Squamous cell carcinoma of the oral cavity, oropharynx, and larynx: a scoping review of treatment guidelines worldwide

Head and neck cancer (HNC) treatments have been based on single or multimodal therapies with surgery, radiotherapy (RT), chemotherapy, and immunotherapy. However, treatment recommendations among countries may differ due to technological/human resources and usual local practices. This scoping review aims to identify, compare, and map the clinical practice guidelines (CPGs) for treating squamous cell carcinoma (SCC) of the oral cavity, oropharynx, and larynx worldwide. A search strategy on global CPGs for HNC was performed by using five electronic databases and grey literature. CPGs were selected for inclusion using EndNote-20 and Rayyan online software. No language or publication date restrictions were applied. The results were analyzed descriptively considering the most updated CPG version. In total, 25 CPGs covering the head and neck region (10), the larynx (7), the oral cavity (5), and the oropharynx (3), were found in 13 geographical regions, and 19 were developed by medical societies from 1996 to 2023. Surgery and RT remain the main modalities for early-stage HNC, with surgery preferred in low-resource countries, and RT in selected cases, especially in the larynx/oropharynx aiming to achieve a cure with organ preservation. Human papillomavirus infection for oropharyngeal SCC is not tested in some Asian countries and there is still no consensus to treat p16-positive cases differently from p16-negative. Recommendations for larynx preservation vary according to facilities in each country, however, individualized choice is emphasized. Inequality across countries/continents is evident, with a similar pattern of recommendations among developed as well as developing ones. No CPGs were found in Latin America as well as Oceania countries, where the incidence of HNC is high and limitations of access to treatment may be encountered

Prognostic factors in patients with stage I or II laryngeal squamous cell carcinoma and organ preservation according to the initial therapeutic modality: surgery or radiotherapy

Introdução: A preservação do órgão em pacientes com carcinoma epidermoide de laringe em estádio clínico inicial de acordo com a modalidade terapêutica ainda é controversa. Este estudo analisa as taxas de preservação laríngea e sobrevida em pacientes com carcinoma epidermoide em estádios I ou II submetidos a tratamento com cirurgia ou radioterapia pareados pelo escore de propensão por estágio clínico. Metodologia: É um estudo de coorte retrospectivo com pacientes tratados consecutivamente de janeiro de 1995 a dezembro de 2014. Dos 151 pacientes que atenderam aos critérios de inclusão, 112 (74,%) eram portadores de tumores glóticos, 92 (60,9%) com estádio clínico I e 103 (68,2%) foram tratados com radioterapia, 96 foram selecionados pelo escore de propensão, pareados pelo estádio clínico, para cada paciente tratado com cirurgia, outro paciente com o mesmo estádio tratado com radioterapia foi selecionado. Resultados: O tempo de seguimento variou de 2 dias a 276 meses com mediana de 55 meses. A taxa de perda de seguimento foi 15,2%. Em relação à sobrevida global e câncer específica, não foram observadas diferenças entre as modalidades terapêuticas, mas os pacientes submetidos à radioterapia apresentaram maior taxa de recorrência local (37,5% x 12,5%, p = 0,021). A taxa de preservação laríngea foi de 78,5%. Não houve correlação entre a probabilidade de preservação da laringe e as variáveis estudadas, embora os pacientes classificados como ASA III ou IV e os submetidos à radioterapia apresentaram uma tendência a maior risco de perda da laringe, mas sem significância estatística. Entre os pacientes submetidos à radioterapia e que evoluíram com recorrência local, 22% foram submetidos à laringectomia parcial de resgate. Conclusão: pacientes portadores de tumores de laringe em estádios iniciais podem ser tratados com cirurgia ou radioterapia com taxas de sobrevida global, câncer específica e taxas de preservação laríngea semelhantes, mas é necessário acompanhamento adequado para o diagnóstico oportuno de recorrências, em fases que o paciente possa ser candidato a laringectomia parcial de resgate parcial, pois os pacientes submetidos à radioterapia apresentam maiores taxas de recidivaIntroduction: Organ preservation in patients with squamous cell carcinoma in the initial clinical stage according to the initial therapeutic modality is still controversial. This study analyzes the rates of laryngeal preservation and survival in patients with stage I or II squamous cell carcinoma underwent treatment with surgery or radiotherapy matched by the propensity score by clinical stage in relation to the therapeutic option. Methodology: It is a retrospective cohort study with patients treated consecutively from January 1995 to December 2014. Of the 151 patients who met the inclusion criteria, 112 (74,%) had glottic tumors, 92 (60.9%) with clinical stage I and 103 (68.2%) were treated with radiotherapy, 96 were selected by the propensity score, matched by the clinical stage, for each patient treated with surgery, another patient with the same stage treated with radiotherapy was selected. Results: The time of follow-up ranged from 2 days to 276 months with a median of 55 months. The rate of loss to follow-up was 15.2%. Regarding overall and cancer specific survival, no differences were observed between the therapeutic modalities, but patients underwent to radiotherapy had a higher rate of local recurrence (37.5% x 12.5%, p = 0.021). The laryngeal preservation rate was 78.5%. There was no correlation between the probability of larynx preservation and the variables studied, although patients classified as ASA III or IV and those underwent to radiotherapy had a tendency to a higher risk of loss of the larynx, but without statistical significance. Among patients undergoing radiotherapy who had local recurrence, 22% underwent salvage partial laryngectomy. Conclusion: Patients with initial laryngeal tumors may be submitted to surgery or radiotherapy with similar overall, cancer specific survival and laryngeal preservation rates, but adequate follow-up aiming to perform and partial laryngectomy to treat the local recurrence is necessary, because patients undergoing radiotherapy have higher risk of recurrenc

Prognostic factors in patients with clinical stage T4 laryngeal squamous cell carcinomas treated by surgery, radiotherapy or therapeutic associations

O câncer de laringe é uma das neoplasias mais comuns das vias aéreas superiores. No Brasil a maioria dos casos são diagnosticados nos estádios clínicos III ou IV. Nos tumores T4a os resultados terapêuticos são discordantes na literatura. Alguns estudos referem melhores taxas de sobrevida global com o tratamento cirúrgico e outros demonstraram taxas de sobrevida global semelhantes entre pacientes submetidos a laringectomia total e os submetidos a quimioradioterapia. Concomitante ao surgimento destas novas modalidades terapêuticas, descritas nas últimas décadas, observou-se nos Estados Unidos queda nas taxas de sobrevida dos pacientes com tumores de laringe. O objetivo deste estudo foi avaliar fatores prognósticos em pacientes portadores de carcinoma epidermóide de laringe cT4aN0-3M0 tratados em quatro instituições - em três diferentes países - de acordo com variáveis demográficas, clínicas, terapêuticas e anatomopatológicas. Em relação as variáveis clínicas, foram observadas piores taxas de sobrevida global nos pacientes com mais de 65 anos, nos classificados como ASA III ou IV, nos casos com tumores com extensão para base de língua. Dentre os pacientes submetidos ao tratamento cirúrgico as piores taxas de sobrevida global foram observados nos casos com margens de ressecção comprometidas, nos com invasão vascular presente e os com estádio linfonodal pN2 ou pN3. As taxas de sobrevida global e câncer específica não diferiu entre os pacientes submetidos ao tratamento cirúrgico ou quimioradioterápico. Por outro lado as melhores taxas de sobrevida livre de recorrência local foi evidenciada nos pacientes submetidos ao tratamento cirúrgico. Na análise multivariada, foram fatores prognósticos independentes para o risco de óbito, a classificação pelo ASA (III ou IV) e o estadiamento linfonodal patológico (pN2 ou pN3) entre os pacientes submetidos à cirurgia, a faixa etária superior a 65 anos, a extensão do tumor para base de língua, para partes moles perilaríngeas e a presença de mais de uma estrutura invadida pelo tumor nos pacientes submetidos a quimioradioterapia. Em conclusão, diversas variáveis são potenciais fatores prognósticos relacionados a sobrevida global, no entando somente a classificação como ASA III ou IV e o estádio pN2 ou pN3 foram identificados como fatores prognósticos independente para o risco de óbito nos pacientes submetidos ao tratamento cirúrgico. Nos pacientes submetidos ao tratamento com quimioradioterapia a faixa etária superior a 65 anos, extensão para base de língua, para partes moles perilaríngeas e presença de duas ou mais estruturas invadidas foram os fatores prognósticos independentes para o risco de óbitoLaryngeal cancer is one of the most common neoplasms of the upper airways. In Brazil most cases are diagnosed at stages III or IV. In T4a tumors, there are discordant treatment results in the literature. Some studies refer to improved rates of overall survival with surgical treatment while other studies show similar rates of overall survival between patients submitted to total laryngectomy or chemoradiotherapy. Concomitant to the emergence of these new therapeutic modalities described in recent decades, a decline in survival rates of patients with laryngeal tumors has been registred in the United States. The aim of this study was to assess prognostic factors in patients with clinical stage cT4aN0-3M0 laryngeal epidermoid carcinomas treated in four institutions, in three different countries, according with demographic, clinical, therapeutic and pathologic variables. With regard to clinical variables, worse rates of overall survival were observed in patients older than 65 years, classified as ASA III or IV, and tumors with tongue base extension. Among the patients who underwent surgical treatment, the worse rates of overall survival were in the cases of involved surgical margins, with vascular invasion present, and in cases with pathological metastatic lymph nodes pN2 or pN3 staging. The rates of overall survival and cancer specific survival did not differ among patients who underwent surgical treatment or chemoradiotherapy. Conversely, improved local recurrence-free survival rates were registred in patients who underwent surgical treatment. In multivariate analysis, the independent prognostic factors for the risk of death, were ASA III or IV classification, and pathological lymph nodes pN2 or pN3 staging among the patients who underwent surgery; age above 65 years, tumors with tongue base extension, extension into the perilaryngeal soft tissues and the presence of more than one structure invaded by tumor in patients who underwent chemoradiotherapy. In conclusion, several variables are potential prognostic factors related too verall survival, however only ASA III or IV and stage pN2 or pN3 were in dependent prognostic factors for the risk of death in patients undergoing surgical treatment. In patients undergoing chemoradiotherapy: age above 65 years, tumors extension to the base of tongue, perilaryngeal soft tissue invasion and presence of two or more structure sinvaded were independent prognostic factors for the risk of deat

Risk Factors and Outcomes of Postoperative Neck Hematomas: An Analysis of 5,900 Thyroidectomies Performed at a Cancer Center

Introduction Postoperative neck hematoma (PNH) is an uncommon but potentially-lethal complication of thyroid surgery. Objective To identify the risk factors for postthyroidectomy hematoma requiring reoperation, the timing, the source of the bleeding, the related respiratory distress requiring tracheotomy, and the late outcomes. Methods We retrospectively analyzed the records of 5,900 consecutive patients submitted to surgery for thyroid diseases at a single institution. Results In total, PNH occurred in 62 (1.1%) patients. Most cases of bleeding occurred within the first 6 hours after thyroidectomy, but 12.5% of the hematomas were observed after 24 hours. Obvious bleeding points were detected in 58.1% of the patients during the reoperation, with inferior thyroid artery branches and superior thyroid vessels being the most frequent bleeding sources. Only two patients required urgent tracheostomy. There were no hematoma-related deaths. Permanent hypoparathyroidism and recurrent laryngeal nerve injury are more frequent following reoperation for PNH. The factors significantly associated with PNH were: older age, concurrent lymph node dissection, and chronic lymphocytic thyroiditis. Gender, previous neck irradiation, presentation at diagnosis (symptomatic or incidental), substernal goiter, thyroidectomy for hyperthyroidism, prior thyroid surgery, malignant histology, the extent of the surgery (total versus non-total thyroidectomy), the use of energy-based vessel sealing devices, the use of the hemostatic agent Surgicel, and the placement of a surgical drain were not significantly associated with PNH. Conclusion Hematoma after thyroid surgery is an uncommon complication, but it is related to significant postoperative morbidity. A better understanding of the risk factors and of the time until hematoma formation can help target high-risk patients for preventive measures and closer postoperative observation

Squamous Cell Carcinoma of the Oral Cavity, Oropharynx, and Larynx: A Scoping Review of Treatment Guidelines Worldwide

Treatment recommendations for head and neck cancer need to be disseminated worldwide becoming available through societies/authors scientific reports and websites with warning updates. This scoping review identifies and compares the worldwide clinical practice guidelines for treating oral, oropharynx, and larynx cancer. We verified the absence of guidelines in Latin American and Oceanian countries, as well as the inequalities between countries/continents, with a similar pattern of recommendations among low-income countries and in developed ones. Recommendations for surgery, radiotherapy, and chemotherapy may differ according to country/institution access and resource

Early metabolic 18F-FDG PET/CT response of locally advanced squamous-cell carcinoma of head and neck to induction chemotherapy: A prospective pilot study.

OBJECTIVE:The objective of this study was to assess the clinical value of 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) after the first cycle of induction chemotherapy (IC) in locally advanced squamous cell carcinoma of the head and neck (LASCCHN). METHODS AND FINDINGS:A prospective, single-arm, single center study was performed, with patients enrolled between February 2010 and July 2013.Patients (n = 49) with stage III/IVA-B LASCCHN who underwent IC with taxanes, cisplatin, and fluorouracil were recruited. Staging procedures included loco-regional and chest imaging, endoscopic examination, and PET/CT scan. On day 14 of the first cycle, a second PET/CT scan was performed. Patients with no early increase in regional lymph node maximum 18F-FDG standard uptake value (SUV), detected using 18F-FDG PET/CT after first IC had better progression-free survival (hazard ratio (HR) = 0.18, 95%, confidence interval (CI) 0.056-0.585; p = 0.004) and overall survival (HR = 0.14, 95% CI 0.040-0.498; p = 0.002), and were considered responders. In this subgroup, patients who achieved a reduction of ≥ 45% maximum primary tumor SUV experienced improved progression-free (HR = 0.23, 95% CI 0.062-0.854; p = 0.028) and overall (HR = 0.11, 95% CI 0.013-0.96; p = 0.046) survival. CONCLUSIONS:These results suggest a potential role for early response evaluation with PET/CT examination in patients with LASCCHN undergoing IC. Increased regional lymph node maximum SUV and insufficient decrease in primary tumor uptake predict poorer outcomes