Risk Factors for Laryngectomy for Dysfunctional Larynx After Organ Preservation Protocols: A Case‐Control Analysis

Abstract

Objective (1) To identify factors associated with severe dysfunctional larynx leading to total laryngectomy after curative treatment of head and neck squamous cell carcinoma and (2) to describe swallowing and voice outcomes. Study Design Retrospective single-institution case-control study. Setting Tertiary care referral center. Methods A 10-year chart review was performed for patients who had previously undergone radiation or chemoradiation for head and neck mucosal squamous cell carcinoma and planned to undergo total laryngectomy for dysfunctional larynx, as well as a control group of matched patients. Controls were patients who had undergone radiation or chemoradiation for mucosal squamous cell carcinoma but did not have severe dysfunction warranting laryngectomy; these were matched to cases by tumor subsite, T stage, and time from last treatment to video swallow study. Main outcomes assessed were postoperative diet, alaryngeal voice, pharyngeal dilations, and complications. Results Twenty-six patients were scheduled for laryngectomy for dysfunctional larynx, of which 23 underwent surgery. Originally treated tumor subsites included the larynx, oropharynx, hypopharynx, oral cavity, and a tumor of unknown origin. The median time from end of cancer treatment to laryngectomy was 11.5 years. All cases were feeding tube or tracheostomy dependent or both prior to laryngectomy. As compared with matched controls, cases were significantly less likely to have undergone IMRT (intensity-modified radiotherapy) and more likely to have pulmonary comorbidities. Eighty-nine percent of cases with follow-up achieved functional alaryngeal voice, and all were able to have oral intake. Conclusion Non-IMRT approaches and pulmonary comorbidities are associated with laryngectomy for dysfunction after radiation or chemoradiation.

Risk Factors for Functional Outcomes in Advanced Laryngeal Squamous Cell Carcinoma

“…15 Maintaining a functional laryngopharynx is an important goal to strive for in every treatment plan, but studies have suggested that appropriate patient selection is key for achieving organ preservation. 5,20,27,30,32 Understanding pre-treatment risk factors associated with a dysfunctional larynx is important to maximize benefit in patients with a high likelihood of organ preservation and limit unnecessary toxicities from definitive CRT in patients with a low likelihood of organ preservation. Our study demonstrates that the baseline functional status of the laryngopharynx, indicated by pre-treatment tracheostomy or gastrostomy tube dependence, is the most significant predictor of a dysfunctional organ after radiation-based therapy.…”

A dynamic prognostic nomogram to predict the benefit from surgical treatment modality for patients with laryngeal squamous cell carcinoma

“…Second, the SEER database lacks the information on overall comorbidity and lifestyle habits, as well as the information on individualized treatment protocols, which may impact the prognosis of patients and lead to a change in subsequent therapeutic decisions. For example, patients with laryngeal dysfunction are more likely to be treated with surgery, while aspiration pneumonia after chemoradiotherapy of laryngeal cancer may affect survival but not cancer‐specific survival 29,30 . Accordingly, the dynamic prognostic nomogram, to some extent, may be limited by the failure to include these prognostic predictors.…”

“…For example, patients with laryngeal dysfunction are more likely to be treated with surgery, while aspiration pneumonia after chemoradiotherapy of laryngeal cancer may affect survival but not cancer-specific survival. 29,30 Accordingly, the dynamic prognostic nomogram, to some extent, may be limited by the failure to include these prognostic predictors. Finally, although the precise and easy-to-use dynamic prognostic nomogram was established with the latest data from a large populationbased US database, we did not perform external validation, leaving its clinical applicability unknown in non-US population.…”

Intensity-Modulated Radiotherapy (IMRT) following Conservative Surgery of the Supraglottic Region: Impact on Functional Outcomes

“…Intensity-modulated radiotherapy (IMRT) has been associated with a reduced toxicity profile in several head and neck tumors both in the curative and postoperative settings. However, its impact in SG cancer is currently supported by limited data [ 13 , 14 , 15 , 16 ]. The introduction of IMRT, as well as the addition of concurrent chemotherapy, has been associated with improved oncological outcomes in Dutch patients treated with chemoradiation for SG tumors [ 17 ].…”