumors. Despite advancements, stable prognosis highlights the need for continuous refinement of therapeutic strategies to balance tumor control and quality of life.

Outcomes of mini-invasive transoral surgery without neck dissection in supraglottic laryngeal cancer: Real world data from a tertiary cancer center

PURPOSE

The neck management in early-stage cN0 supraglottic cancer represents an argument of debate. The aim of our study is to evaluate the oncological and functional outcomes in patients with early-stage cN0 supraglottic carcinoma treated with a wait-and-see policy for the neck.

MATERIALS AND METHODS

Retrospective monocentric cohort study in a referral cancer care center. We collected a consecutive sample of patients from 2000 to 2020 with Squamous Cell Carcinoma of the supraglottis without clinical evidence of nodal metastases (cN0), surgically treated with Transoral Surgery (Laser or Robotic) without neck dissection. From 316 supraglottic cancer we finally selected 66 eligible participants that met all inclusion criteria.

RESULTS

Sixty-six patients (M 75.8 % vs F 24.2 %), median age 65.8 years (IQR 60.9, 70.5). The most common subsite was the epiglottis (62.1 %). Tumor stage distribution was as follows: 35 % cT1, 53 % cT2, 15.2 % cT3. Neither deaths nor major treatment-related complications were reported after surgery. The median follow-up was 62 months. For oncological outcomes, we evaluated 56 patients (10 excluded for adjuvant radiotherapy): 5-year overall survival rate 87 % (CI 95 %: 73.1-94), disease- specific survival rate 95.3 % (CI 95 %: 82-98.8) and neck recurrence-free survival rate 87 % (CI 95 %: 73.1-94). Six patients developed neck recurrence, with a median time of 13 months.

CONCLUSIONS

Supraglottic carcinoma has been historically associated to a considerable risk of occult metastasis. However, in early-stage cases data are still inconclusive. Our results suggest that in such patients a wait-and-see policy does not impact negatively on survival outcomes, while granting the reduced morbidity associated to a minimally invasive surgical approach.

Role of curcumin in selected head and neck lesions. Limitations on the use of the Hep-2 cell line: A critical review

Neoplastic diseases of the upper respiratory airways, as well as head and neck cancers, are a frequent cause of death and significantly affect the quality of life of both patients and survivors. As the frequency increases, new and improved treatment techniques are sought. Promising properties in this respect are expressed by a natural compound - curcumin. Along with its derivatives, it was found useful in the treatment of a series of cancers. Curcumin was found to be effective in clinical trials and in vitro, in vivo anticancer experiments. Nanoformulations (e.g., poly(lactide-co-glycolic acid)-based nanoparticles, nanoemulsions), and modifications of curcumin, as well as its combinations with other substances (e.g., catechins, cisplatin) or treatments (e.g., radiotherapy or local use in inhalation), were found to enhance the antitumor effect. This review aims to summarize the recent findings for the treatment of head and neck diseases, especially squamous cell carcinomas (HNSCCs), including drawing attention to the constant use of the misidentified Hep-2 cell line and proposing databases purposed at eliminating this problem. Moreover, this manuscript focuses on pointing out the molecular mechanisms of therapy that have been reached and emphasizing the shortcomings that still need to be addressed.