Search

Laryngeal preservation and a radical cure are the treatment goals for laryngeal carcinoma, and larynx-preserving therapy is generally preferred for early-stage laryngeal carcinoma. When laryngeal carcinoma recurs locally, patients are often forced to undergo total laryngectomy, resulting in loss of vocal function. However, many patients with laryngeal carcinoma who have residual or recurrent disease after radiotherapy wish to preserve their voice. The purpose of this study was to investigate the possibility of using BNCT as a larynx-preserving treatment for residual or recurrent laryngeal carcinomas following radical irradiation. This study included 15 patients who underwent BNCT for residual or recurrent laryngeal carcinoma after radical laryngeal carcinoma irradiation. The number of treatment sessions for all patients was one irradiation. Before BNCT, the recurrent laryngeal carcinoma stage was rT1aN0, rT2N0, rT2N1, rT3N0, rT3N1, and rT4aN0 in one, six, one, three, one, and three patients, respectively. The median maximum tumor diameter before BNCT was 15 mm (8–22 mm). All patients underwent a tracheostomy before BNCT to mitigate the risk of upper airway stenosis due to laryngeal edema after BNCT. Treatment efficacy was evaluated retrospectively using monthly laryngoscopy after BNCT and contrast-enhanced CT scans at 3 months. The safety of treatment was evaluated based on examination findings and interviews with patients. The median hospital stay after BNCT was 2 days (1–6). The response rate at three months after BNCT in 15 patients with locally recurrent laryngeal carcinoma was 93.3 %, and the CR rate was 73.3 %. The most frequent adverse event associated with BNCT was laryngeal edema, which occurred in nine patients the day after BNCT. The average course of laryngeal edema peaked on the second day after BNCT and almost recovered after 1 week in all patients. One patient had bilateral vocal fold movement disorders. None had dyspnea because of prophylactic tracheostomy. No grade four or higher adverse events occurred. Other grade 2 adverse events included pharyngeal mucositis, diarrhea, and sore throat. Three months after BNCT, tracheostomy tubes were removed in nine patients, retinal cannulas were placed in three patients, and voice cannulas were placed in three patients. BNCT for locally recurrent laryngeal carcinoma can safely deliver radical irradiation to tumor tissues, even in patients undergoing radical irradiation. BNCT has shown antitumor effects against recurrent laryngeal carcinoma. However, further long-term observations of the treatment outcomes are required. [ABSTRACT FROM AUTHOR]

To evaluate long-term oncological outcome for patients with selected glottic squamous cell carcinoma (SCC) classified as T3N0M0 treated by supracricoid partial laryngectomy (SCPL). Analysis of an inception cohort of 46 patients with isolated untreated SCC classified as T3N0M0 and minimum 10-year follow-up, consecutively treated by SCPL between 1982 and 2012 in a French university teaching hospital. The main endpoint was 5- and 10-year actuarial survival and local control estimates. Accessory endpoints comprised cause of death, screening for variables decreasing survival and increasing risk of local recurrence, oncologic consequences of local recurrence, and laryngeal preservation rate. Five- and 10-year actuarial survival was 78.1%, and 53.3%, respectively. The main causes of death were intercurrent disease and metachronous second primary, each in 33.3% of cases. Postoperative mortality (aspiration pneumonia) was 2.1%. There were no significant correlations between survival and any study variables. Five- and 10-year local control was 90.5%. Overall local recurrence varied significantly (P = 0.003), from 2.3% with negative margins (R0) to 100% with positive margins (R1) and/or dysplasia. Local recurrence was associated with a significantly (P < 0.005) increased risk of nodal failure and distant metastasis, and reduced survival. Overall laryngeal preservation was 89.1%. The present results suggest that SCPL should continue to be taught and that this type of partial laryngeal surgery should be included in the various organ-sparing strategies considered in advanced laryngeal cancer. [ABSTRACT FROM AUTHOR]

Supracricoid partial laryngectomy (SCPL) is an organ-preserving surgical technique intended to achieve oncologic control of laryngeal cancer while maintaining laryngeal functions. Most patients who undergo SCPL achieve a serviceable voice. However, several factors can affect the function of the neoglottis after SCPL. We report the case of a 53-year-old male referred for near aphonia after undergoing SCPL for recurrent laryngeal carcinoma initially treated with radiation. Calcium hydroxylapatite injection augmentation of the right arytenoid was performed to assist neoglottic closure. Flexible laryngoscopy demonstrated greatly improved neoglottic closure postoperatively, and the patient's voice was successfully restored. This case demonstrates a novel technique for voice restoration in patients who have undergone partial laryngectomy. [ABSTRACT FROM AUTHOR]

Laryngeal chondrosarcoma (LCS) is a rare tumor of slow evolution whose treatment is poorly codified. For a long time, a radical treatment by total laryngectomy (TL) was proposed. More recent studies tend to propose a conservative surgical approach of the larynx. The objective of this study was to compare the overall survival (OS) of total laryngectomized patients (TL+) versus non-laryngectomized patients (TL-). The secondary objectives were to analyse the reoperation free survival (RFS), the total laryngectomy free survival (TLFS) and to identify the preoperative factors leading surgeons to propose TL. A retrospective analysis of prospectively collected incident cases from the REFCOR and NetSarc-ResOs multicenter databases between March 1997 and June 2021 was conducted. A propensity score matching analysis was performed to compare the OS of TL+ and TL-patients. 74 patients were included. After propensity score, the 5-year OS of TL+ and TL-patients was comparable (100 %, p = 1). The 5-year RFS rate was 69.2 % (95 % CI [57.5–83.4]) and the 5-year TLFS was 61.7 % (95 % CI [50.4–75.5]). Cricoid involvement greater than 50 % (HR 3.58; IC 95 % [1.61–7.92] p < 0.001), an ASA score of 3 or 4 (HR 5.07; IC 95 % [1.64–15.67] p = 0.009) and involvement of several cartilages (HR 5.26; IC 95 % [1.17–23.6] p = 0.04) are prognostic factors for TL. Dyspnea caused by the tumour is a prognostic factor for reoperation (HR 2.59; IC 95 % [1.04–6.45] p = 0.03). These results demonstrate that conservative treatment should be considered as first-line treatment for laryngeal chondrosarcoma. • For a long time, total laryngectomy was proposed to treat laryngeal chondrosarcoma • A propensity score analysis was performed to compare patient laryngectomized or not • The 5-year overall survival was comparable • Cricoid invasion over 50 % is the main prognostic factor for total laryngectomy • Conservative treatment must be considered as first-line treatment [ABSTRACT FROM AUTHOR]

Cancer of the hypopharynx is relatively rare and accounts for roughly 3% of all head and neck cancers. Unfortunately, hypopharyngeal carcinoma has one of the worst prognosis of all head and neck cancers with a reported 5-year overall survival rate of approximately 30-35%. Toxicity related to therapy, and the need for surgical salvage continue to dominate the landscape in this disease. In this article, we set out to discuss a comprehensive overview of the current management principles, recent literature and evidence based therapeutic options surrounding treatment for hypopharyngeal squamous cell carcinoma, with a special focus on the evolution of an organ sparing paradigm. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the impact of 3-Diminsional (3D) tumor volume (TV) and extent of involvement of primary tumor on treatment outcomes in a large uniform cohort of T3 laryngeal carcinoma patients treated with nonsurgical laryngeal preservation strategies.Materials and Methods: The pretreatment contrast-enhanced computed tomography images of 90 patients with T3 laryngeal carcinoma were reviewed. Primary gross tumor volume (GTVp) was delineated to calculate the 3D TV and define the extent of invasion. Cartilage and soft tissue involvement was coded. The extent of invasion was dichotomized into non/limited invasion versus multiple invasion extension (MIE), and was subsequently correlated with survival outcomes.Results: The median TV was 6.6 cm3. Sixty-five patients had non/limited invasion, and 25 had MIE. Median follow-up for surviving patients was 52 months. The 5-year local control and overall survival rates for the whole cohort were 88% and 68%, respectively. There was no correlation between TV and survival outcomes. However, patients with non/limited invasion had better 5-year local control (LC) than those with MIE (95% vs 72%, p = .009) but did not have a significantly higher rate of overall survival (OS) (74% vs 67%, p = .327). In multivariate correlates of LC, MIE maintained statistical significance whereas baseline airway status showed a statistically significance trend with poor LC (p = .0087 and 0.06, respectively). Baseline good performance status was an independent predictor of improved OS (p = .03) in multivariate analysis.Conclusion: The extent of primary tumor invasion is an independent prognostic factor of LC of the disease after definitive radiotherapy in T3 larynx cancer. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of alternating chemoradiotherapy (ACRT) with early assessment of advanced laryngeal cancer.Methods: Patients with stage III or IV glottic or supraglottic squamous cell carcinoma were enrolled. ACRT consisted of two cycles of chemotherapy involving 5-fluorouracil and cisplatin (weeks 1 and 6) and radiotherapy (RT; weeks 2 and 7) administered alternately. An early assessment was performed after one cycle of chemotherapy and RT. Patients with a partial response (PR) or a complete response at early assessment continued ACRT. Patients with stable disease (SD) or progressive disease at early assessment discontinued ACRT and underwent salvage surgery. After completion of ACRT, patients who had residual primary tumor and lymph metastasis underwent salvage surgery.Results: Twenty-eight patients were enrolled in this trial. Median follow-up was 60.0 months. After each cycle of chemotherapy and RT, 24 of the 28 patients (85.7%) were assessed as having a PR at early assessment and continued ACRT, and 4 of 28 patients (14.3%) who were assessed as having SD at early assessment discontinued ACRT and underwent salvage surgery. The estimated 5-year local control and 5-year survival rates were 49.0% and 77.4%, respectively. Larynx preservation was achieved in 17 patients. The estimated 5-year laryngeal preservation rate was 59.4%. Major toxicity included nausea, stomatitis, dermatitis, dysphagia and hemoglobin toxicity. Grade 3 or 4 stomatitis occurred in three patients (10.7%).Conclusion: The clinical results of ACRT with early assessment of advanced laryngeal cancer patients showed sufficient efficacy and safety. [ABSTRACT FROM AUTHOR]

Summary Objective CO 2 laser cordectomy for glottic carcinoma offers excellent oncologic control on a per stage basis as compared with primary radiotherapy. We aim to further investigate the fluctuations of postoperative vocal outcomes following extended laser cordectomy for glottic cancer. Design Single center retrospective cohort study. Methods Eleven patients with glottic squamous cell carcinoma (SCC) who received CO 2 laser cordectomy European Laryngological Society type III-IV with complete datasets at preoperative, immediate postoperative (within 4 months), and delayed (greater than 6 months) time points were included. Results All patients (n = 11) received cordectomy as their primary treatment. Tumor stage was divided evenly between T1 and T2. One patient was referred for post-cordectomy thyroplasty. Mean Voice Handicap Index (VHI) scores increased in the immediate postoperative period (43.3–46.2) but did not reach significance ( P > 0.05). Delayed postoperative VHI (23.3) demonstrated substantial improvement from both pre- and immediate postoperative levels ( P = 0.047). Objective voice rating significantly declined initially ( P = 0.03; Grade, P = 0.01; Breathiness) and recovered to similar preoperative levels. Maximum phonation time (MPT) showed substantial decreases at the initial postoperative period ( P = 0.007). Although significant improvement was made at the delayed postoperative point ( P = 0.009), MPT remained below the preoperative level ( P = 0.028). No significant changes were seen in phonatory subglottic pressures. Conclusions Patients undergoing extended CO 2 laser cordectomy for glottic cancers can experience initial decline in voice quality; however, vocal function routinely returns to preoperative levels following the initial healing period. A small percentage of extended cordectomy patients may require further vocal interventions. [ABSTRACT FROM AUTHOR]

Objectives A 10-year retrospective study investigated factors for survival and laryngeal preservation in advanced laryngeal, hypopharyngeal or epilaryngeal neoplasia. Material and method Two hundred and forty-six patients with advanced cancer of the larynx (17.48%), hypopharynx (48.78%) or epilarynx (33.74%) undergoing primary organ-sparing treatment were included from 1998 to 2008. Treatment comprised chemotherapy followed by radiation therapy for 92.68% of patients, isolated radiation therapy for 1.6% and concomitant or sequential radiation-chemotherapy for 5.7%. General health status, history and tumor status were recorded. Factors influencing survival were analyzed by Kaplan-Meier estimator, log-rank test and Cox models. Results Median overall survival of the population was 2.3 years and median laryngeal preservation 0.99 years in male patients and 2 years in female patients. Survival correlated significantly with body mass index (BMI; P = 0.0004), WHO performance status ( P = 0.0064), alcohol consumption ( P = 0.0004) and cessation ( P < 0.0001) and also T stage ( P = 0.0038), initial laryngeal mobility ( P = 0.0002) and post-chemotherapy assessment ( P < 0.0001). Survival with functional larynx correlated with baseline BMI at first consultation ( P = 0.016), baseline WHO grade ( P = 0.0005), laryngeal mobility ( P < 0.0001), T staging ( P = 0.0009), and T and/or N chemotherapy response to a classical organ preservation protocol ( P < 0.0001). Conclusion Over and above established criteria, the present study highlighted the importance of general health and nutritional status during treatment. [ABSTRACT FROM AUTHOR]

Objective To analyse the treatment options that otorhinolaryngologists would consider if faced with advanced stage laryngeal cancer amenable to total laryngectomy or an organ preservation protocol. Material and methods Prospective study conducted in a French Teaching Hospital based on questionnaires filled in by 163 otorhinolaryngologists in 2012, studying the percentage chance of cure that they would be prepared to trade-off to preserve their larynx, defining the additional information that they would like to receive and identifying any statistical associations between these parameters and various medical and socioeconomic variables. Results A total of 42.3% of otorhinolaryngologists would not consider the slightest trade-off to preserve their larynx and preferred to undergo total laryngectomy. In the group of otorhinolaryngologists who would consider a larynx preservation protocol (57.6%), the percentage chance of cure that they would be willing to trade-off to preserve their larynx ranged between 5 to 100% (median: 15%) and 4.2% of them were willing to trade-off all chances of cure (100%) to avoid total laryngectomy. The percentage of otorhinolaryngologists who would not consider trading off the slightest chance of survival to preserve their larynx increased from 29.3 to 49.5% ( P = 0.01) when they participated in multidisciplinary consultation meetings. In the group of otorhinolaryngologists who would consider a larynx preservation protocol, the median percentage survival trade-off that they would consider in order to preserve their larynx (i) decreased from 20 to 10% ( P = 0.004) when they participated in multidisciplinary consultation meetings and (ii) increased regularly with their number of years of practice ( P = 0.03) and their age ( P = 0.025). Finally, 25.1% of otorhinolaryngologists wanted to receive additional information, although none of the variables analysed affected this desire for more information. Conclusion Treatment options considered by otorhinolaryngologists faced with advanced stage laryngeal cancer were almost equally divided between total laryngectomy and larynx preservation. Number of years of practice and regular participation in head and neck cancer multidisciplinary consultation meetings were variables that significantly influenced this choice. [ABSTRACT FROM AUTHOR]

Résumé Objectif de l’étude Analyse de la décision thérapeutique envisagée par des oncologues radiothérapeutes mis en situation d’être atteints d’un cancer du larynx localement évolué accessible soit à une laryngectomie totale, soit à un protocole de préservation laryngée. Matériels et méthodes Étude prospective réalisée à partir de questionnaires remplis par 104 oncologues radiothérapeutes. Résultats Au total, 30,7 % des oncologues radiothérapeutes n’envisageraient pas d’échanger la moindre chance de survie pour préserver leur larynx. La médiane du pourcentage de chance de guérir que les oncologues radiothérapeutes seraient prêts à échanger pour préserver leur larynx était de 10 % (2–100 %), et 0,9 % d’entre eux seraient prêts à perdre toutes leurs chances de guérir afin d’éviter la laryngectomie totale, 16,3 % des oncologues radiothérapeutes souhaiteraient recevoir un complément d’information avant de prendre leur décision. Le complément d’information le plus fréquemment souhaité concernait le stade précis de la tumeur et les possibilités de rattrapage en cas d’échec du protocole de préservation laryngée. Aucune des variables sociodémographiques analysées n’influait sur le choix d’échanger ou non des chances de survie pour préserver le larynx, le pourcentage de chance que les oncologues radiothérapeutes envisageraient d’échanger et/ou le souhait de recevoir un complément d’information. Conclusion Cette étude prospective souligne que la préservation laryngée n’est pas l’objectif thérapeutique principal partagé par tous les oncologues radiothérapeutes mis en situation d’être atteints d’un cancer du larynx de stade avancé. La laryngectomie totale doit rester un choix thérapeutique qui demande au même titre que les protocoles de préservation d’organe à être proposé et discuté. Purpose To analyse the therapeutic decision considered by radiation oncologists put in a position of being diagnosed with an advanced stage cancer of the larynx accessible either to a total laryngectomy or to an organ preservation protocol. Materials and methods Prospective analysis based on an anonymous survey filled by 104 radiation oncologists. Results A total of 30.7% of radiation oncologists surveyed did not consider any trade in their cure rate to preserve their larynx. The median percentage of cure that they were willing to trade was 10% (2–100%); and 0.9% of them were willing to trade 100% of their chance for cure in order to “avoid” total laryngectomy. A total of 16.3% of radiation oncologists would like to receive more information before making their decision. The additional information most frequently requested concerned the precise stage of the tumour and the potential remedial treatment in case of failure of the laryngeal preservation protocol. None of the analysed demographic variables influenced the choice to trade or not survival chance to preserve the larynx, the percentage of chance that radiation oncologists would consider exchanging, and/or the wish to receive additional information. Conclusion This prospective study highlights that larynx preservation protocol is not the main therapeutic goal shared by all radiation oncologists put in a position of being diagnosed with an advanced stage cancer of the larynx. Total laryngectomy should remain a treatment option that as organ preservation protocols to be proposed and discussed. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We examined the completion rate, safety, and adverse events in patients with T2N0 glottic carcinoma who received chemoradiotherapy with S-1 (tegafur–gimeracil–oteracil potassium). Methods: In T2N0 glottic carcinoma patients, we retrospectively compared the local control rate and outpatient therapy completion rate between 20 patients who received radiotherapy plus S-1 (S-1 group) and 20 who received radiotherapy alone (RT group). Results: Local recurrence was not detected in any of the 20 subjects from the S-1 group, whereas local recurrence was found in 4 of the 20 subjects (20%) from the RT group (p <0.05). Outpatient treatment was completed by 15 of the 20 subjects from the S-1 group and 17 of the 20 subjects from the RT group (p =0.43). Conclusion: We investigated chemoradiotherapy with S-1 in patients who had T2N0 glottic carcinoma and found a higher local control rate when compared with radiotherapy alone as well as comparable safety for outpatient delivery. [Copyright &y& Elsevier]

Abstract: Objective: To analyse, based on an anonymous questionnaire, the treatment decision envisaged and the impact of the medical information delivered in patients facing the diagnosis of an advanced laryngeal cancer amenable to total laryngectomy or a laryngeal preservation protocol. Material and methods: Prospective study conducted in a French teaching hospital based on questionnaires filled in by 269 patients attending the otorhinolaryngology clinic. Results: A total of 28.6% of patients would not consider any trade-off of cure to preserve their larynx; 1.4% of patients were willing to trade all chances of cure in order to avoid total laryngectomy. The median percentage of cure that patients were ready to loose in order to preserve their larynx was 33% (range: 5 to 100%); 47.9% of patients wanted to receive additional information before making their decision with a significant increase among patients with a level of education beyond secondary school (P =0.0006) and among patients with a family history of cancer (P =0.038). The additional information most frequently requested concerned the complications related to the laryngeal preservation protocol (34.1%) and the cure rate (28.6%). After receiving information about the risk of tracheostomy and permanent gastrostomy following the laryngeal preservation protocol, the percentage of subjects who would not consider any trade-off in order to preserve their larynx increased to 31.2% and 56.1%, respectively. Conclusion: Laryngeal preservation is not a major objective of treatment shared by patients filling a questionnaire devoted to the choice of treatment when facing an advanced laryngeal cancer. Specific information concerning the expected results and the inherent risks involved in the various treatment options must be provided in every case. [Copyright &y& Elsevier]

Purpose: The specific aim of this analysis was to evaluate the feasibility of performing a cost-effectiveness analysis using Medicare data from patients treated on a randomized Phase III clinical trial. Methods and Materials: Cost data included Medicare Part A and Part B costs from all providers—inpatient, outpatient, skilled nursing facility, home health, hospice, and physicians—and were obtained from the Centers for Medicare & Medicaid Services for patients eligible for Medicare, treated on Radiation Therapy Oncology Group (RTOG) 9111 between 1992 and 1996. The 47-month expected discounted (annual discount rate of 3%) cost for each arm of the trial was calculated in 1996 dollars, with Kaplan-Meier sampling average estimates of survival probabilities for each month and mean monthly costs. Overall and disease-free survival was also discounted 3%/year. The analysis was performed from a payer''s perspective. Incremental cost-effectiveness ratios were calculated comparing the chemotherapy arms to the radiation alone arm. Results: Of the 547 patients entered, Medicare cost data and clinical outcomes were available for 66 patients. Reasons for exclusion included no RTOG follow-up, Medicare HMO enrollment, no Medicare claims since trial entry, and trial entry after 1996. Differences existed between groups in tumor characteristics, toxicity, and survival, all which could affect resource utilization. Conclusions: Although we were able to test the methodology of economic analysis alongside a clinical trial using Medicare data, the results may be difficult to translate to the entire trial population because of non-random missing data. Methods to improve Medicare data capture and matching to clinical trial samples are required. [Copyright &y& Elsevier]

Summary: Objective: For tongue reconstruction after total or subtotal glossectomy, a rectus abdominis musculocutaneous flap is often used to obtain sufficient flap volume. However, thin patients often have too little fat tissue to ensure adequate flap volume. For this reason we developed a new flap design to compensate for insufficient flap volume in thin patients. Methods: In this series, total or subtotal glossectomy was performed in 20 thin men with a mean age of 58.3 years. The patients had a mean body mass index of 18.22kg/m2 and most were considered emaciated. The defects were reconstructed using a rectus abdominis musculocutaneous flap with two skin islands. The first skin island was used to reconstruct the mucosal defect, and the second was de-epithelialised and used to increase flap volume. Results: Flaps were transferred successfully in 19 out of 20 patients. Most patients could tolerate more than a soft diet without severe aspiration and could engage in conversation. However, four patients required total laryngectomy or a permanent stoma owing to severe aspiration. In this series, the larynx could be preserved in 80% of thin patients, and satisfactory postoperative oral function was obtained. Conclusion: The most important point for obtaining satisfactory oral function is to reconstruct a tongue with a protuberant shape and sufficient volume. We could maintain sufficient flap volume with the de-epithelialised skin island of a rectus abdominis musculocutaneous free flap. We believe our new flap design is effective for tongue reconstruction in thin patients. [Copyright &y& Elsevier]