Treatment Outcomes of T4 Locally Advanced Head and Neck Cancers With Soft Tissue Invasion or Bone and Cartilage Invasion

Do, Ly; Puthawala, Ajmel; Syed, Nisar; Azawi, Samar; Williams, R.; Vora, Nayana

doi:10.1097/coc.0b013e31819380a8

Cited by 8 publications

(10 citation statements)

References 28 publications

(33 reference statements)

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“…If these clinically overstaged T4 patients had been treated with chemoradiation therapy, one could have anticipated local control and functional outcomes similar to patients with T3 disease treated with chemoradiation. To complicate matters, several recently published retrospective reports suggest that patients with cartilage invasion can successfully be treated in a nonsurgical manner [19,20]. Although the extent of cartilage invasion was not specifically quantified in these studies, the findings are nonetheless provocative.…”

Section: B LI M Bobinski R Gandour-edwards Et Almentioning

confidence: 68%

“…They showed local regional control, disease-free survival and laryngectomyfree survival similar to the results from T3 patients treated in RTOG 9111. In another retrospective study, Do et al [20] showed similar local regional control rates between patients with cartilage invasion treated with definitive chemoradiation therapy or surgery followed by chemoradiation. Large prospective trials are needed to test the Figure 1.…”

Section: B LI M Bobinski R Gandour-edwards Et Almentioning

confidence: 93%

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Overstaging of cartilage invasion by multidetector CT scan for laryngeal cancer and its potential effect on the use of organ preservation with chemoradiation

Li¹,

Bobinski²,

Gandour‐Edwards³

et al. 2011

BJR

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Objective: The two currently acceptable treatment options for locally advanced laryngeal cancer are total laryngectomy and organ preservation using chemoradiation. To facilitate therapeutic decision making, the accurate pre-treatment evaluation of cartilage invasion is of paramount importance. The purpose of this study was to evaluate the positive predictive value (PPV) and negative predictive value (NPV) of detecting neoplastic cartilage invasion in laryngeal cancer patients using fast-speed multidetector CT (MDCT). Methods: 61 consecutive patients with clinically staged T3 or T4 squamous cell carcinoma of the larynx or hypopharynx who underwent total laryngectomy were analysed. All patients had MDCT of the neck within 2 weeks prior to surgery. Central radiographic and pathological review was performed in an attempt to correlate findings. MDCT invasion of cartilage was graded based on objective criteria. Results: MDCT scan was found to have a PPV of 78% and an NPV of 100% for detection of invasion through cartilage, with sensitivity being 100% and specificity 96%. For detection of any cartilage invasion (minor, major or through cartilage invasion), PPV and NPV were 63% and 92%, respectively. The sensitivity was 85% and specificity was 75%. For the detection of tumour invasion through cartilage or major cartilage invasion, MDCT scan had a PPV of 53% and an NPV of 95%. 47% (9/19) patients were down-staged from T4 to T3 after central pathology review. Conclusion: The low PPV for cartilage destruction using MDCT suggests that a significant proportion of patients who were treated by total laryngectomy could have been appropriately offered organ preservation if more accurately staged at initial diagnosis.

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Section: B LI M Bobinski R Gandour-edwards Et Almentioning

confidence: 68%

Section: B LI M Bobinski R Gandour-edwards Et Almentioning

confidence: 93%

Overstaging of cartilage invasion by multidetector CT scan for laryngeal cancer and its potential effect on the use of organ preservation with chemoradiation

Li¹,

Bobinski²,

Gandour‐Edwards³

et al. 2011

BJR

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show abstract

“…Literature on larynx preservation protocols is very heterogeneous including T1 and T2 LC or other locations of head and neck cancer, resulting in biased outcomes. Studying “advanced LC” based on staging (stage 3 and 4) means to include T1N2M0 LC cases in the same category as T4N0M0 cases for example. This can lead to significant results bias.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies are comparing survival after total laryngectomy (TL) versus OPPs in advanced LC cases to reconsider the conclusions of the VA and RTOG studies . Most studies published include different stages (T3, T4, N0, N+) of LC, with sometimes non‐LC cases (hypopharynx or oral cavity) with all the prognostic divergence . More studies are needed, with homogeneous categories of patients, to evaluate survival associated with surgery or preservation protocols and determine the most appropriate treatment modality that gives the highest survival outcomes.…”

Section: Introductionmentioning

confidence: 99%

T4a laryngeal cancer survival: Retrospective institutional analysis and systematic review

et al. 2014

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“…For example, Do et al [10] retrospectively analyzed 101 patients with stage T4 head and neck cancers treated with definitive RT or resection, from several centers associated with the University of California Davis. Subset analysis of the CRT group found no differences in LC (50% and 56% at 5 years, respectively) or OS in 26 patients with bone and/or cartilage invasion compared to 42 patients with other T4 criteria.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of thyroid or cricoid cartilage invasion in laryngeal or hypopharyngeal cancer treated with organ preserving strategies

et al. 2012

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BackgroundThe utility of definitive radiotherapy (RT) for locoregionally advanced squamous cell carcinoma (SCC) of the larynx or hypopharynx in the setting of thyroid or cricoid cartilage invasion (TCCI) is controversial. A retrospective review of our experience was performed.MethodsOur institutional database of patients with SCC of the head and neck treated with radiotherapy (90% received concurrent systemic therapy) between 1995 and 2009 was queried. We identified 87 patients with T3-4 laryngeal or T4 hypopharyngeal cancer for whom initial head and neck imaging was available for review. Imaging of all patients was reviewed by a single radiologist specializing in neuroradiology. The presence and extent of TCCI was determined and used for stratification.ResultsMedian follow-up was 34 months. TCCI was found in 25 (29%) patients, eight limited to the inner cortex and another 17 involving both cortices. Local control (LC) was not significantly affected by TCCI limited to the inner cortex. However, TCCI involving both cortices was correlated with diminished LC at 2 years compared to the group of patients with no or minor invasion (55% vs. 81%, p=0.045). However, TCCI involving both cortices was not associated with significantly reduced rates of survival with a functional larynx, or overall survival (OS).ConclusionsOur results suggest that the rate of LC of T3-4 laryngeal or T4 hypopharyngeal SCC treated with definitive RT is not affected by TCCI of the inner cortex. Although decreased LC was significantly associated with TCCI involving both cortices, this factor did not appear to result in reduced rates of survival with a functional larynx or OS. Therefore, organ preservation may remain an option in these patients.

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Treatment Outcomes of T4 Locally Advanced Head and Neck Cancers With Soft Tissue Invasion or Bone and Cartilage Invasion

Cited by 8 publications

References 28 publications

Overstaging of cartilage invasion by multidetector CT scan for laryngeal cancer and its potential effect on the use of organ preservation with chemoradiation

Overstaging of cartilage invasion by multidetector CT scan for laryngeal cancer and its potential effect on the use of organ preservation with chemoradiation

T4a laryngeal cancer survival: Retrospective institutional analysis and systematic review

Prognostic significance of thyroid or cricoid cartilage invasion in laryngeal or hypopharyngeal cancer treated with organ preserving strategies

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