A novel classification scheme for advanced laryngeal cancer midline involvement: implications for the contralateral neck

Böttcher, Arne; Thieme, Nadine; Stromberger, Carmen; Sander, Steffen; Münscher, Adrian; Bier, J; Knopke, S

doi:10.1007/s00432-017-2419-1

Cited by 16 publications

(21 citation statements)

References 25 publications

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“…Several previous studies have demonstrated the pN stage as a prognostic predictor and an efficient indicator for adjuvant therapy, which is mainly based on the number of metastatic lymph nodes and extra‐nodal extension (ENE) . However, a sufficient number of the examined lymph node is key to ensure the precise nodal staging.…”

Section: Introductionmentioning

confidence: 99%

Significance of examined lymph nodes number and metastatic lymph nodes ratio in overall survival and adjuvant treatment decision in resected laryngeal carcinoma

et al. 2020

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Objective:The value of adjuvant therapy in resected laryngeal cancer remains controversial. This large SEER-based cohort study aimed to investigate the existing parameters of lymph node status that could predict survival outcomes and the prognostic value of adjuvant treatment in resected laryngeal carcinoma. Methods: Population-based data from the US Surveillance, Epidemiology, and End Results (SEER-18) Program on patients after laryngectomy and lymphadenectomy (2004-2015) were analyzed. The optimal cut-off values for examined lymph nodes number (ELNs) and metastatic lymph nodes ratio (MLNR) were determined using the X-tile program. Associations of ELNs and MLNR with overall survival were investigated through Cox regression analysis. A survival-predicting model was then constructed to stratified patients. The prognostic value of adjuvant therapy was evaluated in different subgroups. Results: A total of 2122 patients with resected laryngeal cancer were analyzed. A novel survival-predicting model was proposed based on ELNs, MLNR, and other clinicopathological characteristics. Patients were stratified into three subgroups with the increasing risk of death. Only patients in the high-risk group who receiving adjuvant treatment had a significantly better survival outcome than those receiving surgery alone. Conclusion: A new survival-predicting model was established in this study, which was superior in assessing the survival outcomes of patients with resected laryngeal cancer. Notably, this model was also able to assist in the decision making of adjuvant therapy for patients and physicians. K E Y W O R D S cancer risk factors, head and neck cancer, nomogram, survival | 3007 ZHU et al.

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Section: Introductionmentioning

confidence: 99%

Significance of examined lymph nodes number and metastatic lymph nodes ratio in overall survival and adjuvant treatment decision in resected laryngeal carcinoma

et al. 2020

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“…Backes et al [3] described insufficient surgical margins as one of the main risks for reduced overall and recurrence-free survival of laryngeal cancer patients. Böttcher et al [7] retrospectively analyzed 58 locally advanced staged laryngeal cancers following laryngectomy (LE). They described the importance of midline involvement in preoperative CT scans and a 100% risk reduction without midline involvement for contralateral lymph node metastases.…”

Section: Introductionmentioning

confidence: 99%

“…They described the importance of midline involvement in preoperative CT scans and a 100% risk reduction without midline involvement for contralateral lymph node metastases. They considered contralateral elective ND as avoidable in locally advanced laryngeal carcinomas without midline involvement [7]. Oztürkcan et al [28] described a higher risk for contralateral metastases in patients with ipsilateral lymph node invasion with and without extracapsular spread.…”

Section: Introductionmentioning

confidence: 99%

“…Oztürkcan et al [28] described a higher risk for contralateral metastases in patients with ipsilateral lymph node invasion with and without extracapsular spread. Furthermore, different authors described the significant reduction of overall survival (OS) in patients with positive lymph nodes [7,9]. The advantage of ND compared to neck irradiation is the subsequent histopathological examination of occult metastasis to initiate adjuvant therapy [16,17].…”

Section: Introductionmentioning

confidence: 99%

“…However, even the current guidelines recommend ipsi-or bi-lateral ND without concretizing indication for elective ND. A lack of studies and clear recommendations lead to progredient subjective elective ND indication [7]. Marks et al [24] reported 4% lymph node metastases in transglottic and 7-26% in supraglottic carcinomas.…”

Section: Introductionmentioning

confidence: 99%

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Surgical nodal management in hypopharyngeal and laryngeal cancer

Ketterer

Moraga

Beitinger

et al. 2020

Eur Arch Otorhinolaryngol

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Objective The aim of this study is to compare pre-therapeutic staging of the loco-regional lymphatic basin and subsequent surgical management in cN0 versus cN+ hypopharyngeal and laryngeal cancer patients. Methods We analyzed all hypopharyngeal and laryngeal carcinoma patients treated surgically at a single quaternary medical care and cancer center between 2004 and 2014. We established two groups for patients who underwent neck dissection comparing patients with a low LNR (lymph node ratio) to one with a high LNR. Regarding the cN0 cohort, elective neck dissection was evaluated as a secondary predictor variable. Comorbidities, such as anemia and renal insufficiency, were analyzed as potentially influencing disease-free (DFS) and overall survival (OS). Results A total of 310 patients (185 glottic and 125 supraglottic/hypopharyngeal carcinoma) were included. Pre-therapeutic neck MRI-/CT-scan and concomitant neck ultrasound revealed cN+ status in 144 patients resulting in a significant overstaging in 63 patients (44%) who were rated as being pN0 after histological examination. 166 patients were staged cN0 and 21 underwent elective neck dissection (11 local advanced glottic and 10 supraglottic/hypopharyngeal carcinoma). Two cN0 patients showed occult cervical lymph node metastases (10%). Furthermore, we could detect a significant negative impact of the LNR divided by the number of dissected lymph nodes and OS. Conclusion The pre-therapeutic clinical evaluation of lymphatic outgrowth is over-staged. OS decreases with increasing LNR divided by the number of dissected lymph nodes. Renal insufficiency and anemia are significant negative factors, decreasing both OS and DFS. KeywordsHypopharyngeal carcinoma · Laryngeal carcinoma · Overall survival · cN0 · Elective neck dissection · Head and neck cancer Abbreviations CT Computed tomography DFS Disease-free survival DM Distant metastasis HNSCC Head and neck squamous cell carcinoma LNR Lymph node ratio MRI

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Unilateral versus bilateral nodal irradiation: Current evidence in the treatment of squamous cell carcinoma of the head and neck

et al. 2021

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Cancers of the head and neck region often present with nodal involvement. There is a long‐standing convention within the community of head and neck radiation oncology to irradiate both sides of the neck electively in almost all cases to include both macroscopic and microscopic disease extension (so called elective nodal volume). International guidelines for the selection and delineation of the elective lymph nodes were published in the early 2000s and were updated recently. However, diagnostic imaging techniques have improved the accuracy and reliability of nodal staging and as a result, small metastases that used to remain undetected and were thus in the past included in the elective nodal volume, will now be included in high‐dose volumes. Furthermore, the elective nodal areas are situated close to the parotid glands, the submandibular glands and the swallowing muscles. Therefore, irradiation of a smaller, more selected volume of the elective nodes could reduce treatment‐related toxicity. Several researchers consider the current bilateral elective neck irradiation strategies an overtreatment and show growing interest in a unilateral nodal irradiation in selected patients. The aim of this article is to give an overview of the current evidence about the indications and benefits of unilateral nodal irradiation and the use of SPECT/CT‐guided nodal irradiation in squamous cell carcinomas of the head and neck.

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A novel classification scheme for advanced laryngeal cancer midline involvement: implications for the contralateral neck

Abstract: As a consequence, for type A category, a contralateral neck dissection might be avoidable accompanied by a reduction in surgical complications and operating time.

Cited by 16 publications

References 25 publications

Significance of examined lymph nodes number and metastatic lymph nodes ratio in overall survival and adjuvant treatment decision in resected laryngeal carcinoma

Significance of examined lymph nodes number and metastatic lymph nodes ratio in overall survival and adjuvant treatment decision in resected laryngeal carcinoma

Surgical nodal management in hypopharyngeal and laryngeal cancer

Unilateral versus bilateral nodal irradiation: Current evidence in the treatment of squamous cell carcinoma of the head and neck

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