Added subsection title and text to state that surgery and radiation therapy have been the standards for treatment of laryngeal cancer but outcome data from randomized trials are limited; underpowered studies have not fully addressed whether to use surgery or radiation (cited Iyer et al. as reference 1). Also added that selection of primary surgery versus radiation therapy-based treatment should be made in a multidisciplinary setting with consideration of disease stage, comorbidities, and functional status, including voice and swallowing outcomes and lung capacity.
Added text to state that prospective data of two randomized controlled trials reported the incidence of hypothyroidism and provided statistics from a median follow-up of 41 months. Also added that patients who underwent intensity-modulated radiation therapy had higher subclinical hypothyroidism, peaking around 1 year after radiation therapy. Included text to state that younger age, hypopharynx and larynx primary, node positivity, higher dose and fractionation, and D100 were statistically significant factors for developing hypothyroidism (cited Murthy et al. as reference 20 and level of evidence 1iiC).
Added text to state that for patients with well-lateralized oropharyngeal cancer, such as a T1 or T2 tonsil primary tumor with limited extension into the palate or tongue base and limited ipsilateral lymph node involvement without extracapsular extension, elective treatment to the ipsilateral lymph nodes results in only minimal risk of spread to the contralateral neck (cited O'Sullivan et al. as reference 21). Also added that for T3 and T4 tumors that are midline or approach the midline, bilateral nodal treatment is a consideration; in addition to the cervical lymph node chain, retropharyngeal lymph nodes can also be encompassed in the elective nodal treatment.
Added text to state that conventional and hypofractionated regimens have been studied with regard to radiation-dose fractionation for patients with early-stage larynx cancer and added details from a randomized study of patients with early-stage larynx cancer; the underpowered study closed early because of a lack of accrual. Also added that no statistically significant differences were seen between treatment arms in terms of local progression-free survival, and no significant differences were observed in the toxicity profile between the two arms; statistics were added (cited Fein et al. as reference 3 and level of evidence 1iiDiii). Earlier single-institution reports support hypofractionated regimens using 2.25 Gy per fraction for early T1 and T2 larynx cancer with high local control rates (cited Moon et al. as reference 4 and level of evidence 3iiDiv).
Revised text in the treatment options under clinical evaluation lists in the glottis and subglottis sections to state that clinical trials are exploring novel targeted therapy, immunotherapy, novel chemotherapy, radiosensitizers, or particle-beam radiation therapy.
Revised text in the treatment options under clinical evaluation lists in the supraglottis, glottis, and subglottis sections to state that clinical trials are exploring novel targeted therapy, immunotherapy, novel chemotherapy, radiosensitizers, or particle-beam radiation therapy.
Revised option in list of standard treatment options under subglottis to state laryngectomy plus total thyroidectomy and bilateral tracheoesophageal node dissection usually followed by PORT with or without concomitant chemotherapy based on pathological risk factors.
Added option in list of standard treatment options under subglottis to state that chemotherapy administered concomitantly with radiation therapy can be considered for patients who would require total laryngectomy for control of disease, including those with nonbulky T4a disease.
ver historia personal en: www.cerasale.com.ar [dado de baja por la Cancillería Argentina por temas políticos, propio de la censura que rige en nuestro medio]//
weblog.maimonides.edu/farmacia/archives/UM_Informe_Autoevaluacion_FyB.pdf - //
weblog.maimonides.edu/farmacia/archives/0216_Admin_FarmEcon.pdf - //
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