Journal of Clinical Medicine

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9 pages, 481 KiB

Open AccessArticle

Malignant Transformation and Long-Term Outcome of Oral and Laryngeal Leukoplakia

by Botond Bukovszky, János Fodor, Erika Tóth, Zsuzsa S. Kocsis, Ferenc Oberna, Örs Ferenczi and Csaba Polgár

J. Clin. Med. 2023, 12(13), 4255; https://doi.org/10.3390/jcm12134255 - 25 Jun 2023

Cited by 1 | Viewed by 1518

Abstract

Background: Oral or laryngeal leukoplakia has an increased risk for malignant transformation but the risk of the two anatomical sites has not been compared to each other yet. Materials and Methods: Clinical data of 253 patients with leukoplakia (oral = 221 or laryngeal [...] Read more.

Background: Oral or laryngeal leukoplakia has an increased risk for malignant transformation but the risk of the two anatomical sites has not been compared to each other yet. Materials and Methods: Clinical data of 253 patients with leukoplakia (oral = 221 or laryngeal = 32) enrolled from January 1996 to January 2022 were analyzed. One hundred and seventy underwent biopsy and 83 did not. The mean follow-up time was 148.8 months. Risk factors for the malignant transformation of leukoplakia were identified using Cox proportional hazard models. Results: In the oral or laryngeal group, the rate of cancer was 21.7% and 50% (p = 0.002), respectively. The 10-year estimated malignant transformation was 15.1% and 42% (p < 0.0001), respectively. The laryngeal group had an increased risk of malignant transformation (p < 0.0001). The 5-year estimated survival with leukoplakia-associated cancer for the oral or laryngeal group was 40.9% and 61.1% (p = 0.337), respectively. Independent predictors of malignant transformation in the oral group were dysplasia and the grade of dysplasia of the leukoplakia, and in the laryngeal group, dysplasia had a significant impact. The malignant transformation rate was low for oral patients without biopsy or with no dysplasia, 3.9% and 5.1%, respectively. The malignant transformation occurred over 10 years. Conclusions: Patients with dysplastic leukoplakia have an increased risk of malignant transformation, but the risk is higher with laryngeal than with oral leukoplakia. There is no significant difference between the groups regarding survival with leukoplakia-associated cancer. Oral patients with no dysplastic lesions have a low risk of malignant transformation. A complete excision and long-term follow up are suggested for high-risk patients to diagnose cancer in an early stage and to control late (over 10 years) malignant events. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Management in Head and Neck Squamous Cell Carcinoma)

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11 pages, 876 KiB

Open AccessArticle

Transoral Laser Microsurgery versus Robot-Assisted Surgery for Squamous Cell Carcinoma of the Tongue Base (Oncological and Functional Results)—A Retrospective GETTEC Multicenter Study

by Ioana Brudasca, Pierre Philouze, Sylvain Morinière, Benjamin Lallemant, Sébastien Vergez, Olivier Malard, Pierre-Eric Roux, Noémie Rossello, Caroline Payen and Philippe Céruse

J. Clin. Med. 2023, 12(13), 4210; https://doi.org/10.3390/jcm12134210 - 22 Jun 2023

Cited by 1 | Viewed by 939

Abstract

The base of the tongue (BOT) is the second most common site for squamous cell carcinoma (SCC) in the oropharynx. There are currently no clear guidelines for the management of BOT SCC. Our main objective was to compare the oncological outcomes of two [...] Read more.

The base of the tongue (BOT) is the second most common site for squamous cell carcinoma (SCC) in the oropharynx. There are currently no clear guidelines for the management of BOT SCC. Our main objective was to compare the oncological outcomes of two minimally invasive approaches, transoral laser microsurgery (TLM) and transoral robot-assisted surgery (TORS). This was a retrospective French GETTEC (Groupe d’Études des Tumeurs de la Tête et du Cou) multicenter study of patients with BOT SCC removed surgically either by TLM or TORS between 2005 and 2021. The study group included 16 patients treated by TLM and 38 by TORS, with median follow-up times of 14.4 and 37.2 months, respectively. The overall survival (OS) rates at 2 and 3 years were 67% in the TLM group and 90% at 2 years and 86% at 3 years in the TORS group (p = 0.42, p = 0.20). There was no significant difference in recurrence-free survival (RFS) between the two techniques after 2 and 3 years. The tumors removed by TORS were significantly larger. Operative times were significantly shorter in the TLM group. There were no differences in feeding resumption; none of the patients in the TLM group required a tracheotomy. Postoperative hemorrhagic complication rates were similar in the two groups (12% for TLM and 13% for TORS). Both TORS and TLM showed encouraging oncological, functional, and safety results in BOT SCC even in recurrence or second primary cancer patients, without a technique being found superior in terms of OS or RFS. Tumors removed by TORS were larger without an increase in postoperative bleeding, extending the possibilities of transoral treatment. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Management in Head and Neck Squamous Cell Carcinoma)

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12 pages, 1751 KiB

Open AccessArticle

Enteral Nutrition during Radiotherapy for Oropharyngeal Cancers: Prevalence and Prognostic Factors Based on HPV Status (A GETTEC Study)

by Dorian Culié, Renaud Schiappa, Tanguy Pace-Loscos, Bruno Guelfucci, Sebastien Vergez, Renaud Garrel, Nicolas Fakhry, Olivier Dassonville, Gilles Poissonnet, Benjamin Lallemant, Anne Sudaka, Esma Saada-Bouzid, Karen Benezery, Stephane Temam, Phillipe Gorphe, Emmanuel Chamorey and Alexandre Bozec

J. Clin. Med. 2023, 12(9), 3169; https://doi.org/10.3390/jcm12093169 - 28 Apr 2023

Viewed by 1187

Abstract

Nutritional support during radiotherapy is crucial to tolerating and completing oropharyngeal squamous cell carcinoma (OPSCC) treatment. The impact of HPV status on nutritional support is debated. The objective was to evaluate the rate of Reactive Feeding Tube (RFT) use and determine its prognostic [...] Read more.

Nutritional support during radiotherapy is crucial to tolerating and completing oropharyngeal squamous cell carcinoma (OPSCC) treatment. The impact of HPV status on nutritional support is debated. The objective was to evaluate the rate of Reactive Feeding Tube (RFT) use and determine its prognostic factors during definitive radiotherapy for OPSCC. All OPSCC patients treated from 2009 to 2014 were included in this multicentric retrospective study. The impact of tumor p16 status on the risk of RFT was assessed through multivariate analyses. Among the 543 patients, 103 patients required an RFT (19.0%). The use of RFT differed between centers (5% to 32.4%). In multivariate analysis, only tongue base involvement and concurrent chemotherapy were significantly associated with RFT (OR = 2.18 and 3.7, respectively). Tongue base involvement and concomitant chemotherapy were prognostic factors for RFT. HPV status was not a prognostic factor for enteral nutrition during radiotherapy for OPSCC. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Management in Head and Neck Squamous Cell Carcinoma)

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11 pages, 1990 KiB

Open AccessArticle

Evolution of the Incidence of Oral Cavity Cancers in the Elderly from 1990 to 2018

by Alice Renou, Anne-Valérie Guizard, Emilien Chabrillac, Gautier Defossez, Pascale Grosclaude, Sophie Deneuve, Sébastien Vergez, Bénédicte Lapotre-Ledoux, Sandrine D Plouvier, Agnès Dupret-Bories and FRANCIM Network

J. Clin. Med. 2023, 12(3), 1071; https://doi.org/10.3390/jcm12031071 - 30 Jan 2023

Cited by 3 | Viewed by 1301

Abstract

Objectives: To describe the evolution of the incidence of oral cavity cancers (OCC) among elderly patients in France between 1990 and 2018 and to compare it to the incidence of other cancers sharing the same main risk factors. Material and Methods: The incidence [...] Read more.

Objectives: To describe the evolution of the incidence of oral cavity cancers (OCC) among elderly patients in France between 1990 and 2018 and to compare it to the incidence of other cancers sharing the same main risk factors. Material and Methods: The incidence of cancers in mainland France from 1990 to 2018 was estimated from incidence data observed in every cancer registry of the Francim network. Incidence was modeled by a 2-dimensional penalized spline of age and year of diagnosis, associated with a random effect corresponding to the registry. The elderly population was divided into two groups: 70–79 years old and ≥80 years old. Results: There was a 72% increase in the number of OCC cases in women over 70 years of age between the periods 1990–1999 and 2010–2018. As for men, there was a stabilization in the number of cases (+2%). Over the same period, for laryngeal and hypopharyngeal cancers, there was a decrease in incidence in elderly men and an increase in elderly women, although less marked than for OCC. Conclusions: Since the 1990s, the incidence of OCC has been increasing in elderly subjects in France, particularly in women. Population aging and growth or alcohol and tobacco consumption alone do not seem to explain this increase, which is not observed in the same proportions for other upper aerodigestive tract cancer subsites sharing the same main risk factors. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Management in Head and Neck Squamous Cell Carcinoma)

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10 pages, 837 KiB

Open AccessArticle

Relationship between Menopausal Hormone Therapy and Oral Cancer: A Cohort Study Based on the Health Insurance Database in South Korea

by Jin-Sung Yuk and Bo Young Kim

J. Clin. Med. 2022, 11(19), 5848; https://doi.org/10.3390/jcm11195848 - 02 Oct 2022

Cited by 4 | Viewed by 1541

Abstract

The association between the development of oral cavity cancer and sex hormones is unclear and inconsistent. This study aimed to evaluate the relationship between menopausal hormone therapy (MHT) and oral cavity cancer in menopausal women in Korea. In this retrospective cohort study, data [...] Read more.

The association between the development of oral cavity cancer and sex hormones is unclear and inconsistent. This study aimed to evaluate the relationship between menopausal hormone therapy (MHT) and oral cavity cancer in menopausal women in Korea. In this retrospective cohort study, data were provided by the Korean National Health Insurance Service regarding a screening examination conducted from 1 January 2002 to 31 December 2019. Postmenopausal patients aged ≥40 years were considered, including 333,072 women in the MHT group and 847,558 women in the non-MHT group. Participants were divided into MHT types (tibolone, combined estrogen plus progestin by manufacturer, estrogen, combined estrogen plus progestin by physician, and topical estrogen), and the risk factors for oral cavity cancer development were analyzed. There was no significant association between smoking, alcohol consumption, age at menarche, and age at menopause with oral cavity cancer in postmenopausal women. However, the oral estrogen (hazard ratio [HR]: 1.633; 95% confidence interval [CI]: 1.35–1.976) and tibolone groups (HR: 1.633; 95% CI: 1.35–1.976) were associated with an elevated risk of oral cavity cancer. The results of this study suggest that MHT increases the risk of oral cavity cancer in postmenopausal women. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Management in Head and Neck Squamous Cell Carcinoma)

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13 pages, 930 KiB

Open AccessArticle

Videolaryngoendoscopic and Stroboscopic Evaluation in Predicting the Malignancy Risk of Vocal Fold Leukoplakia

by Agata Leduchowska, Joanna Morawska and Wioletta Pietruszewska

J. Clin. Med. 2022, 11(19), 5789; https://doi.org/10.3390/jcm11195789 - 29 Sep 2022

Cited by 1 | Viewed by 3825

Abstract

Background: Vocal fold leukoplakia (VFL), despite our knowledge of its etiopathogenetic factors, and the development of laryngeal visualization, remains a diagnostic and therapeutic challenge. Objective: This research aimed to explore the efficacy of clinical and morphological feature identification in videolaryngoendoscopy (VLE) using a [...] Read more.

Background: Vocal fold leukoplakia (VFL), despite our knowledge of its etiopathogenetic factors, and the development of laryngeal visualization, remains a diagnostic and therapeutic challenge. Objective: This research aimed to explore the efficacy of clinical and morphological feature identification in videolaryngoendoscopy (VLE) using a three-tier classification, and videolaryngostroboscopy (VLS) in predicting the risk of VFL malignant transformation. Material and Methods: We examined 98 patients with VFL by flexible endoscopy under VLE and VLS. Morphological characteristics of 123 lesions including the surface, margin, and texture were assessed; then, VFL was subdivided into three types: I—flat and smooth, II—elevated and smooth, and III—rough. Based on the histopathological findings, 76 (61.79%) lesions were classified as low- and 47 (38.21%) lesions as high-grade dysplasia. Results: The inter-rater agreement between two raters evaluating the VFL in VLE was almost perfect (Cohen’s kappa = 0.826; p < 0.00; 95%CI 0.748–0.904). In ROC curve analysis, the AUC difference between Rater I and Rater II was 0.024 (0.726 vs. 0.702). In multivariate analysis, high-risk VFL was positively related to unilateral plaque localization (p = 0.003), the type III VLE classification (p = 0.013), absence of a mucosal wave (p = 0.034), and a positive history of alcohol consumption (p = 0.047). In ROC analysis, VLE had an AUC of 0.726, with a high sensitivity of 95.7% and low specificity of 40.8%. The NPV was high, at 93.9%; however, the PPV was low, at 50%. The proposed logistic regression model including features significant in multivariate analysis showed lower sensitivity (80.9% vs. 95.7%) and lower NPV (86.2% vs. 93.9%); however, the specificity and PPV were improved (73.7% vs. 40.8% and 65.5% vs. 50.0%, respectively). Conclusions: The combination of clinical history with endoscopic (plaque morphology) and stroboscopic examination (mucosal wave assessment) can fairly estimate the degree of dysplasia in VFL and thus is recommended for use in clinical settings. The findings of this study can be used to guide the decision regarding immediate biopsy or watchful waiting. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Management in Head and Neck Squamous Cell Carcinoma)

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Review

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19 pages, 515 KiB

Open AccessEditor’s ChoiceReview

Oral Cavity Squamous Cell Carcinoma Risk Factors: State of the Art

by Lara Nokovitch, Charles Maquet, Frédéric Crampon, Ihsène Taihi, Lise-Marie Roussel, Rais Obongo, François Virard, Béatrice Fervers and Sophie Deneuve

J. Clin. Med. 2023, 12(9), 3264; https://doi.org/10.3390/jcm12093264 - 03 May 2023

Cited by 12 | Viewed by 2608

Abstract

Head and neck (HN) squamous cell carcinomas (SCCs) originate from the epithelial cells of the mucosal linings of the upper aerodigestive tract, which includes the oral cavity, the pharynx, the larynx, and the sinonasal cavities. There are many associated risk factors, including alcohol [...] Read more.

Head and neck (HN) squamous cell carcinomas (SCCs) originate from the epithelial cells of the mucosal linings of the upper aerodigestive tract, which includes the oral cavity, the pharynx, the larynx, and the sinonasal cavities. There are many associated risk factors, including alcohol drinking coupled with tobacco use, which accounts for 70% to 80% of HNSCCs. Human papilloma virus (HPV) is another independent risk factor for oropharyngeal SCC, but it is only a minor contributor to oral cavity SCC (OSCC). Betel quid chewing is also an established risk factor in southeast Asian countries. However, OSCC, and especially oral tongue cancer, incidence has been reported to be increasing in several countries, suggesting risk factors that have not been identified yet. This review summarizes the established risk factors for oral cavity squamous cell carcinomas and examines other undemonstrated risk factors for HNSCC. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Management in Head and Neck Squamous Cell Carcinoma)

13 pages, 323 KiB

Open AccessReview

Transoral Robotic Surgery for Head and Neck Cancer: Advances and Residual Knowledge Gaps

by Mariam H. Mella, Emilien Chabrillac, Agnès Dupret-Bories, Mathilde Mirallie and Sébastien Vergez

J. Clin. Med. 2023, 12(6), 2303; https://doi.org/10.3390/jcm12062303 - 16 Mar 2023

Cited by 6 | Viewed by 2357

Abstract

Minimally invasive surgery is a growing field in surgical oncology. After acquiring its first Food and Drug Administration approval in 2009 for T1–T2 malignancies of the oral cavity, oropharynx, and larynx, transoral robotic surgery (TORS) has gained popularity thanks to its wristed instruments [...] Read more.

Minimally invasive surgery is a growing field in surgical oncology. After acquiring its first Food and Drug Administration approval in 2009 for T1–T2 malignancies of the oral cavity, oropharynx, and larynx, transoral robotic surgery (TORS) has gained popularity thanks to its wristed instruments and magnified three-dimensional view, enhancing surgical comfort in remote-access areas. Its indications are expanding in the treatment of head and neck cancer, i.e., resection of tumors of the larynx, hypopharynx, or parapharyngeal space. However, this expansion must remain cautious and based on high-level evidence, in order to guarantee safety and oncological outcomes which are comparable to conventional approaches. This narrative review assesses the current role of TORS in head and neck cancer from an evidence-based perspective, and then identifies what knowledge gaps remain to be addressed. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Management in Head and Neck Squamous Cell Carcinoma)

16 pages, 1566 KiB

Open AccessReview

Current Therapeutic Strategies for Patients with Hypopharyngeal Carcinoma: Oncologic and Functional Outcomes

by Alexandre Bozec, Gilles Poissonnet, Olivier Dassonville and Dorian Culié

J. Clin. Med. 2023, 12(3), 1237; https://doi.org/10.3390/jcm12031237 - 03 Feb 2023

Cited by 5 | Viewed by 3934

Abstract

Hypopharyngeal cancer is usually diagnosed at an advanced stage and is associated with a high risk of recurrence and poor survival rates. Although they differ greatly in terms of prognosis, hypopharyngeal cancers are usually treated together with laryngeal cancers in clinical trials. Therefore, [...] Read more.

Hypopharyngeal cancer is usually diagnosed at an advanced stage and is associated with a high risk of recurrence and poor survival rates. Although they differ greatly in terms of prognosis, hypopharyngeal cancers are usually treated together with laryngeal cancers in clinical trials. Therefore, there are very few studies that focus specifically on patients with hypopharyngeal carcinoma. As a result, the therapeutic management of these patients is highly debated, and their clinical outcomes are poorly reported. The aim of this review is therefore to discuss the current therapeutic options in patients with hypopharyngeal carcinoma and their oncologic and functional outcomes. Patients with early-stage tumors can be treated either by conservative surgery (including transoral robot-assisted surgery) or by RT alone. However, most patients are diagnosed with locally advanced tumors that cannot be treated surgically without total laryngectomy. In this situation, the critical issue is to select the patients eligible for a larynx preservation therapeutic program. However, radical surgery with total laryngectomy still plays an important role in the management of patients with hypopharyngeal carcinoma, either as the primary treatment modality (T4 resectable primary tumor, contraindication to larynx preservation therapies) or, more commonly, as salvage treatment. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Management in Head and Neck Squamous Cell Carcinoma)

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