Salvage surgery for recurrent larynx cancer

Mimica, Ximena; Hanson, Martin; Patel, Snehal G.; McGill, Marlena; McBride, Sean; Lee, Nancy; Dunn, Lara; Cracchiolo, Jennifer R.; Shah, Jatin P.; Wong, Richard J.; Ganly, Ian; Cohen, Marc A.

doi:10.1002/hed.25925

Cited by 27 publications

(19 citation statements)

References 31 publications

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“…After rescue laryngectomy an overall survival of 32 months was reported [43] and after rescue neck dissection in patients with only regional disease a 5-year survival of 55% was described [24]. Patients with cancer of the oral cavity (18 months) or the larynx (31 months) were described to have the best median overall survival after rescue surgery when compared to patients with any other primary tumor site [20,44,45].…”

Section: Overall Survival After Rescue Surgerymentioning

confidence: 99%

“…The primary tumor site correlated with the functional impairment, as patients with initial laryngeal cancer had the best functional outcome after rescue surgery when compared with any other tumor site (p = 0.1), especially regarding the domain nutrition (p = 0.08). Accordingly, rescue laryngectomy was described as a functional well-tolerated surgery especially regarding swallowing function [20,45]. Furthermore, the functional integrity of these patients correlated significantly with the initial UICC stage (p = 0.05), the received RT dose during first-line treatment (p = 0.05) but it did not correlated with arising complications associated with rescue surgery (p = 0.6).…”

Section: Functional Outcome After Rescue Surgerymentioning

confidence: 99%

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Surgical rescue for persistent head and neck cancer after first-line treatment

Steinbichler

Golm

Dejaco

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Surgical rescue is a treatment option for persistent disease after first-line treatment treatment of head and neck cancer (HNC). Methods Patients with persistent HNC treated with rescue surgery between 2008 and 2016 were included. Patients who received a rescue neck dissection (ND only) and who received primary site surgery ± ND were analysed separately (primary site surgery ± ND). Results During the observation period, 35 patients received ND only and 17 primary site surgery ± ND. No perioperative mortality was observed. In nine patients with ND only and 12 patients with primary site surgery ± ND at least one complication was encountered. 41/52 (79%) patients had a complete response. Median overall survival of patients receiving rescue surgery was 56 months (95% CI 44-69 months). Median overall survival was best for patients with initial laryngeal and oropharyngeal cancer and worst for patients with hypopharyngeal cancer (p = 0.02). Functional deficits following rescue surgery were mainly observed in the domains speech, nutrition, and shoulder/arm mobility. The risk of functional impairment was higher for patients with rescue surgery at the primary tumor site (OR 2.5 ± 2; p = 0.07). Conclusion Rescue surgery offers patients with resectable, persistent disease a realistic chance to achieve long-term survival. Especially patients with laryngeal and oropharyngeal cancer profited from rescue surgery. Rescue neck dissection is an effective and safe procedure. Patients with rescue surgery at the primary tumor site ± ND should expect complications and permanent functional impairment.

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Section: Overall Survival After Rescue Surgerymentioning

confidence: 99%

Section: Functional Outcome After Rescue Surgerymentioning

confidence: 99%

Surgical rescue for persistent head and neck cancer after first-line treatment

Steinbichler

Golm

Dejaco

et al. 2020

Eur Arch Otorhinolaryngol

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“…The recurrence rates for laryngeal cancer range from 16 to 40%, despite advances in treatment 15 . Because of the high relapse rate in laryngeal cancers, biomarkers associated to prognosis and prediction of immunotherapy response would be highly desirable, also in light of the recent FDA approval of pembrolizumab as first-line treatment in patients with recurrent/metastatic head and neck squamous cell carcinoma 16 .…”

Section: Introductionmentioning

confidence: 99%

A role for the immune system in advanced laryngeal cancer

Tagliabue

Maffini

Fumagalli

et al. 2020

Sci Rep

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To investigate the role of the altered activation of the immune system in the prognosis of patients affected by laryngeal squamous cell carcinoma (LSCC). We analyzed 56 patients with advanced LSCC divided into two groups according to their prognosis: the first group relapsed within 24 months after treatment, the second group had no evidence of disease at 2 years. The presence of stromal tumor infiltrating lymphocytes (TILs) at the tumor-host border was investigated. In 43 patients we evaluated the expression of 395 genes related to immune system activation through a next generation sequencing panel. Priority-LASSO models and clustering analyses were integrated with multivariate Cox proportional hazard modeling to identify independent genes associated with relapse and estimate hazard ratios in relation to gene expression and TILs. TILs and the expression of genes related with immune system activation (FCGR1A, IFNA17, FCRLA, NCR3, KREMEN1, CD14, CD3G, CD19, CD20 and CD79A) were significantly associated with prognostic factors or disease specific survival. In patients with lymph node metastases and advanced T stage (pT4), the expression of other genes was altered. Low TILs count was highly associated with relapse within 2 years (p < 0.001). Low TILs and altered expression of specific genes associated with tumor-immune systems interactions emerged as independent risk factors, associated to poor prognosis and relapse within 2 years in advanced LSCC. Evaluation of patients’ immune profile could be useful for prognosis and future therapeutic approaches towards personalized therapy.

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“…Taken together, these results indicate that primary TL should be the preferred therapeutic option for most patients with T4a LC and, particularly, for those exhibiting thyroid cartilage invasion. Primary TL for patients with T4a LC offers satisfactory oncologic outcomes greatly superior to those reported for patients with T4a hypopharyngeal cancer or those undergoing salvage TL for recurrent LC [26][27][28]. Indeed, Roux et al, in a retrospective monocentric analysis of 63 patients who underwent primary TL, showed a 5-year OS and DSS rates of 56% and 69%, respectively, in the whole cohort, with a significant negative impact of the hypopharyngeal tumor site on DSS (p = 0.005; OR, 10.8; 95% CI, 1.9-58.6) [26].…”

Section: T4a Primary Tumorsmentioning

confidence: 98%

Current Role of Total Laryngectomy in the Era of Organ Preservation

Bozec

Culié

Poissonnet

et al. 2020

Cancers

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In this article, we aimed to discuss the role of total laryngectomy (TL) in the management of patients with larynx cancer (LC) in the era of organ preservation. Before the 1990s, TL followed by radiotherapy (RT) was the standard treatment for patients with locally advanced LC. Over the last 30 years, various types of larynx preservation (LP) programs associating induction or concurrent chemotherapy (CT) with RT have been developed, with the aim of treating locally advanced LC patients while preserving the larynx and its functions. Overall, more than two-thirds of patients included in a LP program will not require total laryngectomy (TL) and will preserve a functional larynx. However, despite these advances, the larynx is the only tumor site in the upper aero-digestive tract for which prognosis has not improved during recent decades. Indeed, none of these LP protocols have shown any survival advantage compared to primary radical surgery, and it appears that certain LC patients do not benefit from an LP program. This is the case for patients with T4a LC (extra-laryngeal tumor extension through the thyroid cartilage) or with poor pretreatment laryngeal function and for whom primary TL is still the preferred therapeutic option. Moreover, TL is the standard salvage therapy for patients with recurrent tumor after an LP protocol.

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Salvage surgery for recurrent larynx cancer

Cited by 27 publications

References 31 publications

Surgical rescue for persistent head and neck cancer after first-line treatment

Surgical rescue for persistent head and neck cancer after first-line treatment

A role for the immune system in advanced laryngeal cancer

Current Role of Total Laryngectomy in the Era of Organ Preservation

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