Larynx Preservation Treatment Research Articles

Neoadjuvant Chemotherapy Improves Feasibility of Larynx Preservation and Prognosis in Resectable Locally Advanced Cervical Esophageal Cancer.

The optimal strategy for cervical advanced esophageal cancer remains controversial in terms of oncologic outcome as well as vocal and swallowing function. Recently, in East Asian countries, neoadjuvant chemotherapy (NAC) has been a standard strategy for advanced esophageal cancer. This study included 37 patients who underwent NAC, and 33 patients who underwent definitive chemoradiation therapy (dCRT) as larynx-preserving treatment for locally advanced cervical esophageal cancer from 2016 to 2021. This study retrospectively investigated outcomes, with comparison between NAC and dCRT for locally advanced cervical esophageal cancer. Larynx preservation was successful for all the patients with NAC and dCRT. After NAC, the rate of complete or partial response was 78.4%, and 30 patients underwent larynx-preserving surgery. On the other hand, after dCRT, the complete response rate was 71.9%, and 4 patients underwent larynx-preserving salvage surgery. Overall survival (OS) and progression free survival were similar between the two groups. However, for the patients with resectable cervical esophageal cancer (cT1/2/3), the 2-year OS rate was significantly higher with NAC (79.9%) than with dCRT (56.8%) (P = 0.022), and the multivariate analyses identified only NAC and cN0, one of the two as a significantly independent factor associated with a better OS (NAC: P = 0.041; cN0, 1: P = 0.036). The study showed that NAC as larynx-preserving surgery for resectable cervical esophageal cancer preserved function and had a better prognosis than dCRT. The authors suggest that NAC may be standard strategy for larynx preservation in patients with resectable cervical esophageal cancer.

Larynx Preservation Treatment Strategies Seen in a National Survey of Cervical Esophageal Cancer Treatment

Larynx Preservation Treatment Strategies Seen in a National Survey of Cervical Esophageal Cancer Treatment

Larynx-preserving treatment strategy for patients with resectable cervical esophageal squamous cell carcinoma.

311 Background: Preservation of the larynx is an important treatment strategy for cervical esophageal squamous cell carcinoma (CESCC), because surgery for CESCC often involves laryngectomy. At our hospital, we actively perform dCRT (cisplatin + 5-fluorouarcil + radiation 60Gy) to preserve laryngeal function. In this study, we compared the treatment results of esophagectomy and definitive chemoradiation (dCRT) for resectable CESCC and examined larynx-preserving treatment strategies. Methods: Patients who were treated for resectable CESCC at our hospital from January 2003 to March 2019 were divided into surgery group and dCRT group for the initial treatment. All patients were eligible for both treatments. The treatment results were compared retrospectively. Results: Of all 61 patients, 23 patients received surgery and 38 received dCRT. There was no significant difference in patients’ characteristics between 2 groups. In surgery group, 19 cases lost their laryngeal function by surgery (82.6%). Recurrence was observed in 7 cases, of which only 3 case was local. In CRT group, 33 cases (86.8%) achieved complete response, of which 16 cases relapsed. 8 cases (21.1%) lost their laryngeal function by additional surgery after dCRT. There was no significant difference in 5-year survival rate between two groups (surgery, 60.8%; dCRT, 70.1%; p = 0.750). In dCRT group, 5-year laryngeal-preserving survival rate was 64.8%, and esophageal stenosis before treatment was the independent risk factor for non-larynx preservation. 5-year laryngeal-preserving survival rate was 78.5%, and 5-year survival rate was 85.4% for non-stenotic cases in dCRT group, which were significantly higher than those for stenotic cases. 5-year laryngeal-preserving survival rate was also high in the patients with Ce localized tumor (72.6%). In those patients, non-stenotic patients and cT1-T3 patients had significantly high 5-year laryngeal-preserving survival rate (87.5% and 92.3%). Conclusions: dCRT for CESCC was comparable to surgery in terms of long-term prognosis, and the rate of larynx preservation was high. Among the cases where the tumor was localized to Ce, the laryngeal preservation rate was particularly high in non-stenotic cases and cases with cT1-T3, and dCRT should be actively indicated for these cases.

Social determinants of physicians’ treatment recommendation in early glottic cancer.

65 Background: Glottic cancer is often diagnosed early due to its deleterious effects on the voice. National cancer treatment guidelines recommend larynx preserving treatment, either surgery or radiation, since both modalities have similar rates of local control and recurrence. Without any survival advantage for either treatment modality, physicians may make treatment recommendations based on other clinical or nonclinical factors. Methods: Using the National Cancer Database, a national hospital-based cancer registry data, this retrospective cohort analysis included adult patients, aged 18 years and older, with clinically confirmed diagnosis of early-stage (T1 and T2) glottic cancer between 2004 and 2017 (n = 27,632). The outcome of interest was physicians’ treatment recommendation of surgery or radiation therapy. Main measures included social determinants of health variables, including race/ethnicity, urban/rural status, health insurance status, and income. We further adjusted for covariates, including age and gender. Logistic regression analysis estimated odds of physicians’ recommendation of radiation versus Surgery, based on social determinants of health factors and adjusting for all covariates in the model. Results: More patients received recommendation for radiation treatment vs surgery (78% vs 22%). Female patients were less likely to receive a recommendation of radiation (aOR = 0.90; 95% CI 0.82, 0.98), while Black patients had increased odds of being recommended radiation compared to White patients (aOR = 1.16, 95% CI 1.04, 1.29). Both facility type and location, and patients’ urban vs. rural status were all associated with treatment recommendation, and individuals residing in rural areas had 32% increased odds of being recommendation radiation treatment vs surgery (aOR = 1.32; 95% CI 1.06, 1.64). Conclusions: Radiation treatment is prevalent in early-glottic cancer care, and we found an association between social determinants of health and physician recommendation of treatment. Further research should examine concordance of patient treatment preference vs physician recommendation.

Delta-volume radiomics of induction chemotherapy to predict outcome of subsequent chemoradiotherapy for locally advanced hypopharyngeal cancer.

Induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) is recommended for larynx-preserving treatment of locally advanced hypopharyngeal cancer (LAHC). However, the conventional evaluation of response is not robust enough to predict the outcome of subsequent treatments. This study aimed to develop an imaging biomarker using changes in radiomic features in invasive tumor front (ITF) by IC to predict treatment outcome of subsequent CCRT in LAHC. From 2006 to 2018, 59 computed tomography (CT) scan images before and after IC in patients with LAHC were used to contour the gross tumor volumes (GTVs). A total of 48 delta-volume radiomics features were acquired from the absolute spatial difference of GTVs (delta-GTV) before and after IC, conceptually representing a consistent portion of ITF. Least absolute shrinkage and selection operator regression (LASSO) was used to select features for establishing the model generating radiomic score (R score). A model including 5 radiomic features from delta-GTV to predict better progression-free survival (PFS) of patients receiving subsequent CCRT was established. The R score was validated with all datasets (area under the curve 0.77). Low R score (<-0.16) was associated with improved PFS (p < 0.05). The established radiomic model for ITF from radiomic features of delta-GTV after IC might be a potential imaging biomarker for predicting clinical outcome of subsequent CCRT in LAHC.

Variation of treatment decision-making for laryngeal cancer in Japan a retrospective observational study using a claim- and electronic medical record-based database.

Primary curative treatment of resectable laryngeal cancer includes surgery and chemoradiotherapy. Other treatment options include radiotherapy, chemoradiotherapy, partial laryngectomy, and total laryngectomy. Larynx-preserving treatments (partial laryngectomy, radiotherapy, and chemoradiotherapy) are recommended in early stage cases, although total laryngectomy is needed in advanced cases. Here, we evaluated trends in treatment strategies and identified the factors that are important in decision making. We performed a retrospective analysis of data acquired from electronic medical records in Japan. Hospitalized laryngeal cancer patients admitted between January 2014 and December 2018 were included in our analyses. The primary outcome was the initial treatment. A total of 363 patients (mean age 71.8 ± 9.5, male/female = 333/30) met the inclusion criteria. Of these, 10.1% of the patients were treated with total laryngectomy, while 17.9% underwent partial resection, 65.8% received radiotherapy (chemoradiotherapy), and 6.1% had no treatment. Larynx-preserving treatment was used in most T1-2 cases (96.9%), and 40% of the patients with T3 cancer underwent total laryngectomy (adjusted odds ratio 26.7 [95% CI, 9.29-91.6]). Of the T3 cancers that were treated, total laryngectomy was performed in only 26.7% of patients aged ≤65 years, but in more than 50% of those aged >65 years. This retrospective study showed that larynx-preserving treatments were used in most T1-2 cases, and suggested that T stage is the most important factor affecting decision making in the treatment of laryngeal cancer. Older patients with T3 disease tended to undergo total laryngectomy, and age is an important factor in the decision-making process for cases of T3 laryngeal cancer.

Radiomic Alterations In Tumor Microenvironment By Induction Chemotherapy Predict Treatment Outcome Of Subsequent Concurrent Chemoradiotherapy For Locally Advanced Hypopharyngeal Cancer

Induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) is recommended for larynx-preserving treatment of locally advanced hypopharyngeal cancer (LAHC). However, biomarkers to predict CCRT response for selecting larynx-preserving candidates remain lacking. This study aimed to develop an imaging biomarker using changes in radiomic features in tumor microenvironment (TME) by IC to predict treatment outcome of subsequent CCRT in LAHC. From 2006 to 2018, computed tomography (CT) scan images obtained by the same protocol before and after IC in LAHC patients were used to contour the gross tumor volumes (GTVs). By using LIFEx software (V.5.10), 47 delta-radiomics features were acquired from the absolute spatial difference of GTVs (delta-GTV) before and after IC, conceptually representing a consistent portion of TME. The data was divided to training/testing groups in the ratio of 8:2. Least absolute shrinkage and selection operator regression (LASSO) in R language was used to select features for establishing the model generating radiomic score (R score). The cutoff of R score for progression was determined by Youden index method. Multivariate regression model was used to identify prognostic factors for progression free survival (PFS). Hematoxylin and eosin stain of biopsied specimens were reviewed to identify histological phenotype of cancer-associated fibroblast (CAF). Mature (thin, wavy, and small spindle-shaped fibroblasts) and immature (large, plump spindle-shaped with prominent nucleoli) groups were categorized by using cutoff 50%. Total 59 LAHC patients with qualified paired CT images were subjected to delta-radiomic analysis. The median follow-up time was 33.5 (IQR 17.9-74.0) months. A model including 5 radiomic features from delta-GTV to predict better PFS of patients receiving subsequent CCRT was established (likelihood ratio test p < 0.05; Table). R score was validated with all dataset (area under the curve = 0.74). Low R score (< -0.34), but not volume changes of GTVs, was associated with better PFS in both univariate (p < 0.05) and multivariate (p < 0.05) analysis. In TME assessment, the histological phenotype of mature CAF, but not tumor infiltrating lymphocyte, correlated with better PFS. Low R score correlated with mature CAF category (positive and negative predictive values: 100% and 75%, respectively), implying CAF as a putative biological rationale behind delta-radiomics. The established model for TME from radiomic features of delta-GTV after IC might be a potential imaging biomarker to predict clinical outcome of subsequent CCRT in LAHC. Phenotype of CAF in TME may correlate with radiomic alterations and clinical outcome.Abstract 3864; TableThe radiomic features obtained from regression modelCoefficientHazard ratiop valueCONVENTIONAL_HUmin0.00021.00020.83HISTO_Skewness0.24721.28040.02SHAPE_Sphericity13.86051045981.78570.04GLRLM_GLNU-0.00030.99970.25GLZLM_LZLGE-0.00650.99360.64 Open table in a new tab

A 10-Year Study on Larynx Preservation Compared With Surgical Resection in Patients With Locally Advanced Laryngeal and Hypopharyngeal Cancers.

BackgroundFew reports from China provide confirmed evidence of the effectiveness of the larynx preservation strategy compared with surgery on the treatment of laryngeal and hypopharyngeal cancers. This study assessed the clinical outcomes of patients with locally advanced laryngeal and hypopharyngeal cancers treated with larynx preservation and determined the optimal larynx preservation procedure.MethodsData of 1,494 patients treated with total laryngectomy or larynx preservation between 2006 and 2014 were retrieved from the database of Sun-Yat Sen University Cancer Center in Guangzhou, China, and 366 eligible patients were selected for final analysis. The clinical outcomes of 228 patients received total laryngectomy and 138 patients received larynx preservation treatments, which comprises induction followed by radiotherapy and concurrent radio-chemotherapy, were compared.ResultsThere was no statistical difference in the 3-, 5-, and 10-year PFS and OS in patients received larynx preservation compared with patients treated with laryngectomy. With respect to T stage, a better overall OS in T2-stage disease (P = 0.036) but poorer PFS (P = 0.005) in T3-stage disease was observed in the larynx preservation group compared with the surgery group in Univariate analysis. T3-stage disease had poorer PFS in multivariable analysis (P = 0.022). With larynx preservation intent, induction chemotherapy followed by radiotherapy showed no advantage in the control of disease progression and survival compared with concurrent chemoradiotherapy. The patient subpopulations who received efficacy assessment after induction chemotherapy exhibited significantly longer PFS and OS compared with those without efficacy assessment.ConclusionsThis is the largest sample size study on larynx preservation treatment for laryngeal and hypopharyngeal cancers in China. Our results indicated that larynx preservation treatments did not jeopardize the survival of patients with advanced resectable laryngeal or hypopharyngeal cancers. Efficacy assessment should be emphasized in induction chemotherapy.

Radiomic Nomogram Improves Preoperative T Category Accuracy in Locally Advanced Laryngeal Carcinoma.

Surgical decision-making on advanced laryngeal carcinoma is heavily depended on the identification of preoperative T category (T3 vs. T4), which is challenging for surgeons. A T category prediction radiomics (TCPR) model would be helpful for subsequent surgery. A total of 211 patients with locally advanced laryngeal cancer who had undergone total laryngectomy were randomly classified into the training cohort (n = 150) and the validation cohort (n = 61). We extracted 1,390 radiomic features from the contrast-enhanced computed tomography images. Interclass correlation coefficient and the least absolute shrinkage and selection operator (LASSO) analyses were performed to select features associated with pathology-confirmed T category. Eight radiomic features were found associated with preoperative T category. The radiomic signature was constructed by Support Vector Machine algorithm with the radiomic features. We developed a nomogram incorporating radiomic signature and T category reported by experienced radiologists. The performance of the model was evaluated by the area under the curve (AUC). The T category reported by radiologists achieved an AUC of 0.775 (95% CI: 0.667–0.883); while the radiomic signature yielded a significantly higher AUC of 0.862 (95% CI: 0.772–0.952). The predictive performance of the nomogram incorporating radiomic signature and T category reported by radiologists further improved, with an AUC of 0.892 (95% CI: 0.811–0.974). Consequently, for locally advanced laryngeal cancer, the TCPR model incorporating radiomic signature and T category reported by experienced radiologists have great potential to be applied for individual accurate preoperative T category. The TCPR model may benefit decision-making regarding total laryngectomy or larynx-preserving treatment.

Functional Results after Larynx-Preserving Treatment of Laryngeal Cancer. Suggestions for follow-up.

ntroduction: Laryngeal cancer and its treatment are associated with both short- and long-term side effects, affecting laryngeal functions and having an impact on the quality of life. Material and methods: Retrospective analysis of the medical records of patients receiving surgical or non-surgical, larynx- -preserving treatment for laryngeal cancer. R esults: After termination of the treatment, the highest proportion of patients with bad voice quality was in the glottic carcinoma group (both in early and late phase), with swallowing dysfunction in the transglottic carcinoma group. Compared to the situation before the treatment, the proportion of patients with impaired voice quality (bad voice quality and loss of voice) initially decreased among all groups (except for supraglottic carcinomas), and during the first post-treatment year either increased or did not change. The proportion of patients with no swallowing dysfunction increased in the supraglottic, subglottic and transglottic carcinoma groups. D iscussion: We consider necessary the implementation of a standard pre- and post-treatment monitoring of the voice and swallowing function in the management of patients with laryngeal cancer.

Rational choice of induction chemotherapy-based larynx preservation for hypopharyngeal cancer

Backgroud: Induction chemotherapy, as a larynx preservation treatment, has been available for over 20 years. We conducted a retrospective study to evaluate the efficacy of this protocol with taxene, cisplatin and 5-fluorouracil in Chinese patients with hypopharyngeal cancer that chose preservation strategy.Material and methods: 170 patients with locally advanced hypopharyngeal cancer were assigned to receive induction chemotherapy. 107 patients (63%) with complete response or partial response received larynx preservation treatment and 63 non-responders (37%) received radical surgery.Results: Median survival time was 30 months (range: 3–59 months). 63 patients (37%) had local-regional failure and 15 (9%) had distant metastasis. Three-year LFS was 27.8% (95% CI: 23.6–32.0%). The estimated three-year overall survival rate was 44.5% (95% CI: 39.5–49.5%). There was no significant difference in the three-year survival rate between responders (44.8%) and non-responders (43.9%) (p = .237), however patients with a partial response had a significant decrease in survival (32.2%) (p < .001).Conclusions: In patients with hypopharyngeal cancer, ICT with TPF regimen followed by RT, as a larynx preservation treatment, may be suitable for complete responders, but not partial responders.

Organ preservation for advanced larynx cancer: A review of chemotherapy and radiation combination strategies

The larynx is an organ of the upper aerodigestive tract that is involved in many critical functions such as breathing, speaking, and swallowing. As a result, both larynx cancer and its treatment may significantly affect quality of life. The management of laryngeal cancer has focused on improving survival while preserving the function of the organ. This manuscript focuses on the use of chemotherapy and radiation therapy as a non-surgical approach and potential organ preservation strategy for patients with advanced larynx cancer. We review the key clinical data on the following treatment courses: (1) induction chemotherapy followed by definitive radiation therapy, (2) concurrent chemotherapy and radiation, and (3) induction chemotherapy followed by concurrent chemo-radiation. We also review the clinical data on organ preservation for patients with hypopharynx cancers. Results from phase III studies suggest that patients with advanced T4 cancers have better outcomes with a primary surgical approach, while for patients with T2N+ and T3 tumors, definitive concurrent chemotherapy and radiation or induction chemotherapy followed by definitive radiation therapy are acceptable options. Choosing the optimal treatment strategy depends on patients’ desires, tumor extent, and adequate follow-up to detect early recurrences in cases of larynx preservation treatments. To proceed with an organ preservation strategy, the patient should have a good pre-treatment larynx function, and there must be a high level of skill and cooperation among various disciplines.

Phosphorylation of gH2AX as a novel prognostic biomarker for laryngoesophageal dysfunction-free survival.

Current larynx preservation treatments have achieved an improvement of laryngoesophageal dysfunction-free survival (LDS) but lead to significant toxicities and recurrences. At present, there is no evidence to select the group of patients that may benefit from preservation approaches instead of surgery. Therefore, laryngeal biomarkers could facilitate pretreatment identification of patients who could respond to chemoradiation-based therapy. In this study, we evaluated retrospectively 53 patients with larynx cancer to determine whether gH2AX phosphorylation (pH2AX) alone or in combination with the membrane protein MAP17 (PDZK1IP1) could be used as prognostic biomarkers. We also evaluated whether the completion of cisplatin treatment and radiotherapy could predict survival in combination with pH2AX.We found that the dose of cisplatin received but not the length of the radiotherapy influenced LDS. High-pH2AX expression was associated with prolonged LDS (HR 0.26, p = 0.02) while MAP17 correlated with overall survival (OS) (HR 0.98, p = 0.05). High-MAP17 and high-pH2AX combined analysis showed improved LDS (with 61.35 months vs 32.2 months, p = 0.05) and OS (with 66.6 months vs 39.8 months, p = 0.01). Furthermore, the subgroup of high-pH2AX and optimal dose of cisplatin was also associated with OS (72 months vs 38.6 months, p = 0.03) and LDS (66.9 months vs 27 months, p = 0.017). These findings suggest that pH2AX alone or better in combination with MAP17 may become a novel and valuable prognostic biomarker for patients with laryngeal carcinoma treated with preservation approaches.

EP-1448: Outcomes and tolerance of larynx preservation treatment in the older population

EP-1448: Outcomes and tolerance of larynx preservation treatment in the older population

Boron Neutron Capture Therapy in the Treatment of Recurrent Laryngeal Cancer

To investigate the safety and efficacy of boron neutron capture therapy (BNCT) as a larynx-preserving treatment option for patients with recurrent laryngeal cancer. Six patients with locally recurrent squamous cell laryngeal carcinoma and 3 patients with persistent laryngeal cancer after prior treatment were treated with BNCT at the FiR1 facility (Espoo, Finland) in 2006 to 2012. The patients had received prior radiation therapy with or without concomitant chemotherapy to a cumulative median dose of 66 Gy. The median tumor diameter was 2.9 cm (range, 1.4-10.9 cm) before BNCT. Boron neutron capture therapy was offered on a compassionate basis to patients who either refused laryngectomy (n=7) or had an inoperable tumor (n=2). Boronophenylalanine-fructose (400 mg/kg) was used as the boron carrier and was infused over 2 hours intravenously before neutron irradiation. Six patients received BNCT once and 3 twice. The estimated average gross tumor volume dose ranged from 22 to 38 Gy (W) (mean; 29 Gy [W]). Six of the 8 evaluable patients responded to BNCT; 2 achieved complete and 4 partial response. One patient died early and was not evaluable for response. Most common side effects were stomatitis, fatigue, and oral pain. No life-threatening or grade 4 toxicity was observed. The median time to progression within the target volume was 6.6 months, and the median overall survival time 13.3 months after BNCT. One patient with complete response is alive and disease-free with a functioning larynx 60 months after BNCT. Boron neutron capture therapy given after prior external beam radiation therapy is well tolerated. Most patients responded to BNCT, but long-term survival with larynx preservation was infrequent owing to cancer progression. Selected patients with recurrent laryngeal cancer may benefit from BNCT.

Trends in Total Laryngectomy: A Population Based Study

Objective: 1) Understand time trends in total laryngectomy rates across the US, including rates of surgery, cost, length of stay, teaching status, size of hospital, and insurance payer. 2) Understand what role the paradigm shift in primary treatment of laryngeal cancer may mean for surgical outcomes, cost, and length of stay. Method: Population-based study from 1997 to 2008 utilizing the HCUP-NIS database: a stratified sample of all US hospital discharges. The sample was all patients who had a principal procedure of ICD-9 code 30.3 or 30.4 (complete or radical laryngectomy). The unit of analysis was census area: Northeast, South, Midwest, and West. Results: The number of laryngectomies done in the US decreased by 32% during the study period. New cases of laryngeal cancer decreased 26% during the same time. The highest rate of laryngectomy is in the South, the lowest in the Midwest and West. Mortality for the procedure is highest in the Northeast: 2.1%. Mean length of stay over the study period increased from 12.7 days to 13.9 days. Length of stay is shortest in the South. Median hospital charges rose dramatically (in 2008 dollars), from $34,934 in 1997 to $61,507 in 2008. Medicare remains the dominant insurance source. Conclusion: The rate of total laryngectomy has dropped more than the incidence of laryngeal cancer has dropped—suggesting that larynx preservation treatment has become dominant. Some implications of this shift are previously unexplored. As the number of procedures drops, the utility of a detailed registry to track outcomes becomes even greater.

Prognostic and predictive significance of p53, EGFr, Ki-67 in larynx preservation treatment

Background The optimal management of advanced laryngeal and hypopharyngeal cancers (L&HC) must involve consideration of both survival and functional effect of the given treatment approach. Despite over two decades of investigations of several treatment options, including surgery, radiotherapy, chemotherapy or some combinations thereof, little consensus exists as to which treatment offers the best survival, together with functional speech and swallowing. Aim To determine predictive and prognostic value of p53, EGFr, Ki-67 in patients with advanced laryngeal and hypopharyngeal cancer, treated with larynx preservation intent. Materials and methods Thirty-three patients received 2–3 cycles of induction chemotherapy (ICHT) consisting of cisplatin and fluoruracil and underwent subsequent radical radiotherapy. Immunohistochemical analyzes of p53, EGFr and Ki-67 were performed. Results Response to ICHT was obtained in 24 patients (75%). Better response to ICHT was correlated only with EGFr expression ( p = 0.04, RR = 1.91). The 5-year loco-regional control (LRC) and disease-specific survival (DSS) rates were 48% and 57%, respectively. The 5-year larynx preservation rate was 68% in responders to ICHT compared to 21% in non-responders ( p = 0.02). It was also higher in patients without EGFr expression (but not significantly, p = 0.43). Conclusion Lack of EGFr expression is a favorable predictive factor for response to ICHT. Neither p53 nor Ki-67 have predictive and prognostic value in larynx preservation treatment.

Angiosarcoma developing after curative induction chemotherapy and radiotherapy for locally advanced squamous cell carcinoma of the larynx

Angiosarcoma arising after radiation is described in breast cancer but occurs elsewhere. Here, we present an angiosarcoma of the neck occurring after curative chemoradiation. This is a case of angiosarcoma developing 5 years after curative therapy for T3N0 squamous cell carcinoma of the supraglottic larynx. Therapy consisted of 3 cycles of induction cisplatin/5-fluorouracil chemotherapy followed by radiotherapy. The patient did well until developing a rapidly progressive lesion of the left neck. Examination showed a 7-cm mass and biopsy revealed angiosarcoma. CT scans assessed the local extent of the tumor and ruled out metastatic disease prior to initiating therapy. Therapy consisted of 4 cycles of paclitaxel chemotherapy. At completion, examination revealed mild induration of the neck with near-complete resolution of the mass. Imaging confirmed this excellent response. This rare therapy-related second malignancy developed after curative larynx-preserving treatment. Paclitaxel was an effective therapy in this setting.

Accelerated Radiotherapy and Larynx Preservation in Favorable-risk Patients with T2 or Worse Hypopharyngeal Cancer

To evaluate the advantage of accelerated fractionation radiotherapy for patients with hypopharyngeal cancer requiring total laryngectomy. Seventy patients with previously untreated, technically resectable hypopharyngeal cancer who received larynx-preserving treatment with radiotherapy between April 1992 and June 2004 were analyzed. No patients had previous history of other malignancy or poor performance status that would possibly affect the outcomes. A total RT dose of > or = 60 Gy/6 weeks was determined depending on the tumor clearance during treatment before December 1998, and fixed to 70 Gy in all patients thereafter. Accelerated fractionation (70 Gy/<49 days) was completed in 35 patients during the latter period. Concomitant platinum-based chemotherapy was used in 41 patients after May 1998. Local control rates at 2 years were 72 and 68% for patients with T2 and T3/T4 disease, respectively. Patients who had received 70 Gy/<49 days achieved a better local control rate than those who had received other, more conservative total dose/overall treatment time with statistical significance (91% versus 50% at 2 years, P < 0.001). Multivariate analysis involving 70 Gy/<49 days of radiotherapy, T-classification (T2 versus T3/4), and use of chemotherapy revealed that administering 70 Gy/<7 weeks was the only independent prognostic factor (P = 0.007) for better local control. Our experience in radiotherapy for hypopharyngeal cancer mirrored the results of previously conducted large randomized trials for various head and neck cancers. Encouraging local control in this study warrants prospective study to test the long-term oncological and functional outcome of larynx-preserving treatment in patients with advanced but resectable volume of this disease.

Larynx preservation treatment: A concomitant scheme of radiotherapy, cisplatin and tegafur

Larynx preservation treatment: A concomitant scheme of radiotherapy, cisplatin and tegafur