Impact of comorbidity on the outcome of laryngeal squamous cancer

BACKGROUND: Comorbidity has been shown to be a determinant in treatment selection and survival in various cancers. We have previously shown that the Adult Comorbidity Evaluation-27 index is applicable in a United Kingdom setting, and the process of comorbidity grading by retrospective notes evaluation is an accurate and reliable process. METHODS: The impact of comorbidity and other factors on survival was examined retrospectively in a cohort of 180 patients with laryngeal squamous cell cancer. RESULTS: This study shows for the first time that the higher comorbidity burden seen in supraglottic cancers in contrast to glottic tumors might account for the poorer prognosis. This study also externally validates the composite comorbidity-TNM staging system described by Piccirillo and shows the composite system to be a better predictor of outcome than TNM staging system alone. CONCLUSIONS: Moderate and severe comorbidity have a greater and statistically significant impact on survival than the TNM staging system.     

Informed consent in advanced laryngeal cancer

PURPOSE: This study was designed to evaluate the relationship between the informed consent process and the treatment received by patients with advanced laryngeal cancer. METHODS: The study group was composed of 101 consecutive patients who were eligible for the Department of Veterans Affairs Laryngeal Cancer Study Group and Radiation Therapy Oncology Group/Head and Neck Intergroup (RTOG 91-11) larynx preservation clinical trials and who underwent treatment at the Mayo Clinic during the years 1985 to 2000. Records were reviewed to evaluate the effect that referral to an oncologist, discussion and documentation of treatment alternatives by the surgeon, offering a chance at a larynx conservation surgical procedure, and treatment recommendation made by the surgeon have on the treatment chosen and received by the patient. RESULTS: Discussion of treatment alternatives by the surgeon (p = .0054), referral to an oncologist (p < .0001), offering a chance for a larynx conservation surgical procedure (p = .047), and treatment recommended by the surgeon (p < .0001) were significantly related to the treatment received by the patient. CONCLUSION: The treatment received by a patient with advanced laryngeal cancer is determined by the treatment recommended by the surgeon, referral to an oncologist, discussion of treatment alternatives by the surgeon, and offering a chance for a larynx conservation surgical procedure.     

喉返神经的显露在甲状腺癌根治术中的意义

目的探讨喉返神经的显露在甲状腺癌根治性手术中的意义。方法回顾分析2003年7月至2006年12月间186例主动显露喉返神经的甲状腺癌根治手术病例资料。结果186例甲状腺癌均施行甲状腺全切或近全切除术。术中均成功显露双侧喉返神经,其中1例右侧非返喉下神经。喉返神经永久性损伤1例,暂时性损伤1例,永久损伤率为0．54％。结论甲状腺癌根治术中应常规在甲状腺下动脉周围寻找喉返神经,主动显露喉返神经不仅可减少喉返神经损伤的发生率,并可提高甲状腺癌手术的彻底性。     

Recent changes in the treatment of patients with advanced laryngeal cancer

Since the original data from the Department of Veterans Affairs Laryngeal Cancer Study Group demonstrated that nonsurgical therapy could achieve survival rates comparable to total laryngectomy in selected cases, there has been a progressive increase in employment of nonsurgical therapy for the management of advanced laryngeal cancer. Both neoadjuvant chemotherapy followed by conventionally fractionated or hyperfractioned radiotherapy for chemotherapy responders, or simultaneously administered chemoradiation has resulted in a significant number of patients who achieved cure while preserving their larynges. Nevertheless, combined chemotherapy and external beam radiation is associated with a variety of acute and chronic sequelae that can have a debilitating impact on function and quality of life. Although no therapeutic option is without risk, the decision regarding the modality of therapy for a patient with advanced laryngeal cancer should prompt a careful review of the current surgical techniques available for treatment. Data on quality of life and aging, as well as advances in minimally invasive surgical techniques, are available today that were not available at the time of the Veterans study. Selection of optimal therapy is often complex and raises the question whether the pendulum may have swung too far in the direction of nonsurgical therapy for advanced laryngeal cancer. This article reviews the current options available for a patient with advanced laryngeal cancer and discusses the impact of therapy.     

Cardiovascular comorbidity and treatment regret in men with recurrent prostate cancer

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Treatment regret can have an adverse impact on a patient's overall outlook and has been associated with a poorer global quality of life. Understanding predictors of regret can help clinicians better counsel patients about their treatments so that later regret can be avoided. In previous studies, regret has been associated with lesser educational attainment, non‐White race, greater post‐treatment declines in sexual function and systemic symptoms. The present study found that, among men with recurrent prostate cancer, those with cardiovascular comorbidity were >50% more likely to regret their treatment choice than men without cardiovascular comorbidity. This study highlights the growing importance of considering comorbidity when counselling patients about prostate cancer treatment options, and provides a rationale for men with cardiovascular comorbidity to give additional consideration to active surveillance for their newly diagnosed prostate cancer.

OBJECTIVE

• ? To determine whether cardiovascular comorbidity is associated with increased treatment regret among men with recurrent prostate cancer.

METHODS

• ? The study cohort comprised 795 men in the Comprehensive, Observational, Multicenter, Prostate Adenocarcinoma (COMPARE) registry who experienced biochemical recurrence at a median (interquartile range) of 5.5 (2.8–9.1) years after prostatectomy (n= 410), external beam radiation therapy (n= 237), brachytherapy (n= 124) or primary androgen deprivation therapy (n= 24).
• ? Multivariable logistic regression analysis was used to determine whether cardiovascular comorbidity was associated with treatment regret.
• ? Cardiovascular comorbidity, which included myocardial infarction, congestive heart failure, angina, diabetes, stroke or circulation problems, was defined using a validated two‐question screening process after adjusting for sociodemographic and treatment factors and post‐treatment bladder and bowel toxicity.

RESULTS

• ? Of 795 men, 14.8% reported regret.
• ? Men with cardiovascular comorbidity were more likely to experience post‐therapy bowel toxicity (P= 0.022).
• ? In the adjusted multivariable model, the factors associated with increased treatment regret were: cardiovascular comorbidity (adjusted odds ratio [AOR]= 1.52 [95% CI:1.00–2.31], P= 0.048); younger age (AOR: 0.97 [95% CI 0.94–0.99] per year increase in age, P= 0.019); and bowel toxicity after treatment (AOR 1.58 [95% CI 1.03–2.43], P= 0.038).

CONCLUSIONS

• ? Among men with recurrent prostate cancer, those with cardiovascular comorbidity were >50% more likely to experience treatment regret than men without cardiovascular comorbidity.
• ? These data provide a rationale for men with cardiovascular comorbidity to give additional consideration to active surveillance for their newly diagnosed prostate cancer.

     

甲状腺手术中常规显露喉返神经的意义

目的 探讨甲状腺手术中常规显露喉返神经(RLN)对保护神经的作用.方法 回顾性分析2009年至2010年间连续实施的232例甲状腺切除手术患者的资料.手术均由同一组医师实施,方式为甲状腺腺叶切除或全切除术,术中常规显露喉返神经.结果 共行腺叶切除181例,甲状腺全切除51例.术中解剖喉返神经280根(98.9%).术后10例患者(3.6%)出现声音嘶哑,其中7例术中证实了喉返神经的完整性,但声带检查出现患侧运动障碍,均在术后2个月内发音恢复正常.另外3例为术中离断性神经损伤并行即刻吻合者,在术后4个月内声音均恢复正常.结论 甲状腺手术中常规显露喉返神经是预防喉返神经永久性损伤的有效方法.     

Circulating CD4‐positive lymphocyte levels as predictor of response to induction chemotherapy in patients with advanced laryngeal cancer

Background. Tumor regression after induction chemotherapy (ICT) identifies laryngeal cancers that are responsive to chemoradiation. Patient immune parameters have recently been associated with response to chemotherapy and may identify responding patients. A retrospective analysis was performed to determine if pretreatment, circulating T lymphocyte levels predicted ICT response in patients with advanced laryngeal cancer. Methods. Pretreatment, circulating T lymphocyte subpopulations were correlated with response to therapy and survival. Results were compared with similar data from an identical phase II trial involving patients with oropharyngeal cancer. Results. An increased percentage of CD4+ cells predicted response to ICT and suggested improved survival in patients with laryngeal, but not oropharyngeal, cancer. In the combined group of patients, increased CD4 levels predicted response to ICT. Conclusion. These findings demonstrate the potential importance of the immune system in chemotherapy response and clinical outcome. Differences in findings between patients with advanced laryngeal and oropharyngeal cancer may reflect different cellular immunity function in the patients with human papillomavirus (HPV)‐16+ oropharyngeal cancer. © 2013 Wiley Periodicals, Inc. Head Neck 36 : 9–14, 2014     

Central compartment dissection in laryngeal cancer

We report here a review of the literature intended to clarify the nomenclature and boundaries of the nodes in the “central compartment” of the neck, the frequency with which tumors from the different laryngeal sites metastasize to these nodes, and the indications for central compartment node dissection in the treatment of cancers of the larynx. From this review, we conclude that, until consensus is reached about grouping of the lymph nodes in this area, it is best to refer to these nodes by their anatomic location, ie, prelaryngeal, pretracheal, or paratracheal lymph nodes. It is also advisable to describe dissection of these nodes as selective neck dissection (SND) with an annotation about the specific lymph node groups removed. Metastases in prelaryngeal and paratracheal lymph nodes in patients with squamous cell carcinoma of the larynx are associated with increased tumor recurrence, more frequent metastases in lymph nodes of the lateral compartment of the neck, and decreased survival. If untreated, they may lead to the development of peristomal recurrence. Therefore, elective treatment of level VI nodes is recommended in patients with squamous cell carcinomas of the subglottic region, advanced glottis carcinomas with subglottic extension, and in certain advanced carcinomas of the supraglottic region. © 2010 Wiley Periodicals, Inc. Head Neck, 2011     

甲状腺手术中常规显露喉返神经的意义

目的 探讨甲状腺手术中常规显露喉返神经(RLN)对保护神经的作用.方法 回顾性分析2009年至2010年间连续实施的232例甲状腺切除手术患者的资料.手术均由同一组医师实施,方式为甲状腺腺叶切除或全切除术,术中常规显露喉返神经.结果 共行腺叶切除181例,甲状腺全切除51例.术中解剖喉返神经280根(98.9%).术后...