Predictors and outcomes for chronic tracheostomy after chemoradiation for advanced laryngohypopharyngeal cancer.
OBJECTIVE
After concurrent chemoradiation for head and neck squamous cell cancer, patients with laryngeal incompetence may not recover function. We assessed variables predicting tracheostomy dependence as a measure of poor laryngeal function after chemoradiation.


METHODS
Retrospective


METHODS
Analysis of 109 patients treated with chemoradiation for locoregionally advanced laryngohypopharyngeal squamous cell cancers between 1992 and 2013. Median follow-up was 17.0 and 17.2 months for tracheostomy and nontracheostomy dependent patients, respectively.


RESULTS
For all patients, multivariate analysis demonstrated persistent tracheostomy was associated with pretreatment tracheostomy, subglottic extension, three-dimensional conformal radiotherapy (3DCRT) and postradiotherapy lymphadenectomy. When analyzed by primary site, tracheostomy dependence was associated with pretreatment tracheostomy, subglottic extension, and 3DCRT in larynx primaries, and with pretreatment tracheostomy and feeding tube dependency in hypopharynx primaries. Tracheostomy dependence did not impact local control, progression-free survival or overall survival on univariate analysis.


CONCLUSIONS
After curative chemoradiation, long-term tracheostomy was associated with pretreatment tracheostomy, subglottic extension, postradiotherapy lymphadenectomy, and 3DCRT but did not impact outcomes. These factors may inform treatment decision making regarding organ preservation approaches for locally advanced laryngeal and hypopharyngeal cancers.


METHODS
4.
Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, U.S.A.
Gina D
GD
Jefferson
Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, U.S.A.
Barry L
BL
Wenig
Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois, U.S.A.|Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, U.S.A.
Michael T
MT
Spiotto
D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D059248:Chemoradiotherapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020266:Radiotherapy, Conformal / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome
Squamous cell carcinoma; concurrent chemoradiotherapy; larynx cancer; organ preservation; tracheostomy