Comparing surgical and nonsurgical larynx-preserving treatments with total laryngectomy for locally advanced laryngeal cancer.

Patel et al. from  Boston University School of Medicine, analyzed the National Cancer Data Base  between 2003 and 2011 (published in Cancer,June 2019) comparing surgical and nonsurgical larynx-preserving treatments with total laryngectomy for locally advanced laryngeal cancer.

They identified 8703 patients with stage III/IV (excluding T1 tumors) laryngeal squamous cell carcinoma treated with chemoradiation (CRT) or partial laryngectomy (PL) and total laryngectomy(TL)  with or without adjuvant therapy.

The authors found that:

• Among patients with non-T4, low nodal burden (T2N1 or T3N0-N1) disease, no survival differences were observed between CRT, PL, and TL.
• Patients who had non-T4, high nodal burden (T2-T3N2-N3) disease who underwent TL with or without adjuvant treatment had a higher risk of death compared with those who received CRT.
• No statistically significant difference in outcome was noted between CRT and PL for all stage groups.   

The authors concluded that patients with non-T4, high nodal burden disease may benefit from definitive CRT. Total laryngectomy remains advantageous in patients with T4 disease.

Head and Neck Squamous Cell Carcinona ( HNSCC) is more common and advanced in those living with Human Immunodeficiency Virus (HIV)

Several studies showed that patients living with HIV have a 3 fold higher risk of developing all types of HNSCC including those associated with HPV despite anti-retroviral therapy. This may be because HIV+ patients have a higher rate of alcohol rate and tobacco rate, increased incidence of oral HPV infection and immune suppression ( low CD4 count).

Findings of several studies illustrated that :

• HPV infection is may be more prevalent in HIV+ patients.
• The  HIV  virus may have a direct oncogenic role in HHNSCC.
• HIV+ patients may present with HNSCC at a younger age and a higher stage.
• Lower CD4 count may predispose patients to HPV related HNCSCC.
• HIV + HNSCC+  have a poorer survival rates than HIV- HPV + .
• HNSCC patients who are HPV+ tend to have a more favorable outcomes regardless of HIV status.

As the number of aging HIV+ patients increases learning more the pathophysiology of HNSCC in these patients, outcomes, and ultimately tailored treatment to these unique patient population will become more important.

Use of nonsteroidal anti-inflammatory drugs improved patient survival for PIK3CA-altered head and neck cancer (HNC).

A new study by UC San Francisco and University of Pittsburgh has found that regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, significantly improves survival for a third or more patients with HNC. 

NSAIDs improved the overall 5-year survival rate from 25% to 78% for patients whose cancer contained a specific altered gene, known as PIK3CA. The survival for patients whose gene was not altered was unaffected by NSAID use.

PIK3CA is the most commonly altered oncogene in head and neck squamous carcinoma, and is found in a third of all tumors. In HNC associated with the human papillomavirus (HPV), PIK3CA is mutated in more than half of tumors.

The retrospective study included 266 patients. Most patients (67%) received post-surgery chemotherapy and/or radiotherapy. PIK3CA gene activating alteration was found in 28% in the patients. Among the patients who regularly used NSAIDs, 93% used aspirin (81mg/day) as a component of the NSAID regiment, and 73% took aspirin exclusively.

The investigators learned that regular use of NSAIDs for at least 6 months provided markedly prolonged improved survival compared to non-use for patients whose PIK3CAgene was mutated or amplified. In these patients, NSAIDs raised overall five-year survival from 25% to 78%. However, patients without alterations in their PIK3CA gene were no better off by taking NSAIDs.

This is the first study to show a strong clinical advantage of regular NSAID use for HNC patients with mutations in the PIK3CA gene and may indicate a clear, biological reason to implement NSAID therapy in certain cases of HNC patients

Through analysis of both cell line and mouse studies, the researchers speculated that NSAIDs likely blocked tumor growth by reducing the production of an inflammatory molecule called prostaglandin E2.

The researchers have designed a prospective, randomized clinical trial to address the study’s limitations (small numbers and retrospective nature of the study) to assess the clinical significance of this therapeutic use.

Head and Neck Cancer: Through the Eyes of a Patient

Itzhak Brook, MD, MSc, and Meryl Kaufman, MEd, CCC-SLP, BRS-S, discuss cancers of the head and neck and talk about how diagnosis and treatment might impact patients and caregivers. To view click this (A Cure Today presentation.)

Episodes:

a.     An Overview of Head and Neck Cancer. Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, discuss the prevalence of cancers of the head and neck, emphasizing the potential risk factors and importance of prevention. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/an-overview-of-head-and-neck-cancer

b.     Head and Neck Cancer: Overcoming Challenges in Treatment. Itzhak Brook, M.D., M.Sc., shares the story of his initial diagnosis and treatment for cancer of the head and neck, outlining the challenges that came along with treatment, with fellow board member of the Head and Neck Cancer Alliance Meryl Kaufman, M.Ed., CCC-SLP, BRS-S. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/head-and-neck-cancer-overcoming-challenges-in-treatment

c.      Head and Neck Cancer: Novel Treatment Approaches. Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, share insight into the role of novel treatment approaches like immunotherapy, robotic surgery and de-escalation in the management of cancers of the head and neck. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/head-and-neck-cancer-novel-treatment-approaches

d.     Getting a Diagnosis of Head and Neck Cancer. Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, discuss which symptoms should lead one to seek a diagnosis of head and neck cancer and which tests are available to aid in evaluation. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/getting-a-diagnosis-of-head-and-neck-cancer

e.     Head and Neck Cancer from a Patient's Perspective.  Itzhak Brook, M.D., M.Sc., considers how experiencing cancer of the head and neck as a patient affected his understandings as a physician and outlines available patient resources with fellow board member of the Head and Neck Cancer Alliance, Meryl Kaufman, M.Ed., CCC-SLP, BRS-S. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/head-and-neck-cancer-from-a-patients-perspective

f.      Adjusting to Life With Head and Neck Cancer. Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, provide their perspectives on adjusting to life with cancer of the head and neck, as a patient or as a caregiver, and share advice for those who must undergo laryngectomy. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/adjusting-to-life-with-head-and-neck-cancer

g.     understanding Treatment Options in Head and Neck Cancer. Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, review the various modalities of treatment for cancers of the head and neck and identify which physicians are responsible for delivering this care. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/understanding-treatment-options-in-head-and-neck-cancer

Meryl Kaufman, M.Ed., CCC-SLP,, and Itzhak Brook, M.D.

"The Laryngectomee Guide” is available in 28 languages

"The Laryngectomee Guide” is available now in 28 languages: English, Russian,Turkish, Greek, Italian, Slovak, Bulgarian, Romanian, Polish, Icelandic, Bosnian, Croatian, Arabic, Hebrew, Spanish, Portuguese, French, Persian (Farsi), Korean, Japanese, Hindi, Tamil, Filipino (Tagalog), Indonesia, Malaysian, Vietnamese, and traditional and simplified Chinese in paperback, Kindle and eBook. eBooks and Kindle are available FREE.

The Guides are available at Amazon and Lulu Publications websites. 

The Guide provides practical information that can assist laryngectomees and their caregivers with medical, dental and psychological issues. It contains information about side effects of radiation and chemotherapy; methods of speaking; airway, stoma, and voice prosthesis care; eating and swallowing; medical, dental and psychological concerns; respiration; anesthesia; and travelling.

Links to obtain paperback, eBook, and Kindle Edition of the Guide in different languages:

English; paperback , Kindle, and eBook
Russian: paperback, and eBook
Turkish: paperback, and eBook.
Greek: paperback, and eBook

Italian: paperback and Kindle, and eBook.

Icelandic: paperback and Kindle and eBook.
Bulgarian: paperback, and eBook.
Bosnian: paperback, and eBook.

Croatian: paperback, and eBook.

Slovak : paperback and eBook.
Romania: paperback (in Amazon, in Lulu), and eBook. 

Polish: paperback  and eBook.

Hebrew paperback and eBook.
Arabic: paperback, eBook, and Kindle.

Spanish (Andine edition): paperback and Kindle, and eBook.
Spanish (Spain edition): paperback and Kindle , and  eBook.
Spanish language (Center America edition): paperback and Kindle.
Spanish (South America edition): paperback and kindle. 
Portuguese: paperback, Kindle, and eBook.
French: paperback and Kindle , and eBook.
Persian (Farsi) : paperback, eBook.  
Korean: paperback, and eBook.
Japanese: paperback, eBook, and kindle.

Hindi : paperback, and eBook. and kindle.

Tamil : paperback. and eBook. 
Filipino (Tagalog): paperback, and eBook. 
Indonesian: paperback, and eBook.

Malaysian: paperback, and eBook.

Vietnamese : paperback, and eBook.
Traditional Chinese: paperback, eBook and Kindle.
Simplified Chinese: paperback in China and paperback from Lulu,  and eBook 

Links to obtain FREE eBook of the Guide:

English click this link.
Russian  click this link.
Turkish click this link. 
Greek  click this link
Italian click this link.

Slovak click this link.
Bulgarian click this link.
Bosnian click this link.

Croatian click this link.
Romanian click this link. 

Polish click on link. and this link

Icelandic click on link
Arabic click this link.

Hebrew click this link
Spanish (Andine edition) click this link.
Spanish (Spain edition) click this link. 
Spanish (Central America edition) click this link
Spanish (South America edition)  click this link.
Portuguese click this link.
French click this link.
Persian (Farsi) click this link.

Hindi click on this link.

Tamil click on this link
Korean click this link.
Japanese click this link.
Filipino (Tagalog) click this link.
Indonesian click this link.

Malaysian click this link

Vietnamese click this link

Traditional Chinese click this link. 
Simplified Chinese click this link.

List of sites to download the Laryngectomee Guide in 24 languages from Otolaryngological and Speech pathology Societies

 

The Guide is available for viewing and free download at the

American Academy of Otolaryngology-Head and Neck Surgery and the Society of Otorhinolaryngology and Head-Neck Nurses, Inc

https://www.entnet.org/sites/default/files/LaryngectomeeGuide.pdf

https://www.entnet.org/content/laryngectomee-guide

 

American Speech-Language-Hearing Association

https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589943346&section=Resources

 

International Association of laryngectomees

https://www.theialvoice.org/the-laryngectomee-guide

 

International Federation of Head and Neck Oncology

https://ifhnos.net/whncd/Index/Video

 

British Association of Oncologist

https://bahno.org.uk/clinicians_area/publications.aspx

 

Hungarian Ear, Nose, Throat and Head and Neck SurgeryMedical Association

http://www.orl.hu/linkek

 

Romanian Society of Otolaringology and Cervico-FacialSurgery

http://www.sorlccf.ro/index.php/ro/

 

Caen University Hospital, France,

http://orl-chu-caen.fr/

 

Association of Speech Pathologist, Associação Portuguesa deTerapeutas da Fala

https://brevemente.aptf.org/ 

Otorrinolaringolog Portogal,

https://www.facebook.com/100061144872555/posts/pfbid0vFa4M8kfi8NzEgzTGkFRpzDMxSYJ2fFyq2jF8SCwLWXkezGThw83c33BBiQKhbC9l/

 

German Society of Otolaryngology, Head and Neck Surgery,

https://onkologie.hno.org/

 

Japanese laryngectomee Society,

https://www.ginreikai.net/2019/12/03/%E5%96%89%E6%91%98%E8%80%85%E3%81%AE%E7%82%BA%E3%81%AE%E3%82%AC%E3%82%A4%E3%83%89%E3%83%96%E3%83%83%E3%82%AF/

 

Asociacion Espaniola de Logopedia, Foniatria, y Audiologia,

http://www.aelfa.org/noticia.asp?idc=1&idn=221&

 

Italian otolaryngology and Ophthalmology Association

http://www.aooi.it/altri-manuali/

 

Clinical Research Organization Association of Turkey 

https://www.croturkey.com/en/books/ 

 

Taiwan Head and Neck Surgery, Society of Otolaryngology Head & Neck Surgery http://www.thns.org.tw/medicine/

 

Society of Head and Neck Surgery of Singapore

 https://www.sohnss.org/

 

Mexican Society of Surgical Oncology,

http://www.soqmexico.org/publicaciones

 

Brazilian Society of Clinical Oncology,

https://goo.gl/twyqdd

 

Brazilian Group of Head and Neck Cancer,

 http://www.gbcp.org.br/informacoes-ao-paciente/

 

Brazilian Oral and Throat Cancer Association,

https://www.acbgbrasil.org/links-interessantes/

 

Brazilian Society of Speech Therapy, and Make SenseCampaign,

https://www.sbfa.org.br/portal2017/themes/2017/departamentos/artigos/materiais_28.pdf

 

Bulgarian Society of Oto-rhinolo-laringology,

 http://orl.bg/?page_id=52

 

Hellenic Society for Head & Neck Cancer (in Greek) Speak and Language Pathology Society of Greece

http://headneckcancer.gr/el/odigos-gia-ton-astheni-me-laryggektomi-i/

 

New Zealand Society of Otolaryngology and Head and NeckSurgery Inc.

https://www.orl.org.nz/

 

Slovak Society of ENT

www.sso.sk  

 

Czech Society of ENT

 https://www.otorinolaryngologie.cz/vzdelavani/informacni-zdroje/

 

 Polish laryngectomeeclub

http://medtech.pl/poradnik/

 

Israeli Society of Speech and language pathologist (Ishla)

https://ishla.org.il/forum-and-articles/%D7%9E%D7%90%D7%9E%D7%A8%D7%99%D7%9D/

                        Russian language Guide                       Turkish language Guide  

Italian language Guide                     Chinese language  Guide    

                                                                 
                                             

                                                                                      Bulgarian language guide                                Arabic language guide 

     Portuguese language Guide                               Persian language Guide

                

                                                       

       Romanian language Guide                                French language Guide

 

        Korean language Guide                             Spanish language Guide

                  

                                     

Japanese language Guide

Bosnian language Guide

Croatian language Guide 

Filipino (Tagalog) language Guide

 

Greek language Guide

Indonesian language guide 

Malaysian language Guide

Slovak language Guide

Polish language Guide

Hebrew language Guide

Vietnamese laryngectomee Guide

Hindi Laryngectomee Guide

Icelandic Laryngectomee guide

Tamil laryngectomee Guide 

Positive initial margins is associated with poorer disease free survival (DFS) among patients with primary laryngeal squamous cell carcinoma who undergo total laryngectomy.

Positive initial margins, even among patients with negative final margins, appeared associated with poorer DFS among patients with primary laryngeal squamous cell carcinoma who received total laryngectomy, according to recently published findings. These were the findingof Tassone and colleagues of the Thomas Jefferson University.

The researchers performed a retrospective cohort study of 237 patients who underwent total laryngectomy for squamous cell carcinoma from February 2008 to July 2016. They considered margins positive if they contained invasive carcinoma, carcinoma in situ or severe dysplasia.

A total of 225 patients had negative final margins, and 127 underwent primary total laryngectomy, whereas 98 received salvage total laryngectomy. Salvage laryngectomy was associated with significantly worse, whereas primary total laryngectomy was not.

The authors concluded that surgical margin status may be an important prognostic factor in head and neck cancer. Furthermore, positive initial frozen margins even in patients with negative final margins, are associated with increased risk of local treatment failure in the context of primary total laryngectomy.

                                                         

                                                          Positive and negative tumor margins

Immunotherapy in head and neck squamous cell carcinoma

Head and neck squamous cell carcinoma is an immuno-suppressive malignancy, with many defects in the host immune system contributing to the progression of disease, as cancer cells evade immune-surveillance due to accumulation of genetic mutations and tumor heterogeneity. Improved understanding of the role of the immune system in cancer has led to the identification of novel therapeutic targets, and the development of a range of novel therapeutic targets which are being investigated for their potential to provide durable responses and improve the outcomes of this disease.

Immuno-oncology is an evolving field of investigation that includes active immunotherapies that are designed to target and harness the patient’s own immune system directly to fight cancer. More specifically, it is designed to leverage the unique properties of the immune system (specificity, adaptability, and memory).The primary goal of immunotherapy is to shift the balance in favor of an immune response against the tumor, allowing tumor eradication or long-term suppression of tumor growth, and the generation of immunological memory. Therapeutic approaches include: Monoclonal antibodies, Immune checkpoint inhibitors, Dendritic cells vaccines, and Adoptive T cell therapy.  The better understanding of the mechanisms of immune escape has led to the development of novel immunotherapies that has shown initial promising results in many solid tumors including Head and neck squamous cell carcinoma.