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PloS One 2018Technological advancements in treatment planning and delivery have propelled the use of intensity-modulated radiation therapy (IMRT) in head and neck squamous cell... (Meta-Analysis)
Meta-Analysis
Systematic review and meta-analyses of intensity-modulated radiation therapy versus conventional two-dimensional and/or or three-dimensional radiotherapy in curative-intent management of head and neck squamous cell carcinoma.
INTRODUCTION
Technological advancements in treatment planning and delivery have propelled the use of intensity-modulated radiation therapy (IMRT) in head and neck squamous cell carcinoma (HNSCC). This review compares IMRT with conventional two-dimensional (2D) and/or three-dimensional (3D) radiotherapy (RT) in curative-intent management of HNSCC.
METHODS
Only randomized controlled trials (RCTs) offering curative-intent RT in patients with non-metastatic HNSCC were included. Outcome data was extracted independently by two reviewers, pooled using the Cochrane methodology, and expressed as risk ratio (RR) or hazard ratio (HR) as appropriate with 95% confidence intervals (CIs). Xerostomia was the primary outcome of interest whereas loco-regional control, overall survival and quality-of-life (QOL) were secondary endpoints.
RESULTS
Seven RCTs involving 1155 patients directly comparing IMRT with 2D/3D-RT in HNSCC were included. The primary objective in five of seven index RCTs was reduction in xerostomia, with only one trial each using loco-regional control and overall survival as primary endpoints for sample size calculation. The use of IMRT was associated with a 36% relative risk reduction in ≥grade 2 acute xerostomia (RR = 0.64, 95%CI = 0.49-0.84; p = 0.001) compared to 2D/3D-RT. More importantly, IMRT significantly reduced the risk of ≥grade 2 late xerostomia (RR = 0.44, 95%CI = 0.34-0.57; p = 0.00001) compared to non-IMRT techniques at all time-points. Within the limitations of inadequate sample size and low statistical power, IMRT also resulted in 24% relative reduction in the risk of loco-regional relapse (HR = 0.76, 0.57-1.01; p = 0.06) and 30% relative reduction in risk of death (HR = 0.70, 95%CI = 0.57-0.88; p = 0.002) compared to 2D/3D-RT. However, this benefit of IMRT for loco-regional control and overall survival was limited to nasopharyngeal cancer patients alone, with no significant difference in efficacy between the two techniques in patients with cancers of the laryngo-pharynx in this analysis, highlighting the inconsistency in results of subgroup analyses stratified by primary site. Inadequate reporting of data precluded statistically pooling of results for QOL outcomes.
CONCLUSIONS
There is consistent moderate-quality evidence that IMRT significantly reduces the risk of moderate to severe acute and late xerostomia compared to 2D/3D-RT in curative-intent radiotherapeutic management of HNSCC. However, the quality of evidence regarding the superiority of IMRT over conventional techniques for disease-related endpoints is rather low due to relative lack of power and inconsistency of results precluding robust conclusions.
Topics: Head and Neck Neoplasms; Humans; Kaplan-Meier Estimate; Radiotherapy, Intensity-Modulated; Randomized Controlled Trials as Topic; Squamous Cell Carcinoma of Head and Neck; Treatment Outcome
PubMed: 29979726
DOI: 10.1371/journal.pone.0200137 -
The Journal of Laryngology and Otology May 2018Advanced hypopharyngeal carcinoma has a dismal prognosis. The optimal treatment for these patients remains under debate. This systematic review aimed to compare survival... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Advanced hypopharyngeal carcinoma has a dismal prognosis. The optimal treatment for these patients remains under debate. This systematic review aimed to compare survival following surgical and non-surgical treatments.
METHODS
A systematic review was conducted of randomised studies, with a descriptive analysis of retrospective observational studies.
RESULTS
Two randomised trials and 11 observational studies were included in the review. A meta-analysis of randomised trials reported a hazard ratio of 0.89 for overall survival in favour of surgical treatment (p = 0.44). Neither treatment was favoured in terms of overall survival. Observational studies did not report a survival advantage with either treatment. The five-year larynx preservation rates for non-surgically treated patients were between 38 and 58 percent.
CONCLUSION
Chemoradiotherapy offers similar survivorship compared to surgery in advanced disease, while also making larynx preservation feasible. It can be used as a treatment in all patients as an alternative to surgery.
Topics: Adult; Aged; Carcinoma; Chemoradiotherapy; Female; Humans; Hypopharyngeal Neoplasms; Hypopharynx; Larynx; Male; Middle Aged; Observational Studies as Topic; Organ Sparing Treatments; Pharyngectomy; Randomized Controlled Trials as Topic; Survival Rate; Treatment Outcome
PubMed: 29891019
DOI: 10.1017/S0022215118000555 -
The Journal of Laryngology and Otology Jul 2017Acellular dermal matrices are increasingly used in laryngotracheal and pharyngeal reconstruction, but specific indications and the type of acellular dermal matrix used... (Review)
Review
BACKGROUND
Acellular dermal matrices are increasingly used in laryngotracheal and pharyngeal reconstruction, but specific indications and the type of acellular dermal matrix used vary. The authors systematically reviewed outcomes relating to acellular dermal matrix use in head and neck reconstruction.
METHODS
Electronic databases were searched through 1 May 2016 for literature on acellular dermal matrix use in laryngotracheal and pharyngeal reconstruction. Studies were appraised for surgical indications, outcomes and study design.
RESULTS
Eleven publications with 170 cases were included. Eight articles reported on acellular dermal matrix use in oncological reconstruction. Most studies were case series; no high-level evidence studies were identified. Graft extrusion was more common in non-oncological applications. In general, post-oncological reconstruction with an acellular dermal matrix demonstrated complication rates similar to those reported without an acellular dermal matrix.
CONCLUSION
Evidence in support of acellular dermal matrix use in head and neck reconstruction is generally poor. Prospective comparative studies are required to define the indications, safety and effectiveness of acellular dermal matrices in laryngotracheal and pharyngeal reconstruction.
Topics: Acellular Dermis; Carcinoma, Squamous Cell; Cervicoplasty; Follow-Up Studies; Laryngeal Neoplasms; Neoplasm Staging; Otorhinolaryngologic Neoplasms; Pharyngeal Neoplasms; Surgical Flaps; Tracheal Neoplasms; Treatment Outcome
PubMed: 28502275
DOI: 10.1017/S0022215117001049 -
Journal of Stomatology, Oral and... Apr 2017Oral human papillomavirus infection amplifies the risk for oropharyngeal cancer. Human papillomavirus-associated cancers in otorhinolaryngology have typical...
INTRODUCTION
Oral human papillomavirus infection amplifies the risk for oropharyngeal cancer. Human papillomavirus-associated cancers in otorhinolaryngology have typical characteristics.
PATIENTS AND METHODS
To improve understanding of management, therapy and prognosis of patients with oropharyngeal human papillomavirus-associated cancers a systematic review of the literature was reported. Medline, The Cochrane Library, Embase and Scielo electronic databases were searched. The search included published articles up to December 2006. A wide search strategy was employed in order to avoid publication biases and to assess studies in which the main aspects concerning oropharyngeal squamous cell carcinoma and human papillomavirus management are analyzed.
RESULTS
A total of 120 articles were identified, of which 16 matched the inclusion criteria.
DISCUSSION
Patients with human papillomavirus-associated oropharyngeal cancers have distinctive risk factors such as a high number of sex partners. They are typically younger, nonusers of tobacco and alcohol and have a better prognosis.
Topics: Antineoplastic Agents; Carcinoma, Squamous Cell; Chemoradiotherapy; Female; Humans; Male; Middle Aged; Oropharyngeal Neoplasms; Palatine Tonsil; Papillomaviridae; Papillomavirus Infections; Papillomavirus Vaccines; Prognosis; Risk Factors; Squamous Cell Carcinoma of Head and Neck; Vaccination
PubMed: 28345518
DOI: 10.1016/j.jormas.2017.02.004 -
International Journal of Pediatric... Jan 2017Pediatric head and neck Squamous cell carcinoma (PHNSCC) is a rare disease. The optimum treatment and outcome remains poorly understood because of rarity. (Review)
Review
INTRODUCTION
Pediatric head and neck Squamous cell carcinoma (PHNSCC) is a rare disease. The optimum treatment and outcome remains poorly understood because of rarity.
METHODS
We conducted an individual patient data analysis of PHNSCC. Two authors independently searched PubMed, google search, and Cochrane library for eligible studies using following search words: Pediatric Head and neck squamous cell carcinoma, Head and neck squamous cell carcinoma under age of 20, Head and neck squamous cell carcinoma in young, PHNSCC till June 1, 2016 published in English language.
RESULTS
Total of 217 patients of PHNSCC were found in the literature. Median age among the cohort was 15 years (Range: 0-20 years) with a clear male preponderance. Oral cavity tumors were commonest 75 (70%) followed by laryngeal neoplasms 16(15%). Median disease free survival was 9 months (Range: 0-216 months). Median overall survival was 48 months (Range: 1-216 months). In univariate analysis treatment modality had significant impact on disease free survival (DFS). Whereas, patients treated with Surgery, Laryngeal primary had significantly better OS. Patients with associated fanconis anemia had significantly worse overall survival (OS).
CONCLUSION
PHNSCC is a rare disease with poorer outcome. Associated DNA defects leads to poorer OS. Patients treated with surgery alone or surgery followed by adjuvant radiation had better DFS and OS. Molecular profiling and personalized therapy may improve survival with limited toxicity.
Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Brachytherapy; Carcinoma, Squamous Cell; Chemoradiotherapy; Chemoradiotherapy, Adjuvant; Child; Child, Preschool; Comorbidity; Disease-Free Survival; Fanconi Anemia; Female; Head and Neck Neoplasms; Humans; Infant; Infant, Newborn; Laryngeal Neoplasms; Male; Mouth Neoplasms; Neoplasm Staging; Otorhinolaryngologic Surgical Procedures; Pharyngeal Neoplasms; Precision Medicine; Prognosis; Radiotherapy; Radiotherapy, Adjuvant; Sex Distribution; Squamous Cell Carcinoma of Head and Neck; Survival Rate; Young Adult
PubMed: 28012539
DOI: 10.1016/j.ijporl.2016.11.005 -
International Forum of Allergy &... Apr 2017To critically evaluate the use of endoscopic nasopharyngectomy in the treatment of recurrent nasopharyngeal carcinoma (NPC) through a case series, systematic literature... (Review)
Review
BACKGROUND
To critically evaluate the use of endoscopic nasopharyngectomy in the treatment of recurrent nasopharyngeal carcinoma (NPC) through a case series, systematic literature review, and pooled analysis.
METHODS
A case series of 18 patients combined with systematic literature review and pooled analysis of PubMed, Web of Science, and Scopus search, identifying 576 papers. After excluding 307 papers as search engine duplicates, only 16 of the remaining papers had adequate patient data to be included.
RESULTS
Our case series of 18 patients had a 2-year disease-free survival (DFS) and overall survival (OS) of 90.0% and 100%, respectively. The pooled analysis of 300 patients that had an endoscopic resection of recurrent NPC showed recurrence-free survival and overall survival were 85.8% and 82.9%, respectively. Most, 56.1%, were recurrent T1 lesions. Resection margins were negative in 90.2% of patients. Local recurrence occurred in 20.1% of patients. Major complications occurred in 13.6% of patients. The mean hospital stay was 5.8 days, the mean operating time was 228.3 minutes, and the mean operative blood loss was 163 mL.
CONCLUSION
Endoscopic resection of recurrent NPC occurs with low surgical morbidity. However, further long-term evaluation with longer follow-up data is needed to evaluate if the survival data is comparable or better than open approaches.
Topics: Adult; Aged; Carcinoma; Endoscopy; Female; Humans; Male; Middle Aged; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Nasopharynx; Neoplasm Recurrence, Local; Pharyngectomy
PubMed: 27865062
DOI: 10.1002/alr.21881 -
World Journal of Surgical Oncology Jul 2016Solitary splenic metastases are a rare occurrence, and the nasopharyngeal carcinoma represents one of the most uncommon primary sources. The present study aimed to... (Review)
Review
BACKGROUND
Solitary splenic metastases are a rare occurrence, and the nasopharyngeal carcinoma represents one of the most uncommon primary sources. The present study aimed to describe a rare case of a solitary single splenic metastasis from nasopharyngeal carcinoma and to assess the number of cases of isolated nasopharyngeal carcinoma metastases to the spleen reported in the literature.
MAIN BODY
We describe the case of a 56-year-old man with a history of nasopharyngeal carcinoma and complete remission after chemo-radiotherapy. Three months after complete remission, positron emission tomography/computed tomography scan revealed a hypermetabolic splenic lesion without increased metabolic activity in other areas. After laparoscopic splenectomy, the pathology report confirmed a single splenic metastasis from undifferentiated carcinoma of the nasopharyngeal type. The postoperative period was uneventful. We also performed a systematic review of the literature using MEDLINE and Google Scholar databases. All articles reporting cases of splenic metastases from nasopharyngeal carcinoma, with or without histologic confirmation, were evaluated. The literature search yielded 15 relevant articles, which were very heterogeneous in their aims and methods and described only 25 cases of splenic metastases from nasopharyngeal carcinoma.
CONCLUSION
The present review shows that solitary splenic metastases from nasopharyngeal carcinoma are a rare event, but it should be considered in patients presenting with splenic lesions at imaging and a history of primary or recurrent nasopharyngeal carcinoma. No evidence supports a negative impact of splenectomy in patients with solitary splenic metastasis from nasopharyngeal carcinoma.
Topics: Biopsy; Carcinoma; Chemoradiotherapy; Herpesvirus 4, Human; Humans; Laparoscopy; Lymphatic Metastasis; Magnetic Resonance Imaging; Male; Middle Aged; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Nasopharynx; Neoadjuvant Therapy; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Rare Diseases; Splenectomy; Splenic Neoplasms; Treatment Outcome
PubMed: 27422630
DOI: 10.1186/s12957-016-0941-2 -
The Laryngoscope Jul 2016Dysphagia is still a treatment-related morbidity, despite advances in treatment modalities for oral and oropharyngeal squamous cell carcinoma. This systematic review... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES/HYPOTHESIS
Dysphagia is still a treatment-related morbidity, despite advances in treatment modalities for oral and oropharyngeal squamous cell carcinoma. This systematic review aimed to analyze the effects of swallowing outcomes of patients with oral or oropharyngeal squamous cell carcinoma treated with primary surgery with primary free flap reconstruction, with or without adjuvant therapy, for patients undergoing treatment with curative intent.
STUDY DESIGN
A comprehensive search strategy was undertaken across MEDLINE, CINAHL, Embase, and Scopus. Gray literature was sought through Cochrane Central Register of Controlled Trials, MedNar, and ProQuest.
METHODS
Studies included patients with oral cavity or oropharyngeal squamous cell carcinoma treated with primary surgery with primary free flap reconstruction. Swallowing function was the primary outcome, evaluated at 6 months or later following surgery. Methodological quality and data extraction was conducted as per the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument and standardized data extraction tool.
RESULTS
Fifteen articles comprising eight cohort studies and seven case series were included. Postoperative radiotherapy and oropharyngeal resections were demonstrated to be associated with increased dysphagia.
CONCLUSION
Advanced tumor-node-metastasis stage and use of adjuvant radiotherapy has been shown to have negative impacts on swallowing function. The majority of patients were able to have gastrostomy tubes removed at 6 months following curative therapy. Larger flap mass for the reconstruction of oral and oropharyngeal defects appeared to improve swallowing outcomes. A protocol for the identification of patients at high and low risk of developing dysphagia is proposed.
LEVEL OF EVIDENCE
N/A. Laryngoscope, 126:1572-1580, 2016.
Topics: Carcinoma, Squamous Cell; Combined Modality Therapy; Deglutition Disorders; Free Tissue Flaps; Humans; Mouth; Mouth Neoplasms; Oropharyngeal Neoplasms; Oropharynx; Pharyngectomy; Postoperative Complications; Plastic Surgery Procedures
PubMed: 26865034
DOI: 10.1002/lary.25894 -
Head & Neck Apr 2016The role of pectoralis major muscle flap (PMMF) in reducing the rate of pharyngocutaneous fistula after salvage total laryngectomy has not been clearly established. The... (Review)
Review
BACKGROUND
The role of pectoralis major muscle flap (PMMF) in reducing the rate of pharyngocutaneous fistula after salvage total laryngectomy has not been clearly established. The purpose of this study was to evaluate the impact of PMMF in reducing pharyngocutaneous fistula rates after total laryngectomy.
METHODS
The analyzed intervention was the use of a PMMF after total laryngectomy.
RESULTS
Pharyngocutaneous fistula occurred in 230 cases (global incidence, 30.9%). In the group of patients who underwent PMMFs, there were 49 cases of pharyngocutaneous fistula, compared with 181 cases in the control group. There was a 22% decreased risk of pharyngocutaneous fistula incidence in the PMMF group (p < .001). Patients who underwent a PMMF had lower risk of pharyngocutaneous fistula compared with the control group (p = .008). There were no changes when only patients who underwent total laryngectomy (p < .001) and those who underwent total pharyngolaryngectomy (p = .007) were separately assessed.
CONCLUSION
Prophylactic use of PMMF decreases the incidence of pharyngocutaneous fistula after salvage total laryngectomy. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2317-E2321, 2016.
Topics: Cutaneous Fistula; Humans; Laryngeal Neoplasms; Laryngectomy; Pectoralis Muscles; Pharyngeal Diseases; Retrospective Studies; Salvage Therapy; Surgical Flaps
PubMed: 26559777
DOI: 10.1002/hed.24248 -
Head & Neck Apr 2016Infection with Helicobacter pylori (H. pylori) plays a role in the development of gastric carcinoma. However, there is controversy as to whether H. pylori infection... (Review)
Review
BACKGROUND
Infection with Helicobacter pylori (H. pylori) plays a role in the development of gastric carcinoma. However, there is controversy as to whether H. pylori infection increases laryngeal or pharyngeal cancers.
METHODS
We managed a systematic review of researches related to H. pylori infection in laryngeal or pharyngeal carcinomas, distributed up to December 2014. Odds ratios (ORs) and 95% confidence intervals (CIs) were assessed by random effects models or according to heterogeneity I(2) .
RESULTS
Eleven studies were involved in the meta-analysis. Overall, H. pylori infection was significantly higher in the study group compared with the normal control group (OR = 2.87; 95% CI = 1.71-4.84; I(2) = 67.1; p < .0001, random effects analysis). The ORs for laryngeal carcinoma were 3.28 (95% CI = 1.91-5.63; I(2) = 58; p < .0001, random effects model). The ORs for pharyngeal cancer were 1.35 (95% CI = 0.86-2.12; p = .188, random effects model).
CONCLUSION
This study supported the proposition that infection with H. pylori was related to laryngeal carcinoma, specifically in the hospital-based control group and diagnosed by polymerase chain reaction (PCR) or enzyme-linked immunosorbent assay (ELISA). Nevertheless, no significant relationship was discovered between H. pylori infection and pharyngeal cancer. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2291-E2296, 2016.
Topics: Helicobacter Infections; Helicobacter pylori; Humans; Laryngeal Neoplasms; Larynx; Pharynx; Stomach Neoplasms
PubMed: 26316145
DOI: 10.1002/hed.24214