Literature Review: A Roundup of Important Recent Studies

Reference: Griffin GR, Chepeha DC, Moyer JS. Interpolated subcutaneous fat pedicle melolabial flap for large nasal lining defects. Laryngoscope. 2013;123:356-359.

—Reviewed by Sue Pondrom

Impact of Treatment Modality and Radiation Technique in Cancer Patients

What is the impact of chemoradiation (CRT) and radiation techniques on toxicity, quality of life (QoL) and functional outcome in hypopharyngeal cancer patients?

Background: In addition to curing the patient, the goals for treatment of hypopharyngeal cancer (HPC) should include laryngeal preservation while minimizing side effects. Patients with T3 and early T4 can be offered the possibility of organ preservation with CRT, but there are high rates of treatment-related toxicity. Inconsistent reports exist regarding treatment-related toxicities and assessment of QoL for this treatment.

Study design: Retrospective analysis.

Setting: Department of Radiation Oncology, Department of Biostatistics, and the Department of Otorhinolaryngology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, Netherlands.

Synopsis: The authors looked at 176 consecutive patients with HPC at one institution from 1996 to 2010. All were treated with CRT or radiotherapy (RT) alone. End points were acute and late toxicity, QoL, assessment and functional outcome using laryngoesophageal dysfunction-free survival (LED-FS), defined by the Larynx Preservation Consensus Panel. All patients experienced one or more acute side effects, with the most serious being grade 3 skin toxicity, mucosal toxicity and dysphagia. Fourteen percent of patients needed hospitalization for severe mucositis, dysphagia and weight loss; intercurrent infection; or severe malaise.

CRT, compared with RT alone, increased the overall rate of grade 3 acute toxicity; however, significantly less grade 3 acute dermatitis, mucositis and pain were observed in patients treated with intensity-modulated radio therapy (IMRT) compared with three-dimensional conformal radiotherapy (3DCRT). Fifty-seven patients experienced one or more types of late toxicity grade 2 or higher, with dysphagia and xerostomia the most common. Use of IMRT, compared with 3DCRT, significantly reduced incidences of late complications. Eighty-three percent of patients with grade 3 acute toxicity later developed grade 3 late toxicity, and 40 percent of patients were feeding-tube dependent at the end of treatment. Regarding functional outcome, 44 percent of patients were still alive at the last follow-up. Of these, 65 patients had organ preservation. All of the patients eligible for QoL analysis had been treated by IMRT, so QoL scores could not be evaluated; however, the deterioration in scores was more pronounced in patients treated by CRT compared to RT alone. QoL scores on all scales deteriorated during treatment.