Radiotherapy For Laryngeal Cancer Research Articles

Risk factors and healing factors for pharyngocutaneous fistula after total laryngectomy for laryngeal cancer: An epidemiological study.

To analyse the risk factors and healing factors of pharyngocutaneous fistula (PCF) in patients with laryngeal cancer after total laryngectomy, and to explore the relevant epidemiology. A retrospective analysis was conducted on laryngeal cancer patients who underwent total laryngectomy in our hospital from January 2010 to December 2022. The 349 patients included in the study were divided into a PCF group of 79 and a non-PCF group of 270. Perform one-way analysis of variance and multivariate logistic analysis on various data of patients included in the statistics, and analyse the risk factors and healing factors of PCF. Smoking, history of radiation therapy for laryngeal cancer, history of chemotherapy for laryngeal cancer, tumour location (larynx, pharynx, oesophagus), preoperative albumin, postoperative proteinaemia, <99 haemoglobin, postoperative haemoglobin, postoperative C-reactive protein (CRP) level are the risk factors for PCF. Also, radiation therapy and postoperative proteinaemia were the main reasons for preventing PCF healing. Smoking history, laryngeal cancer, radiation therapy, albumin, haemoglobin and CRP are risk factors for postoperative PCF after total laryngectomy, while radiation therapy and postoperative hypoalbuminaemia are key factors affecting PCF healing.

217 Quality of life after radiation therapy for laryngeal cancer in the North of Morrocco

217 Quality of life after radiation therapy for laryngeal cancer in the North of Morrocco

Combined Endovascular Antegrade and Direct Retrograde Carotid Artery Stenting for Chronic and Long Segment Common Carotid Artery Occlusion: Technical Note and Review of Literature.

Common carotid artery (CCA) occlusion (CCAO) is a rare cause of ischemic stroke and bypass surgery is the common treatment approach. However, safer alternatives should be developed to treat CCAO. A 68-year-old male was diagnosed with left-sided CCAO with decreased left visual acuity due to neck radiation therapy for laryngeal cancer. Recanalization therapy using a pull-through technique was initiated because cerebral blood flow progressively decreased during the follow-up period. First, after a short sheath was inserted into the CCA, the occluded CCA was retrogradely penetrated through the sheath. Second, a micro-guidewire was guided to the aorta from the femoral sheath where it was caught using a snare wire guided from the cervical sheath. Subsequently, the micro-guidewire was gently pulled out from the cervical sheath, penetrated the occluded lesion, and was secured to the femoral and cervical sheaths. Finally, the occluded lesion was dilated using a balloon, and the stent was placed. Five days postprocedure, the patient was discharged uneventfully and exhibited improved left visual acuity. In terms of reliable penetration of obstructive lesions and reduction of embolic and hemorrhagic complications, combined endovascular antegrade and direct retrograde carotid artery stenting is a versatile and minimally invasive treatment option for CCAO.

Upfront surgery vs radiotherapy for laryngeal cancer: descriptive study on the complications from rural cancer centre

Background: Significant shifts in therapy paradigms for advanced laryngeal carcinoma have occurred more recently. The number of patients receiving surgery alone has significantly decreased, while the number of patients receiving radiotherapy and chemoradiotherapy has significantly increased. Both the treatment modalities have its own advantages and disadvantages. The present study is a consideration to compare the complication rate of both the treatment modalities in the treatment of laryngeal cancer. Methods: The head and neck oncosurgery department at the Kolhapur cancer center in Maharashtra conducted a five-year retrospective record analysis of the patients treated for carcinoma larynx [2017-2022]. The current analysis included all patients with histopathologically confirmed laryngeal cancer. Results: Of the 24 cases if upfront surgery, 8 cases had complications and 8 cases of post RT, 6 cases had complications and this difference was statistically significant (p&lt;0.05). There was significant difference between the pharynocutaneous fistula rates among the two groups. The rates were higher among post radiotherapy patients (p&lt;0.05). Conclusions: The most common complication among post radiotherapy was pharynocutaneous fistula. The most common complications among upfront surgery were pharynocutaneous fistula and stomal stenosis. Pharynocutaneous fistula was significantly higher among post radiotherapy patients when compared to upfront surgery.

Impact of comorbidity scores and lifestyle factors in curative radiotherapy in laryngeal cancer.

The principal goal of treatment of laryngeal cancer is to eliminate atumour while preserving laryngeal function with radio(chemo)therapy being the mainstay of treatment. The aim of this report is to present the influence of comorbidities and lifestyle factors on treatment outcomes in our cohort of patients. During the period 2009-2018, curative radio(chemo)therapy for laryngeal cancer was performed on 189patients. The median OS was 50.8months, with amean PFS of 96.5months, mean LC of 101.4months and amedian follow-up of 38.1months. Acute and late treatment toxicity grade 3-4 was observed in 39.2% patients and 10.1% patients, respectively. Asignificant effect on overall survival was confirmed for the baseline PS (performance status), severity of weight loss, baseline haemoglobin values, history of alcohol abuse, marital status and comorbidities according to the Charlson Comorbidity Index, as well as the ACE-27 and ASA scores. In our cohort of patients treated with radio(chemo)therapy for laryngeal cancer, we found good therapeutic results and an acceptable side-effect profile. Statistically significant predictors of overall survival were the baseline PS, weight loss, anaemia, associated comorbidities, history of alcohol abuse and marital status.

Surgical Treatment of Pharyngocutaneous Fistula Requiring Extensive Neck Skin Reconstruction

Background: Pharyngocutaneous fistula is a major complication that occurs after salvage surgery following radiotherapy for laryngeal cancer. It is characterized by extensive neck skin defects and pharyngeal defects, necessitating biplane reconstruction for surgical treatment.Methods: We retrospectively examined the surgical procedure and postoperative course of pharyngocutaneous fistula in patients with extensive neck skin defects who were operated on in our department.Results: A pectoralis major myocutaneous flap was employed for reconstruction in five cases, while the free anterolateral thigh flap was used in one. In two cases where the pectoralis major myocutaneous flap was used, reconstruction was done with two skin paddles; in one case, a skin paddle and a muscle flap with a skin graft were used for reconstruction. The patient, for whom an anterolateral thigh flap was used, underwent reconstruction using two skin paddles, each containing one perforator artery. A pectoralis major myocutaneous flap with a skin graft and a free anterolateral thigh flap yielded favorable outcomes.Conclusion: A free anterolateral thigh flap is recommended if the neck has anastomotic vessels in unilateral neck dissection. Conversely, if the use of free flaps is avoided, a pectoralis major flap with a skin paddle on the pharyngeal side and a skin graft on the muscle flap on the skin side is recommended.

Intensified Radiation Therapy for Laryngeal Cancer: Oncologic and Functional Outcomes

<h3>Purpose/Objective(s)</h3> To evaluate the outcomes of advanced-stage laryngeal squamous cell carcinoma (SCC) patients (pts) treated with functional-preservation strategy at a tertiary cancer center with a specific focus on laryngo-esophageal dysfunction disease free survival (LDDFS). <h3>Materials/Methods</h3> Retrospective review was conducted of stage III-IVB laryngeal SCC pts who were treated with curative-intent radiotherapy (RT) (2007-2018). Pts were preferentially managed with upfront chemoradiation (CRT); except for those with cN2-3, cT4, or large volume cT3 (induction chemotherapy followed by RT or CRT is an option), and those who were unfit or declined chemotherapy (received accelerated RT). The primary endpoint was 3-yr LDDFS, and secondary endpoints were 3-yr local failure (LF), regional failure (RF), distant metastasis (DM), overall survival (OS), disease-free survival (DFS) and acute and late toxicities. Events for LDDFS included death, tumor relapse (i.e., LF, RF, DM), and late laryngo-esophageal dysfunction (defined by feeding tube dependence, tracheostomy or aspiration pneumonia >6 months post-RT), whichever occurred first. Cox proportional hazard test were used for multivariable analysis (MVA). <h3>Results</h3> A total of 213 cases were included (table 1). With a median follow-up of 37 months, the 3-yr LDDFS was 50%, while the 3-yr OS, DFS, LF, RF, and DM were 81%, 74%, 9%, 5% and 7%, respectively. On MVA, cT4- category was the only predictor of inferior LDDFS (HR: 0.47, [95%CI: 0.29-0.74], p<0.01). The most common grade ≥ 3 acute and late RTOG toxicity were esophageal toxicity: 16.7% and 29.6%, respectively. <h3>Conclusion</h3> Intensified RT resulted in favorable oncologic and functional outcome in only half of the advanced stage laryngeal cancer pts. Future clinical trials are required to investigate further treatment intensification particularly in T4-primary tumors aiming to improve the oncologic and maintain functional outcomes with utilization of LDDFS as the primary endpoint.

Bilateral ocular ischemic syndrome following treatment for laryngeal carcinoma

A 72-year-old male with a history of atherosclerosis and radiation therapy for laryngeal cancer presented with complaints of decreased vision. The exam of the right eye was notable for neovascularization of the iris and significant vaso-occlusive disease of the retina, with non-perfusion of the peripheral retina (Figure 1A). Classical large dot-blot hemorrhages were present in the mid-periphery of left retina consistent with the diagnosis of bilateral Ocular Ischemia Syndrome (OIS) (Figure 1B). Fluorescein angiography demonstrated more severe OIS of the right retina, with global peripheral capillary drop out and optic disc and diffuse vascular leakage (Figure 1C). Far peripheral capillary drop out was seen in the left eye with leaking neovascular vessels near the disc (Figure 1D). CT angiography showed arterial occlusive disease with impairment of carotid artery perfusion of the clinoid segment of the right internal carotid artery on axial CT angiogram, mirroring the severity of retinal ischemia between the two eyes (Figure 2).

Technical note: Toward implementation of MR‐guided radiation therapy for laryngeal cancer with healthy volunteer imaging and a custom MR‐CT larynx phantom

Internal motion of the larynx can cause normal tissue toxicity and/or tumor underdosage during radiotherapy. MR-guided radiation therapy (MRgRT) provides improved soft-tissue contrast for patient setup and real-time gating of radiation based on cine imaging of tumor motion, potentially making it an advantageous modality for laryngeal treatments. However, there are potential concerns regarding the small target size, proximity to heterogeneous tissue interfaces in the airway that may cause dosimetric errors in the presence of the magnetic field, and uncertainty about the ability of MR-linear accelerator (MR-Linac) systems to visualize and track laryngeal motion. To date, there have been no reports of the use of MRgRT for laryngeal treatments. A healthy volunteer was imaged on a ViewRay MRIdian MR-Linac. Organs-at-risk and a laryngeal pseudo target were contoured and used to generate a stereotactic body radiotherapy plan. A custom phantom was created using 3D-printing based on structures delineated on the volunteer images to construct an enclosure containing the target and airway anatomy, with a gap for radiochromic film, and filled with gelatin . The treatment plan was mapped onto the phantom and delivered dose assessed on radiochromic film with global normalization and a 10% dose threshold. A cine MR of the volunteer was acquired to assess the magnitude of larynx motion with speaking and swallowing, and system's ability to gate radiation. A clinically acceptable laryngeal treatment plan and larynx phantom that was MR and computed tomography-visible were successfully created. The delivered dose had good agreement with the treatment plan with a gamma passing rate of 96.5% (3%/2mm). The MR-Linac was able to visualize, track, and gate larynx motion. The MRgRT workflow for laryngeal treatments was assessed and performed in preparation for clinical implementation on the MR-Linac, demonstrating that it is feasible to treat laryngeal cancer patients on the MR-Linac.

Effect of voice rehabilitation following radiotherapy for laryngeal cancer – a 3-year follow-up of a randomised controlled trial

Objectives This study aims to report on the effectiveness of voice rehabilitation following radiotherapy for laryngeal cancer in a long-term perspective, i.e., up to three years after completion of radiotherapy. Methods The study included a total of 74 patients that were randomised into an intervention group (n = 37) or a control group (n = 37). Voice recordings with blinded assessment of voice quality with the GRBAS protocol (Grade, Roughness, Breathiness, Asthenia, Strain) and acoustic analysis was performed at baseline, 12 and 36 months following radiotherapy. Voice rehabilitation was performed in 10 sessions immediately following completion of radiotherapy. Patients also filled out the Swedish Self-Evaluation of Communication Experiences after Laryngeal cancer. Results The S-SECEL demonstrated statistically significant improvements in the intervention group when comparing baseline and 36 months, and no changes in the control group. Acoustic measures did not reveal any significant changes. The perceptual analysis demonstrated that when comparing the changes within the groups between baseline and 36 months there were statistically significant differences between the intervention and control group regarding the voice qualities Roughness, Breathiness and Strain. In the control group, 50% demonstrated deterioration in roughness, while in the intervention group only 7% deteriorated during this time. In Breathiness and Strain, 57 and 50%, respectively, improved in the intervention group, while only 32% and 23% improved, respectively, in the control group. Conclusion Voice rehabilitation following radiotherapy for laryngeal cancer demonstrate positive effects in patient reported outcomes and perceptual measures of voice quality, and the effects remain up to three years following radiotherapy.

P-49 Could organ sparing radiotherapy for larynx cancer have prevented World War I?

P-49 Could organ sparing radiotherapy for larynx cancer have prevented World War I?

Voice Outcomes after Radiotherapy for Laryngeal Cancer

Objective The study was aimed to assess changes in voice outcomes after radiotherapy in laryngeal cancer patients. Materials and Methods The study included 60 laryngeal cancer patients treated with definitive radiotherapy or chemoradiotherapy between 2005 and 2012. The primary endpoint of this study was to assess abnormalities of the patients’ voices after the treatment. The Thai version of the Voice Handicap Index (VHI) and xerostomia questionnaire were conducted by telephone. Videostroboscopic examination was done to objectively assess voice outcomes. Results The median age of patients was 63 years. Most patients had glottic cancer (84.1%) and T1–2 disease (84.1%). The median time from treatment to the study was 46 months. In terms of the total VHI score, most patients were in the normal and slight handicap groups (22% and 71.4%, respectively). Only 4.8% and 1.6% of the patients were in moderate and severe handicap group, respectively. Twenty-eight patients had significant xerostomia. Videostroboscopy examination was done in 23 patients and most common findings were telangiectasia (95.7%), abnormal mucosal wave (47.8%), and abnormal glottic closure configuration (34.8%). Regarding total VHI score, lower radiation dose, conventional radiation dose per fraction, longer period after treatment, and significant xerostomia status were significantly correlated with worse voice outcomes. There were no statistically significant correlations between the videostroboscopic findings and VHI scores. Conclusion Voice outcomes in most of laryngeal cancer patients treated with radiotherapy had a normal or mild handicap at more than 1 year of follow-up. Only 4.8% and 1.6% of the patients had moderate and severe voice outcome handicap, respectively.

Biological tumor markers associated with local control after primary radiotherapy in laryngeal cancer: A systematic review.

BackgroundThe choice of treatment in laryngeal cancer is mainly based on tumor stage, post‐treatment morbidity and quality of life. Biological tumor markers might also be of potential clinical relevance.Objective of the reviewThe aim was to systematically review the value of published biological tumor markers to predict local control in laryngeal cancer patients treated with definitive radiotherapy.Type of ReviewSystematic review.Search strategyPubMed, Embase, Cochrane Library.Evaluation MethodA literature search was performed using multiple terms for laryngeal cancer, radiotherapy, biological markers, detection methods and local control or survival. Studies regarding the relation between biological tumor markers and local control or survival in laryngeal cancer patients primarily treated with radiotherapy were included. Markers were clustered on biological function. Quality of all studies was assessed. Study selection, data extraction and quality assessment was performed by two independent reviewers.ResultsA total of 52 studies out of 618 manuscripts, concerning 118 markers, were included. EGFR and P53 showed consistent evidence for not being predictive of local control after primary radiotherapy, whereas proliferation markers (ie high Ki‐67 expression) showed some, but no consistent, evidence for being predictive of better local control. Other clusters of markers (markers involved in angiogenesis and hypoxia, apoptosis markers, cell cycle, COX‐2 and DNA characteristics) showed no consistent evidence towards being predictors of local control after primary radiotherapy.ConclusionsCell proliferation could be of potential interest for predicting local control after primary radiotherapy in laryngeal cancer patients, whereas EGFR and p53 are not predictive in contrast to some previous analyses. Large diversity in research methods is found between studies, which results in contradictory outcomes. Future studies need to be more standardised and well described according to the REMARK criteria in order to have better insight into which biomarkers can be used as predictors of local control after primary radiotherapy.

RADIOTHERAPY IN COMBINED TREATMENT OF RECURRENT STAGE 3 LARYNGEAL CANCER

The paper presents the treatment results performed in 250 patients with a laryngeal tumor of the third stage. The average life expectancy of these patients generally does not exceed 3−6 months. Chemotherapy is usually considered the standard treatment for the recurrence of head and neck squamous cell cancer patients, previously received radiotherapy. When prescribing the chemotherapy, a tumor regression is observed only in 10−40 % and does not virtually affect the life. Average life expectancy of these patients often varies from 5 to 9 months. The optimal total dose of radiotherapy for the treatment of inoperable recurrent and metastatic cancer was found in this reserach for imroving treatment results. The surgical protocols and techniques under discussion in this paper are certainly of a practical significance. The method for preoperative radiotherapy for larynx cancers was developed and the guidelines have been proven. Also there was proven that preoperative radiotherapy in a combined treatment of recurrent operable laryngeal cancer increases its effectiveness and does not affect postoperative period. Repeated radiotherapy for recurrent inoperable laryngeal cancer is possible only if the changes after previous radio− or combination therapy do not exceed 2 degrees. In addition, a repeated radiotherapy at a total source dose of 40−60 Gy is an effective method of palliative treatment and significantly improves the life expectancy and quality in the patients if compared with palliative chemotherapy. The method used in combination with intratumoral chemo− and radiotherapy significantly improves the efficiency of palliative treatment in the patients with recurrent regional metastasis for inoperable laryngeal cancer, in the primary tumor area, no signs of recurrence were found. Key words: laryngeal cancer, combined cancer treatment, radiotherapy.

Cost-effectiveness analysis of voice rehabilitation for patients with laryngeal cancer: a randomized controlled study

IntroductionVoice problems are common following radiotherapy for laryngeal cancer. Few studies exist covering the effect of voice rehabilitation, and no previous studies exist regarding the cost of said rehabilitation. This randomized controlled study aimed to analyze the cost-effectiveness of voice rehabilitation after radiotherapy for patients with laryngeal cancer.Material and methodsA total of 66 patients with laryngeal cancer with follow-up data 12 months post-radiotherapy were included. Patients were randomized into receiving either voice rehabilitation (n = 32) or no voice rehabilitation (n = 34). The patient outcome was measured as quality-adjusted life years (QALYs). The index range between 0 and 1, where 0 equals death and 1 represents perfect health. The QALYs were assessed with the European Organization for Research and Treatment of Cancer questionnaire QLQ-C30 mapped to EuroQoL 5 Dimension values. The cost of rehabilitation and other healthcare visits was derived from hospital systems. The patients reported the total amount of sick leave days during the first 12 months following radiotherapy. The cost-effectiveness of the voice rehabilitation was compared with no rehabilitation intervention based on the incremental cost-effectiveness ratio.ResultsThe cost per gained QALY with voice rehabilitation compared to no rehabilitation from a societal perspective was − 27,594 € (SEK − 250,852) which indicates that the voice rehabilitation is a cost-saving alternative compared to no rehabilitation due to lower costs and a slightly better health outcome. From a healthcare perspective, the voice rehabilitation indicates a cost 60,800 € (SEK 552,725) per gained QALY.ConclusionFrom a societal perspective, i.e., including the costs of production loss, voice rehabilitation compared to no voice rehabilitation following radiotherapy for laryngeal cancer seems to be cost-saving. When analyzing only the healthcare costs in relation to health outcomes, voice rehabilitation indicates an incremental cost of 60,800 € per gained QALY, which is just above the threshold of the maximum willingness to pay level.

English

English

EP-1202 Associations between smoking cessation after radiotherapy for larynx cancer and patient outcomes

EP-1202 Associations between smoking cessation after radiotherapy for larynx cancer and patient outcomes

A Case of Tracheal Cancer Arising 3 Years after Radiation Therapy for Laryngeal Cancer

A Case of Tracheal Cancer Arising 3 Years after Radiation Therapy for Laryngeal Cancer

Voice Quality in Laryngeal Cancer Patients: A Randomized Controlled Study of the Effect of Voice Rehabilitation

ObjectivesThe study aimed to investigate the short-term and long-term effects of voice rehabilitation in patients treated with radiotherapy for laryngeal cancer as measured by both the acoustic measure smoothed cepstral peak prominence (CPPS) and perceptual measures. A secondary aim was to investigate the relationship between acoustic and perceptual measures. MethodsIn total, 37 patients received voice rehabilitation post-radiotherapy and 37 patients constituted the irradiated control group. Outcome measures were mean CPPS for connected speech and ratings with the auditory-perceptual Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Outcome measures were analyzed 1 (baseline), 6, 12, and 24 months post-radiotherapy, where voice rehabilitation was conducted between the first two time-points. Additional recordings were acquired from vocally healthy participants for comparison. ResultsCPPS values of the voice rehabilitation group and vocally healthy group were not significantly different at 24 months post-radiotherapy. Ten out of 19 patients who received voice rehabilitation yielded a CPPS value above the threshold for normal voice 24 months post-radiotherapy, compared to 11 out of 26 in the irradiated control group. No statistically significant correlations were found between CPPS and perceptual parameters of GRBAS. ConclusionVoice rehabilitation for irradiated laryngeal cancer patients may have positive effects on voice quality up to 24 months post-radiotherapy. The relationship between CPPS and GRBAS as well as the applicability of CPPS for evaluation over several points of measurement needs to be studied further.

Treatment Strategies and Outcomes of Infections After Carotid Interventions

Infections after carotid endarterectomy are a devastating but rare complication, with paucity of literature providing guidelines for management of this complex issue. In this study, we report the experience of a single institution's management of carotid infections occurring after carotid interventions. A retrospective chart review was performed to document presentation, treatment, and outcomes of patients who underwent surgical intervention for carotid infections from 2002 to 2017. Primary end points were mortality and stroke. Secondary end points were cranial nerve injuries, reinfections, and reinterventions. Twenty-nine patients with mean age of 69 ± 2 years (76% male) were treated for carotid infections. Index operation was performed elsewhere in 27 (93%) patients, and 7 (24%) of these patients had prior secondary reinterventions (4 had carotid stenting and 3 had surgical revisions). The most common symptom on presentation was abscess or purulent drainage in 19 (66%) patients; 7 (24%) patients presented with active bleeding, and 10 (34%) patients had carotid pseudoaneurysms. Computed tomography was the diagnostic imaging of choice in 27 of 29 (93%) patients. Incision and drainage were performed in seven patients (five of these were done elsewhere before transfer). Wound and blood cultures were positive in 16 and 2 patients, respectively; the most common organisms identified were staphylococcus and streptococcus (83%). A combination of prosthetic (n = 15) and bovine (n = 5) patches was used at index operation. Median time to presentation was 7 months (range, 0.3-194 months). Femoral vein graft interposition was used for carotid replacement in 24 patients (83%), femoral vein patch angioplasty in 1 (3%), and saphenous vein patch angioplasty in 4 (14%). Early complications included stroke in one patient (3%) and death in one patient on postoperative day 11 from multiorgan system failure (3%). Three patients had tracheostomy (one for prolonged ventilator dependence, one had bilaterally paretic vocal cords, and one had a history of radiation therapy for laryngeal cancer). Cranial nerve injury occurred in eight patients (28%); all resolved at last follow-up. Mean length of hospital stay was 10 ± 1 days. Carotid occlusion occurred in one patient (3%) at 3 months with no clinical sequelae. Follow-up duplex ultrasound did not show any evidence of graft stenosis. At mean follow-up of 17 ± 4 months, there were no carotid reinfections or reinterventions. Treatment of carotid infections with replacement using femoral vein can be performed safely with a low risk of stroke and mortality. This repair is durable at midterm follow-up without clinical complications of reinfection or reintervention.