Risk analysis for tracheostomy dependency in curatively treated laryngeal cancer with organ preservation

Anschuetz, Lukas; Visini, Miranda; Shelan, Mohamed; Eliçin, Olgun; Giger, Roland

doi:10.1002/hed.25373

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…It is the duty of the treating multidisciplinary team to evaluate survival and functional results and their impact on patient's quality of life to adequately counsel the patients. Finally, the patient should be able to make an informed decision and have the possibility to trade off chance of survival against treatment related morbidity 14, 15 …”

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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Section: Discussionmentioning

confidence: 99%

Predicting Factors for Oncological and Functional Outcome in Hypopharyngeal Cancer

et al. 2020

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“…According to the literature reporting only results of laryngeal SCC, the necessity of a tracheostomy varies between 8.2 and 25% [9–11]. Factors related to permanent tracheostomies are pre-treatment tracheostomy, extension of disease (poor laryngeal function prior to treatment), post-irradiated planned or salvage neck dissection and primary RT in the context of organ-preservation protocols [12–15]. Moreover, it has been discussed in the literature, whether the presence of long-term tracheostomy influences the overall survival, but apparently the 5-year survival is not influenced [13].…”

Section: Discussionmentioning

confidence: 99%

Long-term functional outcome after laryngeal cancer treatment

et al. 2019

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Background The functional outcome after the treatment of laryngeal cancer is tightly related to the quality of life of affected patients. The aim of this study is to describe the long-term morbidity and functional outcomes associated with the different treatment modalities for laryngeal cancer. Methods Retrospective chart review of 477 patients undergoing curatively intended treatment for laryngeal cancer at our tertiary referral center from 2001 to 2014: Details on patient and disease characteristics, diagnostics and treatment related functional outcomes were analyzed. Results With a median follow-up of 51 months, the crude rate of functional larynx preservation was 74.6%. Radiotherapy +/− chemotherapy was the dominant treatment modality ( n = 359–75.3%), whereas 24.7% ( n = 118) underwent primary surgery, with 58.5% (69) receiving adjuvant treatment. The 5-year laryngectomy-free survival was 57% (95% CI, 48–66%) after surgery vs. 69% (95% CI, 64–75%) after chemoradiotherapy ( p < 0.01). In stage III-IVB, these rates were 26% (95% CI, 16–39%) vs. 47% (95% CI, 36–59%), respectively ( p < 0.01). Aspiration occurred in 7%, tracheostomy was necessary in 19.8% and feeding tube placement in 25.4%. Feeding tube and tracheostomy necessity was higher in the initially surgically treated group. Primary surgery (HR: 1.67, 95% CI: 1.19–2.32; p < 0.01), stage III-IVB (HR: 4.07, 95% CI: 2.97–5.60; p < 0.01) and tumor recurrence (HR: 3.83, 95% CI: 2.79–5.28; p < 0.01) remained as adverse factors for laryngectomy-free survival. Conclusions Preserving the laryngeal function after cancer treatment is challenging. Advanced tumor stages, primary surgery and recurrence are related to a poor functional outcome. Therefore, the criteria for initial decision-making needs to be further refined. Electronic supplementary material The online version of this article (10.1186/s13014-019-1299-8) contains supplementary material, which is available to authorized users.

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“…Protection of the respiratory tract against the possibility of acute obstruction is always considered paramount 1 . However, the introduction of a surgical airway like a tracheostomy brings with it a significant negative impact on patient quality of life 2,3 . This is an especially important decision in laryngeal cancer, as not only will the patient have to bear the challenges of a tracheostomy, but there is some evidence suggesting that pre‐treatment tracheostomy may be associated with poorer oncologic outcomes 4–6 .…”

Section: Introductionmentioning

confidence: 99%

“…1 However, the introduction of a surgical airway like a tracheostomy brings with it a significant negative impact on patient quality of life. 2,3 This is an especially important decision in laryngeal cancer, as not only will the patient have to bear the challenges of a tracheostomy, but there is some evidence suggesting that pre-treatment tracheostomy may be associated with poorer oncologic outcomes. [4][5][6] An additional option of endoscopic tumor debulking exists as well for select neoplastic cases, but its effects are temporary and it does not always preclude the need for tracheostomy before or during definitive cancer treatment.…”

Section: Introductionmentioning

confidence: 99%

Airway Resistance and Respiratory Distress in Laryngeal Cancer: A Computational Fluid Dynamics Study

et al. 2023

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BackgroundObstructive upper airway pathologies are a great clinical challenge for the airway surgeon. Protection against acute obstruction is critical, but avoidance of unnecessary tracheostomy must also be considered. Decision‐making regarding airway, although supported by some objective findings, is largely guided by subjective experience and training. This investigation aims to study the relationship between clinical respiratory distress and objective measures of airway resistance in laryngeal cancer as determined by computational fluid dynamic (CFD) and morphometric analysis.MethodsRetrospective CT and clinical data were obtained for series of 20 cases, defined as newly diagnosed laryngeal cancer patients who required admission or urgent airway surgery, and 20 controls. Cases and controls were matched based on T‐staging. Image segmentation and morphometric analysis were first performed. Computational models based on the lattice Boltzmann method were then created and used to quantify the continuous mass flow, rigid wall, and constant static pressure inlet boundary conditions.ResultsThe analysis demonstrated a significant relationship between airway resistance and acute obstruction (OR 1.018, 95% CI 1.001–1.045). Morphometric analysis similarly demonstrated a significant relationship when relating measurements based on the minimum cross‐section, but not on length of stenosis. Morphometric measurements also showed significance in predicting CFD results, and their relationship demonstrated that airway pressures increase exponentially below 2.5 mm. Tumor subsite did not show a significant difference, although the glottic subgroup tended to have higher resistances.ConclusionAirway resistance analysis from CFD computation correlated with presence of acute distress requiring emergent management. Morphometric analysis showed a similar correlation, demonstrating a radiologic airway assessment technique on which future risk estimation could be performed.Level of Evidence4 (case–control study) Laryngoscope, 133:2734–2741, 2023

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Risk analysis for tracheostomy dependency in curatively treated laryngeal cancer with organ preservation

Cited by 5 publications

References 18 publications

Predicting Factors for Oncological and Functional Outcome in Hypopharyngeal Cancer

Predicting Factors for Oncological and Functional Outcome in Hypopharyngeal Cancer

Long-term functional outcome after laryngeal cancer treatment

Airway Resistance and Respiratory Distress in Laryngeal Cancer: A Computational Fluid Dynamics Study

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