Elucidation of salvage laryngectomy pathologic and clinical variables to guide further treatment intensification investigation

Scharpf, Joseph; Ward, Matthew C.; Adelstein, David J.; Koyfman, Shlomo A.; Li, Mingsi

doi:10.1002/lary.26782

Cited by 17 publications

(29 citation statements)

References 29 publications

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“…In our cohort, 179 (74%) patients required a TL; 122 (68%) TLs were performed in those with early stage disease at initial presentation. This is in agreement with others publications that are conformed by initially diagnosed early glottic disease treated with radiation alone . Given most studies, including ours, analyze patients initially treated at outside facilities, this phenomenon is difficult to definitively explain.…”

Section: Discussionsupporting

confidence: 90%

“…This study provides a unique overview by analyzing all patients with recurrent laryngeal SCC managed with salvage surgery, independent of the initial curative‐intent treatment modality. It shows that salvage laryngeal surgery provides acceptable oncological outcomes, with 57% DSS at 5‐years post‐salvage comparable to the published literature . Despite the intrinsic challenges of the surgical field in the posttreatment setting and higher rates of complications, salvage resection of recurrent laryngeal cancer has proved to be a safe undertaking.…”

Section: Discussionsupporting

confidence: 58%

“…TL is the most frequent salvage modality. 11,[15][16][17] In our cohort, 179 (74%) patients required a TL; 122 (68%) TLs were performed in those with early stage disease at initial presentation. This is in agreement with others publications that are conformed by initially diagnosed early glottic disease treated with radiation alone.…”

Section: Discussionmentioning

confidence: 92%

“…Fletcher et al found an association between the presence of PNI and a worse OS outcome, with an unadjusted HR of 2.69 ( P = .006) . In contrast, Scharpf et al found that PNI was not a significant adverse event, albeit in a univariate analysis . The presence of positive margins is a well‐known detrimental factor in laryngeal cancer .…”

Section: Discussionmentioning

confidence: 99%

“…It shows that salvage laryngeal surgery provides acceptable oncological outcomes, with 57% DSS at 5-years post-salvage comparable to the published literature. 15,16 Despite the intrinsic challenges of the surgical field in the posttreatment setting and higher rates of complications, salvage resection of recurrent laryngeal cancer has proved to be a safe undertaking. TL is the most frequent salvage modality.…”

Section: Discussionmentioning

confidence: 99%

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Salvage surgery for recurrent larynx cancer

et al. 2019

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Background Despite advances in treatment, the recurrence rates for laryngeal cancer range from 16% to 40%. Methods Patients with recurrent laryngeal cancer treated at Memorial Sloan Kettering (MSK) from 1999 to 2016 were reviewed. Survival outcomes were analyzed. Results Of 241 patients, 88% were male; the median age was 67 years; 71% had primary glottic tumors. At initial treatment, 72% of patients were seen with early stage disease; primary treatment was radiation (68%), chemoradiation (29%), and surgery (3%). The most common salvage surgery was total laryngectomy (74%). Forty‐seven percentage were upstaged at salvage surgery. The 2‐ and 5‐year disease‐specific survival (DSS) was 74% and 57%, respectively. Patients with cT4 disease treated with nonsurgical primary management had a 0% 5‐year DSS. Independent predictors of DSS were tumor location, perineural invasion, margin, and stage. Conclusions Salvage surgery results in acceptable oncologic outcomes. Stage, disease site, perineural invasion, and margins are associated with inferior DSS.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Salvage surgery for recurrent larynx cancer

et al. 2019

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Reply to the letter of the editor: Is tailored management better than salvage in laryngeal squamous cell carcinomas?

2019

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Predicting salvage laryngectomy in patients treated with primary nonsurgical therapy for laryngeal squamous cell carcinoma using machine learning

et al. 2020

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Background Machine learning (ML) algorithms may predict patients who will require salvage total laryngectomy (STL) after primary radiotherapy with or without chemotherapy for laryngeal squamous cell carcinoma (SCC). Methods Patients treated for T1‐T3a laryngeal SCC were identified from the National Cancer Database. Multiple ML algorithms were trained to predict which patients would go on to require STL after primary nonsurgical treatment. Results A total of 16 440 cases were included. The best classification performance was achieved with a gradient boosting algorithm, which achieved accuracy of 76.0% (95% CI 74.5‐77.5) and area under the curve = 0.762. The most important variables used to construct the model were distance from residence to treating facility and days from diagnosis to start of treatment. Conclusion We can identify patients likely to fail primary radiotherapy with or without chemotherapy and who will go on to require STL by applying ML techniques and argue for high‐quality, multidisciplinary regionalized care.

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Elucidation of salvage laryngectomy pathologic and clinical variables to guide further treatment intensification investigation

Abstract: 4. Laryngoscope, 128:823-830, 2018.

Cited by 17 publications

References 29 publications

Salvage surgery for recurrent larynx cancer

Salvage surgery for recurrent larynx cancer

Reply to the letter of the editor: Is tailored management better than salvage in laryngeal squamous cell carcinomas?

Predicting salvage laryngectomy in patients treated with primary nonsurgical therapy for laryngeal squamous cell carcinoma using machine learning

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