Predictive factors of toxicity of TPF induction chemotherapy for locally advanced head and neck cancers

Background The rate of toxic deaths related to induction chemotherapy in the treatment of locally advanced head and neck cancers is unacceptable and calls into question this therapeutic strategy, which is however highly effective in terms of rate and speed of response. The purpose of the study was to investigate predictive factors of toxicity of induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (TPF) in locally advanced head and neck cancers (LAHNC). Methods Between June 2009 and December 2017, 113 patients treated consecutively with TPF were included retrospectively. Patients were receiving induction chemotherapy for either an inoperable cancer or laryngeal preservation. For inoperable cancer, induction chemotherapy was proposed to patients presenting either a large tumor with strong symptoms (dyspnea, dysphagia, pain) or a tumor with rapid progression. Risk factors were chosen among the initial patient and tumour characteristics and chemotherapy modalities. Results Eighty-nine patients (79%) were male; the median age was 58 years [32–71]. Sixty-nine (61%) patients were treated for inoperable cancer and 44 (39%) for laryngeal preservation. 45% had stage IVa cancer, 28% stage III and 25% stage IVb. Sixty percent of patients had a partial response after TPF, 22% had a complete response, 12% were stable, 5% were progressing, and 1% had a discordant response. Thirty-four patients (30%) received enteral feeding during induction chemotherapy with TPF. The possibility of oral feeding without a tube was predictive of a better response (p = 0.003). Seven (6%) patients died during TPF. There was an increased risk of death with preexisting liver dysfunction (liver dysmorphia on imaging or decrease prothrombin rate) (p = 0.032). There was an increased risk of grade ≥ 3 infection if an enteral feeding occurred during the period of induction chemotherapy (p = 0.03). Conclusions TPF induction chemotherapy had an 82% objective response rate with 6% toxic deaths. Nutritional status and the presence of hepatic dysfunction are significant risk factors to be taken into account in therapeutic decisions.

Laser Microsurgery Versus Radiotherapy Versus Open Partial Laryngectomy for T2 Laryngeal Carcinoma: A Systematic Review of Oncological Outcomes

Introduction: The aim of the current systematic review is to update the pooled survival outcome of patients with T2 glottic carcinoma treated with either laser surgery (CO2 transoral laser microsurgery [CO2 TOLMS]), radiotherapy (RT), or open partial laryngectomy (OPL). Methods: A systematic search was performed using the MEDLINE database, Scopus, and Google scholar. The inclusion criteria were studies of patients with T2N0 glottic tumor, treated with either primary CO2 TOLMS, definitive curative RT, or primary OPL, and with reported oncological outcome at 5 years calculated with a Kaplan-Meier or Cox regression method. Results: The results of the current review show that local control (LC) is higher with OPL 94.4%, while there are no differences in LC at 5-year posttreatment for patients treated with RT, compared to those treated with CO2 TOLMS (respectively, 75.6% and 75.4%). Primary treatment with OPL and CO2 TOLMS results in higher laryngeal preservation than primary treatment with RT (respectively 95.8%, 86.9%, and 82.4%). Conclusion: First-line treatment with OPL and CO2 TOLMS should be encouraged in selected T2 patients, because it results in higher laryngeal preservation and similar LC compared to primary treatment with RT. The involvement of the anterior commissure in the craniocaudal plane and T2b impaired vocal cord mobility have a poorer prognosis and LC compared to patients with T2a tumors for both CO2 TOLMS and RT.

Efficacy of transoral laser surgery versus linear accelerator radiotherapy for the treatment of T1 glottic carcinoma: a meta-analysis of oncologic outcomes

ObjectiveA meta-analysis was conducted to compare oncologic outcomes for patients of T1 glottic carcinoma who were treated with transoral laser surgery (TLS) or linear accelerator radiotherapy (linac RT).MethodsAll related studies published up to September 2019 were acquired by searching Pubmed, EMBASE, and Cochrane, with the index words: glottic, vocal, laryngeal, radiation, radiotherapy, irradiation, laser, surgery, cordectomy, carcinoma and cancer. Relative studies which compared oncologic outcomes between linac RT and TLS were included. Sensitivity analysis were performed to evaluate heterogeneity.ResultsA total of twelve eligible studies were included for the analysis, which contained three prospective studies and nine retrospective studies. Patients who underwent TLS had increased overall survival (OR = 1.40, 95% CI=1.02-1.94, P=0.04) and laryngeal preservation (OR = 5.37, 95% CI = 3.05-9.44, P < 0.00001) versus who underwent linac RT. No statistical difference was observed between TLS group and linac RT group in terms of local control (OR=0.88, 95% CI = 0.62-1.24, P = 0.47), disease-specific survival (OR = 0.61, 95% CI = 0.26-1.43, P = 0.26), and disease-free survival (OR = 1.63, 95% CI = 0.70-3.81, P = 0.14).ConclusionsThe results of this meta-analysis indicate that there were clinical benefits for patients with glottic carcinoma after TLS compared with linac RT with respect to overall survival and laryngeal preservation. However, more multi-center randomized controlled trials would be urgently needed to prove these differences.