Supraglottic Laryngeal Cancer Research Articles

Clinical Outcomes of Supraglottic Laryngeal Cancer: Insights from a Decade of Surgical Treatment

Clinical Outcomes of Supraglottic Laryngeal Cancer: Insights from a Decade of Surgical Treatment

Effects of VDR and CYP24A1 gene polymorphisms on the outcome of supraglottic larynx cancer.

Vitamin D has been demonstrated to play a protective role in carcinogenesis. Polymorphisms of the vitamin D receptor (VDR) genes and 24-α-hydroxylase (encoded by CYP24A1) may affect the outcome of some cancers. This study examines the effects of the VDR gene and CYP24A1 single nucleotide polymorphisms on the outcome of supraglottic larynx cancer. Patients diagnosed with supraglottic larynx cancer between 2017 and 2022 were enrolled. Single nucleotide polymorphisms of the VDR gene (rs2228570, rs731236, rs7975232, rs11574113, rs11168267 and rs11168266) and CYP24A1 gene (rs4809960, rs6022999, rs6068816, rs2259735 and rs2296241) were investigated. All patients were followed up for any evidence of local recurrence, regional recurrence, distant metastasis, and second primary tumor development. Cox regression analysis was performed to evaluate the prognostic value of single-nucleotide polymorphisms (SNPs). Kaplan-Meier method was used for survival analysis. 87 patients were included. The mean follow-up time was 45.02±24.47 months. Cox regression analysis for locoregional recurrence revealed that the hazard ratio of rs731236 GG was 2.098 (95% CI, range: 1.047-4.202, p=0.037). Locoregional recurrence for rs731236 AA, AG, and GG were 38.6%, 23.1%, and 53.3%, respectively. In the presence of rs731236 GG polymorphism, disease-specific survival was significantly shorter (47.63±7.48 months, p=0.015), and disease-free survival (45.71±6.3 months) was significantly shorter (p=0.040). Rates of metastases and second primary tumors were not significantly different between SNPs. This study has demonstrated the possible effects of VDR rs731236 SNP on the locoregional recurrence and prognosis of supraglottic larynx cancer.

Transoral robotic supraglottic laryngectomy: Long-term functional and oncologic outcomes

ObjectivesMinimally invasive transoral organ preservation surgeries are being increasingly used for supraglottic tumors. This study investigates the long-term functional and oncologic outcomes of transoral robotic supraglottic laryngectomy (TORS-SGL). Materials and methodsTwenty-three patients with supraglottic laryngeal cancer who underwent TORS-SGL between 2012 and 2015 at a tertiary referral hospital were retrospectively analyzed with at least 5 years of follow-up. The head and neck tumor council and the multidisciplinary oncological board decided whether the patients were suitable for robotic surgery, and the necessity of adjuvant radiotherapy or chemotherapy. Inclusion criteria was histopathological diagnosis of squamous cell carcinoma of the larynx. ResultsTwenty-one patients with T1-T3 supraglottic squamous cell carcinoma were included in this study. Mean follow-up was 48.8 months. Local control was 94.4 % at 2 years and 85.9 % at 5 years. Disease-free survival and overall survival were 85.7 % and 81 % at 2 years and 69.3 % and 57.1 % at 5 years, respectively. There was no permanent tracheostomy or prolonged swallowing dysfunction among patients. Age, perineural and lymphovascular invasion were found to be risk factors affecting overall survival. ConclusionTORS-SGL is a feasible, safe and reliable approach with excellent functional results for T1, T2, and selected T3 supraglottic tumors, providing acceptable long-term oncologic results when compared to alternative treatment modalities.

Outcomes of mini-invasive transoral surgery without neck dissection in supraglottic laryngeal cancer: Real world data from a tertiary cancer center

PurposeThe neck management in early-stage cN0 supraglottic cancer represents an argument of debate. The aim of our study is to evaluate the oncological and functional outcomes in patients with early-stage cN0 supraglottic carcinoma treated with a wait-and-see policy for the neck. Materials and methodsRetrospective monocentric cohort study in a referral cancer care center. We collected a consecutive sample of patients from 2000 to 2020 with Squamous Cell Carcinoma of the supraglottis without clinical evidence of nodal metastases (cN0), surgically treated with Transoral Surgery (Laser or Robotic) without neck dissection. From 316 supraglottic cancer we finally selected 66 eligible participants that met all inclusion criteria. ResultsSixty-six patients (M 75.8 % vs F 24.2 %), median age 65.8 years (IQR 60.9, 70.5). The most common subsite was the epiglottis (62.1 %). Tumor stage distribution was as follows: 35 % cT1, 53 % cT2, 15.2 % cT3. Neither deaths nor major treatment-related complications were reported after surgery. The median follow-up was 62 months. For oncological outcomes, we evaluated 56 patients (10 excluded for adjuvant radiotherapy): 5-year overall survival rate 87 % (CI 95 %: 73.1–94), disease- specific survival rate 95.3 % (CI 95 %: 82–98.8) and neck recurrence-free survival rate 87 % (CI 95 %: 73.1–94). Six patients developed neck recurrence, with a median time of 13 months. ConclusionsSupraglottic carcinoma has been historically associated to a considerable risk of occult metastasis. However, in early-stage cases data are still inconclusive. Our results suggest that in such patients a wait-and-see policy does not impact negatively on survival outcomes, while granting the reduced morbidity associated to a minimally invasive surgical approach.

Complete remission of an early-stage laryngeal cancer under combined pembrolizumab and chemotherapy treatment of a synchronous lung adenocarcinoma

BackgroundAnti-PD1-Checkpoint inhibition (CI) is an established treatment of recurrent and/or metastatic head and neck cancer. A potential benefit from CI in early-stage disease that is usually treated by radiation or surgery has not been investigated so far and is currently not addressed in clinical trials.Case presentationA 58-year-old man was diagnosed with a cT2 supraglottic laryngeal cancer and a synchronous metastasized adenocarcinoma of the lung. As the patient refused any treatment of his laryngeal cancer, he received combined immune-chemotherapy according to the KEYNOTE-189 protocol. After 4 cycles of pembrolizumab/carboplatin/pemetrexed, the patient showed a complete remission of his laryngeal cancer with a clear shrinkage of the mediastinal and hilar lung cancer metastases. After 21 cycles of maintenance therapy, the lung adenocarcinoma shows a stable disease status with no signs of any residual or recurrent laryngeal cancer.ConclusionsAnti-PD1-CI may be a treatment option also for early-stage HNSCC with excellent functional outcome when established therapies are not available.Graphical

En Bloc Resection of Supraglottic Carcinomas with Transoral Laser Microsurgery.

Objective:Complete en bloc supraglottic tumor excision with transoral laser microsurgery (TLM) can be achieved with good postoperative outcomes. We report surgical feasibility and the postsurgical outcomes of en bloc resection of supraglottic laryngeal squamous cell carcinomas (LSCC) with TLM.Methods:Seventeen patients who underwent TLM for supraglottic laryngeal cancer were included in the study. Demographic and pathological data, clinic and follow-up outcomes of the patients were reviewed and analyzed.Results:Type 1 TLM was performed in three patients, type 2a in one patient, type 3b in 12 patients, and type 4b in one patient. Negative surgical margins were achieved in all of the cases. Re-excision or any adjuvant treatment for positive resection margins was not required in any of the cases. Eight patients received adjuvant radiotherapy due to lymph node metastasis. Mean follow-up time was 33.8±15.7 months (range: 10–65 months). None of the patients had recurrence or distant metastasis.Conclusion:The transoral approach with the use of CO2 laser and microscopy offers complete tumor excision for treating supraglottic LSCC. The three-dimensional structure of the supraglottis can be achieved with adequate exposure. En bloc resection is possible with safe margins.

Long-term analysis of bilateral versus unilateral neck dissection in the treatment of early-stage supraglottic laryngeal cancer

OBJECTIVE: This study aimed to investigate the effect of routine bilateral neck dissection on the survival outcomes of supraglottic laryngeal cancer patients with lateralized tumors and clinically negative necks. METHODS: The data of 234 patients surgically treated for supraglottic squamous cell carcinoma between January 2000 and September 2014 were retrospectively collected. Patients treated previously for head and neck cancer, patients who could not be contacted, and those with missing data were excluded. Of the remaining 187 patients, 124 patients with early-stage primaries (T1-T2) (116 males, 8 females; mean age: 55.5±9.5 years; range, 33 to 82 years) were included. Age and sex of the patients, site of the primary tumor, TNM stage, type of the neck dissection, length of follow-up, and survival rates were evaluated. The tumors were classified into three groups according to their relationship with the median line of the larynx, and the neck dissections were recorded as unilateral or bilateral. Recurrences and survival outcomes were evaluated. RESULTS: There was no statistically significant difference in the recurrences according to tumor site groups (p=0.39). Similarly, there was no statistically significant difference in 10-year overall survival rates in patient groups according to the tumor site (p=0.072). We found no statistically significant difference in 10-year overall survival rates between the patients who underwent unilateral and bilateral neck dissection (p=0.580). CONCLUSION: Long-term survival analysis of 124 patients with supraglottic carcinoma did not show a survival benefit of elective contralateral neck dissection in lateralized supraglottic cancer with contralateral clinically negative neck.

Efficacy of superselective neck dissection (IIA and III) for supraglottic laryngeal cancer with clinically negative neck.

The purpose of this study was to determine the safety and efficacy of superselective neck dissection(SSND) (levels IIA and III) for patients with supraglottic squamous cell carcinoma (SCC) of the larynx and clinically negative (N0) neck. This was a prospective analysis of consecutive patients. A prospective analysis of 60 patients with SCC of the supraglottic larynx and N0 neck who underwent surgical treatment of the primary lesion with simultaneous SSND (levels IIA and III). The incidence of occult metastasis in the lymph nodes, regional recurrence, survival rate, and spinal accessory nerve function were evaluated. Ninety-eight superselective neck dissection (levels IIA and III) procedures were performed for 60 patients. The occult metastasis rate was 20% (12 of 60). Four patients (6.7%) developed regional recurrence, none of them was in level IIB. The 5-year overall, cancer-specific and disease-free survival rate was 82.8%, 87.6%, and 80.7%, respectively. Spinal accessory nerve function was maintained in all patients. Superselective neck dissection removing lymph nodes in levels IIA and III was safe and effective for supraglottic SCC of the larynx with clinically negative neck. The spinal accessory nerve function was maintained without compromising clinical outcome.

Association of tumor volume and outcomes in T3 larynx cancer with organ preservation approach.

e18044 Background: Organ preservation approaches to treatment of locally advanced larynx cancers are widely used and consist of radiotherapy (RT) with or without concurrent systemic therapy (CRT). Analyses of the National Cancer Database point to decreasing survival as CRT became widely adopted in place of total laryngectomy (TL). Tumor volume in T3 laryngeal tumors has been postulated as one variable to explain this finding, with higher volume associated with lower local control based on small sample size studies largely in pre-intensity modulated radiotherapy (IMRT) era, and low volume T3 tumors being associated with improved local control with CRT. We sought to validate these findings in a contemporary cohort of T3 larynx patients treated with IMRT. Methods: This was a national, multicentre retrospective cohort study of patients diagnosed with American Joint Committee on Cancer (AJCC) T3 N0-3 M0 glottic and supraglottic cancers who underwent curative intent IMRT with or without systemic treatment from 2002-2018. Tumor volumes were calculated using a validated standardized approach by a Neuroradiologist. Primary predictor was tumor volume, primary outcome was local control (LC), and secondary outcomes included overall survival (OS), as well as late grade 3+ toxicities. Kaplan Meier estimates and log-rank tests were used for survival analyses, with Cox proportional hazards used for univariable analyses. Results: 246 patients met inclusion criteria, 147 glottic and 99 supraglottic cancers. At baseline, glottic patients were more likely to be male (p < 0.01), have a fixed vocal cord (p < 0.01), not have pre-epiglottic space invasion ( < 0.01), be cN0 (p < 0.01), and have lower grade tumors (p < 0.01). Mean tumor volumes for glottic and supraglottic tumors were 5.0 (4.2-5.8) cc and 13.0 (10.3–15.6) cc respectively. Univariable analysis showed systemic therapy was associated with improved local failure (HR 0.49, 95%CI 0.24 – 0.99, p = 0.05). Within the glottic cohort, tumor volume was not associated with local failure (HR 1.09, 95%CI 0.71 – 1.67, p = 0.38), however having a local failure event was associated with increased feeding tube dependence (HR 2.52, 95%CI 1.05 – 6.02, p = 0.04). Median local failure free survival in the overall cohort was 28.5 months, with median OS 23.2 months. There was a trend towards improved local control in the supraglottic cohort compared to glottic patients (log-rank p = 0.08), but the supraglottic cohort had significantly worse overall survival (log-rank p = 0.02). Conclusions: In this retrospective cohort study, there were baseline and outcome differences between patients with T3 glottic and supraglottic larynx cancer, with worse overall survival in supraglottic patients. Tumor volume was not associated with local control in the glottic cohort. These findings are pending further validation in a larger cohort and will be analyzed separately for supraglottic tumors.

Treatment outcomes in patients with supraglottic laryngeal cancer: a single centre study

Background Treatment of squamous cell carcinoma of the supraglottic larynx (SCCSL) in Denmark has changed in several ways from the year 2000 to 2014, including the introduction of IMRT radiation technique and the addition of concurrent chemotherapy (CRT), as well as systematic reduction in waiting times until treatment initiation. Aim/Objectives Our aim is to investigate the effect of the abovementioned factors on overall survival (OS) and locoregional control (LC) for SCCSL patients. Materials and methods Retrospective cohort study with data from the DAHANCA database. We used the Kaplan–Meier and Cumulative Incidence plots as well as Cox regression analysis. Results We found a statistically significant improvement of the 5-year OS of 19.3 percentage points (pp). Cox regression found LC was not improved in patients receiving CRT compared to radiotherapy (RT) alone. Conclusions and significance Introduction of CRT treatment for head and neck cancers in general is known to improve LC. We could not demonstrate this effect for SCCSL specifically, as our results were not statistically significant on this point. OS was significantly improved.

Patterns of cervical lymph node metastasis in supraglottic laryngeal cancer and therapeutic implications of surgical staging of the neck

PurposeAccurate therapeutic management of the neck is a challenge in patients with supraglottic laryngeal cancer. Nodal metastasis is common at all disease stages, and treatment planning relies on clinical staging of the neck, for both surgical and non-surgical treatment. Here, we compared clinical and surgical staging results in supraglottic carcinoma patients treated with primary surgery to assess the accuracy of pre-therapeutic clinical staging and guide future treatment decisions.MethodsRetrospective analysis of clinical, pathological, and oncologic outcome data of 70 patients treated with primary surgery and bilateral neck dissection for supraglottic laryngeal cancer. Patients where clinical and pathological neck staging results differed, were identified and analyzed in detail.ResultsOn pathologic assessment, patients with early stage (pT1/2) primaries showed cervical lymph node metastases in 55% (n = 17/31) of cases, compared to 67% (n = 26/39) of patients with pT3/4 tumors. In 24% (n = 17/70) of all patients, cN status differed from pN status, resulting in an upstaging in 16% of cases (n = 11/70) and a downstaging in 9% (n = 6/70) of cases. 14% of patients with cN0 status had occult metastases (n = 5/30). As assessed by a retrospective tumor board, in case of a non-surgical treatment approach, the inaccurate clinical staging of the neck would have led to an over- or undertreatment of the neck in 20% (n = 14/70) of all patients.ConclusionOur data re-emphasize the high cervical metastasis rates of supraglottic laryngeal cancer across all stages. Inaccurate clinical staging of the neck is common and should be taken into consideration when planning treatment.

An Observational Cohort Study on 194 Supraglottic Cancer Patients: Implications for Laser Surgery and Adjuvant Treatment.

Simple SummarySupraglottic laryngeal cancer patients suffer from a much poorer prognosis than patients with carcinoma arising from the glottis. Outstanding outcomes after laser surgical resection of early-stage supraglottic cancers have been reported by laser surgery centers of excellence. The aim of our retrospective observational cohort study was to assess whether similar results are achieved in the multi-institutional setting of less specialized facilities. We confirmed comparable oncological outcomes in five normal academic teaching hospitals, with a 5-year overall survival rate of 62.0% compared to 59.4–76.0% in the centers of excellence. In the case of microscopic residual tumors after surgical resection (R1) and/or lymph node metastases, adjuvant irradiation is recommended. Our data show that irradiation alone is not sufficiently effective in supraglottic cancers. Thus, for this tumor entity, adjuvant chemoradiation could be recommended. Supraglottic laryngeal cancer is characterized by poor prognosis. In contrast, excellent outcomes have been published in early-stage supraglottic cancers after laser surgery in single-institutional series in centers of excellence. Are these results reproducible in the normal clinical practice of less specialized facilities? As part of an observational cohort study, the outcomes of 194 supraglottic cancer patients were assessed after treatment by larynx-preserving surgery (transoral laser microsurgery [TLM] or open partial laryngectomy [OPL]) or total laryngectomy (TL), with each having risk-adopted adjuvant treatment, or primary (chemo-)radiotherapy (pCRT or pRT). In early-stage supraglottic cancers, TLM achieved a 5-year overall survival (5-year OS) of 62.0%. No significant survival difference could be discerned between patients with and without adjuvant treatment (HR 1.47; 95% CI: 0.80 2.69). The comparison between pCRT and pRT patients suggests that CRT is more effective in supraglottic cancer. The 5-year OS rate achieved in our multiinstitutional setting is comparable to that reached in laser surgery centers of excellence (59.4–76.0%). According to our data and supported by the literature, adjuvant RT (aRT) is not sufficiently effective in supraglottic cancers. In case adjuvant therapy is indicated, adjuvant chemoradiation (aCRT) could be recommended.

Functional and Oncological Outcomes of Open Partial Laryngectomy vs. Transoral Laser Surgery in Supraglottic Larynx Cancer.

The aim of the presented study was to evaluate the outcomes of open partial laryngectomy (OPL) versus transoral laser surgery (TLS) in patients operated on for supraglottic laryngeal carcinoma based on functional parameters (duration of hospitalization, oral nutritional status and duration of transition to oral feeding, weaning status and duration after tracheotomy, and postoperative voice results) and oncological results (overall survival rate, disease-specific survival rate, recurrence, and presence of second primary tumors) in both groups. All laryngeal carcinoma patients who had undergone either OPL or TLS in the period from January 2012 to March 2017 in our center and were followed-up at least for 36 months were included in the study. Statistical analyses were carried out using the t-test and the Mann-Whitney U test to compare the means, and the Kaplan-Meier test for survival analysis. Fifty patients (44 males and 6 females) met the study criteria, of whom 31 had undergone OPL and 19 TLS. Patients that underwent TLS had less tracheotomy needs, needed shorter hospitalization periods, and transitioned to oral feeding earlier, compared to those that underwent OPL. There were no significant differences between the two groups based on oral feeding rates and voice outcomes. The impact of TLS and OPL on organ preservation in supraglottic laryngeal cancer were comparable. For local recurrences, repeated endolaryngeal laser surgeries and adjuvant treatments could be used in the TLS patient group. There were no significant differences between the two groups based on overall survival rate and disease specific survival rate. Although no significant differences were found in our study between the two surgical procedures in terms of oncological outcomes, TLS appeared to produce better functional outcomes in supraglottic laryngeal carcinoma than OPL.

Efficacy of acellular dermis matrix combined with cervical strap muscle as a composite tissue flap for the treatment of laryngeal cancer

Objective: To investigate the clinical efficacy of acellular dermis matrix combined with cervical strap muscle (ADM-CSM) as a composite tissue flap for repairing the laryngeal defect after partial laryngectomy. Methods: The medical records of 33 patients with laryngeal cancer who were diagnosed and treated at the First Affiliated Hospital of Sun Yat-sen University from January 2014 to December 2016 were retrospectively reviewed. The patients consisted of 32 males and 1 female with age range from 39 to 76 years. Laryngeal defects were repaired with ADM-CSM in 14 patients (2 for supraglottic laryngeal cancer, 12 for glottic laryngeal cancer) and with CSM fascial flaps in 19 patients (3 for supraglottic laryngeal cancer, 16 for glottic laryngeal cancer). Kaplan-Meier method was used to calculate the 3-year overall survival and local control rate. The functions of voice and swallowing after operation were evaluated by voice handicap index-30 (VHI-30) and MD Anderson dysphagia inventory. Univariate logistic regression analysis, t-test, and Mann-Whitney U test were used to compare the variables between the two groups. Results: The incidence of laryngeal stenosis was 2/14 in ADM-CSM group and 4/19 in CSM group. In the ADM-CSM group, 3-year overall survival and local control rates were 92.9% and 85.7%, respectively. In the CSM group, 3-year overall survival and local control rates were 78.9% and 84.2%, respectively. The time of operation(3 h vs. 4 h, Z=193.5, P<0.05), time of retaining the feeding tube(14 d vs. 17 d, Z=206.0, P<0.05), and length of stay(18.5 d vs. 22.1 d, t=-2.62, P<0.05) in the ADM-CSM group were significantly less than those in the CSM group. The quality of voice in the CSM group was better than that in the ADM-CSM group (66.85±27.65 vs.45.80±23.19, t=2.19, P<0.05), while swallowing function in the ADM-CSM group was better than that in the ACSM group (80.00[60.00, 80.00]vs.60.00[40.00, 80.00], Z=48.0, P<0.05). Conclusion: ADM-CSM is user-friendly control and safe composite tissue flap for repairing the laryngeal defect after partial laryngectomy, with less scar hyperplasia and higher satisfaction of swallowing function after operation.

Second primary tumors in head and neck cancer patients: The importance of a "tailored" surveillance.

Head and neck cancer survivors have increased risk of developing second primary tumors compared to overall population. Because second primary represents a major cause of morbidity and mortality in this population, early detection is fundamental. In this 10-year single-institution study, we investigated the following: incidence, clinical-pathological risk factors, and survival of patients with second primary tumor. We included all patients with diagnosis of squamous cell carcinoma of the head and neck seen at the Modena University Hospital from 2008 to 2018. Among 1,177 patients included, 222 (18.9%) developed second primary tumor; its survival probability at 5years was 40.6%. Alcohol consumption (p=.0055) and index cancer in oropharynx (p=.0029), supraglottic larynx (p=.0000), glottic larynx (p=.0222) were associated with higher risk of second primary. The most common second primary sites were head and neck district and lung (70, 31.5%, and 67, 30.2%, respectively). Head and neck district were more common in oral cavity (18, 43%) and oropharynx index cancer (20, 31%); lung second primary in hypopharynx (4, 40%), supraglottic larynx (17, 43%), and glottic larynx index cancer (23, 35%). Head and neck cancer survivors developing a second primary tumor have dismal prognosis. Tailored surveillance is recommended.

NIVOLUMAB-INDUCED PULMONARY FIBROSIS: A NEW FINDING

SESSION TITLE: Medical Student/Resident Diffuse Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: The growth of personalized medicine has increased survival in aggressive cancers. Despite their improved side effect profile relative to early chemotherapy, monoclonal antibodies still feature many potentially severe side effects. Here, we present the first reported case of nivolumab-induced rapidly progressive pulmonary fibrosis. CASE PRESENTATION: A 65 year old gentleman with chronic respiratory failure requiring supplemental oxygen, a history of smoking, and stage IV supraglottic laryngeal cancer was started on nivolumab after progression of disease on platinum-based chemotherapy and radiation. Three months after starting nivolumab, honey-combing, traction bronchiectasis, and pulmonary fibrosis with lower lobe predominance was noted on computed tomography (CT) imaging during a hospital admission for dyspnea. (Image 1) Nivolumab was stopped, and oral corticosteroids were started. Despite this, the patient’s respiratory status continued to decline, requiring multiple hospitalizations. After admission for septic shock secondary to pneumonia, the patient suffered respiratory failure requiring intubation, which the patient declined and died with comfort care. DISCUSSION: Nivolumab is an anti-PD1 checkpoint inhibitor human monoclonal antibody approved for second-line use in squamous cell head and neck cancer with disease progression after platinum-based therapy. For this indication, median survival time is increased by 2.4 months. (1) Pneumonitis is a rare adverse effect of nivolumab, seen in 5-6% of patients. The median time of onset ranges widely from days to over a year. Most cases of pneumonitis are mild, and most cases improve or resolve completely. Features associated with worse outcomes include severity at presentation, underlying lung disease, poor lung function, and smoking history. Mainstay of treatment is high dose oral corticosteroids, with severe cases requiring intravenous steroids or additional immunosuppression such as infliximab. (2) Our patient had many of the poor prognostic factors for nivolumab-induced pneumonitis, but instead developed fibrosis. Pneumonitis has been reported many times, but to our knowledge this is the first evidence of pulmonary fibrosis caused by nivolumab. Potentially, the maelstrom of baseline conditions contributed to fibrosis rather than pneumonitis. CONCLUSIONS: Given the prevalence of chronic lung conditions, increasing use of nivolumab, and rapidly progressive nature of this case—from diagnosis to death in six weeks and poor response to steroids—consideration of pulmonary fibrosis as an adverse event of nivolumab may necessitate future considerations. Reference #1: Opdivo. [package insert]. New York, NY: Bristol-Myers-Squibb; 2014. Reference #2: Naidoo J, Wang X, Woo KM, et al. Pneumonitis in Patients Treated With Anti-Programmed Death-1/Programmed Death Ligand 1 Therapy. J Clin Oncol. 2017;35(7):709-717. DISCLOSURES: No relevant relationships by Hazim Bukamur, source=Web Response No relevant relationships by Kendall Creed, source=Web Response My spouse/partner as a Consultant relationship with Abbvie Please note: $1-$1000 Added 05/27/2020 by Ebtesam Islam, source=Web Response, value=Consulting fee No relevant relationships by John Makram, source=Web Response No relevant relationships by Alexandra Wichmann, source=Web Response

Squamous Cell Carcinoma of Head and Neck in Vajira Hospital: The Outcomes in a Real-World Practice

Background: Squamous cell carcinoma of the head and neck (SCCHNC) is the fifth most common cancer in Thailand. Even though the multi-modality treatment including surgery, radiotherapy, and chemotherapy is the standard practice, the survival outcomes are not impressive. Objective: The primary objectives were to determine the overall survival (OS) and 3-year OS of all patients with SCCHNC and as analysis according to the primary site of the primary tumor. The secondary objectives were progression-free survival (PFS), outcomes of induction chemotherapy (IC), prevalence of serious toxicities from treatments, and independent factors of survival. Materials and Methods: Retrospective analyses were conducted in patients who had SCCHNC confirmed by histology with complete details of staging and treatment, excluding nasopharyngeal carcinoma, carcinoma of the salivary glands, carcinoma of paranasal sinuses, and cutaneous squamous cell carcinoma. Results: There were 216 eligible patients. OS of all participants was 24.1 months (IQR 14.3 to 50.1). At the median follow-up of 51.49 months, 3-year OS was 52.2% (95% CI 45 to 95). The patients with primary tumor site at the glottic larynx had the longest OS of 45 months (IQR 21.2 to 64.8). The patients with primary sites at the oral cavity (OS 20.1 months, IQR 13.4 to 45.8), oropharynx (OS 20.05 months, IQR 12.4 to 48.5), hypopharynx (OS 23.3 months, IQR 13.3 to 44.6), and supraglottic or transglottic larynx (OS 25.15, IQR 19.55 to 37.8) had nearly equally worst OS. Stratified by primary site of tumor, the investigators found that PFS of patients with glottic larynx was the longest (23.6 months, IQR 17.5 to 53.4). On the other hand, PFS of patients with supraglottic or transglottic laryngeal cancer, oral cavity cancer, oropharynx, hypopharynx was only 11.35 months (IQR 5.8 to 28.65), 12.5 months (IQR 6.2 to 31.3 months), 13.2 months (IQR 6.3 to 27.8), and 15.1 (IQR 8.9 to 29.3), respectively. The IC did not improve the patients’ outcomes. Thirty patients (22.4%) had serious (grade 3 to 4) adverse effects from definitive treatment, mostly from severe mucositis. The primary sites at the oral cavity and hypopharynx, T4 diseases, and failure to primary definitive treatment were the independent predictors of early deaths. Conclusion: Due to the very late stage at presentation, the OS of the participants was only two years. The primary sites at the oral cavity and hypopharynx, T4 diseases rather than the composite TNM staging, and failure to primary definitive treatment were the independent prognostic factors of short survival. Keywords: Squamous cell carcinoma of the head and neck, Multi-modality treatment, Outcomes, Survival

Surgical, clinical and functional outcomes of transoral robotic surgery for supraglottic laryngeal cancers: A systematic review.

The aim of this systematic review is to shed light the current indications and outcomes of transoral robotic surgery (TORS) supraglottic laryngectomy (SGL) in patients with supraglottic laryngeal cancer. PubMed, Scopus and Cochrane Library were searched by three independent otolaryngologists from the Young Otolaryngologists of IFOS for studies investigating the indications, effectiveness and safety of TORS SGL. Surgical, functional, and survival outcomes have been investigated. Inclusion/exclusion criteria; demographic data; and clinical outcome evaluation of papers were analyzed using PRISMA criteria. A total of 14 papers met our inclusion criteria, accounting for 422 patients (335 males & 87 females). The tumor location mainly consisted of epiglottis (55.4%), aryepglottic fold (31.2%), and ventricular band (5.1%). The following tumor stages were considered: cT1 (35.8%); cT2 (48.6%) and cT3 (13.9%). Feeding tube and percutaneous endoscopic gastrostomy were used in 62.5% and 8.82% of patients, respectively. The 24-month local & regional control rates ranged from 94.3% to 100% and 87.5% to 94.0%, respectively. The 2-year and 5-year overall survival rates ranged from 66.7% to 88.0% and 78.7% to 80.2%, respectively. There was an important heterogeneity between studies with regard to the inclusion/exclusion criteria, follow-up times, complications analysis; surgical and functional outcomes. TORS SGL is an effective approach for treating patients with early stages supraglottic cancers. Future controlled studies are needed to compare functional and survival outcomes between TORS SGL and other surgical approaches. Recommendations have been provided for future studies for better inclusion of patients, analysis of complications and functional outcomes.

Soft tissue necrosis in patients treated with transoral robotic surgery and postoperative radiotherapy: preliminary results

Postoperative radiotherapy (PORT) is indicated in almost two-thirds of patients treated with transoral robotic surgery (TORS) for head and neck tumors. The aim of this study was to quantify the toxicity profile of patients treated with PORT after TORS in oropharyngeal and supraglottic laryngeal cancer focusing on soft tissue necrosis (STN). We retrospectively reviewed 28 patients. Acute and late toxicity were examined. Incidence and severity of STN were recorded. No patient experienced acute grade 3 skin or mucosal toxicity; 1 patient had grade 3 dysphagia. At 12 months, no evaluated patient required enteral nutrition and 2 patients had tracheostomy. STN occurred in 4 (14%) patients: 3 out of 4 (75%) patients with STN had diabetes, whereas 6 out of 13 (25%) patients without STN had diabetes (p = 0.05). We found an acceptable toxicity profile of PORT performed after a TORS procedure. Diabetes mellitus might be a risk factor for STN.

1124P - Single cycle induction treatment with cisplatin/docetaxel plus durvalumab/tremelimumab in stage III-IVB head and neck squamous cell cancer (CheckRad-CD8 trial)

BackgroundIn head and neck squamous cell cancer (HNSCC) a valid predictive parameter for the efficacy of immune-checkpoint inhibitors is still missing especially in locally advanced stages. MethodsIn the phase II CheckRad-CD8 trial unselected patients with HNSCC stage III-IVB receive one cycle of induction chemo-immunotherapy with cisplatin (30mg/m² d1-3)/ docetaxel (75mg/m² d1) plus durvalumab (1500mg absolute d5)/ tremelimumab(75mg absolute d5). Intra- and peritumoral CD8+ cytotoxic T-cells are assessed before and after the induction chemo-immunotherapy. Patients with CD8+ T-cell increase after induction chemo-immunotherapy enter radio-immunotherapy, patients without CD8+ T-cell increase enter radio-chemotherapy. This interim analysis including immunophenotyping of whole blood was performed after 10 patients had completed the re-evaluation after induction chemo-immunotherapy. Results6 patients with oropharyngeal, 2 patients with hypopharyngeal and 2 patients with supraglottic laryngeal cancer were included. The mean pre-treatment intratumoral CD8 density was 1094 CD8+ cells/mm². 8 of 10 patients had a pathological complete response of their primary tumor defined by complete absence of remaining tumor cells in re-biopsies after induction treatment. The other two patients showed an average intratumoral increase from 227 CD8+ cells/mm² to 1074 CD8+ cells/mm². According to RECIST 1.1 criteria 6 patients had a partial response (PR), 3 patients a stable disease (SD), 1 patient was not evaluable. Grade III-IV toxicity included one case of hepatitis and one infectious diarrhea. Detailed immunophenotyping revealed a trend of slight reduction of CD8+ T-cells in the peripheral blood of patients with initially lower numbers of intratumoral CD8+ T-cells. The early activation marker CD69 is increased on T-cells and PD-1 on T-helper cells after induction treatment. ConclusionsThese preliminary results suggest a promising response to single cycle induction treatment with cisplatin/ docetaxel plus durvalumab/ tremelimumab in unselected HNSCC patients. Furthermore, they show an induction of an immune response in both in the tumor tissue and the peripheral blood. Clinical trial identificationNCT03426657. Legal entity responsible for the studyThe authors. FundingAstraZeneca. DisclosureM. Hecht: Research grant / Funding (institution): AstraZeneca; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: MSD. A. Gostian: Advisory / Consultancy: test. M. Eckstein: Honoraria (self), Advisory / Consultancy: AstraZeneca; Advisory / Consultancy, Research grant / Funding (institution): Janssen-Cilag/Johnson&Johnson; Honoraria (self): Astellas; Honoraria (self): Roche. M.G. Hautmann: Honoraria (self): AstraZeneca. S. Laban: Honoraria (self), Advisory / Consultancy: MSD; Honoraria (self), Advisory / Consultancy: BMS; Honoraria (self), Advisory / Consultancy: AstraZeneca; Honoraria (self): Merck Serono. A. Hartmann: Honoraria (self), Advisory / Consultancy: BMS; Honoraria (self), Advisory / Consultancy: MSD; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Roche; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Cepheid; Honoraria (self), Advisory / Consultancy: AstraZeneca; Honoraria (self), Advisory / Consultancy: Boehringer Ingelheim; Honoraria (self), Advisory / Consultancy: AbbVie; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Janssen; Advisory / Consultancy, Research grant / Funding (institution): NanoString; Advisory / Consultancy, Research grant / Funding (institution): Illumina; Advisory / Consultancy: Quiagen; Advisory / Consultancy, Research grant / Funding (institution): Biontech; Advisory / Consultancy: 3D Histotech. U. Gaipl: Research grant / Funding (institution): AstraZeneca; Research grant / Funding (institution): MSD. R. Fietkau: Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Merck Serono; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): AstraZeneca; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Novocure; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Brainlab; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Fresenius Kabi; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): BMS; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): MSD. All other authors have declared no conflicts of interest.