Laryngo-esophageal dysfunction free survival and propensity score matched analysis comparing organ preservation and total laryngectomy in hypopharynx cancer

Petersen, Japke F.; Arends, Coralie R.; Noort, Vincent van der; Al‐Mamgani, Abrahim; Boer, Jan Paul de; Stuiver, Martijn M.; Brekel, Michiel W. M. van den

doi:10.1016/j.oraloncology.2019.06.018

Cited by 6 publications

(5 citation statements)

References 38 publications

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“…Despite this, our hypopharyngeal 5‐year OS of 29% is comparable to the EORTC 24891 trial's surgery and chemoradiotherapy cohorts and other reports of hypopharyngeal patients treated with CRT 27,28 . However, our 5‐year OS is inferior to some reports of hypopharyngeal patients treated with primary surgery, including the GORTEC 2000‐01 study 27,29,30 . The differences in survival outcomes may be due to the differences in inclusion criteria, especially lower T stage disease.…”

Section: Discussioncontrasting

confidence: 64%

“…27,28 However, our 5-year OS is inferior to some reports of hypopharyngeal patients treated with primary surgery, including the GORTEC 2000-01 study. 27,29,30 The differences in survival outcomes may be due to the differences in inclusion criteria, especially lower T stage disease. We observed a LRF of 19%, similar to both the surgery (19%) and induction-chemotherapy arms (23%) in the EORTC trial, demonstrating a potential noninferiority of nonsurgical management.…”

Section: Hypopharynx Cancer Groupmentioning

confidence: 99%

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Outcomes for Organ Preservation with Chemoradiation Therapy for T4 Larynx and Hypopharynx Cancer

et al. 2022

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Objective: Limited data is available to guide non-surgical management of Stage T4 larynx and hypopharynx cancer patients who have inoperable disease or refuse surgery. We aim to review the nonoperative management of T4 laryngeal and hypopharyngeal cancer and report the long-term therapeutic and functional outcomes.Methods: We reviewed the nonoperative management of T4 laryngeal (n = 44) and hypopharyngeal (n = 53) cancer from 1997 to 2015 and performed a univariate analysis (UVA).Results: The 2-/5-year OS rates were 73%/38% for larynx patients and 52%/29% for hypopharynx patients. Locoregional failure (LRF) occurred in 25% and 19% of larynx and hypopharynx patients, respectively. On UVA of the larynx subset, N3 nodal status and non-intensity-modulated radiation therapy were negatively associated with OS; treatment with radiation therapy alone impacted disease-free survival; and age >70 was associated with LRF. On UVA of the hypopharynx subset, only T4b status significantly impacted OS. In the larynx and hypopharynx groups, 68% and 85% received a percutaneous endoscopic gastrostomy (PEG) tube and 32% and 40% received a tracheostomy tube, respectively. At the last follow-up visit, 66% of our larynx cohort had neither tracheostomy or PEG placed and 40% of our hypopharynx cohort had neither. Conclusion:We report better than previously noted outcomes among T4 larynx and hypopharynx patients who have unresectable disease or refuse surgery.

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Section: Discussioncontrasting

confidence: 64%

Section: Hypopharynx Cancer Groupmentioning

confidence: 99%

Outcomes for Organ Preservation with Chemoradiation Therapy for T4 Larynx and Hypopharynx Cancer

et al. 2022

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“…The 2‐year and 5‐year LDFS following chemoradiotherapy was higher than the corresponding rate following radiotherapy. In summary, functional outcomes following chemoradiotherapy or radiotherapy appear to be disappointing and demand improved treatment strategies 17 …”

Section: Discussionmentioning

confidence: 99%

Predicting Factors for Oncological and Functional Outcome in Hypopharyngeal Cancer

et al. 2020

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Objectives/Hypothesis Hypopharyngeal squamous cell carcinoma (SCC) is a rare but aggressive malignancy, with low survival rates and high incidence of tumor and treatment‐related morbidity. This study aims to analyze the long‐term oncologic and functional outcomes of a large cohort of patients and to determine prognostic factors. Study Design Retrospective cohort study. Methods The records of all patients diagnosed with hypopharyngeal SCC and treated with curative intent at our tertiary referral center were reviewed. Patient and initial disease characteristics, features, and complications of primary treatment, recurrence patterns, and corresponding treatments and the oncologic and functional long‐term outcome were determined. Results For a total of 179 patients, primary radiotherapy (RT) was the predominant treatment modality (78%), whereas 22% underwent primary surgery. The median, 2‐year, and 5‐year overall survival (OS) for the study cohort were 47 months, 64% and 43%. The median survival after first and second relapse was 7 and 6 months, respectively. The 2 and 5‐year relapse‐free survival (RFS) was 52% and 36%. The median RFS after first relapse and salvage treatment was 9 months. A nodal status of ≥cN2 (HR = 1.89, CI:1.21–3.05, P < .005) and any other primary tumor localization than pyriform sinus (HR = 1.60, CI: 1.04–2.42, P < .05) were identified as independent risk factors for shorter OS and RFS. Regarding functional outcome, the 2‐ and 5‐year laryngectomy‐free‐survival was 55% and 37%, respectively. Conclusions In this large cohort with long‐term follow‐up, any other primary tumor localization than pyriform sinus and a nodal status of ≥cN2 were identified as risk factors for reduced OS and RFS. Level of Evidence 4 Laryngoscope, 131:E1543–E1549, 2021

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“…4 Across all cases of total laryngectomy, stricture and difficulty swallowing are known complications, 5,6 but this rate is even higher in patients undergoing salvage total laryngectomy, as these patient have an increased rate of gastrostomy tube dependency related to swallowing difficulty-between 20% and 40% in various studies. [5][6][7][8][9][10] Swallowing difficulty is also among the most significant factors to patients when rating their own quality of life. 11,12 Further, gastrostomy tube dependency has been shown to be associated with longer length of stay, increased complications, higher readmission rates, and poorer quality of life across all types of head and neck cancer.…”

Section: Introductionmentioning

confidence: 99%

“…Across all cases of total laryngectomy, stricture and difficulty swallowing are known complications, 5,6 but this rate is even higher in patients undergoing salvage total laryngectomy, as these patient have an increased rate of gastrostomy tube dependency related to swallowing difficulty—between 20% and 40% in various studies 5–10 . Swallowing difficulty is also among the most significant factors to patients when rating their own quality of life 11,12 .…”

Section: Introductionmentioning

confidence: 99%

Predictors of Stricture and Swallowing Function Following Salvage Laryngectomy

et al. 2020

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Background: Long-term functional outcomes are poorly characterized for salvage laryngectomy. We identified predictors of esophageal stricture and swallowing function after salvage laryngectomy in a large cohort.Methods: A retrospective study of 233 patients who underwent salvage total laryngectomy for recurrent/persistent squamous cell carcinoma of the larynx or hypopharynx after radiation (XRT) or chemoradiation (CRT) was performed. Primary outcomes were esophageal dilation within 1 year, time to dilation, and gastrostomy tube dependence. Multivariate logistic and Cox regressions were used for statistical analysis.Results: Dilation was performed in 29.9% of patients. Dilation was twice as likely in patients with post-operative fistula compared to those without (Hazard Ratio (HR) 2.10, 95% Confidence Interval (CI) 1.06-4.13, P = .03). Every year between XRT/CRT and salvage was associated with 10% increase in dilation (HR 1.09, 95% CI 1.03-1.17, P = .01). No factors were associated with dilation by 1 year. About 10% of patients were at least partially gastrostomy tube-dependent 1 year post-operatively. At last follow-up (median 29 months), this rate was 13%. Patients with supraglottic recurrence had an increased risk of gastrostomy tube dependence at 1 year compared to glottic (OR 16.7, 95% CI 1.73-160, P = .02). For every 10 pack years pre-salvage, the OR of requiring tube feeds at last follow-up was 1.24 (95% CI 1.04-1.48, P = .02).Conclusions: Fistula and pre-salvage smoking were associated with stricture post-salvage laryngectomy. No factors were associated with dilation by 1 year. Supraglottic recurrence and smoking were associated with gastrostomy tube dependence. These findings are important for pre-operative counseling prior to salvage laryngectomy.

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Laryngo-esophageal dysfunction free survival and propensity score matched analysis comparing organ preservation and total laryngectomy in hypopharynx cancer

Cited by 6 publications

References 38 publications

Outcomes for Organ Preservation with Chemoradiation Therapy for T4 Larynx and Hypopharynx Cancer

Outcomes for Organ Preservation with Chemoradiation Therapy for T4 Larynx and Hypopharynx Cancer

Predicting Factors for Oncological and Functional Outcome in Hypopharyngeal Cancer

Predictors of Stricture and Swallowing Function Following Salvage Laryngectomy

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