Oncologic and functional outcomes of pretreatment tracheotomy in advanced laryngeal squamous cell carcinoma: A multi-institutional analysis

Serena A Byrd; Mary J Xu; Lauren M Cass; Daniel J Wehrmann; Matthew Naunheim; Kara Christopher; John J Dombrowski; Ronald J Walker; Lori Wirth; John Clark; Paul Busse; Annie Chan; Daniel G Deschler; Kevin Emerick; Derrick T Lin; Mark A Varvares

doi:10.1016/j.oraloncology.2018.01.018

Oncologic and functional outcomes of pretreatment tracheotomy in advanced laryngeal squamous cell carcinoma: A multi-institutional analysis

Oral Oncol. 2018 Mar:78:171-176. doi: 10.1016/j.oraloncology.2018.01.018. Epub 2018 Feb 20.

Authors

Serena A Byrd¹, Mary J Xu², Lauren M Cass³, Daniel J Wehrmann⁴, Matthew Naunheim⁵, Kara Christopher⁶, John J Dombrowski⁷, Ronald J Walker⁸, Lori Wirth⁹, John Clark¹⁰, Paul Busse¹¹, Annie Chan¹², Daniel G Deschler¹³, Kevin Emerick¹⁴, Derrick T Lin¹⁵, Mark A Varvares¹⁶

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, 3635 Vista Ave 6FDT, St Louis, MO 63011, United States. Electronic address: byrds@mskcc.org.
² Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States. Electronic address: mary.xu@ucsf.edu.
³ Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, 3635 Vista Ave 6FDT, St Louis, MO 63011, United States. Electronic address: lauren.cass@health.slu.edu.
⁴ Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, 3635 Vista Ave 6FDT, St Louis, MO 63011, United States. Electronic address: daniel.wehrmann@health.slu.edu.
⁵ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States. Electronic address: matthew_naunheim@meei.harvard.edu.
⁶ Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, 3635 Vista Ave 6FDT, St Louis, MO 63011, United States. Electronic address: kara.christopher@health.slu.edu.
⁷ Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, 3635 Vista Ave 6FDT, St Louis, MO 63011, United States. Electronic address: john.dombrowski@health.slu.edu.
⁸ Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, 3635 Vista Ave 6FDT, St Louis, MO 63011, United States. Electronic address: ron.walker@health.slu.edu.
⁹ Department of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, United States. Electronic address: Lori.wirth@dfci.harvard.edu.
¹⁰ Department of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, United States. Electronic address: jrclark@partners.org.
¹¹ Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States. Electronic address: pbusse@partners.org.
¹² Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States. Electronic address: awchan@partners.org.
¹³ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States. Electronic address: daniel_deschler@meei.harvard.edu.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States. Electronic address: kevin.emerick@meei.harvard.edu.
¹⁵ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States. Electronic address: derrick_lin@meei.harvard.edu.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States. Electronic address: mark_varvares@meei.harvard.edu.

PMID: 29496047
DOI: 10.1016/j.oraloncology.2018.01.018

Abstract

Objectives: Describe the influence of pretreatment tracheotomy and treatment modality (surgical versus non-surgical) on oncologic and functional outcomes.

Materials and methods: Retrospective study of previously untreated advanced-stage laryngeal squamous cell carcinoma patients at two academic tertiary care institutions from 1995 to 2014.

Results: Primary outcomes evaluated were disease-free survival, disease-specific survival, and overall survival of pretreatment tracheotomy versus no pretreatment tracheotomy cohorts. Functional status, measured by tracheotomy decannulation and gastrostomy tube placement/removal, was assessed. Of the 226 patients, 31.4% underwent pretreatment tracheotomy. Five-year disease-specific survival was 72.9%, and overall survival was 48.8% for entire cohort. There was a statistically significant decrease in overall survival (p = .03) and disease-free survival (p = .02) for the pretreatment tracheotomy group compared to no pretreatment tracheotomy, which was largely explained by primary tumor stage. Pretreatment tracheotomy was associated with gastrostomy tube placement and was an independent predictor of worse odds of gastrostomy tube removal. Disease stage, distant metastasis, and age independently conferred worse odds of gastrostomy tube removal.

Conclusion: Patients undergoing pretreatment tracheotomy for primary T4 laryngeal cancer had decreased overall survival compared to patients without pretreatment tracheotomy. There was no difference in local recurrence rates based on tracheotomy status. Organ preservation with chemotherapy and radiation did not result in better functional outcomes than surgery in the pretreatment tracheotomy group as nearly half of patients treated with organ preservation remained tracheotomy dependent. Based on this data, pretreatment tracheotomy may impact oncologic and functional outcomes in advanced disease, and it should be a consideration in an informed decision-making process.

Keywords: Head and neck cancer; Laryngeal neoplasms; Laryngology; Quality of life; Trachea; Treatment outcomes.

Publication types

Multicenter Study

MeSH terms

Adult
Aged
Carcinoma, Squamous Cell / physiopathology
Carcinoma, Squamous Cell / surgery*
Female
Humans
Laryngeal Neoplasms / physiopathology
Laryngeal Neoplasms / surgery*
Male
Middle Aged
Quality of Life
Tracheotomy*
Treatment Outcome