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Head & Neck Jul 2021In this systematic review, we aim to identify prognostic imaging variables of recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In this systematic review, we aim to identify prognostic imaging variables of recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy.
METHODS
A systematic search was performed in PubMed and EMBASE (1990-2020). The crude data and effect estimates were extracted for each imaging variable. The level of evidence of each variable was assessed and pooled risk ratios (RRs) were calculated.
RESULTS
Twenty-two articles were included in this review, 17 on computed tomography (CT) and 5 on magnetic resonance imaging (MRI) variables. We found strong evidence for the prognostic value of tumor volume at various cut-off points (pooled RRs ranging from 2.09 to 3.03). Anterior commissure involvement (pooled RR 2.19), posterior commissure involvement (pooled RR 2.44), subglottic extension (pooled RR 2.25), and arytenoid cartilage extension (pooled RR 2.10) were also strong prognostic factors.
CONCLUSION
Pretreatment tumor volume and involvement of several subsites are prognostic factors for recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy.
Topics: Chemoradiotherapy; Humans; Hypopharyngeal Neoplasms; Larynx; Neoplasm Staging; Prognosis
PubMed: 33797818
DOI: 10.1002/hed.26698 -
Journal of Clinical Laboratory Analysis Feb 2021Tissue engineering has been a topic of extensive research in recent years and has been applied to the regeneration and restoration of many organs including the larynx.... (Review)
Review
OBJECTIVE
Tissue engineering has been a topic of extensive research in recent years and has been applied to the regeneration and restoration of many organs including the larynx. Currently, research investigating tissue engineering of the larynx is either ongoing or in the preclinical trial stage.
METHODS
A literature search was performed on the Advanced search field of PubMed using the keywords: "(laryncheal tissue engineering) AND (cartilage regeneration OR scaffolds OR stem cells OR biomolecules)." After applying the selection criteria, 65 articles were included in the study.
RESULTS
The present review focuses on the rapidly expanding field of tissue-engineered larynx, which aims to provide stem cell-based scaffolds combined with biological active factors such as growth factors for larynx reconstruction and regeneration. The trend in recent studies is to use new techniques for scaffold construction, such as 3D printing, are developed. All of these strategies have been instrumental in guiding optimization of the tissue-engineered larynx, leading to a level of clinical induction beyond the in vivo animal experimental phase.
CONCLUSIONS
This review summarizes the current progress and outlines the necessary basic components of regenerative laryngeal medicine in preclinical fields. Finally, it considers the design of scaffolds, support of growth factors, and cell therapies toward potential clinical application.
Topics: Animals; Humans; Larynx; Printing, Three-Dimensional; Tissue Engineering; Tissue Scaffolds
PubMed: 33320365
DOI: 10.1002/jcla.23646 -
Cancer Immunology, Immunotherapy : CII Dec 2023laryngeal and hypopharyngeal squamous cell carcinoma (SCC) is a common head and neck cancer with significant impact on quality of life due to its crucial roles in...
PD-1 Inhibitors combined with paclitaxel (Albumin-bound) and cisplatin for larynx preservation in locally advanced laryngeal and hypopharyngeal squamous cell carcinoma: a retrospective study.
BACKGROUND
laryngeal and hypopharyngeal squamous cell carcinoma (SCC) is a common head and neck cancer with significant impact on quality of life due to its crucial roles in vocalization, airway protection, and swallowing. This retrospective study aims to evaluate the efficacy and larynx organ preservation of neoadjuvant treatment with PD-1 inhibitors in combination with paclitaxel (Albumin-bound) and cisplatin for locally advanced laryngeal and hypopharyngeal SCC.
METHODS
Medical records of consecutive patients diagnosed with histologically or cytologically confirmed locally advanced SCC of the larynx and hypopharynx, who received PD-1 inhibitor therapy at a single tertiary care center, were reviewed from January 1, 2019, to December 15, 2022. The patients were treated with a combination of PD-1 inhibitors, paclitaxel (Albumin-bound) 260mg/m2, and cisplatin 60mg/m2 (TP) as their first-line therapy. Survival outcomes, laryngectomy-free survival (LFS) rates and response rates were assessed.
RESULTS
The study cohort comprised 156 patients, predominantly male, with a median age of 60.4 years. The estimated one-year overall survival (OS) rate was 94.1%, two-year OS rate was 82.5%, one-year progression-free survival (PFS) rate was 80.4%, and two-year PFS rate was 66.3%. The one-year LFS was 86.4%, and the two-year LFS rate was 73.0%. The overall response rate after TP + PD-1 inhibitors therapy was 88.5%. Common treatment-associated adverse events included rash, thyroid function abnormalities, myelosuppression, and colitis.
CONCLUSION
Neoadjuvant therapy with PD-1 inhibitors in combination with paclitaxel (Albumin-bound) and cisplatin showed promising efficacy and tolerability for larynx preservation in locally advanced laryngeal and hypopharyngeal SCC. The high response rates and favorable survival outcomes suggest this approach as a potential treatment option. Prospective randomized controlled trials are needed to further validate these findings and establish the role of immunotherapy in larynx preservation.
Topics: Humans; Male; Middle Aged; Female; Cisplatin; Immune Checkpoint Inhibitors; Paclitaxel; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck; Prospective Studies; Quality of Life; Laryngeal Neoplasms; Antineoplastic Combined Chemotherapy Protocols; Neoplasm Staging; Larynx; Head and Neck Neoplasms
PubMed: 37804437
DOI: 10.1007/s00262-023-03550-z -
The Laryngoscope Oct 2021To assess the disease control, survival rates, and prognostic factors of exclusive surgical treatment for patients with pT3 N0 laryngeal squamous cell carcinoma (LSCC).
OBJECTIVES/HYPOTHESIS
To assess the disease control, survival rates, and prognostic factors of exclusive surgical treatment for patients with pT3 N0 laryngeal squamous cell carcinoma (LSCC).
STUDY DESIGN
Multicentric retrospective cohort study.
METHODS
Multicentric retrospective case series of previously untreated patients with pT3 R0N0 LSCC, who received exclusive surgery between 2011 and 2019. Tumor location; subsite involvement; grading; and lymphatic, vascular, and perineural invasion were reported. Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were measured.
RESULTS
Fifty-four patients (mean age 67.1; male sex 83.3%; mean follow-up period 37 months) underwent total laryngectomy (48.1%) or partial laryngectomy (51.9%). Ipsilateral or bilateral neck dissection was performed in 46 (85.2%) cases. Perineural invasion was more frequent in case of supraglottic involvement than glottic involvement (85.7% vs. 14.3%, P = .03). Five (9.3%) patients experienced recurrence (3 local recurrences, 1 nodal recurrence, 1 distant recurrence). Rate of recurrence differed between glottic (0%), supraglottic (80%), and transglottic (20%) tumors (P = .01), with a lower risk yielded by glottic involvement (odds ratio [OR], 0.05, 95% confidence interval [95% CI], 0.01-0.56, P = .01). A higher risk was recorded in case of perineural invasion (OR, 66.0, 95% CI, 1.41-3085.3, P = .03). The OS, DSS, and DFS were 79.6%, 96.3%, and 90.7%, without differences regarding the type of surgery. The DFS was lower in case of supraglottic involvement when compared to purely glottic LSCC (83.9% vs. 100%, P = 0.02).
CONCLUSIONS
Exclusive surgery is a safe option for patients with pT3 R0N0 LSCC. Adjuvant treatments or closer follow-up monitoring might be considered in case of supraglottic involvement or perineural invasion.
LEVEL OF EVIDENCE
4 Laryngoscope, 131:2262-2268, 2021.
Topics: Aged; Aged, 80 and over; Disease-Free Survival; Female; Follow-Up Studies; Humans; Laryngeal Neoplasms; Laryngectomy; Larynx; Lymphatic Metastasis; Male; Middle Aged; Neck Dissection; Neoplasm Recurrence, Local; Prognosis; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck; Survival Rate
PubMed: 33755212
DOI: 10.1002/lary.29528 -
The Laryngoscope May 2021A paucity of data exists regarding surgical outcomes for patients undergoing total laryngectomy for a dysfunctional larynx. Herein, we present the largest study...
OBJECTIVE
A paucity of data exists regarding surgical outcomes for patients undergoing total laryngectomy for a dysfunctional larynx. Herein, we present the largest study evaluating the method of closure on postoperative fistula rate and swallowing ability.
METHOD
We performed a retrospective review of patients undergoing total laryngectomy for a dysfunctional larynx after primary radiation or chemoradiation therapy for laryngeal carcinoma from 1998 to 2020. Demographic information, operative details, length of hospitalization, fistula formation, method of fistula treatment, and need for enteral feeding 6 months after surgery were analyzed.
RESULTS
A total of 268 patients were included. Flaps were performed in 140 (52.2%) patients, including radial forearm free flaps (RFFF), pectoralis flaps, and supraclavicular flaps. Sixty-four (23.9%) patients developed postoperative fistulas. There was no significant difference in the fistula rate between flap and primary closure methods (P = .06). However, among patients who had a flap, RFFF had a significantly lower fistula rate (P = .02). Significantly more patients who had initial closure with a pectoralis flap required an additional flap for fistula repair than those who underwent RFFF or primary closure (P < .05). Last, whereas 87 patients (32.5%) required an enteral feeding tube 6 months after surgery, significantly fewer patients who underwent RFFF were feeding tube-dependent (P = < .0001).
CONCLUSION
Herein, we present the largest study of outcomes after total laryngectomy for dysfunctional larynx. Postoperative fistula rates are high, 23%; however, the majority of patients, 67%, will not require long-term enteral support. The RFFF is an excellent option demonstrating the lowest rates of postoperative fistula and enteral feeding tube dependence.
LEVEL OF EVIDENCE
4 Laryngoscope, 131:E1510-E1513, 2021.
Topics: Aged; Aged, 80 and over; Carcinoma; Chemoradiotherapy; Cutaneous Fistula; Enteral Nutrition; Female; Humans; Laryngeal Neoplasms; Laryngectomy; Larynx; Male; Middle Aged; Neoplasm Staging; Postoperative Complications; Radiation Injuries; Plastic Surgery Procedures; Retrospective Studies; Surgical Flaps; Treatment Outcome
PubMed: 33037821
DOI: 10.1002/lary.29154 -
AJNR. American Journal of Neuroradiology Aug 2018
Topics: Carcinoma, Squamous Cell; Humans; Laryngeal Cartilages; Laryngeal Neoplasms; Magnetic Resonance Imaging; Tomography, X-Ray Computed
PubMed: 30049716
DOI: 10.3174/ajnr.A5723 -
European Archives of... Mar 2022Carcinosarcoma, also known as Spindle Cell Carcinoma (SpCC), is a rare type of malignant tumor. Generally, this type of pathology occurs in the urogenital tract, the... (Review)
Review
PURPOSE
Carcinosarcoma, also known as Spindle Cell Carcinoma (SpCC), is a rare type of malignant tumor. Generally, this type of pathology occurs in the urogenital tract, the gastrointestinal tract, respiratory tract and mammary gland; in the larynx, SpCC represents only 2-3% of all malignancies. Due to its rarity, there is currently no generally acceptable treatment guideline for this disease. The aim of this study was to systematically review the literature of SpCC of larynx and report epidemiologic, clinicopathologic and main therapeutic approaches for this entity.
METHODS
A systematic literature review was performed using MEDLINE, EMBASE, PubMed and Scopus databases. For this review, the results were extrapolated in the period between January 1990 to September 2020. Data extraction was performed using a standard registry database. The clinical and pathological staging were recalculated according to the Eight Edition of AJCC Cancer Staging Manual and statistical analyses were performed using SPSS Version 25.0.
RESULTS
A total of 111 patients affected by laryngeal carcinosarcoma were included. From our review arises that surgery is the main treatment for primary laryngeal carcinosarcoma. In this way, various techniques such as minimally invasive laryngoscopy excision, laser CO2 cordectomy, partial laryngectomy (vertical and horizontal) and total laryngectomy. The role of radiotherapy is still controversial. The overall survival (OS) for T1 stage tumor at 5 years of follow-up is 82.9%, the OS for T2 and T3 tumor is 74% and 73.4%. The OS at 5 years of follow-up is 91.7% for supraglottic tumor, 69.3% for glottic tumor and 50% for transglottic site. Subglottic site is described in only 2 cases [12-13], so the OS at 5 years is not statistically significant. The 5-year overall survival in patients without lymph nodes involvement (N0) is 90.2%, 66.7% and 50%, respectively, for N1 and N2 lesions.
CONCLUSION
Primary laryngeal carcinosarcoma is a very rare malignancy. There are no clear guidelines in the management but in the literature, surgery is described as the best modality of therapy; radiation only can be a reasonable alternative with controversial efficacy. The most important prognostic factor is the nodal metastasis.
Topics: Carcinosarcoma; Head and Neck Neoplasms; Humans; Laryngeal Neoplasms; Laryngectomy; Larynx; Neoplasm Staging; Retrospective Studies
PubMed: 34351467
DOI: 10.1007/s00405-021-07027-6 -
European Archives of... Jun 2021To give an overview of the current knowledge regarding the aetiology, epidemiology, and classification of laryngeal dysplasia (LD) and to highlight the contributions of... (Review)
Review
To give an overview of the current knowledge regarding the aetiology, epidemiology, and classification of laryngeal dysplasia (LD) and to highlight the contributions of recent literature. As most cases of dysplasia occur at the glottic level and data on diagnosis and management are almost exclusively from this location, laryngeal dysplasia in this position paper is taken to be synonymous with dysplasia of the vocal folds. LD has long been recognized as a precursor lesion to laryngeal squamous cell carcinoma (SCC). Tobacco and alcohol consumption are the two single most important etiological factors for the development of LD. There is currently insufficient evidence to support a role of reflux. Although varying levels of human papillomavirus have been identified in LD, its causal role is still uncertain, and there are data suggesting that it may be limited. Dysplasia has a varying presentation including leukoplakia, erythroleukoplakia, mucosal reddening or thickening with exophytic, "tumor-like" alterations. About 50% of leukoplakic lesions will contain some form of dysplasia. It has become clear that the traditionally accepted molecular pathways to cancer, involving accumulated mutations in a specific order, do not apply to LD. Although the molecular nature of the progression of LD to SCC is still unclear, it can be concluded that the risk of malignant transformation does rise with increasing grade of dysplasia, but not predictably so. Consequently, grading systems are inherently troubled by the weak correlation between the degree of the dysplasia and the risk of malignant transformation. The best data on LD grading and outcomes come from the Ljubljana group, forming the basis for the World Health Organization classification published in 2017.
Topics: Head and Neck Neoplasms; Humans; Hyperplasia; Laryngeal Neoplasms; Larynx; Leukoplakia; Precancerous Conditions
PubMed: 33051798
DOI: 10.1007/s00405-020-06403-y -
The Journal of Laryngology and Otology Jun 2024To determine oncological and functional outcomes in patients with T3 and T4 laryngeal carcinoma, in which choice of treatment was based on expected laryngeal function...
OBJECTIVE
To determine oncological and functional outcomes in patients with T3 and T4 laryngeal carcinoma, in which choice of treatment was based on expected laryngeal function and not T classification.
METHODS
Oncological outcomes (disease-specific survival and overall survival) as well as functional outcomes (larynx preservation and functional larynx preservation) were analysed.
RESULTS
In 130 T3 and 59 T4 patients, there was no difference in disease-specific survival or overall survival rates after radiotherapy (RT) (107 patients), chemoradiotherapy (36 patients) and total laryngectomy (46 patients). The five-year disease-specific survival rates were 83 per cent after RT, 78 per cent after chemoradiotherapy and 69 per cent after total laryngectomy, whereas overall survival rates were 62, 54 and 60 per cent, respectively. Five-year larynx preservation and functional larynx preservation rates were comparable for RT (79 and 66 per cent, respectively) and chemoradiotherapy (86 and 62 per cent, respectively).
CONCLUSION
There is no difference in oncological outcome after (chemo)radiotherapy or total laryngectomy in T3 and T4 laryngeal carcinoma patients whose choice of treatment was based on expected laryngeal function.
Topics: Humans; Laryngeal Neoplasms; Laryngectomy; Male; Middle Aged; Aged; Female; Larynx; Chemoradiotherapy; Treatment Outcome; Neoplasm Staging; Organ Sparing Treatments; Adult; Retrospective Studies; Aged, 80 and over; Survival Rate; Carcinoma, Squamous Cell
PubMed: 38235588
DOI: 10.1017/S0022215124000112 -
BMJ Case Reports Feb 2022A 79-year-old smoker with a background history of a treated glottic carcinoma and chronic obstructive pulmonary disease presented with progressive hoarseness, symptoms...
A 79-year-old smoker with a background history of a treated glottic carcinoma and chronic obstructive pulmonary disease presented with progressive hoarseness, symptoms of aspiration and shortness of breath for 6 months. Examination revealed an ulcero-fungating mass over the posterior commissure of the larynx. A tracheostomy, direct laryngoscopy and biopsy of the mass was performed to secure his airway and to exclude recurrent glottic carcinoma. Reassuringly, a histopathological examination of the mass revealed numerous fungal yeast bodies. He was then treated with itraconazole for 4 weeks and was followed up as and outpatient with complete resolution and no recurrence of the disease.
Topics: Aged; Carcinoma; Humans; Laryngitis; Laryngoscopy; Larynx; Male; Neoplasm Recurrence, Local
PubMed: 35140081
DOI: 10.1136/bcr-2021-245678