Immunotherapy-Based Therapeutic Strategies for Recurrent Advanced Squamous Cell Carcinoma of the Head and Neck: A Case Report and Literature Review

We present a patient with locoregionally advanced laryngeal carcinoma, who experienced recurrence 2 months after surgery. We exploratively treated this patient with immunotherapy combined with targeted therapy with or without radiation therapy. The patient exhibited a significant and durable response. Thus far, there are no standard or effective second-line therapeutic modalities for recurrent locoregionally advanced laryngeal carcinoma. The efficacy of conventional chemotherapy with anti-epidermal growth factor receptor (anti-EGFR) remains unsatisfactory. The addition of immunotherapy resulted in substantial improvement in the progression-free survival (PFS) and overall survival (OS) of this patient. In this case, immunotherapy combined with anti-EFGR was administered, leading to good tumor response; based on this observation, radiotherapy was added to further intensify tumor control. This therapeutic strategy may be a novel option for recurrent locoregionally advanced squamous cell carcinoma of the head and neck.

Surviving COVID-19 and multiple complications post total laryngectomy

The clinical manifestation of novel COVID-19 is variable. Pre-existing carcinoma and other comorbidities have been associated with increased COVID-19-related morbidity and mortality. Surgical intervention for advanced laryngeal carcinoma in old age during the COVID-19 pandemic may pose multiple challenges to the patient and the treatment team. We report a case of a 67-year-old elderly man who developed SARS-CoV-2 infection on the 21st day following total laryngectomy and neck dissection. The postoperative period was complicated by sequential development of pulmonary embolism, neck infection, pharyngeal leak and COVID-19 which were managed successfully. No close contacts were positive on the reverse transcription-PCR test for SARS-CoV-2. The patient is in follow-up for the past 7 months without any recurrence or COVID-19-related morbidity. The successful recovery and no cross-infection may be attributed to early diagnosis, immediate intervention and properly implemented institutional infection control policy.

Does thyroid-sparing total laryngectomy decrease the risk of hypothyroidism?

Background Thyroid lobectomy is recommended with total laryngectomy for laryngeal cancer in the National Comprehensive Cancer Network (‘NCCN’) guidelines. However, it is associated with a 32–89 per cent risk of hypothyroidism, with or without adjuvant radiotherapy. Objective The study aimed to determine whether preserving the whole thyroid, compared to a single lobe, does indeed significantly lower the incidence of hypothyroidism in the setting of total laryngectomy. Method A retrospective study was conducted at Groote Schuur Hospital in Cape Town, South Africa. Results Eighty-four patients met the inclusion criteria. The overall incidence of hypothyroidism was 45.2 per cent. The incidence of hypothyroidism was significantly reduced in patients who underwent thyroid-sparing total laryngectomy compared to hemithyroidectomy (p = 0.037). Adjuvant radiotherapy was associated with a higher incidence of hypothyroidism (p = 0.001). Conclusion Thyroid-preserving laryngectomy should be advocated in carefully selected patients with advanced laryngeal carcinoma, as it reduces the incidence of hypothyroidism.

Complications of Total Laryngectomy

Objective: To observe Post-operative complications of Total Laryngectomy in advanced Laryngeal Carcinoma Patients. Methods: This prospective observational study was conducted in National Institute of ENT, Tejgaon, Dhaka. Study duration 3 years, from January 2015 to December 2017. 17 patients were selected who underwent total laryngectomy for histologically proven advanced carcinoma larynx. Patients were followed up monthly for 3 months & then after 6 months for life long. Results: The age of the patients ranged from 39 to 66 years. The mean age was 47 years. Most of the cases are supraglottic carcinoma 12 (70.59%), Glottic carcinoma in 5 (29.41%) & no subglottic carcinoma. In this study, out of 12 supraglottic cases, 4 patients were presented in stage III & 8 in stage IV. Among the glottic cases 1 patient presented in stage I, 2 in stage III & 2 patients presented in stage IV. Patients were followed up monthly for 3 months & then after 6 months for life long. 2 patients (11.76%) developed pharyngocutaneous fistula within 7th to 15th post-operative day & these patients were managed conservatively which involved adequate drainage, frequent dressing & fresh blood transfusion. With these conservative management fistula healed completely within 3 to 4 weeks. 3 patients (17.65%) developed wound infection. Wound swab was sent for culture & sensitivity and antibiotics changed accordingly. Wound healed within 2-3 weeks with conservative treatment & adequate aseptic dressing. 1 patient (5.88%) developed postoperative hematoma which was drained immediately. This patient developed wound infection later on & was managed conservatively. 2 patients (11.76%) developed stomal recurrence 4 months after surgery, which was confirmed by biopsy. The cases were inoperable & were sent for radiotherapy. 2 patients (11.76%) developed dysphagia due to pharyngeal stenosis 4 months after surgery. Conclusion: The most frequent troublesome immediate complication is pharyngocutaneous fistula all of which have been treated conservatively with satisfactory result. Preoperative radiotherapy is an important risk factor for the development of pharyngocutaneous fistula in total laryngectomy. Bangladesh J Otorhinolaryngol; April 2019; 25(1): 10-18