Publications (34) View all
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Article: Indikationen zur chirurgischen Therapie von Larynx- und Hypopharynxkarzinomen
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ABSTRACT: In Österreich ist bei Kehlkopfkarzinomen derzeit jährlich mit etwa zehn Neuerkrankungen pro 100.000 Einwohner und bei Hypopharynxkarzinomen mit etwa drei Neuerkrankungen bei Männern zu rechnen. Bei Frauen sind die Inzidenzen etwa um den Faktor 5 geringer. Insgesamt scheint die Rate der Neuerkrankungen den letzten Jahren konstant oder leicht rückläufig zu sein. Etwa 70 % aller Kehlkopfkarzinome sind glottische, also von den Stimmlippen ausgehende Neoplasien. Etwa 30 % sind supraglottische Tumoren, echte subglottische Karzinome sind sehr selten. Die Mehrzahl der Hypopharynxkarzinome geht von den Sinus piriformes aus. Stimmlippentumore führen zu einem typischen und klinisch erkennbaren Frühsymptom: Heiserkeit. Über Wochen hinweg persistierende Stimmstörungen bei Erwachsenen müssen daher stets laryngoskopisch abgeklärt werden. Hierdurch eröffnet sich eine echte Möglichkeit der Früherkennung von Kehlkopfkarzinomen, so dass heute etwa 60 % aller Larynxkarzinome in den klinischen Frühstadien I und II nach UICC bzw. als intraepitheliale Neoplasie (früher so genanntes Karzinoma in situ) diagnostiziert werden können. Bei glottischen Karzinomen werden sogar etwa 75 % in diesen Frühstadien diagnostiziert, bei supraglottischen Tumoren dagegen nur etwa 30 %, bei Hypopharynxkarzinomen unter 15 %. Prinzipiell stehen Chirurgie, Strahlentherapie und medikamentöse Therapie als onkologische Ansätze zur Verfügung. Voraussetzung für den sinnvollen kurativen Einsatz chirurgischer Therapieoptionen ist in der Regel die Erfüllung folgender Bedingungen: • Lokal begrenzte Tumorkrankheit, keine systemische Metastasierung • Tumor muss operationstechnisch in gesunden Grenzen resezierbar sein • Vertretbare perioperative Mortalität/Morbidität • Operation darf nicht zu unzumutbaren Verstümmelungen führen • Fehlen gleichwertiger und weniger beeinträchtigender therapeutischer Alternativen Im Folgenden sollen die Indikationen zur chirurgischen Behandlung von Larynx- und Hypopharynxkarzinomen diskutiert und die Ergebnisse der chirurgischen Therapie kurz zusammengefasst werden. In Austria, around ten new cases of laryngeal cancer can currently be expected per 100.000 persons each year whereas three out of 100.000 men develope hypopharyngeal cancer. Among women, the incidence in both types of carcinoma is lower by a factor of around 5. All in all, the rate of new cases seems to have been constant or to have slightly decreased in the last few years. Approximately 70% of all laryngeal cancer are glottic cancer, that is to say originating from the vocal cords. About 30% are supraglottic tumours, true subglottic cancers are very rare. The majority of hypopharyngeal tumours originate from the piriform sinuses.Vocal cord tumours lead to a typical symptom that can be early detected: hoarseness. Thus, voice problems in adults that persist for several weeks should therefore always checked by laryngoscopy. This leads to there being a real possibility of early diagnosis of laryngeal cancer, which means that today, approximately 60% of all laryngeal tumours can be diagnosed in stage I or II according to UICC or as intraepithelial lesions (former carcinoma in situ). In glottic cancer about 75% are diagnosed in these early stages, whereas in supraglottic tumours the rate is only about 30% and in hypopharyngeal cancer it is less then 15%. Surgery, radiation therapy, chemo- or immunotherapy are the principal types of oncological treatments currently available. The following conditions generally need to be met for curative surgical treatment options: • Local tumour, no systemic metastasis • Tumour has to be resectable in healthy margins • mortality/morbidity • Surgery must not lead to unreasonable mutilation • Lack of other therapeutic alternatives having an equal or lesser impact In the following pages, indications for the surgical treatment of laryngeal and hypopharyngeal cancer will be discussed and the results of surgical therapy will be summarised briefly.Wiener Medizinische Wochenschrift 04/2012; 158(9):255-263. -
Article: Laryngeal chondrosarcoma with unusual dissemination to the humerus.
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ABSTRACT: We report the case of an 81-year-old woman admitted to our clinic with a 16-month history of hoarseness due to unilateral vocal cord immobilization, slowly progressive dysphagia and an episode of painless swelling of the right arm. Radiological and histological workup revealed a medium-grade conventional chondrosarcoma of the cricoid cartilage with paratracheal spread and dissemination to the lung and the humeral bone. To our knowledge, this is the first humeral bone metastasis of laryngeal chondrosarcoma reported in the literature. The course of the presented case underlines the need for an early and detailed clinical and radiological workup of vocal cord immobilization.ORL 04/2012; 74(3):154-7. · 0.91 Impact Factor -
Article: Comparison of four cisplatin-based radiochemotherapy regimens for nonmetastatic stage III/IV squamous cell carcinoma of the head and neck.
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ABSTRACT: To compare the outcomes of four cisplatin-based radiochemotherapy regimens in 311 patients with Stage III/IV squamous cell carcinoma of the head and neck. Concurrent chemotherapy consisted of three courses of cisplatin 100 mg/m(2) on Day 1 (Group A, n = 74), two courses of cisplatin 20 mg/m(2) on Days 1-5 plus 5-fluorouracil 1,000 mg/m(2) on Days 1-5 (Group B, n = 49), two courses of cisplatin 20 mg/m(2) on Days 1-5 plus 5-fluorouracil 600 mg/m(2) on Days 1-5 (Group C, n = 102), or two courses of cisplatin 20 mg/m(2) on Days 1-5 (Group D, n = 86). The groups were retrospectively compared for toxicity and outcomes, and 11 additional factors were evaluated for outcomes. No significant difference was observed among the groups regarding radiation-related acute oral mucositis and radiation-related late toxicities. Acute Grade 3 skin toxicity was significantly more frequent in Group B than in the patients of the other three groups (p = .013). The chemotherapy-related Grade 3 nausea/vomiting rate was 24% for Group A, 8% for Group B, 9% for Group C, and 6% for Group D (p = .003). The corresponding Grade 3 nephrotoxicity rates were 8%, 1%, 2%, and 1% (p = .019). The corresponding Grade 3-4 hematologic toxicity rates were 35%, 41%, 19%, and 21% (p = .027). Chemotherapy could be completed in 50%, 59%, 74%, and 83% of the Group A, B, C, and D patients, respectively (p = .002). Toxicity-related radiotherapy breaks occurred in 39%, 43%, 21%, and 15% of Groups A, B, C, and D, respectively (p = .005). The 3-year locoregional control rate was 67%, 72%, 60%, and 59% for Groups A, B, C, and D, respectively (p = .48). The corresponding 3-year metastasis-free survival rates were 67%, 74%, 63%, and 79% (p = .31), and the corresponding 3-year survival rates were 60%, 63%, 50%, and 71% (p = .056). On multivariate analysis, Karnofsky performance status, histologic grade, T/N category, preradiotherapy hemoglobin level, completion of chemotherapy, and radiotherapy breaks were associated with the outcome. The four compared radiochemotherapy regimens were not significantly different regarding treatment outcomes. Two courses of cisplatin 20 mg/m(2) on Days 1-5 were better tolerated than the other three regimens.International journal of radiation oncology, biology, physics 07/2011; 80(4):1037-44. · 4.59 Impact Factor -
Article: Radiochemotherapy versus surgery plus radio(chemo)therapy for stage T3/T4 larynx and hypopharynx cancer - results of a matched-pair analysis.
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ABSTRACT: The standard treatment for non-metastatic T3/T4 larynx and hypopharynx cancer varies. This study compared definitive radiochemotherapy to surgery followed by radio(chemo)therapy. Forty-four patients treated with radiochemotherapy were matched to 88 patients receiving surgery plus radio(chemo)therapy. Groups were matched 1:2 for eight factors including age, gender, performance status, tumour site, histologic grade, T-/N-category and AJCC stage. Groups were compared for loco-regional control, metastases-free survival, overall survival and toxicity. Two-year loco-regional control rates were 75% after surgery plus radio(chemotherapy) and 66% after radiochemotherapy (p=0.39). Metastases-free survival rates were 76% and 77%, respectively (p=0.76). Overall survival rates were 67% and 63%, respectively (p=0.95). During follow up, 60% and 9% of the patients, respectively, received a total laryngectomy (p=0.004). Grade ≥3 oral mucositis and haematologic toxicity rates were higher with radiochemotherapy. Other toxicities were similar. Outcomes of radiochemotherapy appeared similar to those of surgery plus radio(chemo)therapy. The larynx preservation rate was higher after radiochemotherapy.European journal of cancer (Oxford, England: 1990) 07/2011; 47(18):2729-34. · 4.12 Impact Factor -
Article: Induction chemotherapy with paclitaxel and cisplatin followed by radiotherapy for larynx organ preservation in advanced laryngeal and hypopharyngeal cancer offers moderate late toxicity outcome (DeLOS-I-trial).
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ABSTRACT: A prospective multicenter phase-II trial (12 centers) was performed by the German larynx organ preservation group (DeLOS) to evaluate the effect of induction chemotherapy (ICHT) with paclitaxel/cisplatin (TP), followed by accelerated-hyperfractionated (concomitant boost) radiotherapy (RT) in responders. The trial was focused on larynx preservation, tumor control, survival, salvage surgery and late toxicity in patients with advanced larynx/hypopharynx carcinoma eligible for total laryngectomy (LE). Seventy-one patients (40 larynx, 87.5% St. III, IV; 31 hypopharynx, 93.4% St. III, IV) were enrolled into the study and treated with ICHT (200 mg/m(2) paclitaxel, 100 mg/m(2) cisplatin; day 1, 22) according to the DeLOS protocol. Patients with complete or partial tumor response proceeded to RT (69.9 Gy in 5.5 weeks). Non-responders received a LE followed by postoperative RT (56-70 Gy in 5.5-7 weeks). The response rate to ICHT for larynx cancer was 69.6% (7.1% complete, 62.5% partial response) and for hypopharyngeal cancer was 84.3% (6.9% complete, 77.4% partial response). Overall survival after 36 months was 60.3% (95% CI, 48.4-72.2%), after 42 months was 56.5% (95% CI, 44.2-68.8%). Laryngectomy-free survival was as follows: after 36 months, 43.0% (95% CI, 30.9-55.0%); after 42 months, 41.3% (95% CI, 29.3-53.3%). Both parameters did not show different outcomes after distinguishing larynx from hypopharynx. LE was indicated in 15 non-responders after ICHT. Five of the 15 non-responders refused the laryngectomy. Two of the five received RT instead and had no evidence of disease 42 months after RT. Late toxicity (dysphagia III, IV LENT SOMA score in laryngectomy-free survivors: after 6 months, 1.8%; 12 months, 11.4%; 18 months, 14.5%; 24 months, 8.1%; 36 months, 16%) and salvage surgery (4 pharyngocutaneous fistulas in 27 operations) were tolerable. In a large portion of patients eligible for LE, the larynx could be preserved with satisfying functional outcome. Good responders after ICHT had also a good general outcome with relatively rare severe late toxicities. Due to a slight increase of relevant late dysphagia, functional outcome regarding swallowing and tracheotomy free breathing should be more focused in future larynx organ preservation trials.Archives of Oto-Rhino-Laryngology 11/2008; 266(8):1291-300. · 1.29 Impact Factor
