El-Naggar AK, JKC C, JR G, T T, PJ S (2017) WHO 2017 Classification of Tumours, 4th Edition, Volume 9 Head and Neck. WHO Classification of Tumours. WHO Press, World Health Organization, Geneva, Switzerland.
Annelienke M van Hulst, Wouter Kroon, Evi S van der Linden, Lily Nagtzaam, Sarah R Ottenhof, Inge Wegner, Amy C Gunning, Wilko Grolman, Weibel Braunius
Grade of dysplasia and malignant transformation in adults with premalignant laryngeal lesions.
Head Neck. 2016 Apr;38 Suppl 1:E2284-90. doi: 10.1002/hed.24185. Epub 2015 Aug 13.
Abstract/Text
BACKGROUND: The purpose of this systematic review was to determine the significance of the grade of dysplasia in the development of invasive carcinoma.
METHODS: A systematic search was performed to identify all relevant evidence. Titles and abstracts were screened using predefined criteria. Remaining articles were critically appraised. Absolute risks and 95% confidence intervals (CIs) were calculated.
RESULTS: Seven articles were included. Four studies demonstrated an increased risk for the development of laryngeal carcinoma from mild, moderate, and severe dysplasia. Three studies showed an increased risk between the categories of mild and moderate dysplasia.
CONCLUSION: The risk of malignant transformation seems to increase with the grade of dysplasia, although percentages between studies are highly dissimilar. The wide variety and overlapping 95% CIs make it difficult to formulate a strong recommendation. However, moderate dysplasia is more prone for malignant transformation than previously thought, which might influence follow-up and treatment decisions in the future. © 2015 Wiley Periodicals, Head Neck 38: E2284-E2290, 2016.
© 2015 Wiley Periodicals, Inc.
B Cosway, V Paleri
Laryngeal dysplasia: an evidence-based flowchart to guide management and follow up.
J Laryngol Otol. 2015 Jun;129(6):598-9. doi: 10.1017/S0022215115000833. Epub 2015 Apr 10.
Abstract/Text
BACKGROUND: Laryngeal dysplasia is an important pre-malignant lesion. In 2010, a consensus statement by ENT surgeons and pathologists was published outlining the management and follow up of patients with laryngeal dysplasia.
OBJECTIVE: After reviewing these guidelines, we noted the need for a flowchart for laryngologists to improve efficiency in managing dysplasia and encourage adherence to evidence-based protocols.
RESULT: A diagram has been produced to aid other ENT units around the country.
Daniel Novakovic, Alan T L Cheng, Yvonne Zurynski, Robert Booy, Paul J Walker, Robert Berkowitz, Henley Harrison, Robert Black, Christopher Perry, Shyan Vijayasekaran, David Wabnitz, Hannah Burns, Sepehr N Tabrizi, Suzanne M Garland, Elizabeth Elliott, Julia M L Brotherton
A Prospective Study of the Incidence of Juvenile-Onset Recurrent Respiratory Papillomatosis After Implementation of a National HPV Vaccination Program.
J Infect Dis. 2018 Jan 4;217(2):208-212. doi: 10.1093/infdis/jix498.
Abstract/Text
BACKGROUND: Recurrent respiratory papillomatosis is a rare but morbid disease caused by human papillomavirus (HPV) types 6 and 11. Infection is preventable through HPV vaccination. Following an extensive quadrivalent HPV vaccination program (females 12-26 years in 2007-2009) in Australia, we established a method to monitor incidence and demographics of juvenile-onset recurrent respiratory papillomatosis (JORRP) cases.
METHODS: The Australian Paediatric Surveillance Unit undertakes surveillance of rare pediatric diseases by contacting practitioners monthly. We enrolled pediatric otorhinolaryngologists and offered HPV typing. We report findings for 5 years to end 2016.
RESULTS: The average annual incidence rate was 0.07 per 100000. The largest number of cases was reported in the first year, with decreasing annual frequency thereafter. Rates declined from 0.16 per 100000 in 2012 to 0.02 per 100000 in 2016 (P = .034). Among the 15 incident cases (60% male), no mothers were vaccinated prepregnancy, 20% had maternal history of genital warts, and 60% were first born; 13/15 were born vaginally. Genotyped cases were HPV-6 (n = 4) or HPV-11 (n = 3).
CONCLUSION: To our knowledge, this is the first report internationally documenting decline in JORRP incidence in children following a quadrivalent HPV vaccination program.
© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Elissa Meites, Laura Stone, Raiza Amiling, Vidisha Singh, Elizabeth R Unger, Craig S Derkay, Lauri E Markowitz
Significant Declines in Juvenile-onset Recurrent Respiratory Papillomatosis Following Human Papillomavirus (HPV) Vaccine Introduction in the United States.
Clin Infect Dis. 2021 Sep 7;73(5):885-890. doi: 10.1093/cid/ciab171.
Abstract/Text
BACKGROUND: Juvenile-onset recurrent respiratory papillomatosis (JORRP) is a rare and serious disease caused by human papillomavirus (HPV) presumably acquired during vaginal delivery. HPV vaccination of females through age 26 years, recommended in the United States since 2006, can prevent HPV transmission. We assessed trends in JORRP cases before and after HPV vaccine introduction in the United States.
METHODS: Case-patients were identified from 26 pediatric otolaryngology centers in 23 U.S. states. Demographics and clinical history were abstracted from medical records. Case-patients were grouped by year of birth, and birth-cohort incidences were calculated using number of births from either national or state-level natality data from the 23 states. We calculated incidence rate ratios (IRR) and 95% confidence intervals (CI) in 2-year intervals.
RESULTS: We identified 576 U.S. JORRP case-patients born in 2004-2013. Median age at diagnosis was 3.4 years (interquartile range: 1.9, 5.5). Number of identified JORRP case-patients declined from a baseline of 165 born in 2004-2005 to 36 born in 2012-2013. Incidence of JORRP per 100 000 births using national data declined from 2.0 cases in 2004-2005 to 0.5 cases in 2012-2013 (IRR = 0.2, 95% CI = .1-.4); incidence using state-level data declined from 2.9 cases in 2004-2005 to 0.7 cases in 2012-2013 (IRR = 0.2, 95% CI = .1-.4).
CONCLUSIONS: Over a decade, numbers of JORRP case-patients and incidences declined significantly. Incidences calculated using national denominator data are likely underestimates; those calculated using state-level denominator data could be overestimates. These declines are most likely due to HPV vaccination. Increasing vaccination uptake could lead to elimination of this HPV-related disease.
Published by Oxford University Press for the Infectious Diseases Society of America 2021.
Marisa A Ryan, Grace R Leu, Patrick A Upchurch, David E Tunkel, Jonathan M Walsh, Emily F Boss
Systemic Bevacizumab (Avastin) for Juvenile-Onset Recurrent Respiratory Papillomatosis: A Systematic Review.
Laryngoscope. 2021 May;131(5):1138-1146. doi: 10.1002/lary.29084. Epub 2020 Sep 22.
Abstract/Text
OBJECTIVES: Juvenile onset recurrent respiratory papillomatosis (JORRP) can cause severe or disseminated disease. Surgical treatment may be inadequate. Systemic bevacizumab has shown initial success for severe JORRP. The objective of this systematic review was to assess usage, effectiveness, and safety of this treatment.
METHODS: We searched PubMed, Embase, and Web of Science for studies of humans with JORRP treated with systemic bevacizumab. Two researchers independently reviewed the studies to determine inclusion and aggregate data on patient characteristics, dosing protocols, treatment response, adverse events, and level of evidence.
RESULTS: Of 80 identified articles, 12 studies were included detailing 20 distinct cases. At a mean age of 12.8 years (range = 1-43 years) patients received initial dosing of 5 to 10 mg/kg of bevacizumab followed by ongoing doses at a mean 3-week intervals (range = 2-5 weeks). All patients had clinically significant disease reduction with reduced need for surgery. Six patients (30%) had complete response in at least one involved anatomic site. Eleven (55%) required no surgery after initiating treatment. There was recurrence in all four patients whose treatment was stopped, but had rapid improvement with treatment resumption. Six (30%) experienced mild or moderate adverse events.
CONCLUSIONS: Marked improvement in severe JORRP has been reported from systemic bevacizumab. Treatment protocols vary, and treatment discontinuation was not feasible in any reported patient. Based on currently available data, systemic bevacizumab can be considered for severe JORRP as it appears to be well tolerated and effective. A clinical trial could enhance the understanding of its safety and efficacy for this indication. Laryngoscope, 131:1138-1146, 2021.
© 2020 American Laryngological, Rhinological and Otological Society Inc, "The Triological Society" and American Laryngological Association (ALA).
T Kodaira, Y Kagami, T Shibata, N Shikama, Y Nishimura, S Ishikura, K Nakamura, Y Saito, Y Matsumoto, T Teshima, Y Ito, T Akimoto, K Nakata, T Toshiyasu, K Nakagawa, Y Nagata, T Nishimura, T Uno, M Kataoka, A Yorozu, M Hiraoka, Radiation Therapy Study Group of the Japan Clinical Oncology Group
Results of a multi-institutional, randomized, non-inferiority, phase III trial of accelerated fractionation versus standard fractionation in radiation therapy for T1-2N0M0 glottic cancer: Japan Clinical Oncology Group Study (JCOG0701).
Ann Oncol. 2018 Apr 1;29(4):992-997. doi: 10.1093/annonc/mdy036.
Abstract/Text
BACKGROUND: We assessed the non-inferiority of accelerated fractionation (AF) (2.4 Gy/fraction) compared with standard fractionation (SF) (2 Gy/fraction) regarding progression-free survival (PFS) in patients with T1-2N0M0 glottic cancer (GC).
PATIENTS AND METHODS: In this multi-institutional, randomized, phase III trial, patients were enrolled from 32 Japanese institutions. Key inclusion criteria were GC T1-2N0M0, age 20-80, Eastern Cooperative Oncology Group performance status of 0-1, and adequate organ function. Patients were randomly assigned to receive either SF of 66-70 Gy (33-35 fractions), or AF of 60-64.8 Gy (25-27 fractions). The primary end point was the proportion of 3-year PFS. The planned sample size was 360 with a non-inferiority margin of 5%.
RESULTS: Between 2007 and 2013, 370 patients were randomized (184/186 to SF/AF). Three-year PFS was 79.9% (95% confidence interval [CI] 73.4-85.4) for SF and 81.7% (95% CI 75.4-87.0) for AF (difference 1.8%, 91% CI-5.1% to 8.8%; one-sided P = 0.047 > 0.045). The cumulative incidences of local failure at 3 years for SF/AF were 15.9%/10.3%. No significant difference was observed in 3-year overall survival (OS) between SF and AF. Grade 3 or 4 acute and late toxicities developed in 22 (12.4%)/21 (11.5%) and 2 (1.1%)/1 (0.5%) in the SF/AF arms.
CONCLUSION: Although the non-inferiority of AF was not confirmed statistically, the similar efficacy and toxicity of AF compared with SF, as well as the practical convenience of its fewer treatment sessions, suggest the potential of AF as a treatment option for early GC.
CLINICAL TRIALS REGISTRATION: UMIN Clinical Trial Registry, number UMIN000000819.
Rony Benson, G Prashanth, Supriya Mallick
Moderate hypofractionation for early laryngeal cancer improves local control: a systematic review and meta-analysis.
Eur Arch Otorhinolaryngol. 2020 Nov;277(11):3149-3154. doi: 10.1007/s00405-020-06012-9. Epub 2020 May 6.
Abstract/Text
INTRODUCTION: Radiation therapy is considered the standard treatment for early glottic cancers; and recent trials have evaluated the role of hypofractionation with mixed results. We conducted this systematic review and meta-analysis to assess the impact of hypofractionation in early glottic cancers.
METHODS: We performed a comprehensive search of the PubMed, Embase and Google scholar to look for studies which have evaluated the role of hypofractionation in early glottic cancers. Only prospective trials were included in the present analysis. RevMan software (Cochrane Collaboration's Information Management System) was used for the meta-analysis.
RESULTS: The analysis included a total of five studies and 1153 patients. Hypofractionation was found to significantly improve local control rates with an Odds ratio of 0.55 [95% CI 0.13-0.85]. The voice preservation rates with hypofractionation ranged from 86 to 94%. No significant improvement in overall survival was noted with the used of hypofractionation [hazard ratio 1.09, 95% CI 0.69-1.71]. There was an increased incidence of grade 2 or higher acute mucositis toxicity with use of hypofractionation [Odds ratio 1.54, 95% CI 1.12-2.11]. The incidence of acute skin toxicity was not increased with use of hypofractionation. Late toxicity was very low and not increased with use of hypofractionation.
CONCLUSION: Moderate hypofractionation as compared to conventional fractionation, in laryngeal cancer, is associated with significantly improved local control without impact on overall survival. The use of hypofractionation is associated with an increased incidence of acute mucositis though incidence of long-term toxicity was not significantly increased. Hence, moderate-dose hypo-fractionation should be considered as the new standard of care in early laryngeal cancer.
Naomi Kiyota, Makoto Tahara, Junki Mizusawa, Takeshi Kodaira, Hirofumi Fujii, Tomoko Yamazaki, Hiroki Mitani, Shigemichi Iwae, Yasushi Fujimoto, Yusuke Onozawa, Nobuhiro Hanai, Takenori Ogawa, Hiroki Hara, Nobuya Monden, Eiji Shimura, Shujiro Minami, Takashi Fujii, Kaoru Tanaka, Akihiro Homma, Seiichi Yoshimoto, Nobuhiko Oridate, Koichi Omori, Tsutomu Ueda, Kenji Okami, Ichiro Ota, Kiyoto Shiga, Masashi Sugasawa, Takahiro Asakage, Yuki Saito, Shigeyuki Murono, Yasumasa Nishimura, Kenichi Nakamura, Ryuichi Hayashi, Head and Neck Cancer Study Group of the Japan Clinical Oncology Group (JCOG-HNCSG)
Weekly Cisplatin Plus Radiation for Postoperative Head and Neck Cancer (JCOG1008): A Multicenter, Noninferiority, Phase II/III Randomized Controlled Trial.
J Clin Oncol. 2022 Jun 20;40(18):1980-1990. doi: 10.1200/JCO.21.01293. Epub 2022 Mar 1.
Abstract/Text
PURPOSE: The standard treatment for postoperative high-risk locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) is chemoradiotherapy with 3-weekly cisplatin (100 mg/m2). However, whether chemoradiotherapy with weekly cisplatin (40 mg/m2) yields comparable efficacy with 3-weekly cisplatin in postoperative high-risk LA-SCCHN is unknown.
PATIENTS AND METHODS: In this multi-institutional open-label phase II/III trial, patients with postoperative high-risk LA-SCCHN were randomly assigned to receive either chemoradiotherapy with 3-weekly cisplatin (100 mg/m2) or with weekly cisplatin (40 mg/m2) to confirm the noninferiority of weekly cisplatin. The primary end point of phase II was the proportion of treatment completion, and that of phase III was overall survival. A noninferiority margin of hazard ratio was set at 1.32.
RESULTS: Between October 2012 and December 2018, a total of 261 patients were enrolled (3-weekly cisplatin, 132 patients; weekly cisplatin, 129 patients). At the planned third interim analysis in the phase III part, after a median follow-up of 2.2 (interquartile range 1.19-3.56) years, chemoradiotherapy with weekly cisplatin was noninferior to 3-weekly cisplatin in terms of overall survival, with a hazard ratio of 0.69 (99.1% CI, 0.374 to 1.273 [< 1.32], one-sided P for noninferiority = .0027 < .0043). Grade 3 or more neutropenia and infection were less frequent in the weekly arm (3-weekly v weekly, 49% v 35% and 12% v 7%, respectively), as were renal impairment and hearing impairment. No treatment-related death was reported in the 3-weekly arm, and two (1.6%) in the weekly arm.
CONCLUSION: Chemoradiotherapy with weekly cisplatin is noninferior to 3-weekly cisplatin for patients with postoperative high-risk LA-SCCHN. These findings suggest that chemoradiotherapy with weekly cisplatin can be a possible treatment option for these patients.
Akihiro Shiotani, Masayuki Tomifuji, Koji Araki, Taku Yamashita, Koichiro Saito
Videolaryngoscopic transoral en bloc resection of supraglottic and hypopharyngeal cancers using laparoscopic surgical instruments.
Ann Otol Rhinol Laryngol. 2010 Apr;119(4):225-32.
Abstract/Text
OBJECTIVES: We assessed the outcome of en bloc transoral resection of supraglottic and hypopharyngeal cancer using a distending laryngoscope with rigid videoendoscopic and laparoscopic surgical instruments.
METHODS: We enrolled 30 patients with T1, T2, or selected T3 supraglottic and hypopharyngeal cancer in the study; 9 patients had undergone radiotherapy. Neck dissections were performed for node-positive patients. Postoperative radiotherapy was administered to patients with multiple lymph node metastases or positive surgical margins.
RESULTS: This surgical environment provided a wide view of the operative field, facilitating bimanual manipulation of laparoscopic surgical instruments, and enabled us to perform en bloc transoral resection. In 21 cases with a minimum follow-up period of 1 year (average, 33 months; range, 15 to 56 months), the 3-year disease-specific survival rate and the laryngeal preservation rate were each 95%. Normal food intake was eventually possible in all cases. Tracheostomy was performed for 2 patients as a prophylactic measure and for 1 patient because of a postoperative hemorrhage.
CONCLUSIONS: These results indicate that videolaryngoscopic transoral en bloc resection using laparoscopic surgical instruments can be one of the minimally invasive treatment options for supraglottic and hypopharyngeal cancers with satisfactory oncological outcome and postoperative laryngeal function.
Akihiro Shiotani, Masayuki Tomifuji, Koji Araki, Taku Yamashita
Transoral videolaryngoscopic surgery for en bloc resection of supraglottic and hypopharyngeal cancers.
Otolaryngol Head Neck Surg. 2011 Feb;144(2):288-9. doi: 10.1177/0194599810392148. Epub 2011 Jan 4.
Abstract/Text
Taku Yamashita, Masayuki Tomifuji, Koji Araki, Takaomi Kurioka, Akihiro Shiotani
Endoscopic transoral oropharyngectomy using laparoscopic surgical instruments.
Head Neck. 2011 Sep;33(9):1315-21. doi: 10.1002/hed.21604. Epub 2010 Nov 29.
Abstract/Text
BACKGROUND: Recently, several transoral approaches for minimally invasive surgery have been developed for oropharyngeal cancer. However, all approaches have certain disadvantages. Therefore, we built and examined new surgical environments for improving the situation.
METHODS: Endoscopic transoral resection using a pharyngeal retractor or distending laryngoscope, rigid videoendoscope, and laparoscopic surgical instruments was performed in 17 patients with oropharyngeal squamous cell carcinoma. Postoperative results regarding oncology and function as well as complications were documented.
RESULTS: The 2-year relapse-free survival rate was 100%. Postoperative swallowing and speech function were satisfactory: 94.1% of cases scored ≤1 on the functional outcome swallowing scale (FOSS) and ≤1 on the communication score. Further, no perioperative mortality occurred.
CONCLUSIONS: The improved surgical environment made it possible to perform a safe and reliable en bloc resection with a wide field of view and sufficient working space. Our system can be useful, although further studies on additional cases are required.
Copyright © 2010 Wiley Periodicals, Inc.
Masayuki Tomifuji, Koji Araki, Taku Yamashita, Akihiro Shiotani
Transoral videolaryngoscopic surgery for oropharyngeal, hypopharyngeal, and supraglottic cancer.
Eur Arch Otorhinolaryngol. 2014 Mar;271(3):589-97. doi: 10.1007/s00405-013-2575-0. Epub 2013 Jun 1.
Abstract/Text
In this retrospective cohort study, we evaluated the oncological and functional outcomes of transoral videolaryngoscopic surgery (TOVS). Using distending laryngoscope and videolaryngoscope, wide operative field and working space could be obtained and tumor could be resected in en bloc. Sixty patients with T1, T2, and selected T3 laryngeal or pharyngeal squamous cell carcinomas (Stage I: n = 17, Stage II: n = 16, Stage III: n = 7, Stage IV: n = 20 cases) were enrolled and followed up for at least 24 months or until the patient's death. Fifty-three patients underwent initial treatment, and seven patients had recurrent cancer after chemoradiation. In principle, node-positive patients underwent a simultaneous neck dissection. Patients with multiple nodal metastases or a positive surgical margin received postoperative radiotherapy. For initial treatment, the 5-year overall survival and disease-specific survival rates were 77 and 95 %, respectively. For supraglottic and hypopharyngeal cancers, the 5-year laryngeal preservation rates were 89 and 96 %, respectively. For salvage surgery, the overall survival, disease-specific survival, and laryngeal preservation rates were 75, 75, and 80 %, respectively. The median times before patients could resume eating and swallowing a soft diet were 6 and 9 days, respectively. The patients' Functional Outcome Swallowing Scale stages were 0-2 in 93.3 % of the cases and 3 or 4 in 6.7 % of the cases. A percutaneous endoscopic gastrostomy was indicated for 1 (1.7 %) patient. Four (6.7 %) patients received transient tracheostomy. TOVS is a satisfactory and minimally invasive treatment option for laryngeal and pharyngeal cancers.
塩谷彰浩：経口的喉頭・下咽頭部分切除術.耳鼻臨床101：68-69，2008.
Arlene A Forastiere, Helmuth Goepfert, Moshe Maor, Thomas F Pajak, Randal Weber, William Morrison, Bonnie Glisson, Andy Trotti, John A Ridge, Clifford Chao, Glen Peters, Ding-Jen Lee, Andrea Leaf, John Ensley, Jay Cooper
Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer.
N Engl J Med. 2003 Nov 27;349(22):2091-8. doi: 10.1056/NEJMoa031317.
Abstract/Text
BACKGROUND: Induction chemotherapy with cisplatin plus fluorouracil followed by radiotherapy is the standard alternative to total laryngectomy for patients with locally advanced laryngeal cancer. The value of adding chemotherapy to radiotherapy and the optimal timing of chemotherapy are unknown.
METHODS: We randomly assigned patients with locally advanced cancer of the larynx to one of three treatments: induction cisplatin plus fluorouracil followed by radiotherapy, radiotherapy with concurrent administration of cisplatin, or radiotherapy alone. The primary end point was preservation of the larynx.
RESULTS: A total of 547 patients were randomly assigned to one of the three study groups. The median follow-up period was 3.8 years. At two years, the proportion of patients who had an intact larynx after radiotherapy with concurrent cisplatin (88 percent) differed significantly from the proportions in the groups given induction chemotherapy followed by radiotherapy (75 percent, P=0.005) or radiotherapy alone (70 percent, P<0.001). The rate of locoregional control was also significantly better with radiotherapy and concurrent cisplatin (78 percent, vs. 61 percent with induction cisplatin plus fluorouracil followed by radiotherapy and 56 percent with radiotherapy alone). Both of the chemotherapy-based regimens suppressed distant metastases and resulted in better disease-free survival than radiotherapy alone. However, overall survival rates were similar in all three groups. The rate of high-grade toxic effects was greater with the chemotherapy-based regimens (81 percent with induction cisplatin plus fluorouracil followed by radiotherapy and 82 percent with radiotherapy with concurrent cisplatin, vs. 61 percent with radiotherapy alone). The mucosal toxicity of concurrent radiotherapy and cisplatin was nearly twice as frequent as the mucosal toxicity of the other two treatments during radiotherapy.
CONCLUSIONS: In patients with laryngeal cancer, radiotherapy with concurrent administration of cisplatin is superior to induction chemotherapy followed by radiotherapy or radiotherapy alone for laryngeal preservation and locoregional control.
Copyright 2003 Massachusetts Medical Society
American Society of Clinical Oncology, David G Pfister, Scott A Laurie, Gregory S Weinstein, William M Mendenhall, David J Adelstein, K Kian Ang, Gary L Clayman, Susan G Fisher, Arlene A Forastiere, Louis B Harrison, Jean-Louis Lefebvre, Nancy Leupold, Marcy A List, Bernard O O'Malley, Snehal Patel, Marshall R Posner, Michael A Schwartz, Gregory T Wolf
American Society of Clinical Oncology clinical practice guideline for the use of larynx-preservation strategies in the treatment of laryngeal cancer.
J Clin Oncol. 2006 Aug 1;24(22):3693-704. doi: 10.1200/JCO.2006.07.4559. Epub 2006 Jul 10.
Abstract/Text
PURPOSE: To develop a clinical practice guideline for treatment of laryngeal cancer with the intent of preserving the larynx (either the organ itself or its function). This guideline is intended for use by oncologists in the care of patients outside of clinical trials.
METHODS: A multidisciplinary Expert Panel determined the clinical management questions to be addressed and reviewed the literature available through November 2005, with emphasis given to randomized controlled trials of site-specific disease. Survival, rate of larynx preservation, and toxicities were the principal outcomes assessed. The guideline underwent internal review and approval by the Panel, as well as external review by additional experts, members of the American Society of Clinical Oncology (ASCO) Health Services Committee, and the ASCO Board of Directors.
RESULTS: Evidence supports the use of larynx-preservation approaches for appropriately selected patients without a compromise in survival; however, no larynx-preservation approach offers a survival advantage compared with total laryngectomy and adjuvant therapy with rehabilitation as indicated.
RECOMMENDATIONS: All patients with T1 or T2 laryngeal cancer, with rare exception, should be treated initially with intent to preserve the larynx. For most patients with T3 or T4 disease without tumor invasion through cartilage into soft tissues, a larynx-preservation approach is an appropriate, standard treatment option, and concurrent chemoradiotherapy therapy is the most widely applicable approach. To ensure an optimum outcome, special expertise and a multidisciplinary team are necessary, and the team should fully discuss with the patient the advantages and disadvantages of larynx-preservation options compared with treatments that include total laryngectomy.
Arlene A Forastiere, Nofisat Ismaila, Jan S Lewin, Cherie Ann Nathan, David J Adelstein, Avraham Eisbruch, Gail Fass, Susan G Fisher, Scott A Laurie, Quynh-Thu Le, Bernard O'Malley, William M Mendenhall, Snehal Patel, David G Pfister, Anthony F Provenzano, Randy Weber, Gregory S Weinstein, Gregory T Wolf
Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update.
J Clin Oncol. 2017 Nov 27;:JCO2017757385. doi: 10.1200/JCO.2017.75.7385. Epub 2017 Nov 27.
Abstract/Text
Purpose To update the guideline recommendations on the use of larynx-preservation strategies in the treatment of laryngeal cancer. Methods An Expert Panel updated the systematic review of the literature for the period from January 2005 to May 2017. Results The panel confirmed that the use of a larynx-preservation approach for appropriately selected patients does not compromise survival. No larynx-preservation approach offered a survival advantage compared with total laryngectomy and adjuvant therapy as indicated. Changes were supported for the use of endoscopic surgical resection in patients with limited disease (T1, T2) and for initial total laryngectomy in patients with T4a disease or with severe pretreatment laryngeal dysfunction. New recommendations for positron emission tomography imaging for the evaluation of regional nodes after treatment and best measures for evaluating voice and swallowing function were added. Recommendations Patients with T1, T2 laryngeal cancer should be treated initially with intent to preserve the larynx by using endoscopic resection or radiation therapy, with either leading to similar outcomes. For patients with locally advanced (T3, T4) disease, organ-preservation surgery, combined chemotherapy and radiation, or radiation alone offer the potential for larynx preservation without compromising overall survival. For selected patients with extensive T3 or large T4a lesions and/or poor pretreatment laryngeal function, better survival rates and quality of life may be achieved with total laryngectomy. Patients with clinically involved regional cervical nodes (N+) who have a complete clinical and radiologic imaging response after chemoradiation do not require elective neck dissection. All patients should undergo a pretreatment baseline assessment of voice and swallowing function and receive counseling with regard to the potential impact of treatment options on voice, swallowing, and quality of life. Additional information is available at www.asco.org/head-neck-cancer-guidelines and www.asco.org/guidelineswiki .
