LitAlert #50

Treatment insights and patient outcome of laryngeal cancer in Stockholm, Sweden

Blomkvist R, Marklund L, Hammarstedt-Nordenvall L, Gottlieb-Vedi E, Mäkitie A, Palmgren B. Treatment and outcome among patients with laryngeal squamous cell carcinoma in Stockholm-A population-based study. Laryngoscope Investig Otolaryngol. 2023 Mar 6;8(2):441-449.

Squamous cell carcinoma exhibits declining incidence in the Nordic countries with approximately 170 cases in Sweden each year. Survival rates suggest favorable outcomes for early-stage laryngeal squamous cell carcinoma (LSCC), but with poor survival linked to advanced disease. Compared to other oncologic diseases there has been a lack of improvement for LSCC over the past decades, as observed in the United States. This retrospective analysis explores outcomes for LSCC patients in Stockholm between the years 2000-2014, aiming to examine correlations between stage, treatment, and outcomes in relation to recurrence-free and overall survival (RFS and OS, respectively). The 5-year OS for all patients was 65%. Notably, T3 glottic LSCC exhibited unexpectedly poor survival compared to T4 tumors. Patients with T4 disease were primarily treated with laryngectomy and postoperative radiotherapy (RT) or chemoradiotherapy (CRT), while T3 LSCC cases were predominantly treated with RT or CRT. The results suggest that primary total laryngectomy with adjuvant RT or CRT may enhance survival for advanced LSCC.

Importance of identification of malnutrition in advanced pharyngeal and laryngeal cancer patients

Brown T, Edwards A, Pashley A, Lehn B, Vasani S, Hodge R, Bauer J. Nutritional status and post-operative complications in patients undergoing surgery for advanced pharyngeal or laryngeal cancer. Eur Arch Otorhinolaryngol. 2023 Dec;280(12):5531-5538.

Malnutrition is common in patients with HNC and has been recognized as a crucial prognostic factor linked with poorer quality of life and reduced survival in patients treated with radiotherapy. However, few studies have assessed the risk associated with malnutrition using validated nutrition assessment tools. The objective of this retrospective cohort study was to assess the correlation between nutritional status on post-operative complications and the length of stay among patients undergoing laryngectomy, pharyngectomy, or pharyngolaryngectomy for HNC. Furthermore, it investigated the incidence of malnutrition in the same population and the study revealed a 40% incidence of pre-operative malnutrition. Malnourished patients exhibited a significantly higher incidence of any complication, with 57.5% of patients affected by at least one complication, and a higher incidence in the malnourished group compared to the well-nourished group. Furthermore, there was also a significant difference for increased pressure injuries and a clinically significant longer median length of stay in malnourished patients compared to well-nourished patients. Promptly addressing malnutrition is crucial to mitigate post-operative risks, shorten hospital stays, and should be a fundamental aspect of prehabilitation programs.

New patient-reported outcome measure to monitor adverse effects of radiation therapy in HNC patients

Gharzai LA, Mierzwa ML, Peipert JD, Kirtane K, Casper K, Yadav P, Rothrock N, Cella D, Shaunfield S. Monitoring Adverse Effects of Radiation Therapy in Patients With Head and Neck Cancer: The FACT-HN-RAD Patient-Reported Outcome Measure. JAMA Otolaryngol Head Neck Surg. 2023 Oct 1;149(10):884-890.

Radiation therapy plays a crucial role in the treatment of head and neck squamous cell carcinoma (HNSCC); however, patients experience various adverse effects (AEs). Patient-reported outcome (PRO) measures are essential in assessing these AEs, yet existing options frequently focus solely on disease-related symptoms or adverse effects from non-RT treatments. The aim of this qualitative study was to create a PRO measure for the most prevalent radiation therapy-related adverse effects (FACT-HN-RAD) for HNSCC. The most common AEs related to radiation therapy were identified by surveys and qualitative interviews by patients and radiation oncologists. This led to the development and validation of the 8-item FACT-HN-RAD, including pain, dysphagia, xerostomia, dysgeusia, voice changes, dermatitis, fatigue, and weight loss. This measure provides a tool for ongoing monitoring of patient-reported treatment-related AEs and recovery in clinical and research settings.

Survival outcomes in T3 laryngeal cancers

Rao KN, Pai PS, Dange P, Kowalski LP, Strojan P, Mäkitie AA, Guntinas-Lichius O, Robbins KT, Rodrigo JP, Eisbruch A, Takes RP, de Bree R, Coca-Pelaz A, Piazza C, Chiesa-Estomba C, López F, Saba NF, Rinaldo A, Ferlito A. Survival Outcomes in T3 Laryngeal Cancers: Primary Total Laryngectomy vs. Concurrent Chemoradiation or Radiation Therapy-A Meta-Analysis. Biomedicines. 2023 Jul 28;11(8):2128.

Treatment of laryngeal cancers, constituting 20% of head and neck squamous cell carcinomas, has shown a significant change over the past three decades. Despite well-conducted trials comparing surgical and non-surgical methods, especially in T3 laryngeal tumors, debates persist on survival improvements. This meta-analysis seeks to comprehensively examine the survival outcomes of total laryngectomy versus chemoradiotherapy or radiotherapy alone for T3 laryngeal cancers, filling a gap in existing research. The combined 2-year overall survival (OS) rates were 73% for TL, 74.7% for CRT, and 57.9% for RT alone. For the 3-year period, the rates were 64.3% (TL), 62.9% (CRT), and 52.4% (RT), while the 5-year rates were 54.2% (TL), 52.7% (CRT), and 40.8% (RT). The conclusion of the analysis reveals comparable OS rates between TL and CRT in the treatment of T3 laryngeal cancers, whereas the use of RT alone is discouraged and should be reserved for patients unsuitable for more aggressive treatment options.

Larysuicide: Identifying high suicide risk in laryngeal cancer patients online

Tu Z, Li C, Hu Q, Luo J. Larysuicide: an online risk stratification system to identify patients at high risk of suicide after the laryngeal cancer diagnosis. J Cancer Res Clin Oncol. 2023 Aug;149(9):6455-6465.

There has been swift advancement in the treatment of laryngeal cancer and longer survival rates for the patients, nevertheless the patient's quality of life remains dissatisfactory. The incidence of suicide in these patients is more than five times higher compared to the general population. The purpose of the study was firstly to perform a retrospective study to find potential suicide risk factors. Secondly, to create an online risk stratification system, named Larysuicide, to identify individuals that have an increased risk of suicide following a laryngeal cancer diagnosis. The Larysuicide model incorporated the seven strongest predictors age, race, cancer site, pathological subtype, grade, stage at presentation, and radiation with the model demonstrating good discrimination (C index: 0.745 in training, 0.759 in validation, 0.749 in testing). Calibration and decision curve analyses confirmed its clinical utility. Patients identified as high-risk by Larysuicide had a significantly higher risk of post-cancer diagnosis suicide. In conclusion, Larysuicide may serve as a valuable tool for healthcare professionals in implementing early and tailored psychological interventions.

Recent advancements of imaging and radiomics in head and neck cancer patients

Wishart LR, Ward EC, Galloway G. Advances in and applications of imaging and radiomics in head and neck cancer survivorship. Curr Opin Otolaryngol Head Neck Surg. 2023 Dec 1;31(6):368-373.

Radiological imaging plays an important role in detection, staging, and management of head and neck cancer (HNC). The imaging techniques CT, MRI, ultrasound, and PET are all well-established and employed at various stages in the HNC care. This review explores recent advancements utilizing advanced imaging and radiomics to assess treatment-related toxicities and functional challenges following chemoradiotherapy for HNC. Recent studies have demonstrated the viability of radiological imaging, particularly advanced MRI, to assess treatment-induced changes in head and neck muscles and predict clinical issues such as lymphedema, fibrosis, and dysphagia. Additionally, advanced radiological feature analysis and radiomics are increasingly focused on predicting distinct functional outcomes. In conclusion, novel imaging techniques hold promise for advancing our understanding of HNC pathophysiology, enhancing the assessment and treatment of functional deficits post-treatment.

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