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Predictors and outcomes for chronic tracheostomy after chemoradiation for advanced laryngohypopharyngeal cancer
Author(s) -
Jefferson Gina D.,
Wenig Barry L.,
Spiotto Michael T.
Publication year - 2016
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25585
Subject(s) - medicine , larynx , univariate analysis , chemoradiotherapy , radiation therapy , head and neck cancer , multivariate analysis , lymphadenectomy , subglottis , tracheotomy , surgery , cancer , glottis
Objectives/Hypothesis After concurrent chemoradiation for head and neck squamous cell cancer, patients with laryngeal incompetence may not recover function. We assessed variables predicting tracheostomy dependence as a measure of poor laryngeal function after chemoradiation. Study Design Retrospective Methods Analysis of 109 patients treated with chemoradiation for locoregionally advanced laryngohypopharyngeal squamous cell cancers between 1992 and 2013. Median follow‐up was 17.0 and 17.2 months for tracheostomy and nontracheostomy dependent patients, respectively. Results For all patients, multivariate analysis demonstrated persistent tracheostomy was associated with pretreatment tracheostomy, subglottic extension, three‐dimensional conformal radiotherapy (3DCRT) and postradiotherapy lymphadenectomy. When analyzed by primary site, tracheostomy dependence was associated with pretreatment tracheostomy, subglottic extension, and 3DCRT in larynx primaries, and with pretreatment tracheostomy and feeding tube dependency in hypopharynx primaries. Tracheostomy dependence did not impact local control, progression‐free survival or overall survival on univariate analysis. Conclusion After curative chemoradiation, long‐term tracheostomy was associated with pretreatment tracheostomy, subglottic extension, postradiotherapy lymphadenectomy, and 3DCRT but did not impact outcomes. These factors may inform treatment decision making regarding organ preservation approaches for locally advanced laryngeal and hypopharyngeal cancers. Level of Evidence 4. Laryngoscope , 126:385–391, 2016