Risk Factors for Functional Outcomes in Advanced Laryngeal Squamous Cell Carcinoma

Abstract

Objective Chemoradiation for patients with laryngeal squamous cell carcinoma (SCC) may achieve organ preservation, but appropriate patient selection remains unknown. This study investigates pre‐treatment risk factors associated with functional and survival outcomes after radiation‐based therapy in patients with advanced laryngeal SCC. Methods A retrospective cohort study was performed on 75 adult patients with stage III or IV laryngeal SCC receiving definitive radiation‐based therapy from 1997 to 2016 at a tertiary care center. Tracheostomy and gastrostomy dependence were the primary functional outcomes. Multivariable logistic regressions were performed to evaluate relationships between pre‐treatment factors and tracheostomy and gastrostomy dependence. Time‐to‐event analyses were performed to determine risk factors associated with overall survival. Results Among 75 patients included in the analysis, 30 (40%) patients were tracheostomy dependent and 31 (41%) were gastrostomy tube dependent. The median length of follow‐up was 31 months (range = 1 to 142 months). Pre‐treatment tracheostomy was a significant predictor of post‐treatment tracheostomy (aOR = 13.9, 95% CI = 3.35 to 57.5) and moderate–severe comorbidity was a significant predictor of post‐treatment gastrostomy dependence (aOR = 2.96, 95% CI = 1.04 to 8.43). The five‐year overall survival was 51% (95% CI = 38 to 64%). Pre‐treatment gastrostomy tube dependence was associated with an increased risk of death (aHR = 2.45, 95% CI = 1.09 to 5.53). Conclusions Baseline laryngeal functional status and overall health in advanced laryngeal SCC are associated with poor functional outcomes after radiation‐based therapy, highlighting the importance of patient selection when deciding between surgical and non‐surgical treatment plans. Laryngoscope, 133:594–600, 2023

Oncological and functional outcome after laryngectomy for laryngeal and hypopharyngeal cancer: a population-based analysis in Germany from 2001 to 2020

“…Here, 14% and 7%, respectively, of patients who received a radiochemotherapy or a total laryngectomy were still PEG dependent after 12 months. Hence, the gastrostomy tube dependence seems to be lower than after radiochemotherapy for this type of advanced cancer 18 , 29 . Furthermore, chronic or recurrent dysphagia was reported by 36.8% of the patients, i.e.…”