An update on larynx cancer Steuer, Conor E.; El‐Deiry, Mark; Parks, Jason R. ...
CA: a cancer journal for clinicians,
January/February 2017, Letnik:
67, Številka:
1
Journal Article
Surgical cancer resection requires an accurate and timely diagnosis of the cancer margins in order to achieve successful patient remission. Hyperspectral imaging (HSI) has emerged as a useful, ...noncontact technique for acquiring spectral and optical properties of tissue. A convolutional neural network (CNN) classifier is developed to classify excised, squamous-cell carcinoma, thyroid cancer, and normal head and neck tissue samples using HSI. The CNN classification was validated by the manual annotation of a pathologist specialized in head and neck cancer. The preliminary results of 50 patients indicate the potential of HSI and deep learning for automatic tissue-labeling of surgical specimens of head and neck patients.
Objectives
To examine survival endpoints in patients with tumor (T)4b oral cavity squamous cell carcinoma (OCSCC) with pathologically proven masticator space invasion treated with primary surgery ...followed by adjuvant therapy.
Study Design
Retrospective review at an academic cancer center.
Methods
Twenty‐five patients with T4b OCSCC with pathologic masticator space invasion were treated with primary surgery from May 2012 to December 2016. Only patients with ≥ 2 years follow‐up from date of surgery were included. Sixteen patients received adjuvant chemoradiation.
Results
Median follow‐up time was 39 months from date of surgery. Overall survival (OS), disease‐specific survival (DSS), and recurrence‐free survival at 24 months were 44.0%, 63.2%, and 52.6%, respectively. On univariate analyses, adjuvant chemoradiation was associated with improved OS. Advanced age and prolonged length of hospital stay was associated with worse OS.
Conclusion
For pT4b OCSCCA involving the masticator space, primary surgical resection followed by adjuvant chemoradiation demonstrates 24‐month DSS of > 50% and OS of 44%.
Level of Evidence
4 Laryngoscope, 131:E466–E472, 2021
Background
With an expectation of excellent locoregional control, ongoing efforts to de‐intensify therapy for patients with human papillomavirus–associated squamous cell oropharyngeal cancer ...necessitate a better understanding of the metastatic risk for patients with this disease. The objective of this study was to determine what factors affect the risk of metastases in patients with squamous cell cancers of the oropharynx.
Methods
Under a shared use agreement, 547 patients from Radiation Therapy Oncology Group 0129 and 0522 with nonmetastatic oropharyngeal squamous cell cancers who had a known p16 status and smoking status were analyzed to assess the association of clinical features with the development of distant metastases. The analyzed factors included the p16 status, sex, T stage, N stage, age, and smoking history.
Results
A multivariate analysis of 547 patients with a median follow‐up of 4.8 years revealed that an age ≥ 50 years (hazard ratio HR, 3.28; P = .003), smoking for more than 0 pack‐years (HR, 3.09; P < .001), N3 disease (HR, 2.64; P < .001), T4 disease (HR, 1.63; P = .030), and a negative p16 status (HR, 1.60; P = .044) were all factors associated with an increased risk of distant disease.
Conclusions
Age, smoking, N3 disease, T4 disease, and a negative p16 status were associated with the development of distant metastases in patients with squamous cell cancers of the oropharynx treated definitively with concurrent chemoradiation.
According to an analysis of more than 500 patients with squamous cell cancer of the oropharynx, smoking for more than 0 pack‐years (P < .001), N3 disease (AJCC 7th edition) (P < .001), an age ≥ 50 years (P = .003), T4 disease (AJCC 7th edition) (P = .030), and a negative p16 status (P = .044) are associated with an increased risk of distant disease. Increased age and p16 status are newly identified risk factors for the development of metastases in patients with squamous cell cancers of the oropharynx.
This study intends to investigate the feasibility of using hyperspectral imaging (HSI) to detect and delineate cancers in fresh, surgical specimens of patients with head and neck cancers.
A clinical ...study was conducted in order to collect and image fresh, surgical specimens from patients (
= 36) with head and neck cancers undergoing surgical resection. A set of machine-learning tools were developed to quantify hyperspectral images of the resected tissue in order to detect and delineate cancerous regions which were validated by histopathologic diagnosis. More than two million reflectance spectral signatures were obtained by HSI and analyzed using machine-learning methods. The detection results of HSI were compared with autofluorescence imaging and fluorescence imaging of two vital-dyes of the same specimens.
Quantitative HSI differentiated cancerous tissue from normal tissue in
surgical specimens with a sensitivity and specificity of 91% and 91%, respectively, and which was more accurate than autofluorescence imaging (
< 0.05) or fluorescence imaging of 2-NBDG (
< 0.05) and proflavine (
< 0.05). The proposed quantification tools also generated cancer probability maps with the tumor border demarcated and which could provide real-time guidance for surgeons regarding optimal tumor resection.
This study highlights the feasibility of using quantitative HSI as a diagnostic tool to delineate the cancer boundaries in surgical specimens, and which could be translated into the clinic application with the hope of improving clinical outcomes in the future.
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Objectives
The patterns of care for salivary gland adenoid cystic carcinomas (ACC) are unknown. We sought to assess predictors of receiving postoperative radiation and/or chemotherapy for patients ...with nonmetastatic, definitively resected ACC, as well as report unexpected nodal disease.
Methods
The National Cancer Data Base was queried for definitively resected nonmetastatic ACC from 2004 to 2014. Logistic regression, Kaplan‐Meier, and Cox proportional‐hazard models were utilized. Propensity‐score matched analysis was employed to reduce confounding variables.
Results
A total of 3,136 patients met entry criteria: 2,252 (71.8%) received postoperative radiation, with 223 (7.4%) also receiving concurrent chemotherapy. Median follow‐up was 4.87 years. In clinically lymph node negative (cN0) patients, 7.4% had pathologically positive lymph nodes (pN) + after elective neck dissection. Patients who lived closer to their treatment facility and had positive margins were more likely to receive postoperative radiation. Black patients and uninsured patients were less likely to receive radiation. Older age, male sex, advancing stage, and positive surgical margins were associated with worse overall survival (OS). With limited follow‐up, receipt of radiation or chemotherapy was not associated with OS.
Conclusion
Postoperative radiation was frequently given for resected ACC, with a minority receiving chemotherapy. Black patients and uninsured patients were less likely to receive radiation. Postoperative radiation and/or chemotherapy had no association with OS but were given in greater frequency in more advanced disease, and our series is limited by short follow‐up. The disparity findings for this rare disease need to be addressed in future studies.
Level of Evidence
2c Laryngoscope, 129:377–386, 2019
The purpose of this study was to provide further insights into whether age and/or sex are associated with prognosis in oral tongue squamous cell carcinoma.
This was a retrospective cohort study ...utilizing hospital registry data from 2006 to 2016 obtained from the National Cancer Database. Identified patients were divided into various cohorts based on age, sex, and staging. A descriptive analysis was performed using chi-square tests and overall survival rates were estimated using Kaplan-Meier method.
A total of 17 642 patients were included in the study. The 5-year overall survival rates were 82.0% (95% CI: 79.8%-84.0%) in younger patients versus 67.5% (95% CI: 66.7%-68.3%, p-value <0.0001) older patients. The median overall survival for females was 143.4 months (95% CI: 133.2-NA) versus 129.8 (95% CI: 125.4-138.7, p-value <0.0001) in males.
Our analysis suggests that younger age and female sex are both predictors of improved survival in oral tongue squamous cell carcinoma.
Background
Data objectively evaluating acute post‐transoral robotic surgery (TORS) swallow function are limited. Our goal was to characterize and identify clinical variables that may impact swallow ...function components 3 weeks post‐TORS.
Methods
Retrospective cohort study. Pre/postoperative use of the Modified Barium Swallow Impairment Profile (MBSImP) and Penetration‐Aspiration Scale (PAS) was completed on 125 of 139 TORS patients (2016–2019) with human papillomavirus (HPV)‐associated oropharyngeal squamous cell carcinoma. Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scores were retrospectively calculated. Uni/multivariate analysis was performed.
Results
Dysfunctional pre‐TORS DIGEST scores were predictive of post‐TORS dysphagia (p = 0.015). Pre‐TORS MBSImP deficits in pharyngeal stripping wave, swallow initiation, and clearing pharyngeal residue correlated with airway invasion post‐TORS based on PAS scores (p = 0.012, 0.027, 0.048, respectively). Multivariate analysis of DIGEST safety scores declined with older age (p = 0.044). Odds ratios (ORs) for objective swallow function components after TORS were better for unknown primary and tonsil primaries compared to base of tongue (BOT) (OR 0.35–0.91).
Conclusions
Preoperative impairments in specific MBSImP components, older patients, and BOT primaries may predict more extensive recovery in swallow function after TORS.
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