title: Persistent tracheostomy after primary chemoradiation for advanced laryngeal or hypopharyngeal cancer.
abstract: BACKGROUND
  Despite the demonstrated survival equivalence between chemoradiation and ablative surgery as primary treatment for advanced laryngeal and hypopharyngeal cancers, a subset of patients who undergo organ-preservation therapy have persistent tracheostomy requirement after completion of treatment.
  
  
  METHODS
  Patients who received primary chemoradiation for advanced laryngeal or hypopharyngeal cancer in a 3-year interval were identified. Rate of persistent posttreatment tracheostomy requirement was evaluated. The 12-month overall mortality rate was compared between patients who did and did not receive a tracheostomy before treatment.
  
  
  RESULTS
  In 60 patients identified for this study, T3/T4 status and hemilarynx fixation at the time of presentation were associated with persistent tracheostomy requirement 6 and 12 months posttreatment (p = .022; p < .001; and p = .032; p = .0495, respectively). Twelve-month mortality was higher in T3/T4 patients who received pretreatment tracheostomy (p = .034).
  
  
  CONCLUSIONS
  Patients with advanced laryngeal or hypopharyngeal cancer who require tracheostomy before treatment have low rates of decannulation and higher short-term mortality than those who do not require tracheostomy before organ-preservation therapy.
authors.affiliation: Division of Otolaryngology, Department of Surgery, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Tennant
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cash
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Bumpous
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Potts
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D014139:Tracheostomy / Q000706:statistics & numerical data*
keywords: advanced laryngeal and hypopharyngeal cancer; chemoradiation; laryngeal organ preservation; persistent tracheostomy requirement; tracheostomy