Factors predictive of poor functional outcome after chemoradiation for advanced laryngeal cancer.
OBJECTIVE
The study goal was to determine whether pretreatment parameters can be used to predict poor outcomes related to laryngeal function among survivors after organ preservation therapy for advanced laryngeal cancer.


METHODS
A retrospective analysis of patients treated in an ongoing chemoradiation trial.


METHODS
Academic tertiary care referral medical center. PATIENDS AND METHODS: Among the 65 patients receiving concomitant intra-arterial cisplatin and radiation therapy for stage III and IV laryngeal cancer between 1993 and 1999, we identified 45 who were available for follow-up and were disease free 6 months after the completion of therapy. A nominal logistic regression analysis was performed to study the effect of age, gender, T and N classification, vocal cord fixation, massive cartilage destruction, and neck dissection on the likelihood of requiring a tracheostomy tube for breathing and/or a gastrostomy tube for feeding at 6 months after the completion of therapy.


METHODS
Persistent use of gastrostomy tube feedings and/or tracheostomy at 6 months after the completion of therapy.


RESULTS
Sixteen patients (36%) required a feeding tube and/or a tracheostomy (tracheostomy 13, gastrostomy 13, both 10). Regression analysis of all pretreatment factors indicated vocal cord fixation as being the strongest predictor of a poor functional outcome (defined as the persistent need for a feeding tube and/or tracheostomy at 6 months after therapy). Among the 27 patients in this subset, 15 (56%) had a poor functional outcome. In contrast, only 1 (6%) of 18 patients without vocal cord fixation had poor laryngeal function. Although the history of pulmonary disease was not a significant parameter by itself, when combined with vocal cord fixation, 6 of 8 patients had a poor functional outcome.


CONCLUSIONS
Pretreatment parameters may be used to predict a poor functional outcome after chemoradiation. Because of the high likelihood of poor function, laryngeal cancer patients seeking organ preservation therapy with chemoradiation should be cautioned if they present with a fixed vocal cord.
Staton
Jonathan
J
Department of Otolaryngology-Head and Neck Surgery, University of Tennessee, Memphis, College of Medicine, USA.
Robbins
K Thomas
KT
Newman
Lisa
L
Samant
Sandeep
S
Sebelik
Merry
M
Vieira
Francisco
F
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011829:Radiation Dosage; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome