A Novel Laryngeal Function Preservation Therapy for Advanced Laryngeal Cancer (T3, 4) by Superselective Intra-arterial Chemotherapy

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. DESIGN: A retrospective analysis of patients treated in an ongoing chemoradiation trial. SETTING: Academic tertiary care referral medical center. PATIENTS 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. MAIN OUTCOME MEASURE: 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. CONCLUSION: 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.

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Severe late dysphagia after multimodal treatment of stage III/IV laryngeal and hypopharyngeal cancer

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyz158 ◽

2019 ◽

Vol 50 (2) ◽

pp. 185-192 ◽

Cited By ~ 1

Author(s):

Gene Huh ◽

Soon-Hyun Ahn ◽

Jun-Girl Suk ◽

Min-Hyung Lee ◽

Won Shik Kim ◽

...

Keyword(s):

Cancer Patients ◽

Laryngeal Cancer ◽

Multimodal Treatment ◽

Concurrent Chemoradiotherapy ◽

Primary Treatment ◽

Hypopharyngeal Cancer ◽

Stage Iii ◽

Laryngeal Function ◽

Significant Difference

Abstract Background Long-term side effects after radiotherapy for organ preservation ‘could deteriorate’ the laryngeal function. This study intended to identify the incidence of severe late dysphagia following the multimodal treatment for stage III/IV laryngeal and hypopharyngeal cancer ‘to evaluate the function of larynx’. Methods The medical records of patients successfully treated for laryngeal and hypopharyngeal cancer with a multimodal approach, including radiotherapy, were retrospectively analyzed. ‘Functional larynx was defined as tolerable oral diet without severe late dysphagia or tracheostoma’. Results The study included 99 patients with a median follow-up period of 72 months. ‘Tracheostomy during the follow-up period was required in only one patient due to aspiration pneumonia, and dysphagia is the main determinant for functional larynx’. The probability of maintaining functional larynx was 63% for 10 years, when the treatment was started with radiotherapy or concurrent chemoradiotherapy. In upfront surgery (operation first and adjuvant radiotherapy/concurrent chemoradiotherapy) group, 37% of patients required total laryngectomy as primary treatment and 43% of patients could maintain laryngeal function for 10 years. And severe late dysphagia in the latter group developed mainly after laryngeal preservation surgery. The patients aged ≥65 years showed significantly higher incidence of dysphagia. Severe late dysphagia was very rare in laryngeal cancer successfully cured with radiotherapy/concurrent chemoradiotherapy (1/25, 4%); however, it gradually increased over time in hypopharyngeal cancer patients showing a statistically significant difference from laryngeal cancer patients (P = 0.040). Conclusion Severe late dysphagia occurred in 19.2% of patients treated for laryngeal and hypopharyngeal cancers, regardless of whether treatment started with radiotherapy/concurrent chemoradiotherapy or surgery.

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