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Three-Dimensional Map of Isoprognostic Zones in Glottic Cancer Treated by Transoral Laser Microsurgery as a Unimodal Treatment Strategy

INTRODUCTION: The Union for International Cancer Control–American Joint Committee on Cancer TNM staging system for glottic squamous cell carcinoma (SCC) includes different types of lesions defined by the involvement of specific subsites in each T category. Our study aims to identify different subcat...

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Autores principales: Piazza, Cesare, Filauro, Marta, Paderno, Alberto, Marchi, Filippo, Perotti, Pietro, Morello, Riccardo, Taboni, Stefano, Parrinello, Giampiero, Incandela, Fabiola, Iandelli, Andrea, Missale, Francesco, Peretti, Giorgio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5972218/
https://www.ncbi.nlm.nih.gov/pubmed/29872643
http://dx.doi.org/10.3389/fonc.2018.00175
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author Piazza, Cesare
Filauro, Marta
Paderno, Alberto
Marchi, Filippo
Perotti, Pietro
Morello, Riccardo
Taboni, Stefano
Parrinello, Giampiero
Incandela, Fabiola
Iandelli, Andrea
Missale, Francesco
Peretti, Giorgio
author_facet Piazza, Cesare
Filauro, Marta
Paderno, Alberto
Marchi, Filippo
Perotti, Pietro
Morello, Riccardo
Taboni, Stefano
Parrinello, Giampiero
Incandela, Fabiola
Iandelli, Andrea
Missale, Francesco
Peretti, Giorgio
author_sort Piazza, Cesare
collection PubMed
description INTRODUCTION: The Union for International Cancer Control–American Joint Committee on Cancer TNM staging system for glottic squamous cell carcinoma (SCC) includes different types of lesions defined by the involvement of specific subsites in each T category. Our study aims to identify different subcategories according to tumor local extension and determine oncologic outcomes after treatment by transoral laser microsurgery (TLM) alone. METHODS: We retrospectively evaluated 410 patients affected by previously untreated pT1-pT3 glottic SCC treated by TLM alone from January 2005 to December 2015 at the Departments of Otorhinolaryngology—Head and Neck Surgery, Universities of Genoa and Brescia, Italy. All patients had at least 2 years of follow-up. Clinical, radiological, surgical, and histopathological data were reviewed and tumors divided into six subcategories: I, pT1a not involving the anterior commissure (AC); II, pT1b involving the AC; III, pT2 extending superficially to the supraglottis or the subglottis; IV, pT2 infiltrating the vocal muscle; V, pT3 involving the anterior paraglottic space; VI, pT2 or pT3 with vertical extension across the AC with/without involvement of the pre-epiglottic space. Recurrence-free survival (RFS), local control with laser alone (LCL), and organ preservation (OP) were defined as the primary oncologic outcomes. RESULTS: The 2, 5, and 10-year RFS for the entire series were 85.7, 80.3, and 73.8%, LCL rates 93.8, 92.1, and 89.6%, and OP rates 96.8, 95.9, and 93.5%, respectively. However, when comparing the rates of RFS, LCL, and OP for each subcategory, important differences emerged. In particular, subcategories V and VI showed a significantly increased risk of local recurrence [hazard ratio (HR) = 9.2 and 13.3, respectively]. These subcategories also had a significantly reduced probability to achieve LCL (HR: 73.6 and 93.5, respectively) and OP (HR: 6.4 and 8.1, respectively). CONCLUSION: The present classification in subcategories allows introducing the concept of a three-dimensional map of isoprognostic zones in glottic SCC treated by TLM alone as a useful tool in its management by a multidisciplinary tumor board.
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spelling pubmed-59722182018-06-05 Three-Dimensional Map of Isoprognostic Zones in Glottic Cancer Treated by Transoral Laser Microsurgery as a Unimodal Treatment Strategy Piazza, Cesare Filauro, Marta Paderno, Alberto Marchi, Filippo Perotti, Pietro Morello, Riccardo Taboni, Stefano Parrinello, Giampiero Incandela, Fabiola Iandelli, Andrea Missale, Francesco Peretti, Giorgio Front Oncol Oncology INTRODUCTION: The Union for International Cancer Control–American Joint Committee on Cancer TNM staging system for glottic squamous cell carcinoma (SCC) includes different types of lesions defined by the involvement of specific subsites in each T category. Our study aims to identify different subcategories according to tumor local extension and determine oncologic outcomes after treatment by transoral laser microsurgery (TLM) alone. METHODS: We retrospectively evaluated 410 patients affected by previously untreated pT1-pT3 glottic SCC treated by TLM alone from January 2005 to December 2015 at the Departments of Otorhinolaryngology—Head and Neck Surgery, Universities of Genoa and Brescia, Italy. All patients had at least 2 years of follow-up. Clinical, radiological, surgical, and histopathological data were reviewed and tumors divided into six subcategories: I, pT1a not involving the anterior commissure (AC); II, pT1b involving the AC; III, pT2 extending superficially to the supraglottis or the subglottis; IV, pT2 infiltrating the vocal muscle; V, pT3 involving the anterior paraglottic space; VI, pT2 or pT3 with vertical extension across the AC with/without involvement of the pre-epiglottic space. Recurrence-free survival (RFS), local control with laser alone (LCL), and organ preservation (OP) were defined as the primary oncologic outcomes. RESULTS: The 2, 5, and 10-year RFS for the entire series were 85.7, 80.3, and 73.8%, LCL rates 93.8, 92.1, and 89.6%, and OP rates 96.8, 95.9, and 93.5%, respectively. However, when comparing the rates of RFS, LCL, and OP for each subcategory, important differences emerged. In particular, subcategories V and VI showed a significantly increased risk of local recurrence [hazard ratio (HR) = 9.2 and 13.3, respectively]. These subcategories also had a significantly reduced probability to achieve LCL (HR: 73.6 and 93.5, respectively) and OP (HR: 6.4 and 8.1, respectively). CONCLUSION: The present classification in subcategories allows introducing the concept of a three-dimensional map of isoprognostic zones in glottic SCC treated by TLM alone as a useful tool in its management by a multidisciplinary tumor board. Frontiers Media S.A. 2018-05-22 /pmc/articles/PMC5972218/ /pubmed/29872643 http://dx.doi.org/10.3389/fonc.2018.00175 Text en Copyright © 2018 Piazza, Filauro, Paderno, Marchi, Perotti, Morello, Taboni, Parrinello, Incandela, Iandelli, Missale and Peretti. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Piazza, Cesare
Filauro, Marta
Paderno, Alberto
Marchi, Filippo
Perotti, Pietro
Morello, Riccardo
Taboni, Stefano
Parrinello, Giampiero
Incandela, Fabiola
Iandelli, Andrea
Missale, Francesco
Peretti, Giorgio
Three-Dimensional Map of Isoprognostic Zones in Glottic Cancer Treated by Transoral Laser Microsurgery as a Unimodal Treatment Strategy
title Three-Dimensional Map of Isoprognostic Zones in Glottic Cancer Treated by Transoral Laser Microsurgery as a Unimodal Treatment Strategy
title_full Three-Dimensional Map of Isoprognostic Zones in Glottic Cancer Treated by Transoral Laser Microsurgery as a Unimodal Treatment Strategy
title_fullStr Three-Dimensional Map of Isoprognostic Zones in Glottic Cancer Treated by Transoral Laser Microsurgery as a Unimodal Treatment Strategy
title_full_unstemmed Three-Dimensional Map of Isoprognostic Zones in Glottic Cancer Treated by Transoral Laser Microsurgery as a Unimodal Treatment Strategy
title_short Three-Dimensional Map of Isoprognostic Zones in Glottic Cancer Treated by Transoral Laser Microsurgery as a Unimodal Treatment Strategy
title_sort three-dimensional map of isoprognostic zones in glottic cancer treated by transoral laser microsurgery as a unimodal treatment strategy
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5972218/
https://www.ncbi.nlm.nih.gov/pubmed/29872643
http://dx.doi.org/10.3389/fonc.2018.00175
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