1,399 results on '"glottic cancer"'
Search Results
102. Modified approach of the anterior commissure for transoral cordectomy in case of difficult exposure: a surgical innovation.
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Mattei, Alexia, Boulze, Carole, Santini, Laure, Le Flem, Matthieu, Dessi, Patrick, Fakhry, Nicolas, and Giovanni, Antoine
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VOCAL cords , *VOICE disorders , *OPERATIVE surgery , *TECHNOLOGICAL innovations , *LASER endoscopy , *THIRD molar surgery - Abstract
Purpose: To propose, in patients presenting a difficult laryngeal exposure, a surgical innovation allowing to perform a transoral laser cordectomy for cancers reaching the anterior commissure or the anterior third of vocal folds (according to the European Laryngological Society classification of laryngeal endoscopic cordectomies). Methods: Our surgical technique consisted of adding to conventional cordectomies a modified relaxation thyroplasty proposed by Isshiki (type III), also called relaxation thyroplasty by a medial approach in the European Laryngological Society classification system. The anterior commissure retrusion is usually employed in the management of high-pitched voice disorders, but can also allow a better exposure of the anterior commissure. Results: We described here this surgical innovation through the example of our first two patients. For both patients, the definitive histologic analysis showed negative microscopic margins and there was no post-operative complication. There was no need for a tracheostomy. They were allowed to take a normal diet after 2 days and were discharged after 4 days. The voice was breathy and hoarse as expected in case of extended cordectomy. Conclusions: This surgical innovation corresponding to the addition of an anterior commissure retrusion by a bilateral thyrotomy could be useful in the ELS classification of endoscopic cordectomies. It should allow surgeons to carry out a transoral CO2 laser cordectomy in patients with a T1 and sometimes T2 glottic carcinoma, even with a difficult laryngeal exposure. [ABSTRACT FROM AUTHOR]
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- 2020
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103. Dosimetric comparison of intensity-modulated radiation therapy for early-stage glottic cancers with and without the air cavity in the planning target volume.
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Asher, David, Amestoy, William, Studenski, Matthew T., Samuels, Stuart E., Abramowitz, Matthew C., Freedman, Laura M., Elsayyad, Nagy, and Samuels, Michael A.
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GLOTTIS , *RADIOTHERAPY , *CAROTID artery , *AIR , *SPINAL cord - Abstract
For early-stage glottic cancers, intensity-modulated radiation therapy (IMRT) has been shown to have comparable local control to 3D-conformal radiotherapy with the advantage of decreased dose to the carotid arteries. The planning target volume (PTV) for early glottic cancers typically includes the entire larynx, plus a 3 to 5 mm uniform margin. The air cavity within the larynx creates a challenge for the inverse optimization process as the software attempts to "build up" dose within the air. This unnecessary attempt at dose build-up in air can lead to hot spots within the rest of the PTV and surrounding soft tissue. We hypothesized that removal of the air from the PTV would decrease hot spots and allow for a more homogeneous plan while still maintaining adequate coverage of the PTV. We analyzed 20 consecutive patients with early-stage glottic cancer, T1-2N0, who received IMRT at our institution from April 2015 to December 2016. Each patient received 63 to 65.25 Gy in 2.25 Gy per fraction. Two plans were created for each case: one in which the PTV included the laryngeal air cavity and one in which the air cavity was subtracted from the PTV to create a new PTV-air structure. Dosimetric variables were collected for PTV-air structure from both IMRT plans, including V100%, D98% D2%, and D0.2%. Dosimetric variables for spinal cord and the carotid arteries were also recorded. Homogeneity index (HI) defined as D98/D2 was calculated. Two-sided t-tests were used to compare dosimetric variables. The median PTV volume was 69.9 cc (standard deviation [SD] ± 28.7 cc) and the median air cavity volume removed was 11.0 cc (SD ± 3.4 cc). A 2-sided t-test revealed a statistically significant decrease in max dose (112.7% vs 108.8%, p value = 0.0002) and improvement of HI (0.93 vs 0.91, p value = 0.0023) for the PTV air in the IMRT plan optimized for PTV air, which had air excluded, compared to the IMRT plan optimized for PTV with air included. There was no significant worsening of PTV-air coverage or significant increase in doses to the organs at risk (OARs). The removal of the air cavity from the PTV for early-stage glottic cancers does not compromise PTV coverage or sparing of OARs and can result in a more homogeneous IMRT plan. A more homogeneous plan has the potential to reduce treatment morbidity, although further study is warranted to investigate the clinical impact of air cavity removal from the PTV. [ABSTRACT FROM AUTHOR]
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- 2019
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104. Prognostic significance of surgical margins after transoral laser microsurgery for early-stage glottic squamous cell carcinoma.
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Jumaily, Mejd, Faraji, Farhoud, Osazuwa-Peters, Nosayaba, Walker, Ronald J., and Ward, Gregory M.
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SQUAMOUS cell carcinoma , *SURGICAL site , *MICROSURGERY , *LASERS , *MULTIVARIATE analysis - Abstract
Objectives: The impact of positive tumor margin status and other clinicopathological factors on prognosis in early stage glottic squamous cell carcinoma (SCC) treated with transoral laser microsurgery (TLM) remains unclear. This study examined overall survival (OS) rates of patients with positive tumor margin status compared to negative tumor margin status after TLM in clinical T1-2 glottic SCC.Materials and Methods: The National Cancer Data Base (NCDB) was queried for patients who underwent resection of T1-2 glottic SCC by TLM. Patients were treated from 2004 to 2013. Overall survival was assessed with Kaplan-Meier curve analysis, and univariate and multivariate Cox proportional hazards analysis. Differences in clinicopathologic factors between positive and negative margin groups were compared using Pearson Chi-squared analysis.Results: Of 747 patients meeting inclusion criteria, 598 (80.1%) had negative margins. Median follow-up time was 48.0 months. Unadjusted 5-year OS for positive margins (80.0%) was lower compared to that of negative tumor margins (82.9%), but this was not statistically significant (P = 0.265). This persisted after multivariate analysis (P = 0.960). When tumors were stratified by T stage (647 T1, 100 T2), unadjusted 5-year OS based on margin status remained statistically insignificant for both T1 (P = 0.933) and T2 tumors (P = 0.350).Conclusion: Positive margins did not negatively impact overall survival among patients with TLM-treated early-stage glottic cancer. This finding might be useful clinically in deciding treatment modality for early stage glottic SCC. [ABSTRACT FROM AUTHOR]- Published
- 2019
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105. VoiceS: voice quality after transoral CO2 laser surgery versus single vocal cord irradiation for unilateral stage 0 and I glottic larynx cancer—a randomized phase III trial
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Reinhardt, Philipp, Giger, Roland, Seifert, Eberhard, Shelan, Mohamed, Riggenbach, Elena, Terribilini, Dario, Joosten, Andreas, Schanne, Daniel H., Aebersold, Daniel M., Manser, Peter, Dettmer, Matthias S., Simon, Christian, Ozsahin, Esat M., Moeckli, Raphaël, Limacher, Andreas, Caparrotti, Francesca, Nair, Deepa, Bourhis, Jean, Broglie, Martina A., Al-Mamgani, Abrahim, and Elicin, Olgun
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- 2022
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106. 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
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Carmelo Saraniti, Enzo Chianetta, Barbara Verro, Giuseppe Greco, Francesca Montana, Saraniti, Carmelo, Montana, Francesca, Chianetta, Enzo, Greco, Giuseppe, and Verro, Barbara
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Laser surgery ,Glottis ,Microsurgery ,medicine.medical_specialty ,Surgical margin ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Laryngeal cancer ,Squamous cell carcinoma ,medicine ,Carcinoma ,Humans ,Transoral laser microsurgery ,030223 otorhinolaryngology ,Laryngeal Neoplasms ,Neoplasm Staging ,Retrospective Studies ,Carcinoma espinocelular ,business.industry ,Margins of Excision ,Retrospective cohort study ,Organ Preservation ,Carbon Dioxide ,medicine.disease ,Tongue Neoplasms ,Surgery ,Settore MED/31 - Otorinolaringoiatria ,Otorhinolaryngology ,Glottic cancer ,030220 oncology & carcinogenesis ,Cohort ,Resection margin ,Câncer de laringe ,Cirurgia a laser ,Laser Therapy ,business - 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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- 2022
107. Commentary about mesenchymal stem cells and scarred vocal folds
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Alexia Mattei, Jérémy Magalon, Mélanie Velier, Françoise Dignat-George, Antoine Giovanni, and Florence Sabatier
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Vocal folds ,Scarring ,Fibrosis ,Mesenchymal stromal cells ,Glottic cancer ,Bone marrow ,Medicine (General) ,R5-920 ,Biochemistry ,QD415-436 - Abstract
Abstract A commentary to “Hertegård, S., Nagubothu, S.R., Malmström, E. et al. Treatment of vocal fold scarring with autologous bone marrow-derived human mesenchymal stromal cells - first phase I/II human clinical study. Stem Cell Res Ther 11, 128 (2020)” concerning the surgical intervention including a scar resection, the use of the Voice Handicap Index, the surgical and regulatory points of view regarding the inclusion of patients with laryngeal carcinomas history, and the side effects of bone marrow harvesting.
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- 2020
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108. Outcomes of radiotherapy in early stage glottic laryngeal carcinoma: a single center experience
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Kemal Ekici, Oztun Temelli, Ayse Fatma Eraslan, Simay Gurocak, Nihal Kaplan Bozdag, Emin Tamer Elkiran, Ersoy Kekilli, and Ahmet Kizilay
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glottic cancer ,radiotherapy ,treatment ,side effect ,Medicine - Abstract
Our aim was to determine the treatment outcomes and the prognostic factors affecting local control in early stage glottic carcinoma (ESGC) treated with definitive radiotherapy (RT). Between April 2003 and May 2015, 76 patients with ESGC were treated at Inonu University Hospital. There were 58 patients with T1a, 7 T1b and 11 with T2 tumors. Twenty-two patients were treated with conformal radiotherapy, 31 patients were treated with conventional RT and 23 patients were treated with intensity modulated radiotherapy as initial treatment. During a median follow-up of 51 months (range 6-136), 11 patients had failures. Five year overall survival rates were 73.7% in T1 and 81.8% T2. Local control rate was 85.5% in our patients. Patients who were over 61 years had significantly lower local control (p = 0.042). One patient treatment was interrupted because of grade 3 edema. One patient had grade 3 dermatitis, 2 patients grade 3 mucositis and 4 patients grade 3 edema, respectively. Our results suggest that curative radiotherapy is an effective treatment modality in ESGC without increasing toxicity. Age proved to be the only independent prognostic factor affecting local control after primary radiotherapy according to the results of this study. [Med-Science 2016; 5(4.000): 928-32]
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- 2016
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109. Complete response of glottic cancer to intra-arterial infusion chemotherapy combined with radiotherapy: A report of 4 cases.
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Yamakuni R, Sekino H, Ikeda M, Endo Y, Ikeda M, Ishii S, Fukushima K, Murono S, Suzuki Y, and Ito H
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Surgical resection is recommended for advanced-stage, resectable glottic cancer. However, total laryngectomy results in the loss of vocal function and reduces patients' quality of life. At our institution, patients with cT3N0M0 stage III resectable glottic cancer who wish to preserve their larynx are treated with super-selective cisplatin infusion with concomitant radiotherapy (RADPLAT) to improve local control over systemic chemotherapy. Herein, we present 4 patients with glottic cancer who underwent biweekly intra-arterial infusion chemotherapy combined with radiation therapy 3 times. For intra-arterial infusion chemotherapy, 100 mg cis-diaminodichloroplatinum was infused into the superior thyroid artery, including the superior laryngeal artery branch. Thereafter, intensity-modulated radiation therapy was administered at doses of 70 Gy in 35 fractions for 3 patients and 66 Gy in 33 fractions for 1 patient. These patients showed complete response after chemoradiotherapy with no recurrence or metastases during the follow-up period to date (mean follow-up period: 56 months, range: 39-76 months)., (© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)
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- 2023
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110. Seeking Medical Assistance for Dysphonia Is Associated with an Improved Survival Rate in Laryngeal Cancer: Real-World Evidence
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Yi-An Lu, Ming-Shao Tsai, Li-Ang Lee, Shu-Ru Lee, Li-Yun Lin, Chain-Fen Chang, Wan-Ni Lin, Li-Jen Hsin, Chun-Ta Liao, Hsueh-Yu Li, Yu-Wen Wen, and Tuan-Jen Fang
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laryngeal cancer ,glottic cancer ,dysphonia ,hoarseness ,overall survival ,Medicine (General) ,R5-920 - Abstract
(1) Background: Patients with laryngeal cancer usually present with dysphonia. However, some studies reported that the duration from dysphonia to cancer diagnosis has been prolonged significantly in recent years. This study aimed to evaluate that in the initial dysphonia-related diagnosis and the interval between the diagnosis of laryngeal cancer may affect the overall survival (OS). (2) Methods: The 1997–2013 Longitudinal Health Insurance Database was used in this study. A propensity score with 1-to-1 matching was applied to balance the baseline characteristics. The OS was examined by the Kaplan-Meier method and log-rank test. (3) Results: A total of 2753 patients with a first primary laryngeal cancer diagnosis were identified. The patients without prior dysphonia-related diagnosis (PD−) group did have a significantly worse five-year survival (p = 0.015) comparing with those with a prior dysphonia-related diagnosis (PD+) group among glottic cancer patients. The group with a shorter dysphonia-to-diagnosis interval had a better five-year OS than the prolonged group (p = 0.007) in laryngeal cancer. (4) Conclusions: Looking for medical assistance before a diagnosis of glottic cancer is associated with a better overall survival, while a diagnostic delay of more than 30 days from the first medical examination for dysphonia is associated with a worse outcome among in patients with laryngeal cancer.
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- 2021
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111. Factors responsible for the development of carbon granuloma post transoral laser cordectomy.
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Nerurkar, Nupur Kapoor and Shah, Ruchi
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GRANULOMA , *VOICE disorders , *DATA analysis , *DYSPLASIA , *RADIOTHERAPY , *CARBON , *MEDICAL lasers , *WOUND healing , *TREATMENT effectiveness , *RETROSPECTIVE studies ,VOCAL cord surgery ,LARYNGEAL tumors - Abstract
Our study was performed with an aim to analyse the factors responsible for the formation of a carbon granuloma (CG) following transoral laser microlaryngeal cordectomy (TLMC) for early glottic carcinoma. Our study comprises of retrospective data analysis of 78 patients who underwent TLMC for early glottic carcinoma between 2012 and 2017 with the laser settings of an acublade with scanning system, size 1-2 mm, depth 1-3 (250-750 μm), power 10 watts in a repeat mode with time off 0.25 s. A total of 19 patients had undergone type 1 cordectomy, 38 patients a type 2 cordectomy, 20 patients a type 3 cordectomy and 1 type 4 cordectomy. In the follow-up period, patients were divided into two groups-group A, who healed well and group B, who developed a CG. Both groups were analysed based on surgical factors (type of cordectomy, postoperative surface of vocal fold and cautery use) and healing factors (presence of diabetes mellitus and laryngopharyngeal reflux). Of 81 cordectomies, 15 (18.5%) developed a CG at an average period of 4 weeks postoperatively. All 15 patients were managed medically and by 4-8 weeks, 13 carbon granulomas resolved. Surgical excision in 2 patients who did not improve revealed granulation tissue. Of 40 type 2 cordectomies, 9 developed a CG (22.5%); of 20 type 3 cordectomies, 5 developed a CG (25%) and the 1 patient of type 4 cordectomy developed a CG (100%). Patients with cautery use, diabetes mellitus (DM) and laryngopharyngeal reflux (LPR) had a higher rate of CG formation. To summarise, in our study, a CG developed in 18.5% of our TLMC patients at an average postoperative duration of 4 weeks. An algorithm for treating and preventing this type of lesion is recommended. [ABSTRACT FROM AUTHOR]
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- 2019
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112. Glottic exposure for transoral laser microsurgery: Proposal of a mini-version of the laryngoscore.
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Incandela, Fabiola, Paderno, Alberto, Missale, Francesco, Laborai, Andrea, Filauro, Marta, Mora, Francesco, Del Bon, Francesca, Piazza, Cesare, and Peretti, Giorgio
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Objectives: Good laryngeal exposure (GLE) is typically regarded as an essential prerequisite for transoral laser microsurgery (TLM). The Laryngoscore is a preoperative scoring system aimed at predicting glottic visualization through the laryngoscope using easy patient-derived parameters. However, the presence of subjective variables may hamper its reliability and reproducibility. The aim of the present study was to provide a validation of the Laryngoscore and to develop a revised mini-version of the same, called mini-Laryngoscore (mLS), which could allow even quicker, yet sufficiently accurate, preoperative prediction of GLE.Study Design: Prospective cohort study.Methods: We prospectively evaluated 310 consecutive patients submitted to TLM between 2014 and 2017, grading each patient according to the variables considered in the Laryngoscore.Results: Among the 11 variables of the previous Laryngoscore, three were confirmed as statistically significant at validation: interincisors gap, thyromental distance, and upper jaw dental status. We chose these three variables as part of the revised mLS (ranging from 0 to 4). In our cohort, 30% of the patients obtained a score of 0, 57% a score of 1, 11% a score of 2, and 2% a score of ≥3. GLE was achieved in 97%, 85%, 65%, and 20% of cases, respectively.Conclusion: Our validation confirmed the predictive ability of the Laryngoscore. Furthermore, although composed of only three clinical parameters, the mLS was still able to convey useful information regarding the possibility of obtaining GLE.Level Of Evidence: 2 Laryngoscope, 129:1617-1622, 2019. [ABSTRACT FROM AUTHOR]- Published
- 2019
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113. Altered-fractionation radiotherapy improves local control in early-stage glottic carcinoma: A systematic review and meta-analysis of 1762 patients.
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Sapienza, Lucas Gomes, Ning, Matthew Stephen, Taguchi, Senzo, Calsavara, Vinícius Fernando, Pellizzon, Antônio Cássio de Assis, Gomes, Maria José Leite, Kowalski, Luiz Paulo, and Baiocchi, Glauco
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META-analysis , *CARCINOMA , *RADIOTHERAPY , *PERFORMING arts , *RETROSPECTIVE studies - Abstract
Objectives: To perform a systematic review of 1762 patients to comprehensively assess the benefit of altered-fractionation radiotherapy (ART) in early stage glottic carcinoma (ESGC).Materials and Methods: Studies were identified in PubMed and EMBASE. Inclusion criteria were: (1) diagnosis of squamous cell ESGC (Tis, T1, T2); (2) ART versus conventionally-fractionationated radiotherapy (CRT); and (3) provision of number of local recurrence events and total numbers per fractionation arm. The random-effects model was fitted to estimate the pooled hazard ratio (HR). Subgroup sensitivity analyses were performed based on ART strategy (hypo- versus hyperfractionation), treatment-day reductions, machine type, tumor stage, and anterior commissure involvement.Results: Eleven studies met inclusion criteria: 4 randomized controlled trials (RCTs) and 7 two-arm retrospective studies. ART was associated with 38% fewer (HR 0.62; 95% CI: 0.46-0.82, p = 0.0009) and 60% fewer (HR 0.40; 95% CI: 0.24-0.66, p = 0.0003) local failure events in pooled analyses of the RCTs and retrospective studies, respectively. Both hyperfractionation (HR 0.65; 95% CI: 0.43-0.97, p = 0.03) and hypofractionation (HR 0.55; 95% CI: 0.33-0.91, p = 0.02) strategies were superior to CRT. The benefit persisted for all treatment- and tumor-related parameters, including anterior commissure involvement, with the exception of a pooled analysis of studies with predominantly T2 (<50% T1) cases (HR 0.60, 95% CI: 0.30-1.20, p = 0.15).Conclusion: Both hypofractionation and hyperfractionation improve local control in ESGC, including T1 tumors and for anterior commissure involvement. However, this benefit may not persist for T2 tumors, for which alternative strategies should be considered. [ABSTRACT FROM AUTHOR]- Published
- 2019
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114. Microvascular density and hypoxia-inducible factor in intraepithelial vocal fold lesions.
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Rzepakowska, Anna, Żurek, Michał, Grzybowski, Jakub, Pihowicz, Paweł, Górnicka, Barbara, Niemczyk, Kazimierz, and Osuch-Wójcikiewicz, Ewa
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HYPOXIA-inducible factors , *VOCAL cords , *BARRETT'S esophagus , *DYSPLASIA , *DENSITY - Abstract
Objective: The promotion of neovascularisation is a crucial aspect of carcinogenesis. The study evaluates the microvascular density (MVD) and expression of hypoxia-induced factor (HIF-1α) in hypertrophic vocal fold (VF) lesions of different histopathological states including non-dysplastic, low-grade, high-grade dysplasia and invasive glottic cancer.Materials and methods: Histological specimens collected from patients diagnosed and treated in a single centre with different histological grades were immunohistochemically stained with CD31, CD34 and HIF-1α. Of the total number of 77 analysed VF specimens, 20 were non-dysplastic, 20 had low-grade dysplasia, 17 high-grade dysplasia and 20 were invasive cancers.Results: The highest mean value for MVD evaluated with expression of CD31 (MVD CD31) was 21.23 ± 14.46 and identified in the low-grade dysplasia group. The average MVD CD31 was 13.74 ± 5.56 and 20.11 ± 9.28 in the high-grade dysplasia and invasive cancer group, respectively. The highest MVD evaluated with CD34 (MVD CD34) was revealed for invasive cancer 35.64 ± 17.21. The MVD CD34 was higher for low-grade than in high-grade dysplasia (25.87 ± 12.30 vs 24.65 ± 15.92, respectively). The expression of HIF-1α was strong or very strong in 60% of non-dysplastic lesions, 100% of low-grade dysplasia cases, 53% of high-grade dysplasia cases and 50% of invasive cancer cases. The comparison of MVD CD31 with MVD CD34 revealed a strong positive correlation (ρ value 0.727). The comparison of both MVD CD31 and MVD CD34 with HIF-1α resulted in no linear relationship (ρ value of 0.143 and 0.165, respectively).Conclusion: The stage of low-grade dysplasia in intraepithelial vocal fold lesions is related to significant advancement of angiogenesis together with the highest hypoxia level. [ABSTRACT FROM AUTHOR]
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- 2019
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115. Transoral laser microsurgery in early glottic cancer involving the anterior commissure.
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Jacobi, Christian, Freundorfer, Raffaela, and Reiter, Maximilian
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GLOTTIS , *MICROSURGERY , *SQUAMOUS cell carcinoma , *LASERS , *OPERATIVE surgery , *PROGRESSION-free survival - Abstract
Purpose: Treatment modalities for glottic cancer comprise surgery, (chemo-)radiation, and combined treatment options. Glottic cancer involving the anterior commissure (AC) requires special preoperative assessment and surgical skills, as it is commonly considered a risk factor for local recurrence. The aim of this study is to analyze the oncological effectiveness of transoral laser microsurgery (TLM) in the early glottic cancer involving the AC. Methods: We retrospectively analyzed the data of all patients with primary, early staged (T1–2) glottic squamous cell carcinoma who were treated between 2004 and 2014. Patients were preferably treated by TLM (rather than open surgical techniques) if appropriated transoral exposure of the endolarynx was ensured. Voice outcomes were not assessed. Results: 186 patients with early glottic cancer were included, 143 were treated by TLM and 43 by other therapy modalities [OT open surgical techniques (n = 32) or primary (chemo-)radiation (n = 11)], respectively. In 84 patients (59%) of the TLM cohort, the AC was involved (OT cohort n = 29 (73%), p = 0.143). The 1-, 3-, and 5-year local control rates after TLM were 91%, 86%, and 81% in patients without AC infiltration and 84%, 74%, and 70% in patients with AC infiltration, respectively, showing no statistical difference (p = 0.180). The 5-year disease-free survival and laryngeal preservation rate (LPR) did not differ with regard to AC infiltration (p = 0.215 and p = 0.261). Comparing the treatment modalities, the 5-year LPR was 90% for TLM and 83% for OT regardless of infiltration of the AC (p = 0,653 and p = 0.267, respectively). Conclusion: TLM is an effective surgical treatment for early glottic cancer with AC involvement in patients with adequate transoral laryngeal exposure. [ABSTRACT FROM AUTHOR]
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- 2019
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116. Outcomes of Treating Early Glottic Neoplasms With a Potassium Titanyl Phosphate Laser.
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Nouraei, S. A. Reza, Dorman, Edwin B., Macann, Andrew, and Vokes, David E.
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GLOTTIS , *MEDICAL lasers , *SQUAMOUS cell carcinoma , *SURVIVAL , *TREATMENT effectiveness , *ABLATION techniques ,LARYNGEAL tumors - Abstract
Objectives: The aim of this study was to assess the outcome of treating glottic dysplasia and early squamous cell carcinoma (SCC) with potassium titanyl phosphate (KTP) photoangiolytic laser ablation. Methods: Patient demographics, comorbidities, and tumor characteristics were recorded. Perceptual, patient-reported, and objective voice outcomes were assessed. Use of treatment modalities in addition to the KTP laser, development of locoregional or metastatic SCC, and overall survival were recorded. Results: There were 23 patients with glottic dysplasia and 18 patients with glottic SCC. Mean age at treatment was 69 years. Most patients (95%) were male. Posttreatment fundamental frequency fell from 132 ± 35 to 116 ± 24 Hz (P = .03). Overall, 61% of patients achieved a normal voice. There was a learning-curve, and most treatment failures occurred in the first half of the series. Five-year KTP-only disease-control rates were 87.1% and 53.5% for dysplasia and malignancy, respectively. Five-year overall survival was 56%, with no laryngectomies or deaths due to SCC. Conclusions: Ablating dysplasia and early glottic cancer using a KTP laser is a viable treatment option. It has a learning curve and a failure rate but, in this series, no ultimate loss of oncologic control. Its introduction into clinical practice should be managed carefully in the context of multidisciplinary cancer care. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]
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- 2019
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117. Lower cranial nerve palsy during radiotherapy for glottic cancer in a patient with Wegener's granulomatosis: An interesting case report.
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Lazzari, Grazia, Briatico Vangosa, Alessandra, Assunta De Cillis, Maria, Buccoliero, Giovanni, and Silvano, Giovanni
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CRANIAL nerves , *GRANULOMATOSIS with polyangiitis , *CANCER radiotherapy , *PARALYSIS , *IMMUNOSUPPRESSION , *CANCER patients - Abstract
The aim of the present study was to report an unusual case of multiple lower cranial nerve palsies in a patient with Wegener's granulomatosis (WG) during radiotherapy for glottic cancer. WG is an autoimmune disease characterized by necrotizing granulomas mainly in the upper and lower respiratory tract or kidneys; however, the involvement of cranial nerves is not uncommon. Prior to the use of cyclophosphamide (CYC) the 1-year mortality rate was ~82%; the introduction of rituximab (RTX) has revolutionized the course of the WG, with remission rates comparable to those of CYC and superior effectiveness in relapsing patients. Hypogammaglobulinemia and B-cell depletion are the best known monitored side effects affecting survival due to secondary infections. Immunodepression and relapse with lower cranial nerve palsy have a negative impact on prognosis. We herein present the case of a heavily pre-treated GPA patient with secondary immunosuppression, who underwent radiotherapy for glottic cancer and developed multiple low cranial nerve palsies during treatment, which was interrupted at 60 Gy. The possible related causes and the association between previous immunosuppressive treatments and radiotherapy were also analyzed to elucidate the cause of this complication. [ABSTRACT FROM AUTHOR]
- Published
- 2019
118. Narrow band imaging for risk stratification of glottic cancer within leukoplakia.
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Rzepakowska, Anna, Sielska‐Badurek, Ewelina, Osuch‐Wójcikiewicz, Ewa, Niemczyk, Kazimierz, and Żurek, Michal
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DIAGNOSTIC ultrasonic imaging ,DISEASE risk factors ,GLOTTIS cancer ,LEUKOPLAKIA ,PRECANCEROUS conditions - Abstract
Background: This study investigates relevance of narrow band imaging (NBI) in stratifying risk of malignant transformation within leukoplakia. Methods: We conducted a prospective analysis that included 62 patients with 91 changes of leukoplakia on vocal folds. The NBI was obtained before microsurgery. Categorization of the lesion as benign was made when vessels of surrounding epithelium were classified as type I, II, or IV according to Ni classification. If there were visualized intraepithelial papillary capillary loops of type V, the lesion was classified as malignant. Results were compared to the histopathological diagnosis. Results: The NBI assessment classified 75 lesions (82.4%) as benign and 16 (17.6%) as malignant. Histopathological results revealed the diagnosis of no dysplastic changes or low grade dysplasia in 77 cases (84.6%). Another 14 cases (15.4%) occurred with high‐grade dysplasia, carcinoma in situ, and invasive cancer. Sensitivity, specificity, and accuracy of NBI in predicting malignancy within leukoplakia were 100%, 97.4%, and 97.8%, respectively. The kappa index was 0.92 (95% confidence interval 81.1%‐100%). Conclusion: The noninvasive procedure of an NBI endoscopy may be recommended as an accurate method in predicting the risk of malignant transformation within the vocal fold leukoplakia and, therefore, would be useful in the clinic for planning the patient's therapy. [ABSTRACT FROM AUTHOR]
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- 2018
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119. Researcher from Regional Cancer Center Reports Details of New Studies and Findings in the Area of Glottic Cancer (Impact of Anterior Commissure Involvement and Frozen Guided Resections on Oncological Outcomes after Laser Cordectomy in Early...).
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A recent study conducted in India examined the treatment options for early glottic cancer, specifically focusing on transoral laser microsurgery (TLM). The study found that TLM is a safe and effective treatment for early glottic carcinoma, with comparable oncological benefits to open partial laryngectomy (OPL) and radiation therapy (RT). The study also highlighted the importance of considering anterior commissure involvement (ACI) and frozen margin positivity as negative predictive factors. The findings suggest that ACI should be taken into account when staging glottic tumors and that vigilant follow-up is necessary for patients with frozen margin positivity. [Extracted from the article]
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- 2023
120. Study Results from Dalhousie University in the Area of Glottic Cancer Reported (Management of Positive Resection Margins Following Transoral Laser Microsurgery for Glottic Cancer).
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A study conducted by Dalhousie University in Halifax, Canada, explored the management of positive resection margins (PMs) following transoral laser microsurgery (TLM) for glottic squamous cell carcinoma (SCC). The study found that re-resection was an appropriate treatment for cases of PMs, based on long-term data collected from 2007 to 2018. Close observation as a management strategy for PMs was discontinued due to a high rate of recurrence. The study concluded that re-resection is an effective treatment option for early-stage glottic SCC. [Extracted from the article]
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- 2023
121. Investigators at Taipei Veterans General Hospital Describe Findings in Glottic Cancer (Long-term Oncologic Results and Voice Outcomes In Patients With Glottic Cancer After Modified Type Iii Cordectomy).
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Keywords: Taipei; Taiwan; Asia; Cancer; Cordectomy; Drugs and Therapies; Glottic Cancer; Glottic Carcinoma; Health and Medicine; Oncology; Radiotherapy; Surgery EN Taipei Taiwan Asia Cancer Cordectomy Drugs and Therapies Glottic Cancer Glottic Carcinoma Health and Medicine Oncology Radiotherapy Surgery 596 596 1 11/06/23 20231110 NES 231110 2023 NOV 7 (NewsRx) -- By a News Reporter-Staff News Editor at Drug Week -- Data detailed on Oncology - Glottic Cancer have been presented. Taipei, Taiwan, Asia, Cancer, Cordectomy, Drugs and Therapies, Glottic Cancer, Health and Medicine, Oncology, Radiotherapy, Surgery, Glottic Carcinoma. [Extracted from the article]
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- 2023
122. Study Results from Yildirim Beyazit University Broaden Understanding of Glottic Cancer (Oncological Outcomes of Transoral Laryngeal Microsurgery With Fiber-optic Diode Laser for Early Glottic Cancer: a Single-center Experience).
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Keywords: Ankara; Turkey; Eurasia; Cancer; Cordectomy; Glottic Cancer; Glottic Carcinoma; Health and Medicine; Microsurgery; Oncology; Operative Surgical Procedures; Surgery EN Ankara Turkey Eurasia Cancer Cordectomy Glottic Cancer Glottic Carcinoma Health and Medicine Microsurgery Oncology Operative Surgical Procedures Surgery 1533 1533 1 10/30/23 20231103 NES 231103 2023 OCT 31 (NewsRx) -- By a News Reporter-Staff News Editor at Medical Devices & Surgical Technology Week -- Data detailed on Oncology - Glottic Cancer have been presented. Ankara, Turkey, Eurasia, Cancer, Cordectomy, Glottic Cancer, Glottic Carcinoma, Health and Medicine, Microsurgery, Oncology, Operative Surgical Procedures, Surgery. [Extracted from the article]
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- 2023
123. New Squamous Cell Carcinoma Study Results Reported from Kurume University (Comparative Treatment Outcome In T3n0 Glottic Cancer With and Without Vocal Fold Fixation Receiving Radiation Therapy and Concurrent Low-dose Intra-arterial Cisplatin...).
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Keywords: Fukuoka; Japan; Asia; Alkylating Agents; Antineoplastics; Cancer; Chlorine Compounds; Cisplatin Therapy; Drugs and Therapies; Glottic Cancer; Glottic Carcinoma; Health and Medicine; Nitrogen Compounds; Oncology; Pharmaceuticals; Platinum Compounds; Radiation Therapy; Squamous Cell Carcinoma EN Fukuoka Japan Asia Alkylating Agents Antineoplastics Cancer Chlorine Compounds Cisplatin Therapy Drugs and Therapies Glottic Cancer Glottic Carcinoma Health and Medicine Nitrogen Compounds Oncology Pharmaceuticals Platinum Compounds Radiation Therapy Squamous Cell Carcinoma 602 602 1 10/24/23 20231024 NES 231024 2023 OCT 24 (NewsRx) -- By a News Reporter-Staff News Editor at Cancer Weekly -- Investigators discuss new findings in Oncology - Squamous Cell Carcinoma. For more information on this research see: Comparative Treatment Outcome In T3n0 Glottic Cancer With and Without Vocal Fold Fixation Receiving Radiation Therapy and Concurrent Low-dose Intra-arterial Cisplatin Infusion. [Extracted from the article]
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- 2023
124. Investigators at University of Alabama Birmingham Describe Findings in Glottic Cancer (Transcriptional Subtypes of Glottic Cancer Characterized By Differential Activation of Canonical Oncogenic Programming).
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Keywords for this news article include: Birmingham, Alabama, United States, North and Central America, Cancer, Glottic Cancer, Glottic Carcinoma, Health and Medicine, Oncology, University of Alabama Birmingham. Keywords: Birmingham; State:Alabama; United States; North and Central America; Cancer; Glottic Cancer; Glottic Carcinoma; Health and Medicine; Oncology EN Birmingham State:Alabama United States North and Central America Cancer Glottic Cancer Glottic Carcinoma Health and Medicine Oncology 418 418 1 10/16/23 20231017 NES 231017 2023 OCT 17 (NewsRx) -- By a News Reporter-Staff News Editor at Cancer Weekly -- Current study results on Oncology - Glottic Cancer have been published. [Extracted from the article]
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- 2023
125. Comparison Between Early Glottic Carcinoma and Epithelial Dysplastic Lesions of the Vocal Fold Via Voice Analysis
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Young Ae Kang, Ho-Ryun Won, Jae Won Chang, and Bon Seok Koo
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Male ,Glottis ,medicine.medical_specialty ,Vocal Cords ,Voice analysis ,030507 speech-language pathology & audiology ,03 medical and health sciences ,Speech and Hearing ,0302 clinical medicine ,Biopsy ,Carcinoma ,medicine ,Humans ,030223 otorhinolaryngology ,Laryngeal Neoplasms ,Pathological ,Leukoplakia ,medicine.diagnostic_test ,business.industry ,Carcinoma in situ ,LPN and LVN ,medicine.disease ,Otorhinolaryngology ,Dysplasia ,Glottic cancer ,Radiology ,0305 other medical science ,business ,Carcinoma in Situ - Abstract
Vocal fold leukoplakia is clinically defined by the presence of white mucosal lesions. Benign and malignant lesions of vocal fold leukoplakia can be distinguished clinically based on pathological biopsy. This study compared the acoustic and aerodynamic parameters of vocal cord carcinoma and dysplasia (mild to severe).From February 2014 to December 2018, 1,925 voice evaluation assessments were collected before laryngeal microsurgery (LMS). Of 147 patients clinically diagnosed with vocal cord leukoplakia before LMS, 112 male patients were selected for examination. The pathologic findings after LMS were divided into the carcinoma group (56 patients) and dysplasia group (56 patients). Only patients with carcinoma in situ and early glottis cancer were included in the carcinoma group. Analysis of covariance was used to calibrate the age between the two groups.There was no difference in smoking duration between the two groups. F0 (P0.00), jitter (P0.00), and mean pitch (P = 0.010) were significantly higher, while the mean sound pressure level parameter (P = 0.024) was significantly lower, in the carcinoma group than in the noncarcinoma group.In patients with early glottis cancer, differences in voice analysis parameters may be used to differentiate between early glottic carcinoma and noncarcinoma.
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- 2021
126. Larynx Cancer
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Cahlon, Oren, Riaz, Nadeem, Lee, Nancy Y., Lee, Nancy Y., editor, and Lu, Jiade J., editor
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- 2013
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127. Single Stage Transoral Laser Microsurgery for Early Glottic Cancer
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Yaniv Hamzany, Hagit Shoffel-Havakuk, Stav Devons-Sberro, Shani Shteinberg, Dan Yaniv, and Aviram Mizrachi
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glottic cancer ,CO2 laser ,excisional biopsy ,single stage ,transoral laser microsurgery ,complete removal ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Objectives: The purpose of the study was to present the outcome of our management protocol of a single stage transoral laser microsurgery (SSTLM), with the intention of complete removal of a lesion, considered to be an early glottic cancer.Methods: Between January 2015 to February 2017 patients with the clinical appearance of an early glottic cancer, who were candidates for (SSTLM) management protocol, were included in this study. Type of cordectomy was determined by pre- and intra-operative evaluation of the extent of lesion in cord layers.Results: Thirty patients (6 females, 24 males; mean age 65 years) underwent SSTLM. Twenty-two patients had malignant histopathological diagnosis of severe dysplasia or Cis in 4 patients, microinvasice carcinoma in 3 patients and invasive carcinoma in 15 patients (T1a tumor in 14 and T1b tumor in 1). Eight patients had a nonmalignant histological diagnosis of keratosis without atypia in 2 patients, mild dysplasia in 2 patients and moderate dysplasia in 3 patients. Based on pre- and intra-operative evaluation, 14 subepithelial (type I), 10 subligamental (type II), and 6 transmuscular (type III) cordectomies were performed. Comparison of cordectomies types with postoperative histopathologic diagnosis showed an adequate extent of resection in 26 out of 30 patients (87%). Considering only patients without recent background of direct laryngoscopy and biopsy, an adequate resection was performed in 90% of patients. None of the patients was further treated by external beam radiation. At average follow-up of 21 months, none of the patients developed local recurrence.Conclusion: In selected cases, a SSTLM for clinical appearance of an early glottic cancer, allows a reliable histopathologic diagnosis and a high local control rate with favorable cost effectiveness. A careful pre- and intraoperative evaluation for selecting the appropriate cases for this management is required in order to avoid under- or over-treatment.
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- 2018
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128. Vocal Fold Cancer Transoral Laser Microsurgery Following European Laryngological Society Laser Cordectomy Classification
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Abie H. Mendelsohn and Marc Joseph Remacle
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laser cordectomy ,glottic cancer ,voice ,endoscopy ,KTP ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
BackgroundThe surgical treatment of glottic, or vocal cord, cancer has seen considerable progression over the past several decades. Specifically, there has been a stark transition from open partial laryngectomy surgery to endoscopic laser microsurgical techniques which have been inspired in large part by two landmark studies: Professor Wolfgang Steiner’s original case series describing transoral laser microsurgery for glottic cancer (1993) and the European Laryngological Society’s (ELS) classification scheme (2000). We performed a comprehensive review of published literature to characterize the pattern of this novel modality as compared with two landmark studies over the past four decades.MethodsAn English literature search was conducted on PubMed for available original investigations on surgical treatment of glottic laryngeal cancer published over the past 40 years. Our Boolean criteria included the following terms: cancer, glottic, laryngeal, surgery, endoscopic, and laser. The publication rates were calculated as annual compound growth as well as corrected growth rates as defined by the Fisher equation for inflation effects.ResultsOur review identified 13,372 studies covering larynx cancer and 3,557 studies covering glottic cancer original studies. Among these, we analyzed the compound annual growth rates and correct growth rates for three distinct publication periods or epochs, prior to 1993, 1993–1999, and 2000–2017. For all but two of the search term groups covering both glottic cancer as well as larynx cancer, there was a substantial growth improvement in the time period following the ELS classification scheme as compared with the growth rate of the time period following Steiner’s case series.ConclusionThe progress toward minimally invasive treatment of glottic cancer has progressed steadily over the past several decades. Analysis of publication show increased growth during the time period following the ELS classification scheme over the time period following Steiner’s landmark study. A mistake would be concluding any diminished importance of Professor Steiner’s work, instead, our analysis demonstrates the wide-spread adoption of the endoscopic laser cordectomy procedure following the ELS classification system. Complex surgical techniques such as transoral laser microsurgery are optimally disseminated within well-defined classification schemes, though further validation is warranted.
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- 2018
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129. Three-Dimensional Map of Isoprognostic Zones in Glottic Cancer Treated by Transoral Laser Microsurgery as a Unimodal Treatment Strategy
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Cesare Piazza, Marta Filauro, Alberto Paderno, Filippo Marchi, Pietro Perotti, Riccardo Morello, Stefano Taboni, Giampiero Parrinello, Fabiola Incandela, Andrea Iandelli, Francesco Missale, and Giorgio Peretti
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transoral laser microsurgery ,laryngeal cancer ,glottic cancer ,carbon dioxide laser ,prognosis ,oncologic outcomes ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
IntroductionThe Union for International Cancer Control–American Joint Committee on Cancer TNM staging system for glottic squamous cell carcinoma (SCC) includes different types of lesions defined by the involvement of specific subsites in each T category. Our study aims to identify different subcategories according to tumor local extension and determine oncologic outcomes after treatment by transoral laser microsurgery (TLM) alone.MethodsWe retrospectively evaluated 410 patients affected by previously untreated pT1-pT3 glottic SCC treated by TLM alone from January 2005 to December 2015 at the Departments of Otorhinolaryngology—Head and Neck Surgery, Universities of Genoa and Brescia, Italy. All patients had at least 2 years of follow-up. Clinical, radiological, surgical, and histopathological data were reviewed and tumors divided into six subcategories: I, pT1a not involving the anterior commissure (AC); II, pT1b involving the AC; III, pT2 extending superficially to the supraglottis or the subglottis; IV, pT2 infiltrating the vocal muscle; V, pT3 involving the anterior paraglottic space; VI, pT2 or pT3 with vertical extension across the AC with/without involvement of the pre-epiglottic space. Recurrence-free survival (RFS), local control with laser alone (LCL), and organ preservation (OP) were defined as the primary oncologic outcomes.ResultsThe 2, 5, and 10-year RFS for the entire series were 85.7, 80.3, and 73.8%, LCL rates 93.8, 92.1, and 89.6%, and OP rates 96.8, 95.9, and 93.5%, respectively. However, when comparing the rates of RFS, LCL, and OP for each subcategory, important differences emerged. In particular, subcategories V and VI showed a significantly increased risk of local recurrence [hazard ratio (HR) = 9.2 and 13.3, respectively]. These subcategories also had a significantly reduced probability to achieve LCL (HR: 73.6 and 93.5, respectively) and OP (HR: 6.4 and 8.1, respectively).ConclusionThe present classification in subcategories allows introducing the concept of a three-dimensional map of isoprognostic zones in glottic SCC treated by TLM alone as a useful tool in its management by a multidisciplinary tumor board.
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- 2018
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130. High Frequency Jet Ventilation during Transoral Laser Microsurgery for Tis-T2 Laryngeal Cancer
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Francesco Mora, Francesco Missale, Fabiola Incandela, Marta Filauro, Giampiero Parrinello, Alberto Paderno, Palmiro Della Casa, Cesare Piazza, and Giorgio Peretti
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high frequency jet ventilation ,transoral laser microsurgery ,laryngeal cancer ,glottic cancer ,supraglottic cancer ,surgical margins ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
BackgroundTransoral laser microsurgery (TLM) for early to intermediate laryngeal squamous cell cancer (SCC) can be technically challenging when adequate exposure of the posterior laryngeal compartment is required due to the presence of the orotracheal tube. The goal of our study was to analyze the efficacy of high frequency jet ventilation (HFJV) in achieving appropriate laryngeal exposure and safe oncologic resection of lesions located in such a position.MethodsWe reviewed the clinical records of 62 patients affected by Tis-T2 SCC of the posterior laryngeal compartment treated by TLM between 02/2012 and 12/2016. The cohort was divided into two groups according to the anesthesiologic technique used: Group A included patients treated using intraoperative infraglottic HFJV, while Group B encompassed patients treated by standard orotracheal intubation. The main outcome was postoperative surgical margin status. Group comparison analysis was performed.ResultsSignificant difference in deep margin status was observed between the two groups: in Group A, the rate of negative deep margins was 86% compared to 56% in Group B (p = 0.04). A trend of better overall and superficial margin control was observed for patients treated using HFJV (Group A), although no statistical significance was achieved.ConclusionUse of HFJV during TLM allows easier and safer management of patients affected by Tis-T2 SCC of the posterior laryngeal compartment, reducing the rates of positive superficial and deep surgical margins.
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- 2017
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131. Comparative Treatment Outcome in T3N0 Glottic Cancer With and Without Vocal Fold Fixation Receiving Radiation Therapy and Concurrent Low-Dose Intra-Arterial Cisplatin Infusion
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Shintarou Sueyoshi, Chikayuki Hattori, Chiyoko Tsuji, Hirohito Umeno, Norimitsu Tanaka, Koichiro Muraki, Takeharu Ono, Takashi Kurita, Syuichi Tanoue, Yusaku Miyata, Mioko Fukahori, Toshi Abe, Kiminobu Sato, Etsuyo Ogo, and Shun-ichi Chitose
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medicine.medical_specialty ,medicine.medical_treatment ,Treatment outcome ,Urology ,Antineoplastic Agents ,Vocal Cords ,Intra arterial ,Humans ,Medicine ,Laryngeal Neoplasms ,Retrospective Studies ,Fixation (histology) ,Cisplatin ,Squamous Cell Carcinoma of Head and Neck ,business.industry ,Low dose ,General Medicine ,Tongue Neoplasms ,Radiation therapy ,Treatment Outcome ,Otorhinolaryngology ,Head and Neck Neoplasms ,Glottic cancer ,Concomitant ,Carcinoma, Squamous Cell ,business ,medicine.drug - Abstract
Objectives: Selective radiotherapy and concomitant intra-arterial cisplatin infusion (m-RADPLAT) with a lower cisplatin dosage have been performed for organ and function preservation in patients with locally advanced squamous cell carcinoma of the larynx (SCC-L), and results showing a lower rate of adverse events have been reported. This study evaluated the treatment outcomes of patients with T3N0 glottic SCC-L with or without vocal fold fixation (VFF) who were treated with m-RADPLAT. Methods: We retrospectively reviewed the data of 33 patients with T3N0 SCC-L who received m-RADPLAT. Results: The vocal fold in patients with VFF 3 months after completing m-RADPLAT resumed normal movement in 15 patients (83%) and persisted fixation in 3 (17%). The 3-year local control, laryngeal cancer-specific survival, and overall survival rates of patients with or without VFF were 88.9% and 86.7%, 94.1% and 93.3%, and 88.9% and 86.7%, respectively. Additionally, the 3-year freedom from laryngectomy, laryngectomy-free survival, and laryngo-esophageal dysfunction-free survival rates of patients with or without VFF were 94.4% and 86.7%, 88.9% and 73.3%, and 83.3% and 73.3%, respectively. Grade 3 or higher toxicities were observed in all patients: leukopenia in 4 patients (12%), neutropenia in 5 (15%), anemia in 2 (6%), thrombocytopenia in 3 (9%), and mucositis in 2 (6%). Conclusions: This study demonstrated that m-RADPLAT yielded VFF improvement and a favorable survival while maintaining laryngeal function not only in patients with T3N0 glottic SCC-L without VFF but also in patients with VFF.
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- 2021
132. Hypofractionated Radiotherapy of Early Glottic Cancer - A Single Institution Experience of 52.5 Gray in 15 Fractions among Patients Attending a Tertiary Care Center
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Preeya Vasanthakumary, Gargy Anjolian David, Anjana Sasikumar Nair, Anilkumar Karumathil, and Siva Rama Krishnan Ramachandran
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Hypofractionated Radiotherapy ,medicine.medical_specialty ,business.industry ,Glottic cancer ,General surgery ,medicine ,Center (algebra and category theory) ,Single institution ,business ,Tertiary care ,Gray (unit) - Abstract
BACKGROUND The standard conventional radiation schedule for early laryngeal cancer is 64 - 70 Gy in 2 Gy per fraction over 6.5 - 7 weeks. Hypofractionated radiotherapy in early laryngeal cancer allows delivery of larger dose per fraction (fraction size) in decreased overall treatment time with improved local control and similar survival rates. Reduction in treatment time also optimizes the usage of radiotherapy resources. The purpose of this study was to estimate the local control rates, survival rates and toxicity profile of hypofractionated radiotherapy of 52.5 Gy in 15 fractions for early glottic cancer. METHODS Twenty-eight patients with early glottic squamous cell carcinoma (SCC) treated with hypofractionated definitive radiotherapy from June 2015 to December 2019 were analyzed. The median age was 61 years. Total dose of 52.5 Gy in 15 fractions was delivered over three-four weeks with a fraction size of 3.5 Gy. The median follow-up period was 23.8 months. RESULTS The 5-year local control rates were 96.4 % with one recurrence. The 5-year overall survival rate was 100 % and cause specific survival at 5 years was 100 %. There was no association of T1 sub staging, T2 (P - 0.40) and no significant association of anterior commissure involvement (P = 0.408, chi square value = 3.982) and pretreatment haemoglobin (P - 0.480) on local control. Late complications include laryngeal oedema (21.5 %), altered thyroid function (3.6 %), cardiac complication (3.6 %) and altered voice quality (14.3 %).There was no association of local control with field size (FS) (P = 0.812), beam energy (P = 0.098 ) overall treatment time of less than thirty days (P - 0.747). CONCLUSIONS Local control with hypofractionated radiotherapy for early laryngeal glottis squamous cell carcinoma is excellent with no severe complications. The short overall treatment time enables channelling of radiotherapy resources in low budget countries with long wait list for radiation. KEYWORDS Early Laryngeal Cancer, Glottic Cancer, Hypofractionated Radiotherapy, Overall Treatment Time.
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- 2021
133. Assessment of Early Stage Glottic Cancer Depth of Resection After Transoral Laser Cordectomy
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Tal Goldman, Eran Fridman, Jacob T. Cohen, and Miki Paker
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Laser surgery ,Larynx ,Glottis ,medicine.medical_specialty ,medicine.medical_treatment ,Vocal Cords ,law.invention ,Resection ,law ,medicine ,Humans ,Stage (cooking) ,Laryngeal Neoplasms ,Retrospective Studies ,business.industry ,Lasers ,Laser ,Tongue Neoplasms ,Treatment Outcome ,medicine.anatomical_structure ,Otorhinolaryngology ,Glottic cancer ,Cordectomy ,Surgery ,Laser Therapy ,Radiology ,business - Abstract
Surgeons generally determine depth of resection during transoral laser cordectomy by visual inspection of the surgical field. Our aim was to examine the correlation between early glottic cancer depth of resection as reported by surgeons in the operation report and depth of resection defined by pathology specimens, using various staining techniques intended to differentiate between the distinct vocal fold layers based on particular collagen deposition.Retrospective study.A voice and swallowing clinic at a tertiary referral hospital.We compared depth of cordectomy assessed intraoperatively by surgeons and by pathologists using Picrosirius red stain and collagen I immunohistochemistry stain in 32 patients who underwent transoral laser cordectomy for early glottic cancer.For type I, II, and III cordectomy, the respective proportions of patients were 14 (47%), 9 (30%), and 7 (23%) according to surgeons' estimations; 2 (6%), 17 (55%), and 12 (39%) according to Picrosirius red stain; and 3 (11%), 12 (44%), and 12 (45%) according to immunohistochemistry for collagen I.Surgeons' reported depth of resection did not correlate with depth of resection established by either staining technique. Determining depth of resection necessitates special stains, which should help in the clinical assessment of cordectomy type.
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- 2021
134. Near-complete glottic obstruction from a loose glottic cancer mass
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Ke, Janny Xue Chen, Wafa, Karim, Piccott, Devin, and Galgay, Susan
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- 2021
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135. Voice rehabilitation with tragal cartilage and perichondrium after vertical partial laryngectomy for glottic cancer
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Magdalena Chirila, Cristina Tiple, Florina Veronica Dinescu, Rodica Muresan, and Sorana D Bolboaca
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Cartilage ,glottic cancer ,medialization ,partial laryngectomy ,perichodrium ,voice restoration ,Medicine - Abstract
Background: The goal of the study is to test medialization of the neocord after oncological surgery for glottic cancer, using autologous tragal cartilage and perichondrium by the direct approach. Materials and Methods: Sixteen patients underwent comprehensive assessment including auditory perceptual assessment, videostrobolaryngoscopy, and acoustic voice analysis. The cartilage graft was inserted into a pocket created in the tyroarytenoid - lateral cricoarytenoid muscle complex or the excavated musculomembranous part of the neocord, and fixed by placing the perichondrium by the direct approach. The patients were evaluated preoperatively, and at 14 days, 60 days, and 6 months later. Results: Improvement of voice and breathiness was correlated with the increase of closed quotient and harmonic-to-noise ratio; the acoustic voice parameters studied showed significant differences between preoperative and postoperative voices, and these objective measurements of voice changes provided accurate and documentary evidence of the results of surgical treatment. Conclusion: This method may be considered a safe and efficient phonosurgical procedure for voice restoration.
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- 2015
136. The Multimodal Diagnostic Approach Necessary in Detecting Elusive Submucosal Laryngeal Cancer.
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Reimer CS and Dowdall JR
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Submucosal laryngeal lesions have proven themselves to be a diagnostic challenge in the field of medicine, often presenting inconsistently between endoscopic visualization, various imaging modalities, and biopsy. The conflicting clinical picture can lead to a delay in definitive diagnosis and treatment. A variety of laryngeal imaging modalities exist that give a unique perspective of the tumor being evaluated and can be used in combination to clarify discrepancies in presentation. This report describes the clinical course of an undiagnosed laryngeal squamous cell carcinoma (SCC) presenting with persistent dysphonia, dysphagia, and unilateral vocal fold immobility. A negative head and neck computerized tomography (CT) scan reduced the concern for cancer, so symptomatic treatment with vocal fold augmentation was performed. Augmentation curiously worsened the dysphonia and also may have delayed the process of definitive diagnosis. Upon presenting to the laryngology clinic, stroboscopy demonstrated no vibration of the affected vocal fold. Submucosal vascular irregularity was noted with narrow band imaging with a very subtle keratotic mucosal change raising suspicion for underlying malignancy. Despite two CT scans that failed to visualize the lesion initially, a biopsy revealed keratinizing SCC, which was subsequently staged as T3N0M0. The patient elected to receive radiation therapy alone given his medical comorbidities. This case showcases the elusive ability submucosal laryngeal cancers have in diagnostic workups. Heavy reliance on any single diagnostic modality may be misleading, resulting in delayed diagnosis and treatment. An early, thorough, and multimodal approach that analyzes the cumulative results of a variety of diagnostic tools is essential in identifying and treating these elusive cancers in a timely manner., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Reimer et al.)
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- 2023
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137. Clinical Outcomes of Radiotherapy for Stage 1 Glottic Carcinoma: Comparing Accelerated Hyperfractionation and Once-daily Fractionation.
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Endo M, Fukuda Y, Okada K, Ogawa K, Nakamura M, Takahashi S, Murakami E, Shibayama C, Kawahara M, Akahane K, Onaga R, Nagatomo T, Kanazawa T, Nishino H, Mori H, and Shirai K
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- Humans, Retrospective Studies, Dose Fractionation, Radiation, Radiotherapy Dosage, Radiotherapy, Carcinoma, Squamous Cell pathology, Laryngeal Neoplasms radiotherapy, Pneumonia, Aspiration
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Background/aim: Accelerated hyperfractionation (AHF) is used in head and neck cancer to improve the local control (LC) rate, but reports of outcomes for early-stage GC are limited. The outcomes of radiotherapy (RT) for stage 1 glottic carcinoma (GC) were retrospectively analyzed, comparing AHF and once-daily fractionation (ODF) using 2.0-2.4 Gy., Patients and Methods: A total of 102 patients with stage 1 GC underwent RT alone between 2007 and 2021, with 43 in the AHF group and 59 in the ODF group. A p-value less than 0.05 was considered to indicate a significant difference., Results: The 5-year LC rate was 98% in the AHF group and 91% in the ODF group (p=0.19). During RT, significantly more patients in the AHF group required opioids due to mucositis than in the ODF group (74% vs. 25%, p<0.001), and the rate of aspiration pneumonia tended to be higher in the AHF group than in the ODF group (7% vs. 0%, p=0.072)., Conclusion: There was no difference in the LC rate between AHF and ODF for stage 1 GC. Moreover, the AHF group required opioids at a higher rate and tended to have a higher risk of developing aspiration pneumonia., (Copyright © 2023, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)
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- 2023
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138. Overview of glottic laryngeal cancer treatment recommendation changes in the NCCN guidelines from 2011 to 2022.
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Arboleda LPA, Neves AB, Kohler HF, Vartanian JG, Candelária LM, Borges MF, Fernandes GA, de Carvalho GB, Kowalski LP, Brennan P, Santos-Silva AR, and Curado MP
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- Humans, Quality of Life, Glottis surgery, Glottis pathology, Laryngeal Neoplasms pathology, Laryngeal Neoplasms radiotherapy, Larynx pathology, Larynx surgery, Head and Neck Neoplasms pathology, Tongue Neoplasms pathology
- Abstract
Background: The treatment of glottic cancer remains challenging, especially with regard to morbidity reduction and larynx preservation rates. The National Comprehensive Cancer Network (NCCN) has published guidelines to aid decision-making about this treatment according to the tumor site, clinical stage, and patient medical status., Aim: The present review was conducted to identify changes in the NCCN guidelines for glottic cancer treatment made between 2011 and 2022 and to describe the published evidence concerning glottic cancer treatment and oncological outcomes in the same time period., Methods and Results: Clinical practice guidelines for head and neck cancer published from 2011 up to 2022 were obtained from the NCCN website (www.NCCN.org). Data on glottic cancer treatment recommendations were extracted, and descriptive analysis was performed. In addition, a review of literature registered in the PubMed database was performed to obtain data on glottic cancer management protocols and treatment outcomes from randomized controlled trials, systematic reviews, and meta-analyses published from 2011 to 2022. In total, 24 NCCN guidelines and updates and 68 relevant studies included in the PubMed database were identified. The main guideline changes made pertained to surgical and systemic therapies, the consideration of adverse features, and new options for the treatment of metastatic disease at initial presentation. Early-stage glottic cancer received the most research attention, with transoral endoscopic laser surgery and radiotherapy assessed and compared as the main treatment modalities. Reported associations between treatment types and survival rates for this stage of glottic cancer appear to be similar, but functional outcomes can be highly compromised., Conclusion: NCCN panel members provide updated recommendations based on currently accepted treatment approaches for glottic cancer, constantly reviewing new surgical and non-surgical techniques. The guidelines support decision-making about glottic cancer treatment that should be individualized and prioritize patients' quality of life, functionality, and preferences., (© 2023 The Authors. Cancer Reports published by Wiley Periodicals LLC.)
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- 2023
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139. Laryngeal Cancer
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Chevalier, Dominique, Lefèbvre, Jean Louis, Arnold, Wolfgang, editor, Ganzer, Uwe, editor, Anniko, Matti, editor, Bernal-Sprekelsen, Manuel, editor, Bonkowsky, Viktor, editor, Bradley, Patrick J., editor, and Iurato, Salvatore, editor
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- 2010
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140. Voice Outcomes after Radiotherapy Treatment for Early Glottic Cancer: Long-Term Follow-Up.
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Watson, Megan, Drosdowsky, Allison, Frowen, Jacqui, and Corry, June
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Summary Objectives The aim of this study was to investigate long-term voice outcomes and voice-related quality of life (QOL) for early glottic cancer treated with radiotherapy. Study Design Long-term exploratory follow-up study of a prospective patient cohort comparing outcomes at a mean of 11 years postradiotherapy with the original 1-year posttreatment results. Method Eight patients completed voice tasks for auditory perception and acoustic and aerodynamic measures. Patient-reported voice-related QOL (VR-QOL) and voice quality were measured. Changes in outcomes over time were analysed using repeated-measures linear mixed models. Results Acoustic and aerodynamic outcomes remained stable from 1 year postradiotherapy to long-term follow-up, with only jitter mildly increasing from 1.9% at 1 year posttreatment to 2.8% (difference = 1.0%, 95% confidence interval [CI] = 0.1–1.9). Perceptually, voice remained relatively stable with only phonation breaks slightly increasing within the normal range, from 1.1 to 1.7 (difference = 0.6, 95% CI = 0.3–0.9) and breathy quality increasing from normal to slight impairment, with scores increasing from 1.8 to 2.4 (difference = 0.6, 95% CI = 0.3–1.1). QOL scores indicate a good level of VR-QOL that were unchanged at long-term follow-up when compared with 1 year posttreatment. Conclusions Improvement in voice outcomes found at 1 year postradiotherapy were largely maintained long term, with only minor changes observed. QOL scores indicate that a high level of VR-QOL was maintained many years after curative radiotherapy. [ABSTRACT FROM AUTHOR]
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- 2018
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141. Single Stage Transoral Laser Microsurgery for Early Glottic Cancer.
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Hamzany, Yaniv, Shoffel-Havakuk, Hagit, Devons-Sberro, Stav, Shteinberg, Shani, Yaniv, Dan, and Mizrachi, Aviram
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LARYNGEAL cancer treatment ,MICROSURGERY - Abstract
Objectives: The purpose of the study was to present the outcome of our management protocol of a single stage transoral laser microsurgery (SSTLM), with the intention of complete removal of a lesion, considered to be an early glottic cancer. Methods: Between January 2015 to February 2017 patients with the clinical appearance of an early glottic cancer, who were candidates for (SSTLM) management protocol, were included in this study. Type of cordectomy was determined by pre- and intra-operative evaluation of the extent of lesion in cord layers. Results: Thirty patients (6 females, 24 males; mean age 65 years) underwent SSTLM. Twenty-two patients had malignant histopathological diagnosis of severe dysplasia or Cis in 4 patients, microinvasice carcinoma in 3 patients and invasive carcinoma in 15 patients (T1a tumor in 14 and T1b tumor in 1). Eight patients had a nonmalignant histological diagnosis of keratosis without atypia in 2 patients, mild dysplasia in 2 patients and moderate dysplasia in 3 patients. Based on pre- and intra-operative evaluation, 14 subepithelial (type I), 10 subligamental (type II), and 6 transmuscular (type III) cordectomies were performed. Comparison of cordectomies types with postoperative histopathologic diagnosis showed an adequate extent of resection in 26 out of 30 patients (87%). Considering only patients without recent background of direct laryngoscopy and biopsy, an adequate resection was performed in 90%of patients. None of the patients was further treated by external beam radiation. At average follow-up of 21 months, none of the patients developed local recurrence. Conclusion: In selected cases, a SSTLM for clinical appearance of an early glottic cancer, allows a reliable histopathologic diagnosis and a high local control rate with favorable cost effectiveness. A careful pre- and intraoperative evaluation for selecting the appropriate cases for this management is required in order to avoid under- or over-treatment. [ABSTRACT FROM AUTHOR]
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- 2018
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142. An unusual case of a glottic carcinoma metastasis to the tracheal lumen.
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Blioskas, Sarantis, Karkos, Peter, Konstantinidis, Iordanis, Chatzopoulos, Kyriakos, Psillas, George, Chytiroglou, Prodromos, and Markou, Konstantinos
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METASTASIS , *LARYNGEAL cancer - Abstract
Various mechanisms such as second primary lesion, tumour seeding or lymphogenous and haematogenous metastasis could be proposed to explain the nature of dual malignant lesions. We report the case of a glottic laryngeal carcinoma combined with a secondary endotracheal tumour. Following the imaging modalities, the patient underwent total laryngectomy and wide excision of the trachea. Histopathology ultimately established that the tracheal lesion was a metastatic tumour secondary to regional lymphatic spread of the glottic tumour. To our knowledge, there is no previous report in the English literature concerning tracheal lymphogenous metastatic involvement in the context of laryngeal malignancy. Paradoxical lymphatic spread must always remain an issue of head and neck oncology. [ABSTRACT FROM AUTHOR]
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- 2018
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143. Is There a Change in the Treatment of T1 Glottic Cancer After CO2 Laser? A Comparative Study with Cold Steel.
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Demir, Uygar Levent, Çevik, Turgut, and Kasapoğlu, Fikret
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LARYNGEAL cancer treatment , *CARBON dioxide lasers , *ONCOLOGIC surgery , *SURGICAL complications , *ANTERIOR commissure - Abstract
Objective: Carbon dioxide (CO2) laser provides high local control and disease-specific survival rates with minor morbidity and good quality of life in transoral cordectomy. We aimed to compare the oncological outcome and survival between cold steel and CO2 laser in the treatment of early glottic cancer. Methods: In this retrospective study, the participants were divided into two groups. The first group comprised patients who were operated upon between 2001 and 2007 using cold steel (group 1, n=38), and the second group comprised patients who were operated upon between 2008 and 2016 using CO2 laser (group 2, n=88). Both groups were compared regarding age, gender, pathological grade, T stage, type of cordectomy, margin status, anterior commissure involvement, follow-up, locoregional recurrence, and disease- free survival (DFS). Results: The overall survival rate and DFS were similar between the two groups (94.7% vs. 98.9% and 100% vs. 98.9%, respectively), and no association was found between surgical margin positivity and local recurrence. However, a significant association between the presence of anterior commissure involvement and recurrence was found in all 126 patients (p=0.016). Local recurrence was significantly higher in the group 2 (p=0.024), but it did not affect overall survival and DFS in these patients (100% vs. 94.1%). Conclusion: Although CO2 laser excision is considered to be superior to cold steel regarding surgical time and bleeding control, the local recurrence rates were found to be higher with the laser than the cold steel. Thus, we argue that cases should be selected more carefully concerning the anterior commissure, depth of tumor invasion lateral to vocal muscle, difficulty at endoscopic exposure for lesions with anterior commissure involvement, and reliability of surgical margins at frozen sections. [ABSTRACT FROM AUTHOR]
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- 2018
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144. Three-Dimensional Map of Isoprognostic Zones in Glottic Cancer Treated by Transoral Laser Microsurgery as a Unimodal Treatment Strategy.
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Piazza, Cesare, Filauro, Marta, Paderno, Alberto, Marchi, Filippo, Perotti, Pietro, Morello, Riccardo, Taboni, Stefano, Parrinello, Giampiero, ncandela, Fabiola, Iandelli, Andrea, Missale, Francesco, and Peretti, Giorgio
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MICROSURGERY ,SQUAMOUS cell carcinoma ,PRESERVATION of organs, tissues, etc. - Abstract
Introduction: The Union for International Cancer Control-American Joint Committee on Cancer TNM staging system for glottic squamous cell carcinoma (SCC) includes different types of lesions defined by the involvement of specific subsites in each T category. Our study aims to identify different subcategories according to tumor local extension and determine oncologic outcomes after treatment by transoral laser microsurgery (TLM) alone. Methods: We retrospectively evaluated 410 patients affected by previously untreated pT1-pT3 glottic SCC treated by TLM alone from January 2005 to December 2015 at the Departments of Otorhinolaryngology-Head and Neck Surgery, Universities of Genoa and Brescia, Italy. All patients had at least 2 years of follow-up. Clinical, radiological, surgical, and histopathological data were reviewed and tumors divided into six subcategories: I, pT1a not involving the anterior commissure (AC); II, pT1b involving the AC; III, pT2 extending superficially to the supraglottis or the subglottis; IV, pT2 infiltrating the vocal muscle; V, pT3 involving the anterior paraglottic space; VI, pT2 or pT3 with vertical extension across the AC with/without involvement of the pre-epiglottic space. Recurrence-free survival (RFS), local control with laser alone (LCL), and organ preservation (OP) were defined as the primary oncologic outcomes. Results: The 2, 5, and 10-year RFS for the entire series were 85.7, 80.3, and 73.8%, LCL rates 93.8, 92.1, and 89.6%, and OP rates 96.8, 95.9, and 93.5%, respectively. However, when comparing the rates of RFS, LCL, and OP for each subcategory, important differences emerged. In particular, subcategories V and VI showed a significantly increased risk of local recurrence [hazard ratio (HR) = 9.2 and 13.3, respectively]. These subcategories also had a significantly reduced probability to achieve LCL (HR: 73.6 and 93.5, respectively) and OP (HR: 6.4 and 8.1, respectively). Conclusion: The present classification in subcategories allows introducing the concept of a three-dimensional map of isoprognostic zones in glottic SCC treated by TLM alone as a useful tool in its management by a multidisciplinary tumor board. [ABSTRACT FROM AUTHOR]
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- 2018
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145. Laryngeal exposure and margin status in glottic cancer treated by transoral laser microsurgery.
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Piazza, Cesare, Paderno, Alberto, Grazioli, Paola, Del Bon, Francesca, Montalto, Nausica, Perotti, Pietro, Morello, Riccardo, Filauro, Marta, Nicolai, Piero, and Peretti, Giorgio
- Abstract
Objective: Laryngeal exposure is one of the most limiting factors in transoral laser microsurgery (TLM) for glottic cancer. We evaluated the correlation between the degree of laryngeal exposure, as assessed by an easy previously described scoring tool (Laryngoscore), and histopathologic surgical margin status after TLM.Study Design: Prospective evaluation of 147 patients affected by Tis-T2 glottic cancer treated by TLM with curative intent between January 2012 and April 2016.Methods: All patients were preoperatively assessed and classified as having good (group A including Laryngoscore class 0-I) or suboptimal laryngeal exposure (group B including class II-III). Margins were classified as negative (more than 1 mm margin between healthy tissue and tumor) or positive (one/multiple superficial or deep margins involved by invasive or in situ carcinoma). Patients with multiple superficial or deep margin positivity were scheduled for TLM re-excision, open partial laryngectomy, or postoperative radiotherapy.Results: Twenty-one type I, 54 type II, 19 type III, 7 type IV, 41 type V, and 5 type VI cordectomies (according to the European Laryngological Society classification) were performed with an en-bloc or multi-bloc technique according to the size, site, and exposure of the lesion. Group A included 109 (74%) and group B included 38 (26%) patients. Positive surgical margins were overall observed in 39 (26.5%) cases: 21 (19.2%) in group A versus 18 (47.4%) in group B (P = 0.001).Conclusion: Laryngeal exposure is one of the most important factors influencing TLM resection of glottic cancer within safe surgical margins. The importance of its adequate preoperative assessment cannot be overemphasized.Level Of Evidence: 2b. Laryngoscope, 128:1146-1151, 2018. [ABSTRACT FROM AUTHOR]- Published
- 2018
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146. Results of a multi-institutional, randomized, non-inferiority, phase III trial of accelerated fractionation versus standard fractionation in radiation therapy for T1-2N0M0 glottic cancer: Japan Clinical Oncology Group Study (JCOG0701).
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Kodaira, T, Kagami, Y, Shibata, T, Shikama, N, Nishimura, Y, Ishikura, S, Nakamura, K, Saito, Y, Matsumoto, Y, and Teshima, T
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RANDOMIZED controlled trials , *RADIOTHERAPY , *PROGRESSION-free survival , *HEAD & neck cancer , *MEDICAL care costs - Abstract
Background: We assessed the non-inferiority of accelerated fractionation (AF) (2.4 Gy/fraction) compared with standard fractionation (SF) (2 Gy/fraction) regarding progression-free survival (PFS) in patients with T1-2N0M0 glottic cancer (GC). Patients and methods: In this multi-institutional, randomized, phase III trial, patients were enrolled from 32 Japanese institutions. Key inclusion criteria were GC T1-2N0M0, age 20-80, Eastern Cooperative Oncology Group performance status of 0-1, and adequate organ function. Patients were randomly assigned to receive either SF of 66-70 Gy (33-35 fractions), or AF of 60-64.8 Gy (25-27 fractions). The primary end point was the proportion of 3-year PFS. The planned sample size was 360 with a non-inferiority margin of 5%. Results: Between 2007 and 2013, 370 patients were randomized (184/186 to SF/AF). Three-year PFS was 79.9% (95% confidence interval [CI] 73.4-85.4) for SF and 81.7% (95% CI 75.4-87.0) for AF (difference 1.8%, 91% CI-5.1% to 8.8%; onesided P=0.047>0.045). The cumulative incidences of local failure at 3 years for SF/AF were 15.9%/10.3%. No significant difference was observed in 3-year overall survival (OS) between SF and AF. Grade 3 or 4 acute and late toxicities developed in 22 (12.4%)/21 (11.5%) and 2 (1.1%)/1 (0.5%) in the SF/AF arms. Conclusion: Although the non-inferiority of AF was not confirmed statistically, the similar efficacy and toxicity of AF compared with SF, as well as the practical convenience of its fewer treatment sessions, suggest the potential of AF as a treatment option for early GC. [ABSTRACT FROM AUTHOR]
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- 2018
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147. Objective and self-evaluation voice analysis after transoral laser cordectomy and radiotherapy in T1a-T1b glottic cancer.
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Lombardo, Nicola, Aragona, Teodoro, Alsayyad, Said, Pelaia, Girolamo, Terracciano, Rosa, and Savino, Rocco
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VOICE analysis , *HEALTH outcome assessment , *RADIOTHERAPY , *PHOTOTHERAPY , *MEDICAL lasers , *GLOTTIS , *SOUND , *TUMOR classification , *HUMAN voice , *TREATMENT effectiveness , *RETROSPECTIVE studies , *SELF diagnosis , *SURGERY ,VOCAL cord surgery ,TONGUE tumors - Abstract
Voice quality outcome becomes an important factor in the choice of the therapeutic option. The differences between radiotherapy and laser cordectomy have been extensively debated in the literature. We analyzed the vocal outcomes after carbon dioxide (CO2) laser cordectomy and radiotherapy treatment for T1a-b early glottic cancer by means of objective and subjective voice evaluation. A retrospective study was performed on 56 cancer patients, 30 treated with cordectomy and 26 with radiotherapy. All patients underwent laser cordectomy which was performed under general anesthesia using a surgical microscope in laryngeal suspension. The laser we used was an Ultrapulse one, 10.6-μm wavelength, and a power setting of 2 to 4 W in an Ultrapulse mode was selected. Two different sets of data were recorded: (a) voice acoustic analysis (jitter, shimmer, fundamental frequency and noise/harmonic ratio) and (b) voice handicap index (VHI). Data collected were statistically analyzed using SPSS 20.0 for Windows. Jitter, shimmer, and signal-to-noise ratio were significantly altered in both glottic cancer patient groups as compared to the control group. On the contrary, no statistically significant alteration of the fundamental frequency was found in both treatment groups. Interestingly, jitter and shimmer values were significantly more compromised in transoral laser surgery patients as compared with radiotherapy-treated patients. The VHI was also significantly altered in both cancer patient groups as compared to the control group. More importantly, however, the self-evaluation voice analysis was not significantly different between the two treatment groups, contrary to what we observed for two of the four parameters measured in the objective voice analysis. Given the importance of the self-perception of the voice quality, no treatment can be considered superior from the patients' point of view. Therefore, we suggest that priority should be given to the endoscopic surgery, due to lower costs, lower morbidity, and shorter hospitalization. [ABSTRACT FROM AUTHOR]
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- 2018
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148. Laryngeal Cancer: Epidemiology and Treatment Outcomes
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Mendenhall, William M., Hinerman, Russell W., Amdur, Robert J., Vaysberg, Mikhail, Werning, John W., Brady, L. W., editor, Heilmann, H. -P., editor, Molls, M., editor, Nieder, C., editor, Harari, P. M., editor, Connor, N. P., editor, and Grau, C., editor
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- 2009
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149. High Frequency Jey Ventilation durimg Transoral Laser Microsurgery for Tis-T2 Laryngeal Cancer.
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Mora, Francesco, Missale, Francesco, Incandela, Fabiola, Filauro, Marta, Parrinello, Giampiero, Paderno, Alberto, Casa, Palmiro Della, Piazza, Cesare, and Peretti, Giorgio
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SQUAMOUS cell carcinoma ,CANCER treatment ,HEALTH outcome assessment ,DIAGNOSIS - Abstract
Background: Transoral laser microsurgery (TLM) for early to intermediate laryngeal squamous cell cancer (SCC) can be technically challenging when adequate exposure of the posterior laryngeal compartment is required due to the presence of the orotracheal tube. The goal of our study was to analyze the efficacy of high frequency jet ventilation (HFJV) in achieving appropriate laryngeal exposure and safe oncologic resection of lesions located in such a position. Methods: We reviewed the clinical records of 62 patients affected by Tis-T2 SCC of the posterior laryngeal compartment treated by TLM between 02/2012 and 12/2016. The cohort was divided into two groups according to the anesthesiologic technique used: Group A included patients treated using intraoperative infraglottic HFJV, while Group B encompassed patients treated by standard orotracheal intubation. The main outcome was postoperative surgical margin status. Group comparison analysis was performed. results: Significant difference in deep margin status was observed between the two groups: in Group A, the rate of negative deep margins was 86% compared to 56% in Group B (p = 0.04). A trend of better overall and superficial margin control was observed for patients treated using HFJV (Group A), although no statistical significance was achieved. conclusion: Use of HFJV during TLM allows easier and safer management of patients affected by Tis-T2 SCC of the posterior laryngeal compartment, reducing the rates of positive superficial and deep surgical margins. [ABSTRACT FROM AUTHOR]
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- 2017
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150. Role of imaging in the follow-up of T2-T3 glottic cancer treated by transoral laser microsurgery.
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Marchi, Filippo, Piazza, Cesare, Ravanelli, Marco, Gaggero, Giovanna, Parrinello, Giampiero, Paderno, Alberto, Perotti, Pietro, Filauro, Marta, Maroldi, Roberto, and Peretti, Giorgio
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GLOTTIS cancer , *LASER surgery , *SQUAMOUS cell carcinoma , *ENDOSCOPY , *COMPUTED tomography - Abstract
An unblinded retrospective analysis of prospectively collected data was carried out on 138 patients affected by glottic pT2 and selected pT3 squamous cell carcinomas (SCC) treated by transoral laser microsurgery (TLM). The entire cohort was divided into two groups: Group A included 78 'high-risk' patients (pT2 with impaired vocal cord mobility, pT3 for anterior paraglottic and/or pre-epiglottic space invasion, presence of angioembolization, perineural spread, and positive lymph nodes in the neck) who underwent postoperative surveillance by endoscopy and imaging (CT or MR), while Group B included 60 'low-risk' patients (pT2 with absence of the above-mentioned features) who underwent endoscopic follow-up alone. Aim of the present study was to assess the diagnostic gain in performing combined endoscopic and radiologic surveillance in the 'high-risk' group compared to endoscopy alone in the 'low-risk' one. There was no significant difference in terms of overall and disease-specific survivals between the two follow-up policies in spite of their different risk profiles. The same was true for organ preservation rate, which was 81% in the 'high-risk' and 89% in the 'low-risk' group. In contrast, the cumulative probability of disease-free survival was 54% for Group A and 65% for Group B ( p = 0.0023). Therefore, our combined endoscopy and imaging surveillance protocol allowed increasing the submucosal recurrence detection rate in 'high-risk' pT2-pT3 glottic SCC to 43%. An earlier detection of submucosal recurrences made salvage surgery by TLM feasible in at least half of cases, thus closing the gap between oncologic outcomes obtained in 'high-'- vs. 'low-risk' patients and leading to organ preservation rates that are favorably comparable to those obtained with open-neck partial laryngectomies and non-surgical organ preservation protocols. [ABSTRACT FROM AUTHOR]
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- 2017
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