Oncologic and functional outcomes of pretreatment tracheotomy in advanced laryngeal squamous cell carcinoma: A multi-institutional analysis

Byrd, Serena; Xu, Mary Jue; Cass, Lauren M.; Wehrmann, Daniel; Naunheim, Matthew R.; Christopher, Kara M.; Dombrowski, John; Walker, Rebecca; Wirth, Lori J.; Clark, John R.; Busse, Paul; Chan, Annie W.; Deschler, Daniel G.; Emerick, Kevin S.; Lin, Derrick T.; Varvares, Mark A.

doi:10.1016/j.oraloncology.2018.01.018

Cited by 12 publications

(18 citation statements)

References 16 publications

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“…Last, noncancer and treatment-related deaths were higher in the concomitant arm. 9 Although there is no consensus in the literature 8,[12][13][14][15][16][17][18][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.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Furthermore, the knowledge about organ and function preservation rates of CRT is scarce. Two recent publications questioned the success of organ sparing with CRT: Byrd et al 8 retrospectively analyzed 226 patients with oropharyngeal carcinoma who were treated with CRT and found half of them remained tracheostomy dependent after treatment. In addition, the RTOG 91-11 study showed a trend for poorer OS in the concomitant CRT arm compared to the induction chemotherapy arm, despite the improved laryngectomy-free survival.…”

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confidence: 99%

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

Heukelom

Navran

Gouw

et al. 2019

Otolaryngol.--head neck surg.

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Objective The aim of the current study was to determine the incidence of organ function preservation failure (OFPF) in patients with head and neck squamous cell carcinoma (HNSCC) treated by (chemo)radiotherapy and to identify its risk factors. Study Design Retrospective cohort analysis. Setting Tertiary cancer care center. Subjects and Methods A single-center retrospective cohort analysis was done (n = 703) in which OFPF after (chemo)radiotherapy was assessed. OFPF was defined as local failure or pure functional failure in the absence of local failure because of major surgical intervention (total laryngectomy, commando resection, permanent tracheostomy) or feeding tube dependence >2 years. Results OFPF occurred in 153 patients (21.8%). Reasons for OFPF were local failure in 103 patients (14.6%) and functional failure in 50 patients (7.2%). Evidence of functional failure included need for total laryngectomy (n = 9, 1.3%), commando resection (n = 2, 0.3%), permanent tracheostomy (n = 16, 2.3%), and/or long-term feeding tube for functional reasons (n = 23, 3.3%). In a Cox proportional hazards model, OFPF was worse for patients with T4 tumors (hazard ratio [HR] <0.5 and P < .001 for all other stages), for laryngeal vs oropharyngeal cancer (HR, 1.83; 95% confidence interval [CI], 1.20-2.79, P = .005, hypopharyngeal not significant), and for smokers (HR, 1.68; 95% CI, 1.10-2.56, P = .015). Exploratory multivariate analysis by tumor site showed that T4 tumor and pretreatment tracheostomy were the strongest predictive factors for OFPF in laryngeal and hypopharyngeal carcinoma while T4 tumor and smoking were predictive for poor OFPF in oropharyngeal carcinoma. Conclusion This work shows a detrimental effect of smoking on functional outcomes after (chemo-)radiotherapy for HNSCC. Moreover, T4 tumor, laryngeal subsite, and pretreatment tracheostomy are strong predictors of OFPF.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Heukelom

Navran

Gouw

et al. 2019

Otolaryngol.--head neck surg.

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“…In a multi-institutional study containing 226 patients with advanced laryngeal cancers, 31.4% (71/226) underwent pretreatment tracheotomy. Moreover, their results showed that patients who underwent pretreatment tracheotomy had a statistically significant decrease in both OS (HR 1.55, 95% CI=1.03−2.34, P =0.03) and DFS (HR 1.54, 95% CI = 2.07−2.22, P =0.02) ( 15 ). Some studies have also revealed that pretreatment tracheotomy was a strong predictor for long-term tracheostomy after organ-preservation strategy in laryngeal and hypopharyngeal cancers ( 16 , 17 ).…”

Section: Discussionmentioning

confidence: 99%

Posttreatment Non-Improved Vocal Cord Mobility Indicates the Need of Salvage Surgery for Hypopharyngeal Carcinomas

Zhang

Zhu

et al. 2021

Front. Oncol.

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IntroductionWe aimed to analyze the relationship between the changed status of vocal cord mobility and survival outcomes.MethodsSeventy-eight patients with dysfunctional vocal cords and hypopharyngeal carcinomas accepted non-surgical treatment as the initial therapy between May 2009 and December 2016. Vocal cord mobility was assessed before and after the initial non-surgical treatment. The cord mobility status was classified as normal, impaired, and fixed. Patients with improved mobility (IM) (n =56) were retrospectively analyzed for disease-free survival (DFS), recurrence-free survival (RFS), and overall survival (OS) and compared with 22 patients with non-improved mobility (non-IM).ResultsFifty-six (71.8%) patients had improved cord mobility after the initial non-surgical treatment. The non-improved cord mobility was significantly associated with shortened DFS (P=0.005), RFS (P=0.002), and OS (P<0.001). If non-improved cord mobility was regarded as an indicator for local-regional recurrence within 1 year, the sensitivity and the specificity were 60.9%, 87.5% respectively. The multivariate analysis showed that improved cord mobility (P=0.006) and salvage surgery (P=0.015) were both independent protective factors for OS.ConclusionChanges in cord mobility are a key marker for predicting prognosis. Non-improved cord mobility may indicate a high possibility of a residual tumor, therefore, patients whose cord mobility remains dysfunctional or worsens after non-surgical treatment might need an aggressive salvage strategy.

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“…Several clinical trials have been conducted to investigate the optimal treatment for LC (21,24,25). The Veterans Administration randomized clinical trial (RCT) comprising two treatment arms revealed that the usage of primary CRT offered patients who underwent surgery an equal survival chance (17). Concomitantly, the CRT group had a two-thirds likelihood of preservation of the larynx for stage III/IV laryngeal cancer (21).…”

Section: Discussionmentioning

confidence: 99%

“…As the N classification and clinical stage were the significant indicators from the survival analysis and they were not well balanced for the surgery and surgery + CRT groups, PSM was additionally performed to obtain a matched cohort and to investigate if there were any survival differences between the two groups (16)(17)(18). The patient characteristics following matching with well-balanced N classification and stage are summarized in Table IV.…”

Section: Comparison Of Treatment Modalities Prior To and Following Psmmentioning

confidence: 99%

Clinical effect of postoperative chemoradiotherapy in resected advanced laryngeal squamous cell carcinoma

et al. 2019

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Laryngeal squamous cell carcinoma (LSCC) is one of the most prevalent types of head and neck malignancies. Advanced LSCC has failed to demonstrate a satisfactory prognosis, despite the progresses in the diagnosis and treatment, and the optimal treatment modality continues to be debated. To evaluate the clinical utility and survival outcomes of adjuvant chemoradiotherapy (CRT) for patients with resected advanced LSCC, a retrospective analysis of 232 patients with LSCC who had undergone total laryngectomy and neck dissection between 2005 and 2010 was conducted. Of the 232 eligible patients, 167 patients (72%) received surgery alone, whereas 65 patients (28%) received surgery + adjuvant CRT. In the overall cohort, the 5-and 10-year overall survival (OS) rates were 55.2 and 48.3%, respectively. Multivariate analysis revealed that the clinical stage was significantly associated with OS. However, the N classification was an independent indicator in disease-free survival and laryngeal cancer-specific survival. In those patients with stage IV disease, patients receiving adjuvant CRT exhibited a markedly improved survival benefit compared with patients receiving surgical treatment only, following propensity score matching of the data (P<0.05). The application of adjuvant CRT confers additional survival benefits in comparison with surgery-only treatment regimens for advanced LSCC. However, additional prospective studies are required.

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Oncologic and functional outcomes of pretreatment tracheotomy in advanced laryngeal squamous cell carcinoma: A multi-institutional analysis

Cited by 12 publications

References 16 publications

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

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

Posttreatment Non-Improved Vocal Cord Mobility Indicates the Need of Salvage Surgery for Hypopharyngeal Carcinomas

Clinical effect of postoperative chemoradiotherapy in resected advanced laryngeal squamous cell carcinoma

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