Prognostic Significance of Presentation-to-Diagnosis Interval in Patients With Oropharyngeal Carcinoma

Ho, Tang; Zahurak, Marianna; Koch, Wayne M.

doi:10.1001/archotol.130.1.45

Cited by 35 publications

(46 citation statements)

References 23 publications

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“…Symptomatically, otalgia has not been previously reported as a presenting feature of laryngeal carcinoma in an HIV/AIDS patient. Otalgia as a symptom in patients with squamous carcinomas of the head and neck is not uncommon (6%-20%) [13,14] and is usually associated with more aggressive disease [13,14]. This symptom occurred in our first patient who, although she was initially staged clinically with a T2N0M0 SCC of the supraglottis, progressed on to having a rapidly metastasizing tumor.…”

Section: Discussionmentioning

confidence: 70%

Squamous Cell Carcinoma of the Larynx in HIV-Positive Patients: Difficulties in Diagnosis and Management

et al. 2006

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Patients who are infected with human immunodeficiency virus (HIV) are at increased risk of developing laryngeal squamous cell carcinoma. This malignancy on average appears in a younger age group at a more advanced stage and has a more aggressive course in HIV patients. These patients have difficult management challenges, diagnostically, in staging, and particularly in determining the optimal treatment for each individual patient because their underlying HIV infection can markedly increase morbidity associated with active treatments. They frequently have problems associated with swallowing both before and after treatment. We present two cases that highlight difficulties in the diagnosis and management of these patients as well as post-treatment complications, with particular emphasis on swallowing problems.

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Section: Discussionmentioning

confidence: 70%

Squamous Cell Carcinoma of the Larynx in HIV-Positive Patients: Difficulties in Diagnosis and Management

et al. 2006

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“…Where delay was considered as a categorical variable, the cutoff time period for delay varied substantially, although several studies considered patient delays of >3 months as being relevant to stage at diagnosis. 9,12,15,16,18,20,23,28,30,33 The biologic basis for a 3-month period of delay was not discussed in any study, although there is indication that this period of delay may be relevant to stage at diagnosis for breast cancer. 36 Because of the great variability in case mix, definitions of delay, and statistical methodologies, we deemed that this literature could not be quantitatively synthesized.…”

Section: Description Of the Studiesmentioning

confidence: 99%

“…Koinuven et al 29 found no relationship between either patient or provider delays >2 months and stage at diagnosis in multivariate analysis of pharyngeal cancers at all sites. Ho et al 30 found that subjects with provider delays >3 months had a significantly greater likelihood of being diagnosed with tumor, node, metastases (TNM) stage IV oropharyngeal cancer.…”

Section: Diagnostic Delay and Stage At Diagnosis For Pharyngeal Cancersmentioning

confidence: 99%

“…Pharyngeal carcinomas are associated with a wide-ranging set of symptoms, and patients with this disease experience the highest number of symptoms prior to diagnosis. 26 Carvalho et al 15 Brouha et al 27 Provider delay Jovanovic et al 19 ; Kerdpon and Sriplung 23 Wildt et al 22 27 Provider delay Koinuven et al 29 Ho et al 30 Laryngeal cancers…”

Section: Symptoms Associated With Head and Neck Cancersmentioning

confidence: 99%

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Diagnostic delay and disease stage in head and neck cancer: A systematic review

et al. 2009

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Possible explanations for the lack of an observed relationship between patient delay and stage include: inaccurate measurement of delay, lack of sensitivity of disease stage to delay-related disease progression, and variation in tumor aggressiveness, which could lead to variation in symptom progression rates. We call for better evidence about the relationship between diagnostic delay and disease progression and/or disease outcomes. If demonstrated and validated, such associations would provide a much stronger argument than description of delay alone for education programs around symptom recognition and for more active screening of high-risk individuals.

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“…Multivariate analysis in the study of Denis et al [24] also showed stage IV disease as an important factor for short survival. The results of multivariate analysis in the study of Ho et al [59] have also presented overall clinical stage as one of the strongest factors for survival.…”

Section: Discussionmentioning

confidence: 99%

Concurrent radiochemotherapy in locally-regionally advanced oropharyngeal squamous cell carcinoma: analysis of treatment results and prognostic factors

2012

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BackgroundConcurrent radiochemotherapy is a recommended treatment option for patients with locally advanced squamous cell head and neck carcinomas with recent data showing the most significant absolute overall and event-free survival benefit achieved in patients with oropharyngeal tumours. The aim of this study was to analyse the results of three-dimensional conformal radiotherapy given with concomitant weekly cisplatin in patients with advanced oropharyngeal carcinoma and to identify prognostic factors influencing outcomes of this patients category.MethodsSixty-five patients with stage III or IV squamous cell carcinoma of the oropharynx who underwent concurrent radiochemotherapy between January 2005 and December 2010 were retrospectively analyzed. All patients received radiotherapy to 70 Gy/35 fractions/2 Gy per fraction/5 fractions per week. Concurrent chemotherapy consisted of weekly cisplatin (30 mg/m2) started at the first day of radiotherapy.ResultsMedian age was 57 years (range, 36 to 69 years) and 59 (90.8%) patients were male. Complete composite response was achieved in 47 patients (72.3%). Local and/or regional recurrence was the most frequent treatment failure present in 19 out of 25 patients (76.0%). At a median follow-up of 14 months (range, 5 to 72 months), 2-year local relapse-free, regional relapse-free, locoregional relapse-free, disease-free, and overall survival rates were 48.8%, 57.8%, 41.7%, 33.2% and 49.7%, respectively.On multivariate analysis the only significant factor for inferior regional relapse-free survival was the advanced N stage (p = 0.048). Higher overall stage was independent prognostic factor for poorer local relapse-free survival, locoregional relapse-free survival and disease-free survival (p = 0.022, p = 0.003 and p = 0.003, respectively). Pre-treatment haemoglobin concentration was an independent prognostic factor for local relapse-free survival, regional relapse-free survival, locoregional relapse-free survival, disease-free survival, and overall survival (p = 0.002, p = 0.021, p = 0.001, p = 0.002 and p = 0.002, respectively).ConclusionsPoor treatments results of this study suggested that introduction of intensity-modulated radiotherapy, use of induction chemotherapy followed by concurrent radiochemotherapy, accelerated radiotherapy regimens, and molecular targeted therapies could positively influence treatment outcomes. The incorporation of reversal of anaemia should be also expected to provide further improvement in locoregional control and survival in patients with advanced squamous cell carcinoma of the oropharynx.

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Prognostic Significance of Presentation-to-Diagnosis Interval in Patients With Oropharyngeal Carcinoma

Abstract: To evaluate the prognostic impact of presentation-to-diagnosis interval (PDI) and its association with other clinical factors in patients with oropharyngeal squamous cell carcinoma (OpSCC).

Cited by 35 publications

References 23 publications

Squamous Cell Carcinoma of the Larynx in HIV-Positive Patients: Difficulties in Diagnosis and Management

Squamous Cell Carcinoma of the Larynx in HIV-Positive Patients: Difficulties in Diagnosis and Management

Diagnostic delay and disease stage in head and neck cancer: A systematic review

Concurrent radiochemotherapy in locally-regionally advanced oropharyngeal squamous cell carcinoma: analysis of treatment results and prognostic factors

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