Persistent Tracheostomy after Organ Preservation Protocol in Patients Treated for Larynx and Hypopharynx Cancer

Abstract

Introduction Squamous cell carcinoma of the larynx is currently the second most common malignancy of the airway after lung cancer, and hypopharyngeal cancer accounts for fewer than 5% of head and neck cancers. The nonsurgical options for patients with this disease are related to significant long-term toxicities and the need for persistent tracheostomy, which adversely affects the quality of life of these patients. Objective To evaluate the need for tracheostomy, and the influence of this in the overall and specific survival rates of patients diagnosed with all stages of laryngeal carcinoma treated by chemoradiotherapy. Methods A retrospective study of patients diagnosed with laryngeal carcinoma was performed according to the criteria of the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) 7th edition, in a tertiary hospital. Results A total of 21 patients were evaluated, 8 patients required a tracheotomy (31%) during the treatment protocol, 7 (35%) men and 1 (100%) women. According to subsite 4/4 patient with glottis cancer (p ≤ 0.001), 2/10 patients with supra glottis cancer and 2/7 patients with hypopharyngeal cancer. During follow up, just in 1 patient was possible to close the tracheostomy. Conclusion Persistent tracheostomy dependence after primary chemoradiation increases significantly the morbidity, and decreases the quality of life of those patients. Patients with glottis cancer are prone to need a tracheostomy, but no statistical difference regarding the oncological stage and the need for a tracheostomy were detected. A more thorough selection of the patients is needed to improve the quality of life and reduce permanent tracheostomy dependence.

Organ Function Preservation Failure after (Chemo)Radiotherapy in Head and Neck Cancer: A Retrospective Cohort Analysis

“…Furthermore, the data on predictive factors for OFPF are scarce and frequently conflicting. Cuny at al 17 showed, as in our study, that T-stage to be an independent predictive factor for OFPF while Chiesa Estomba et al 12 did not demonstrate any correlation between stage and functional failure. Similar to different publications on transoral robotic surgery, 20-22 anterior commissure involvement was not predictive of functional outcomes in our study.…”

“…Although there is no consensus in the literature 8,12-19 about the optimal definition of OFPF, the definition used in the current study covers, in our opinion, all the relevant issues involved in functional outcomes of these patients. Furthermore, the data on predictive factors for OFPF are scarce and frequently conflicting.…”

Tracheostomy dependence following “organ preservation” (chemo)radiation protocol for laryngeal and hypopharyngeal cancers

“…Our results did not find tumor subsite to be a significant predictor for tracheostomy requirement. In contrast both Estomba et al and Tennant et al found higher tracheostomy dependence rates 1 year following treatment completion in patients who had glottic disease 3,4 . This difference could be explained by a higher propensity to recommend patients for laryngectomy at our institution if patients had severe pre‐treatment laryngeal dysfunction due to glottic involvement and were medically fit for surgery.…”

“…Our results are similar to those previously reported in the literature. Estomba et al reviewed a smaller cohort of laryngeal and hypopharyngeal cancer patients treated with primary (chemo)radiotherapy, and found that 31.1% (8/21) required tracheostomy insertion with a 12.5% (1/8) successful decannulation rate 3 . Tennant et al reported 43.4% (23/53) of their patients required tracheostomy insertion with two confirmed decannulations (8.7%) at the end of their study period 4 .…”

Decannulation of Tracheostomy-Dependent Patients: Results and Review of Techniques of Reconstructive Transoral Laser Microsurgery

“…Several indications for permanent tracheostomy were considered as indisputable such as chronic upper airway obstruction, swallowing disorders with aspiration, and long term mechanical ventilation. 7-9 Up to date, there is not any European study about the medical economic impact of patients with tracheostomy. Altman et al 4 have estimated the cost of tracheostomy in American health institutions of 155 469 dollars per patient which represents a great financial impact for the health care budget.…”