RESUMEN
OBJECTIVE: The objective was to assess swallowing, mouth opening and speech function during the first year after radiation-based treatment (RT(+)) after introduction of a dedicated preventive rehabilitation program for stage III-IV oropharyngeal carcinoma (OPC). METHODS: Swallowing, mouth opening and speech function were collected before and at six- and twelve-month follow-up after RT(+) for OPC as part of ongoing prospective assessments by speech-language pathologists . RESULTS: Objective and patient-perceived function deteriorated until 6 months and improved until 12 months after treatment, but did not return to baseline levels with 25%, 20% and 58% of the patients with objective dysphagia, trismus and speech problems, respectively. Feeding tube dependency and pneumonia prevalence was low. CONCLUSION: Despite successful implementation, a substantial proportion of patients still experience functional limitations after RT(+) for OPC, suggesting room for improvement of the current rehabilitation program. Pretreatment sarcopenia seems associated with worse functional outcomes and might be a relevant new target for rehabilitation strategies.
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Carcinoma , Trastornos de Deglución , Neoplasias Orofaríngeas , Trastornos de Deglución/epidemiología , Trastornos de Deglución/etiología , Humanos , Neoplasias Orofaríngeas/complicaciones , Neoplasias Orofaríngeas/radioterapia , Habla , Trismo/epidemiología , Trismo/etiologíaRESUMEN
Swallowing muscle strength exercises are effective in restoring swallowing function. In order to perform the exercises with progressive load, the swallow exercise aid (SEA) was developed. Precise knowledge on which muscles are activated with swallowing exercises, especially with the SEA, is lacking. This knowledge would aid in optimizing the training program to target the relevant swallowing muscles, if necessary. Three healthy volunteers performed the three SEA exercises (chin tuck against resistance, jaw opening against resistance and effortful swallow) and three conventional exercises [conventional effortful swallow (cES), Shaker and Masako] in supine position inside an MRI scanner. Fast muscle functional MRI scans (generating quantitative T2-maps) were made immediately before and after the exercises. Median T2 values at rest and after exercise were compared to identify activated muscles. After the three SEA exercises, the suprahyoid, infrahyoid, sternocleidomastoid, and lateral pterygoid muscles showed significant T2 value increase. After the Shaker, the lateral pterygoid muscles did not show such an increase, but the three other muscle groups did. The cES and Masako caused no significant increase in any of these muscle groups. During conventional (Shaker) exercises, the suprahyoid, infrahyoid, and sternocleidomastoid muscles are activated. During the SEA exercises, the suprahyoid, infrahyoid, sternocleidomastoid, and lateral pterygoid muscles are activated. The findings of this explorative study further support the potential of the SEA to improve swallowing rehabilitation.
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Trastornos de Deglución , Deglución , Electromiografía , Terapia por Ejercicio , Humanos , Imagen por Resonancia Magnética , Músculos del CuelloRESUMEN
BACKGROUND: The objective of this study was to explore the 10-year plus outcomes of Intensity Modulated Radiotherapy with concomitant chemotherapy (CRT) combined with preventive swallowing rehabilitation (CRT+) for head and neck cancer (HNC). METHODS: Subjective and objective swallowing, trismus, and speech related outcomes were assessed at 10-year plus after CRT+. Outcomes were compared to previously published 6-year results of the same cohort. RESULTS: Fourteen of the 22 patients at 6-year follow-up were evaluable. Although objective swallowing-related outcomes showed no deterioration (eg, no feeding tube dependency and no pneumonia), swallowing-related quality of life slightly deteriorated over time. No patients had or perceived trismus. Voice and speech questionnaires showed little problems in daily life. Overall quality of life (QOL) was good. CONCLUSIONS: After CRT with preventive rehabilitation exercises for advanced HNC, swallowing, trismus, and speech related outcomes moderately deteriorated from 6 to 10 years, with an on average good overall QOL after.
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Trastornos de Deglución , Neoplasias de Cabeza y Cuello , Quimioradioterapia/efectos adversos , Deglución , Trastornos de Deglución/etiología , Neoplasias de Cabeza y Cuello/terapia , Humanos , Calidad de Vida , Habla , Trismo/etiología , Trismo/prevención & controlRESUMEN
BACKGROUND: Sarcopenia might be a relevant lead for optimization of the condition of patients with head and neck cancer (HNC) before chemoradiotherapy (CRT) to prevent long-term functional swallowing impairment, such as feeding tube dependency. METHODS: Regression analyses were performed to assess the association between skeletal muscle mass index (SMI), as a measure of sarcopenia, and prolonged (>90 days) feeding tube dependency in 128 patients with HNC treated with primary CRT. RESULTS: Sixty-one patients (48%) became prolonged feeding tube-dependent. Lower SMI increased the risk of prolonged feeding tube dependency in multivariable analysis (risk ratio 1.08; 95% confidence interval 1.02-1.14, P = .01) adjusted for body mass index, abnormal diet, and socioeconomic status. CONCLUSIONS: Sarcopenia contributes to the risk of prolonged feeding tube dependency of patients with HNC treated with primary CRT. As sarcopenia might be a modifiable factor prior to treatment, it should be explored as a target for pretreatment patients' condition.
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Quimioradioterapia , Nutrición Enteral , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/terapia , Intubación Gastrointestinal , Sarcopenia/complicaciones , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Clase SocialRESUMEN
BACKGROUND: We studied the relationship between trismus (maximum interincisor opening [MIO] ≤35 mm) and the dose to the ipsilateral masseter muscle (iMM) and ipsilateral medial pterygoid muscle (iMPM). METHODS: Pretreatment and post-treatment measurement of MIO at 13 weeks revealed 17% of trismus cases in 83 patients treated with chemoradiation and intensity-modulated radiation therapy. Logistic regression models were fitted with dose parameters of the iMM and iMPM and baseline MIO (bMIO). A risk classification tree was generated to obtain optimal cut-off values and risk groups. RESULTS: Dose levels of iMM and iMPM were highly correlated due to proximity. Both iMPM and iMM dose parameters were predictive for trismus, especially mean dose and intermediate dose volume parameters. Adding bMIO, significantly improved Normal Tissue Complication Probability (NTCP) models. Optimal cutoffs were 58 Gy (mean dose iMPM), 22 Gy (mean dose iMM) and 46 mm (bMIO). CONCLUSIONS: Both iMPM and iMM doses, as well as bMIO, are clinically relevant parameters for trismus prediction.
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Quimioradioterapia/efectos adversos , Neoplasias de Cabeza y Cuello/terapia , Radioterapia de Intensidad Modulada/efectos adversos , Carcinoma de Células Escamosas de Cabeza y Cuello/terapia , Trismo/etiología , Adulto , Anciano , Quimioradioterapia/métodos , Bases de Datos Factuales , Relación Dosis-Respuesta en la Radiación , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Músculo Masetero/efectos de la radiación , Persona de Mediana Edad , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Países Bajos , Valor Predictivo de las Pruebas , Pronóstico , Músculos Pterigoideos/efectos de la radiación , Dosificación Radioterapéutica , Radioterapia de Intensidad Modulada/métodos , Estudios Retrospectivos , Medición de Riesgo , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Resultado del Tratamiento , Trismo/fisiopatologíaRESUMEN
BACKGROUND: With the increasing necessity for total laryngectomy (TL) after prior (chemo)radiotherapy, prosthetic vocal rehabilitation outcomes might have changed. METHODS: Retrospective cohort study including all patients laryngectomized between 2000 and 2012 with a voice prosthesis (VP) in the Netherlands Cancer Institute. RESULTS: Median device lifetimes of the standard Provox2 and Vega VPs are 63 and 66 days, respectively, and for the problem-solving ActiValve Light and Strong VPs 143 and 186 days, respectively. In multivariable analysis, salvage TL and TL for a dysfunctional larynx (compared to primary TL) were associated with a shorter device lifetime. Almost half of the patients (48%) experienced tracheoesophageal puncture tract-related problems, and this concerned 12% of all VP replacements. CONCLUSIONS: Compared to historical cohorts, device lifetimes of regular Provox2 and Vega voice prostheses have decreased. Complications are not occurring more frequently but affect more patients. Nevertheless, the clinical reliability and validity of prosthetic voice rehabilitation is still sound.
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Neoplasias Laríngeas/rehabilitación , Neoplasias Laríngeas/cirugía , Laringectomía/rehabilitación , Laringe Artificial , Anciano , Estudios de Cohortes , Femenino , Humanos , Neoplasias Laríngeas/patología , Masculino , Persona de Mediana Edad , Países Bajos , Falla de Prótesis , Reoperación , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Incidences of pharyngocutaneous fistulization (PCF) after total laryngectomy (TL) reported in the literature vary widely, ranging from 2.6 to 65.5%. Comparison between different centers might identify risk factors, but also might enable improvements in quality of care. To enable this on a national level, an audit in the 8 principle Dutch Head and Neck Centers (DHNC) was initiated. METHODS: A retrospective chart review of all 324 patients undergoing laryngectomy in a 2-year (2012 and 2013) period was performed. Overall PCF%, PCF% per center and factors predictive for PCF were identified. Furthermore, a prognostic model predicting the PCF% per center was developed. To provide additional data, a survey among the head and neck surgeons of the participating centers was carried out. RESULTS: Overall PCF% was 25.9. The multivariable prediction model revealed that previous treatment with (chemo)radiotherapy in combination with a long interval between primary treatment and TL, previous tracheotomy, near total pharyngectomy, neck dissection, and BMI < 18 were the best predictors for PCF. Early oral intake did not influence PCF rate. PCF% varied quite widely between centers, but for a large extend this could be explained with the prediction model. PCF performance rate (difference between the PCF% and the predicted PCF%) per DHNC, though, shows that not all differences are explained by factors established in the prediction model. However, these factors explain enough of the differences that, compensating for these factors, hospital is no longer independently predictive for PCF. CONCLUSIONS: This nationwide audit has provided valid comparative PCF data confirming the known risk factors from the literature which are important for counseling on PCF risks. Data show that variations in PCF% in the DHNCs (in part) are explainable by the variations in these predictive factors. Since elective neck dissection is a major risk factor for PCF, it only should be performed on well funded indication.
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Fístula Cutánea/etiología , Laringectomía , Enfermedades Faríngeas/etiología , Complicaciones Posoperatorias/etiología , Fístula del Sistema Respiratorio/etiología , Adulto , Anciano , Fístula Cutánea/epidemiología , Femenino , Humanos , Incidencia , Masculino , Auditoría Médica , Persona de Mediana Edad , Disección del Cuello/efectos adversos , Evaluación de Resultado en la Atención de Salud , Enfermedades Faríngeas/epidemiología , Faringectomía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Fístula del Sistema Respiratorio/epidemiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Esophageal speech (ES), tracheoesophageal speech (TES) and/or electrolarynx speech (ELS) are three speech rehabilitation methods which are commonly provided after total laryngectomy (TL). METHODS: A systematic review of the literature was conducted to evaluate comparative acoustic, perceptual, and patient-reported outcomes for ES, TES, ELS and healthy speakers. RESULTS: Twenty-six articles could be included. In most studies, methodological quality was low. It is likely that an inclusion bias exists, many studies only included exceptional speakers. Significant better outcomes are reported for TES compared to ES for the acoustic parameters, fundamental frequency, maximum phonation time and intensity. Perceptually, TES is rated with a significant better voice quality and intelligibility than ES and ELS. None of the speech rehabilitation groups reported clearly better outcomes in patient-reported outcomes. CONCLUSIONS: Studies on speech outcomes after TL are flawed in design and represent weak levels of evidence. There is an urge for standardized measurement tools for evaluations of substitute voice speakers. TES is the favorable speech rehabilitation method according to acoustic and perceptual outcomes. All speaker groups after TL report a degree of voice handicap. Knowledge of caretakers and differences in health care and insurance systems play a role in the speech rehabilitation options that can be offered.
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Laringectomía/rehabilitación , Voz Alaríngea/métodos , Humanos , Medición de Resultados Informados por el Paciente , Inteligibilidad del Habla , Resultado del Tratamiento , Calidad de la VozRESUMEN
Hypopharynx cancer has the worst prognosis of all head and neck squamous cell cancers. Since the 1990s, a treatment shift has appeared from a total laryngectomy towards organ preservation therapies. Large randomized trials evaluating treatment strategies for hypopharynx cancer, however, remain scarce, and frequently this malignancy is evaluated together with larynx cancer. Therefore, our aim was to determine trends in incidence, treatment and survival of hypopharynx cancer. We performed a population-based cohort study including all patients diagnosed with T1-T4 hypopharynx cancer between 1991 and 2010 in the Netherlands. Patients were recorded by the national cancer registry database and verified by a national pathology database. 2999 patients were identified. The incidence increased significantly with 4.1% per year until 1997 and decreased non-significantly afterwards. For women, the incidence increased with 1.7% per year during the entire study period. Total laryngectomy as primary treatment significantly decreased, whereas radiotherapy and chemoradiation increased. The 5-year overall survival significantly increased from 28% in 1991-2000 to 34% in 2001-2010. Overall survival for T3 was equal for total laryngectomy and (chemo)radiotherapy, but for T4-patients the survival was significantly better after primary total laryngectomy (± adjuvant radiotherapy). This large population-based study demonstrates a shift in treatment preference towards organ preservation therapies. The 5-year overall survival increased significantly in the second decade. The assumed equivalence of organ preservation and laryngectomy may require reconsideration for T4 disease.
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Neoplasias Hipofaríngeas/epidemiología , Anciano , Quimioradioterapia/tendencias , Estudios de Cohortes , Femenino , Humanos , Neoplasias Hipofaríngeas/patología , Neoplasias Hipofaríngeas/terapia , Incidencia , Laringectomía/tendencias , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Radioterapia Adyuvante/tendencias , Sistema de Registros , Estudios Retrospectivos , Distribución por SexoRESUMEN
BACKGROUND: The efficacy of rehabilitative exercises for chronic dysphagia treatment in head and neck cancer survivors has not been studied extensively and is ambiguous. METHODS: A prospective clinical phase II study using an intensive strength training program was carried out in 17 head and neck cancer survivors with chronic dysphagia. Both swallow and nonswallow exercises were performed for 6-8 weeks with a newly developed tool allowing for progressive muscle overload, including chin tuck, jaw opening, and effortful swallow exercises. Outcome parameters were feasibility, compliance, and parameters for effect. RESULTS: Feasibility in terms of the program completion rate was 88%. Compliance with the exercises was 97%. After the training period, chin tuck, jaw opening, and anterior tongue strength had substantially improved. All but 1 patient reported to benefit from the exercises. CONCLUSION: Feasibility and compliance were high. Some objective and subjective effects of progressive load on muscle strength and swallowing function could be demonstrated.
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Trastornos de Deglución/rehabilitación , Deglución/fisiología , Neoplasias de Cabeza y Cuello/rehabilitación , Entrenamiento de Fuerza/métodos , Adulto , Anciano , Supervivientes de Cáncer , Enfermedad Crónica , Trastornos de Deglución/etiología , Estudios de Factibilidad , Femenino , Fluoroscopía , Neoplasias de Cabeza y Cuello/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Fuerza Muscular/fisiología , Cooperación del Paciente/estadística & datos numéricos , Estudios Prospectivos , Sobrevivientes , Resultado del TratamientoRESUMEN
BACKGROUND: Heat and moisture exchangers (HMEs) improve respiratory function after laryngectomy, but there is virtually no information on the benefit of traditional stoma cloths or other covers. METHODS: Two sequential studies were performed: (1) an ex vivo test was used to compare the humidifying capacity of stoma cloths to other coverings; and (2) a 4-week randomized trial was then performed to assess patient acceptability of cloths both alone and with an HME (N = 18). RESULTS: The humidifying capacity of the coverings tested varied widely. For stoma cloths, a humidifying capacity of 13.7 mg/L was found to decrease to 8.5 mg/L if air-leaks around the cloth occurred. Patients who used HMEs disliked stoma cloths because they interfered with voicing, they became soiled more easily, and were less effective at reducing coughing and mucus production. CONCLUSION: Although less acceptable to patients who use an HME, stoma cloths do provide significant humidifying capacity and should be encouraged when HMEs are unavailable or inappropriate. © 2017 Wiley Periodicals, Inc. Head Neck 39: 921-931, 2017.
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Humedad , Neoplasias Laríngeas/cirugía , Laringectomía , Prioridad del Paciente , Estomas Quirúrgicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Reduced hyoid displacement is thought to contribute to aspiration and pharyngeal residues in head and neck cancer (HNC) patients with dysphagia. To further study hyoid elevation and anterior excursion in HNC patients, this study reports on temporal/kinematic measures of hyoid displacement, with the additional goal to investigate correlations with clinical swallowing impairment. A single-blind analysis of data collected as part of a larger prospective study was performed at three time points before and after chemoradiotherapy. Twenty-five patients had undergone clinical swallowing assessments at baseline, 10-weeks, and 1-year post-treatment. Analysis of videofluoroscopic studies was done on different swallowing consistencies of varying amounts. The studies were independently reviewed frame-by-frame by two clinicians to assess temporal (onset and duration) and kinematic (anterior/superior movement) measures of hyoid displacement (ImageJ), laryngeal penetration/aspiration, and presence of vallecula/pyriform sinus residues. Patient-reported oral intake and swallowing function were also evaluated. Mean maximum hyoid displacement ranged from 9.4 mm (23 % of C2-4 distance) to 12.6 mm (27 %) anteriorly, and from 18.9 mm (41 %) to 24.9 mm (54 %) superiorly, depending on bolus volume and consistency. Patients with reduced superior hyoid displacement perceived significantly more swallowing impairment. No correlation between delayed or reduced hyoid excursion and aspiration or residue scores could be demonstrated. Hyoid displacement is subject to variability from a number of sources. Based on the results, this parameter seems not very valuable for clinical use in HNC patients with dysphagia.
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Carcinoma de Células Escamosas/complicaciones , Trastornos de Deglución/diagnóstico , Deglución/fisiología , Neoplasias de Cabeza y Cuello/complicaciones , Hueso Hioides/fisiología , Anciano , Fenómenos Biomecánicos , Carcinoma de Células Escamosas/terapia , Quimioradioterapia , Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Femenino , Fluoroscopía , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/terapia , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Método Simple Ciego , Carcinoma de Células Escamosas de Cabeza y CuelloRESUMEN
OBJECTIVES/HYPOTHESIS: Head and neck cancer (HNC) patients may develop oropharyngeal dysfunction as result of volume loss or muscle atrophy of the tongue or pharyngeal musculature following treatment with surgery and/or chemoradiotherapy. If intensive swallowing therapy offers no further improvement, and the functional problems persist, transplantation of autologous adipose tissue (lipofilling) might restore functional outcomes by compensating the existing tissue defects or tissue loss. STUDY DESIGN: Case series. METHODS: In this prospective pilot feasibility study, the application of lipofilling was studied in seven HNC patients with chronic dysphagia. The procedure was carried out under general anesthesia in several sessions using the Coleman technique. Swallowing outcomes were evaluated with standard videofluoroscopy (VFS) for obtaining objective Penetration Aspiration Scale (PAS) and residue scores. Subjective Functional Oral Intake Scale scores and Swallowing Quality of Life Questionnaire were also completed. Magnetic resonance imaging was used to evaluate the post-treatment injected fat. RESULTS: Five patients completed the intended three lipofilling sessions, whereas two completed two injections. One patient dropped out of the study after two injections because of progressive dysphagia requiring total laryngectomy. Four of the six remaining patients showed improved PAS scores on post-treatment VFS assessments, with two patients no longer showing aspiration for a specific consistency. Two patients were no longer feeding tube dependent. Patient-reported swallowing and oral intake improved in four out of six patients. CONCLUSIONS: Based on the results, the lipofilling technique seems safe and, in selected cases, of potential value for improving swallowing function in this small therapy-refractory HNC patient cohort. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:2672-2678, 2016.
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Tejido Adiposo/trasplante , Trastornos de Deglución/terapia , Neoplasias de Cabeza y Cuello/complicaciones , Adulto , Anciano , Deglución/fisiología , Trastornos de Deglución/etiología , Estudios de Factibilidad , Femenino , Fluoroscopía , Neoplasias de Cabeza y Cuello/terapia , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/terapia , Estudios Prospectivos , Radioterapia/efectos adversosRESUMEN
Previous studies have shown that a "Preventive Exercise Program" (PREP) is cost-effective compared to the standard exercise program provided in "Usual Care" (UC) in patients with advanced head and neck cancer. The current paper specifically estimates the cost-effectiveness of the TheraBite jaw rehabilitation device (TB) which is used as part of the PREP, compared to Speech Language Pathology (SLP) sessions as part of UC, and herewith intents to inform reimbursement discussions regarding the TheraBite device. Costs and outcomes [quality-adjusted life-years (QALYs)] of the TB compared to SLP were estimated using a Markov model of advanced head and neck cancer patients. Secondary outcome variables were trismus, feeding substitutes, facial pain, and pneumonia. The incremental cost-effectiveness ratio (ICER) was estimated from a health care perspective of the Netherlands, with a time horizon of 2 years. The total health care costs per patient were estimated to amount to 5,129 for the TB strategy and 6,915 for the SLP strategy. Based on the current data, the TB strategy yielded more quality-adjusted life-years (1.28) compared to the SLP strategy (1.24). Thus, the TB strategy seems more effective (+0.04) and less costly (-1,786) than the SLP only strategy. At the prevailing threshold of 20,000/QALY the probability for the TB strategy being cost-effective compared to SLP was 70 %. To conclude, analysis of presently available data indicates that TB is expected to be cost-effective compared to SLP in a preventive exercise program for concomitant chemo-radiotherapy for advanced head and neck cancer patients.
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Quimioradioterapia/efectos adversos , Trastornos de Deglución/prevención & control , Terapia por Ejercicio , Neoplasias de Cabeza y Cuello , Quimioradioterapia/métodos , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Trastornos de Deglución/etiología , Terapia por Ejercicio/economía , Terapia por Ejercicio/instrumentación , Terapia por Ejercicio/métodos , Femenino , Neoplasias de Cabeza y Cuello/economía , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/terapia , Humanos , Masculino , Persona de Mediana Edad , Modelos Económicos , Estadificación de Neoplasias , Países Bajos , Años de Vida Ajustados por Calidad de VidaRESUMEN
In an observational prospective study, feasibility and outcomes of a dedicated multidisciplinary rehabilitation program (HNR) for head and neck cancer (HNC) patients were evaluated. HRQoL was assessed before and after HNR with EORTC C30 and H&N-35 QoL questionnaires in 52 consecutive patients. Initial HRQoL scores were compared with EORTC reference scores for HNC patients and post-HNR with those available for the general healthy population. Distress was assessed before and after HNR with the distress thermometer (DT). At completion of HNR with a mean duration of 7 months, overall HRQoL was significantly improved (p < 0.001). Role, Emotional, and Social function scales and most EORTC C30 and H&N35 symptom scale items showed a statistically significant (p < 0.01) and clinically relevant improvement. Mean distress score before HNR was above the cutoff value of 5, suggesting the need for referral to rehabilitation. After completing HNR, distress decreased significantly to 3.0 (p < 0.001). HRQoL pretreatment was poorer than that of the EORTC reference HNC population, whereas at the completion of the HNR program, the HRQoL was comparable to that of the general population reference level. We conclude that a dedicated multidisciplinary HNR program is feasible and suggest that it has a positive impact on HRQoL. The multidisciplinary approach may have added value over mono-disciplinary interventions. However, our results should be judged cautiously due to the observational nature of the study.
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Neoplasias de Cabeza y Cuello/rehabilitación , Calidad de Vida , Estrés Psicológico/diagnóstico , Adulto , Anciano , Estudios de Factibilidad , Femenino , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/psicología , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Encuestas y Cuestionarios , Evaluación de SíntomasRESUMEN
OBJECTIVES/HYPOTHESIS: Tumor volume has been postulated to be an important prognostic factor for oncological outcome after radiotherapy or chemoradiotherapy. This postulate was retrospectively investigated in a consecutively treated cohort of T3-T4 larynx cancer patients. STUDY DESIGN: Retrospective cohort study. METHODS: For 166 patients with T3-T4 larynx cancer (1999-2008), pretreatment computed tomography and magnetic resonance imaging scans were available for tumor volume delineation. Patients were treated with radiotherapy, chemoradiotherapy, or total laryngectomy with postoperative radiotherapy. Both a dedicated head and neck radiologist and the first author determined all tumor volumes. Statistical analysis was by Kaplan-Meier plots and Cox proportional hazard models. RESULTS: Patients with T3 larynx cancer had significantly smaller tumor volumes than patients with T4 larynx cancer (median = 8.1 cm(3) and 15.8 cm(3), respectively; P < .0001). In the group treated with total laryngectomy and postoperative radiotherapy, no association was found between tumor volume and local or locoregional control or overall survival. In the group treated with radiotherapy, a nonsignificant trend was observed between local control and tumor volume. In the chemoradiotherapy group, however, a significant impact of tumor volume was found on local control (hazard ratio = 1.07; 95% confidence interval = 1.01-1.13; P = .028). CONCLUSIONS: Tumor volume was not significantly associated with local control, locoregional control, or overall survival in the surgically treated group. In the group treated with radiotherapy, there was no statistically significant association, but a trend was observed between local control and tumor volume. Only in patients treated with concurrent chemoradiotherapy was a significant impact of tumor volume on local control found. LEVEL OF EVIDENCE: 4.
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Neoplasias Laríngeas/patología , Estadificación de Neoplasias/métodos , Carga Tumoral , Anciano , Biopsia , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/terapia , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia/tendenciasRESUMEN
BACKGROUND: The purpose of this study was to determine time trends for primary treatment modalities in advanced laryngeal cancer, overall survival (OS), and laryngectomy-free interval (LFI) over the last 2 decades in The Netherlands. METHODS: We conducted an analysis of T3 to T4 laryngeal cancer data from 2 combined national (population-based and pathology-based) cancer registries. RESULTS: A total of 2072 T3 cases (14.7%) and 1722 T4 cases (12.2%) were identified. Total laryngectomy as primary treatment modality decreased, whereas radiotherapy (RT) increased. For T3 disease, 5-year OS after primary total laryngectomy (+/- adjuvant RT), RT, and chemoradiotherapy (CRT) was 49%, 47%, and 45%, respectively. For T4 disease, this was 48%, 34%, and 42% (overall p < .0001), respectively. Five-year LFI for T3 disease was 81% (RT) and 77% (CRT), and for T4 disease it was 81% and 87%, respectively. CONCLUSION: From 1991 to 2010 total laryngectomy as primary treatment modality for advanced laryngeal cancer decreased and RT increased. T3 disease showed similar survival rates for all primary treatment modalities. For T4 disease, total laryngectomy (+ adjuvant RT) showed the best survival. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1247-E1255, 2016.
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Neoplasias Laríngeas/epidemiología , Neoplasias Laríngeas/terapia , Adulto , Anciano , Anciano de 80 o más Años , Quimioradioterapia , Terapia Combinada , Femenino , Humanos , Laringectomía , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Países Bajos/epidemiología , Sistema de Registros , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Resultado del TratamientoRESUMEN
The aim of this study was to investigate to what extent changes in speech after C-IMRT treatment are related to mean doses to the tongue and velopharynx (VP). In 34 patients with advanced hypopharyngeal, nasopharyngeal, or oropharyngeal cancer, changes in speech from pretreatment to 10 weeks and 1 year posttreatment were correlated with mean doses to the base of tongue (BOT), oral cavity (OC) and tonsillar fossa/soft palate (VP). Differences in anteroposterior tongue position, dorsoventral degree of tongue to palate or pharynx constriction, grooving, strength, nasality, and laryngeal rise, were assessed by acoustic changes in three speech sounds that depend on a (post-) alveolar closure or narrowing (/t/, /s/, /z/), three with a tongue to palate/pharyngeal narrowing (/l/, /r/, /u/), and in vowel /a/ at comfortable and highest pitch. Acoustically assessed changes in tongue positioning, shape, velopharyngeal constriction, and laryngeal elevation were significantly related to mean doses to the tongue and velopharynx. The mean dose to BOT predicted changes in anteroposterior tongue positioning from pre- to 10-weeks posttreatment. From pretreatment to 1-year, mean doses to BOT, OC, and VP were related to changes in grooving, strength, laryngeal height, nasality, palatalization, and degree of pharyngeal constriction. Changes in speech are related to mean doses to the base of tongue and velopharynx. The outcome indicates that strength, motility, and the balance between agonist and antagonist muscle forces change significantly after radiotherapy.
Asunto(s)
Carcinoma de Células Escamosas/terapia , Neoplasias de Cabeza y Cuello/terapia , Laringe/efectos de la radiación , Estadificación de Neoplasias , Faringe/efectos de la radiación , Radioterapia de Intensidad Modulada/métodos , Habla/fisiología , Lengua/efectos de la radiación , Adulto , Anciano , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/fisiopatología , Quimioradioterapia , Relación Dosis-Respuesta en la Radiación , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/fisiopatología , Humanos , Laringe/fisiopatología , Masculino , Persona de Mediana Edad , Músculos Faríngeos/fisiopatología , Músculos Faríngeos/efectos de la radiación , Faringe/fisiopatología , Habla/efectos de la radiación , Carcinoma de Células Escamosas de Cabeza y Cuello , Lengua/fisiopatologíaRESUMEN
BACKGROUND: The most frequent cause of voice prosthesis failure is microbial biofilm formation on the silicone valve, leading to destruction of the material and transprosthetic leakage. The Provox ActiValve valve is made of fluoroplastic, which should be insusceptible to destruction. The purpose of this study was to determine if fluoroplastic is insusceptible to destruction by Candida species. METHODS: Thirty-three dysfunctional Provox ActiValves (collected 2011-2013). Biofilm analysis was performed with Illumina paired-end sequencing (IPES), assessment of biofilm-material interaction with fluorescence in situ hybridization (FISH), and confocal laser scanning microscopy (CLSM). RESULTS: IPES (n = 10) showed that Candida albicans and Candida tropicalis are dominant populations on fluoroplastic and silicone. Microbial diversity is significantly lower on fluoroplastic. Lactobacillus gasseri is the prevalent bacterial strain on most voice prostheses. FISH and CLSM (n = 23): in none of the cases was ingrowth of Candida species present in the fluoroplastic. CONCLUSION: Fluoroplastic material of Provox ActiValve seems insusceptible to destruction by Candida species, which could help improve durability of voice prostheses. © 2015 Wiley Periodicals, Inc. Head Neck 38: E432-E440, 2016.
Asunto(s)
Biopelículas , Laringe Artificial/microbiología , Adulto , Anciano , Candida/aislamiento & purificación , Femenino , Humanos , Hibridación Fluorescente in Situ , Lactobacillus/aislamiento & purificación , Laringectomía , Masculino , Microscopía Confocal , Persona de Mediana Edad , Plásticos , Diseño de Prótesis , Análisis de Secuencia de ARNRESUMEN
The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore, a model-based cost-effectiveness analysis of using HMEs versus usual care (UC) (including stoma covers, suction system and/or external humidifier) for patients after laryngectomy was performed. Primary outcomes were costs, QALYs and incremental cost-effectiveness ratio (ICER). Secondary outcomes were pulmonary infections, and sleeping problems. The analysis was performed from a health care perspective of Poland, using a time horizon of 10 years and cycle length of 1 year. Transition probabilities were derived from various sources, amongst others a Polish randomized clinical trial. Quality of life data was derived from an Italian study on similar patients. Data on frequencies and mortality-related tracheobronchitis and/or pneumonia were derived from a Europe-wide survey amongst head and neck cancer experts. Substantial differences in quality-adjusted survival between the use of HMEs (3.63 QALYs) versus UC (2.95 QALYs) were observed. Total health care costs/patient were 39,553 PLN (9465 Euro) for the HME strategy and 4889 PLN (1168 Euro) for the UC strategy. HME use resulted in fewer pulmonary infections, and less sleeping problems. We could conclude that given the Polish threshold of 99,000 PLN/QALY, using HMEs is cost-effective compared to UC, resulting in 51,326 PLN/QALY (12,264 Euro/QALY) gained for patients after total laryngectomy. For the hospital period alone (2 weeks), HMEs were cost-saving: less costly and more effective.