Fungal contribution in chondroradionecrosis of the larynx
Objective To assess the prevalence of invasive fungal elements in the specimens of patients who underwent salvage total laryngectomy for chondroradionecrosis (CRN) in the absence of recurrent or persistent malignancy. Study Design Retrospective chart review. Setting Tertiary academic medical center....
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| Veröffentlicht in: | The Laryngoscope 2017-05, Vol.127 (5), p.E159-E165 |
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| container_title | The Laryngoscope |
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| creator | Worthen, Mary Jusufbegovic, Mia Bumpous, Jeffrey M. Vaughn, Andrew Cash, Elizabeth Yang, Xiu Fichandler, Craig Tennant, Paul |
| description | Objective
To assess the prevalence of invasive fungal elements in the specimens of patients who underwent salvage total laryngectomy for chondroradionecrosis (CRN) in the absence of recurrent or persistent malignancy.
Study Design
Retrospective chart review.
Setting
Tertiary academic medical center.
Methods
One hundred fifty‐nine patients were identified who underwent salvage total laryngectomy. Pathology reports were reviewed, and all laryngectomy specimens that did not contain residual malignancy were reevaluated for evidence of invasive fungal elements.
Results
Twelve of 159 (7.5%) patients who underwent total laryngectomy after primary radiotherapy or chemoradiotherapy had no evidence of residual malignancy. Each of these specimens contained histopathologic evidence of CRN; invasive fungal elements were identified in 25%. There was no statistical difference in demographic or treatment‐related variables between patients who underwent salvage total laryngectomy with evidence of persistent or recurrent malignancy in the laryngectomy specimen versus patients without evidence of tumor on final histopathologic analysis. Patients with evidence of ulceration or necrosis in the laryngectomy specimen had reduced overall survival, irrespective of the presence of persistent malignancy (hazard ratio = 2.923, 95% confidence interval = 1.023–8.352, P = .045).
Conclusion
Among salvage total laryngectomy patients, no difference was identified between patients who underwent total laryngectomy for recurrent or persistent malignancy after primary radiotherapy and those who received total laryngectomy without evidence of malignancy in their specimens. Invasive fungal elements were detected in several laryngectomy specimens that did not contain residual malignancy. Empiric antifungal therapy may therefore benefit patients diagnosed with CRN who are at risk for progression to nonfunctional larynx. Patients with evidence of ulceration or necrosis in the salvage laryngectomy specimen had worse overall survival.
Level of Evidence
4. Laryngoscope, 127:E159–E165, 2017 |
| doi_str_mv | 10.1002/lary.26313 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2336963873</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4321672741</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3443-32f32dcc6ce74036efb636c65fffdfd6a2d83722b066a21a1e27cc9f1cae5ae03</originalsourceid><addsrcrecordid>eNp9kF9LwzAUxYMobk5f_ABS8E3oTHLbpH0cw6kwEERBn0KaP66ja2baovv2pnb6uKd7uffHOZyD0CXBU4Ixva2k300pAwJHaExSIHGS5-kxGocnxFlK30borGnWGBMOKT5FI8oZYwAwRvmiqz9kFSlXt74surZ0dVTWkVq5WnvnpQ4Ho7xryiZyNmpXJur96u9zdGJl1ZiL_Zyg18Xdy_whXj7dP85ny1hBkkAM1ALVSjFleIKBGVswYIql1lptNZNUZ8ApLTALO5HEUK5UbomSJpUGwwRdD7pb7z4707Ri7TpfB0tBAVjOIONwiCJZxkNPhNFA3QxUH6jxxoqtLzchjiBY9F2KPpv47TLAV3vJrtgY_Y_-lRcAMgBfZWV2B6TEcvb8Poj-ACHmfoM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1887100162</pqid></control><display><type>article</type><title>Fungal contribution in chondroradionecrosis of the larynx</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Worthen, Mary ; Jusufbegovic, Mia ; Bumpous, Jeffrey M. ; Vaughn, Andrew ; Cash, Elizabeth ; Yang, Xiu ; Fichandler, Craig ; Tennant, Paul</creator><creatorcontrib>Worthen, Mary ; Jusufbegovic, Mia ; Bumpous, Jeffrey M. ; Vaughn, Andrew ; Cash, Elizabeth ; Yang, Xiu ; Fichandler, Craig ; Tennant, Paul</creatorcontrib><description>Objective
To assess the prevalence of invasive fungal elements in the specimens of patients who underwent salvage total laryngectomy for chondroradionecrosis (CRN) in the absence of recurrent or persistent malignancy.
Study Design
Retrospective chart review.
Setting
Tertiary academic medical center.
Methods
One hundred fifty‐nine patients were identified who underwent salvage total laryngectomy. Pathology reports were reviewed, and all laryngectomy specimens that did not contain residual malignancy were reevaluated for evidence of invasive fungal elements.
Results
Twelve of 159 (7.5%) patients who underwent total laryngectomy after primary radiotherapy or chemoradiotherapy had no evidence of residual malignancy. Each of these specimens contained histopathologic evidence of CRN; invasive fungal elements were identified in 25%. There was no statistical difference in demographic or treatment‐related variables between patients who underwent salvage total laryngectomy with evidence of persistent or recurrent malignancy in the laryngectomy specimen versus patients without evidence of tumor on final histopathologic analysis. Patients with evidence of ulceration or necrosis in the laryngectomy specimen had reduced overall survival, irrespective of the presence of persistent malignancy (hazard ratio = 2.923, 95% confidence interval = 1.023–8.352, P = .045).
Conclusion
Among salvage total laryngectomy patients, no difference was identified between patients who underwent total laryngectomy for recurrent or persistent malignancy after primary radiotherapy and those who received total laryngectomy without evidence of malignancy in their specimens. Invasive fungal elements were detected in several laryngectomy specimens that did not contain residual malignancy. Empiric antifungal therapy may therefore benefit patients diagnosed with CRN who are at risk for progression to nonfunctional larynx. Patients with evidence of ulceration or necrosis in the salvage laryngectomy specimen had worse overall survival.
Level of Evidence
4. Laryngoscope, 127:E159–E165, 2017</description><identifier>ISSN: 0023-852X</identifier><identifier>EISSN: 1531-4995</identifier><identifier>DOI: 10.1002/lary.26313</identifier><identifier>PMID: 27666333</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Chondroradionecrosis ; Female ; Fungal infections ; fungal invasion ; Gangrene ; Humans ; Laryngeal Neoplasms - radiotherapy ; Laryngectomy ; Larynx ; Male ; Middle Aged ; Mycoses - complications ; Mycoses - microbiology ; Radiation Injuries - microbiology ; Radiation Injuries - surgery ; Radiation therapy ; Retrospective Studies ; Salvage Therapy ; Survival Rate ; Throat surgery ; Treatment Outcome</subject><ispartof>The Laryngoscope, 2017-05, Vol.127 (5), p.E159-E165</ispartof><rights>2016 The American Laryngological, Rhinological and Otological Society, Inc.</rights><rights>2017 The American Laryngological, Rhinological and Otological Society, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3443-32f32dcc6ce74036efb636c65fffdfd6a2d83722b066a21a1e27cc9f1cae5ae03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Flary.26313$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Flary.26313$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27666333$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Worthen, Mary</creatorcontrib><creatorcontrib>Jusufbegovic, Mia</creatorcontrib><creatorcontrib>Bumpous, Jeffrey M.</creatorcontrib><creatorcontrib>Vaughn, Andrew</creatorcontrib><creatorcontrib>Cash, Elizabeth</creatorcontrib><creatorcontrib>Yang, Xiu</creatorcontrib><creatorcontrib>Fichandler, Craig</creatorcontrib><creatorcontrib>Tennant, Paul</creatorcontrib><title>Fungal contribution in chondroradionecrosis of the larynx</title><title>The Laryngoscope</title><addtitle>Laryngoscope</addtitle><description>Objective
To assess the prevalence of invasive fungal elements in the specimens of patients who underwent salvage total laryngectomy for chondroradionecrosis (CRN) in the absence of recurrent or persistent malignancy.
Study Design
Retrospective chart review.
Setting
Tertiary academic medical center.
Methods
One hundred fifty‐nine patients were identified who underwent salvage total laryngectomy. Pathology reports were reviewed, and all laryngectomy specimens that did not contain residual malignancy were reevaluated for evidence of invasive fungal elements.
Results
Twelve of 159 (7.5%) patients who underwent total laryngectomy after primary radiotherapy or chemoradiotherapy had no evidence of residual malignancy. Each of these specimens contained histopathologic evidence of CRN; invasive fungal elements were identified in 25%. There was no statistical difference in demographic or treatment‐related variables between patients who underwent salvage total laryngectomy with evidence of persistent or recurrent malignancy in the laryngectomy specimen versus patients without evidence of tumor on final histopathologic analysis. Patients with evidence of ulceration or necrosis in the laryngectomy specimen had reduced overall survival, irrespective of the presence of persistent malignancy (hazard ratio = 2.923, 95% confidence interval = 1.023–8.352, P = .045).
Conclusion
Among salvage total laryngectomy patients, no difference was identified between patients who underwent total laryngectomy for recurrent or persistent malignancy after primary radiotherapy and those who received total laryngectomy without evidence of malignancy in their specimens. Invasive fungal elements were detected in several laryngectomy specimens that did not contain residual malignancy. Empiric antifungal therapy may therefore benefit patients diagnosed with CRN who are at risk for progression to nonfunctional larynx. Patients with evidence of ulceration or necrosis in the salvage laryngectomy specimen had worse overall survival.
Level of Evidence
4. Laryngoscope, 127:E159–E165, 2017</description><subject>Chondroradionecrosis</subject><subject>Female</subject><subject>Fungal infections</subject><subject>fungal invasion</subject><subject>Gangrene</subject><subject>Humans</subject><subject>Laryngeal Neoplasms - radiotherapy</subject><subject>Laryngectomy</subject><subject>Larynx</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mycoses - complications</subject><subject>Mycoses - microbiology</subject><subject>Radiation Injuries - microbiology</subject><subject>Radiation Injuries - surgery</subject><subject>Radiation therapy</subject><subject>Retrospective Studies</subject><subject>Salvage Therapy</subject><subject>Survival Rate</subject><subject>Throat surgery</subject><subject>Treatment Outcome</subject><issn>0023-852X</issn><issn>1531-4995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kF9LwzAUxYMobk5f_ABS8E3oTHLbpH0cw6kwEERBn0KaP66ja2baovv2pnb6uKd7uffHOZyD0CXBU4Ixva2k300pAwJHaExSIHGS5-kxGocnxFlK30borGnWGBMOKT5FI8oZYwAwRvmiqz9kFSlXt74surZ0dVTWkVq5WnvnpQ4Ho7xryiZyNmpXJur96u9zdGJl1ZiL_Zyg18Xdy_whXj7dP85ny1hBkkAM1ALVSjFleIKBGVswYIql1lptNZNUZ8ApLTALO5HEUK5UbomSJpUGwwRdD7pb7z4707Ri7TpfB0tBAVjOIONwiCJZxkNPhNFA3QxUH6jxxoqtLzchjiBY9F2KPpv47TLAV3vJrtgY_Y_-lRcAMgBfZWV2B6TEcvb8Poj-ACHmfoM</recordid><startdate>201705</startdate><enddate>201705</enddate><creator>Worthen, Mary</creator><creator>Jusufbegovic, Mia</creator><creator>Bumpous, Jeffrey M.</creator><creator>Vaughn, Andrew</creator><creator>Cash, Elizabeth</creator><creator>Yang, Xiu</creator><creator>Fichandler, Craig</creator><creator>Tennant, Paul</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope></search><sort><creationdate>201705</creationdate><title>Fungal contribution in chondroradionecrosis of the larynx</title><author>Worthen, Mary ; Jusufbegovic, Mia ; Bumpous, Jeffrey M. ; Vaughn, Andrew ; Cash, Elizabeth ; Yang, Xiu ; Fichandler, Craig ; Tennant, Paul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3443-32f32dcc6ce74036efb636c65fffdfd6a2d83722b066a21a1e27cc9f1cae5ae03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Chondroradionecrosis</topic><topic>Female</topic><topic>Fungal infections</topic><topic>fungal invasion</topic><topic>Gangrene</topic><topic>Humans</topic><topic>Laryngeal Neoplasms - radiotherapy</topic><topic>Laryngectomy</topic><topic>Larynx</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mycoses - complications</topic><topic>Mycoses - microbiology</topic><topic>Radiation Injuries - microbiology</topic><topic>Radiation Injuries - surgery</topic><topic>Radiation therapy</topic><topic>Retrospective Studies</topic><topic>Salvage Therapy</topic><topic>Survival Rate</topic><topic>Throat surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Worthen, Mary</creatorcontrib><creatorcontrib>Jusufbegovic, Mia</creatorcontrib><creatorcontrib>Bumpous, Jeffrey M.</creatorcontrib><creatorcontrib>Vaughn, Andrew</creatorcontrib><creatorcontrib>Cash, Elizabeth</creatorcontrib><creatorcontrib>Yang, Xiu</creatorcontrib><creatorcontrib>Fichandler, Craig</creatorcontrib><creatorcontrib>Tennant, Paul</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><jtitle>The Laryngoscope</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Worthen, Mary</au><au>Jusufbegovic, Mia</au><au>Bumpous, Jeffrey M.</au><au>Vaughn, Andrew</au><au>Cash, Elizabeth</au><au>Yang, Xiu</au><au>Fichandler, Craig</au><au>Tennant, Paul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fungal contribution in chondroradionecrosis of the larynx</atitle><jtitle>The Laryngoscope</jtitle><addtitle>Laryngoscope</addtitle><date>2017-05</date><risdate>2017</risdate><volume>127</volume><issue>5</issue><spage>E159</spage><epage>E165</epage><pages>E159-E165</pages><issn>0023-852X</issn><eissn>1531-4995</eissn><abstract>Objective
To assess the prevalence of invasive fungal elements in the specimens of patients who underwent salvage total laryngectomy for chondroradionecrosis (CRN) in the absence of recurrent or persistent malignancy.
Study Design
Retrospective chart review.
Setting
Tertiary academic medical center.
Methods
One hundred fifty‐nine patients were identified who underwent salvage total laryngectomy. Pathology reports were reviewed, and all laryngectomy specimens that did not contain residual malignancy were reevaluated for evidence of invasive fungal elements.
Results
Twelve of 159 (7.5%) patients who underwent total laryngectomy after primary radiotherapy or chemoradiotherapy had no evidence of residual malignancy. Each of these specimens contained histopathologic evidence of CRN; invasive fungal elements were identified in 25%. There was no statistical difference in demographic or treatment‐related variables between patients who underwent salvage total laryngectomy with evidence of persistent or recurrent malignancy in the laryngectomy specimen versus patients without evidence of tumor on final histopathologic analysis. Patients with evidence of ulceration or necrosis in the laryngectomy specimen had reduced overall survival, irrespective of the presence of persistent malignancy (hazard ratio = 2.923, 95% confidence interval = 1.023–8.352, P = .045).
Conclusion
Among salvage total laryngectomy patients, no difference was identified between patients who underwent total laryngectomy for recurrent or persistent malignancy after primary radiotherapy and those who received total laryngectomy without evidence of malignancy in their specimens. Invasive fungal elements were detected in several laryngectomy specimens that did not contain residual malignancy. Empiric antifungal therapy may therefore benefit patients diagnosed with CRN who are at risk for progression to nonfunctional larynx. Patients with evidence of ulceration or necrosis in the salvage laryngectomy specimen had worse overall survival.
Level of Evidence
4. Laryngoscope, 127:E159–E165, 2017</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>27666333</pmid><doi>10.1002/lary.26313</doi><tpages>7</tpages></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Chondroradionecrosis Female Fungal infections fungal invasion Gangrene Humans Laryngeal Neoplasms - radiotherapy Laryngectomy Larynx Male Middle Aged Mycoses - complications Mycoses - microbiology Radiation Injuries - microbiology Radiation Injuries - surgery Radiation therapy Retrospective Studies Salvage Therapy Survival Rate Throat surgery Treatment Outcome |
| title | Fungal contribution in chondroradionecrosis of the larynx |
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