Is elective neck dissection indicated during salvage surgery for head and neck squamous cell carcinoma?

Among patients with head and neck squamous cell carcinoma with a negative neck who are initially treated with (chemo)radiotherapy, a number of cases will recur locally without obvious neck recurrence. There is little information available as to the most efficacious management of the neck in these cases. We have reviewed the literature to see what conclusions can be drawn from previous reports. We conducted a bibliography search on MEDLINE and EMBASE databases. Studies published in the English language and those on squamous cell carcinoma of the oral cavity, nasopharynx, oropharynx, larynx and hypopharynx were included. Data related to neck management were extracted from the articles. Twelve studies satisfied the inclusion criteria. Five studies reported only one treatment plan (either neck dissection or observation), while the others compared neck dissection to observation. The rate of occult metastases ranged from 3.4 to 12 %. The studies included a variable distribution of primary sites and stages of the recurrent primary tumors. The risk of occult neck node metastasis in a clinically rN0 patient correlated with tumor site and T stage. Observation of the neck can be suggested for patients with T1-2 glottic tumors, who recurred with less advanced tumors (rT1-2). For patients with more advanced laryngeal recurrences or recurrence at other high-risk sites, neck dissection could be considered for the rN0 patient, particularly if the neck was not included in the previous radiation fields.     

Use of gastrostomy in head and neck cancer: a systematic review to identify areas for future research

Clin. Otolaryngol. 2010, 35 , 177–189 Objectives: To perform a systematic review of studies, which investigate the role of gastrostomy tube feeding in head and neck squamous cell cancer. Design: A systematic review of the English literature, identifying areas of clinical equipoise and recommendations for future studies. Main outcome measures: Varying practices in G-tube use in HNSCC, the benefits and disadvantages of G-tubes, the effect of G-tube placement on multidimensional outcomes in patients with head and neck cancer, including quality of life and health economics and to draw themes that may lend themselves to future research. Results: The search identified 216 articles of which 59 were considered relevant. During treatment, a significant number of patients need enteral nutritional supplementation through nasogastric or G-tubes. Gastrostomy tubes have a good safety profile. Most clinicians agree that the use should be restricted to advanced tumours. Studies on prophylactic insertion of G-tubes do not show a consistent advantage to the nutritional status compared with NG tubes. At 1 year, G-tube retention rates vary between 10% and 30%. The presence of a feeding tube has a negative impact on quality of life. Placing G-tubes may have an adverse effect on swallowing after chemoradiation. Conclusions: There is a lack of consensus among clinicians about indications for placing G-tubes. There is sufficient equipoise in this area for further investigation of the effect of varying feeding practices on functional outcomes, quality of life and health economics.     

Priorities for the head and neck cancer patient, their companion and members of the multidisciplinary team and decision regret

Aims

To compare the treatment outcome priorities of patients, their companions and members of the multidisciplinary team (MDT), and also to determine if the former two groups suffered from regret of their decision.

Materials and methods

Patients were eligible if attending with a companion at least 6 months after radiotherapy for head and neck cancer given with curative intent. They were interviewed by two clinicians separately with questions from the Chicago Priority Scale and Ottawa Decision Regret Scale.

Results

In total, 30 patients, 30 companions and 25 members of the MDT were evaluated. ‘Being cured of my cancer’, ‘living as long as possible’, ‘having no pain’ and ‘being able to swallow all foods and drinks’ were the top four priorities for all three groups. Patients ranked ‘having no pain’ lower than either companions (P = 0.003) and members of the MDT (P = 0.006). Patients ranked ‘keeping my appearance unchanged’ as less important than members of the MDT (P = 0.013) and ‘keeping my normal sense of taste and smell’ as more important than members of the MDT (P = 0.013). The post-treatment regret score was 12.50 for patients and 10.33 for companions out of 100 (P value was not significant).

Conclusions

There was a strong agreement between patients, their companions and members of the MDT with regards to priorities in head and neck cancer outcomes and low post-treatment regret for patients and their companions. These results suggest that the patients’ companions and members of the MDT are able to exercise good judgment when it comes to supporting patients in decision making.     

Open conservation partial laryngectomy for laryngeal cancer: A systematic review of English language literature

Background

Different modalities of treatment in early laryngeal cancer lead to equivalent oncological outcomes. Hence this systematic review was undertaken to synthesise the key oncological outcomes following primary open partial laryngectomy for laryngeal cancer.

Methods

A systematic review of the English literature with statistical pooling of outcomes, the main outcome measure being local control at 24 months.

Results

A total of 53 articles satisfied inclusion criteria and were included in the review. The pooled local control rate at 24 months from 5061 patients was 89.8% (95% CI 88.3–91.2), pooled overall survival was 79.7% (n = 3967; 95% CI 76.5–782.8) and pooled mean disease free survival was 84.8% (n = 2344; 95% CI 80.6–88.7). The pooled mean operative mortality, laryngectomy for function, tracheostomy decannulation and permanent gastrostomy rates were 0.7%, 1.7%, 96.3%, and 2.0%, respectively.

Conclusions

Open conservation laryngectomy is a good option in selected primary laryngeal cancers with excellent oncological outcomes.     

Quality of life in laryngectomees: a post-treatment comparison of laryngectomy alone versus combined therapy.

Patients with advanced and recurrent laryngeal and hypopharyngeal cancer often need combined therapy, which is associated with greater morbidity than single modality treatment. The aim of this study was to assess the quality of life in laryngectomees and to assess whether differences exist between the irradiated and the non-irradiated patients. The University of Michigan Head and Neck Quality of Life questionnaire, a validated instrument for assessing the head and neck cancer related functional status and well-being, was used for this purpose. Subjects for the study included patients who had undergone total laryngectomy for laryngeal or hypophyarngeal squamous cancer. No significant difference between the groups was evident in the various domain scores, although a trend towards higher scores was seen in the combined therapy group. This study suggests that long-term side effects induced by radiotherapy do not adversely affect the quality of life in laryngectomised patients.