Impact of Previous Tracheotomy as a Prognostic Factor in Patients with Locally Advanced Squamous Cell Carcinoma of the Larynx Submitted to Concomitant Chemotherapy and Radiation

• Published in: O.R.L. Journal for oto-rhino-laryngology and its related specialties Vol. 70; no. 6; pp. 381 - 388
• Main Authors: Herchenhorn, Daniel, Dias, Fernando L., Ferreira, Carlos G., Araújo, Carlos M., Lima, Roberto A., Small, Isabele A., Kligerman, Jacob
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.01.2008; S. Karger AG
• Subjects: Adult; Aged; Airway Obstruction - mortality; Airway Obstruction - pathology; Airway Obstruction - surgery; Analysis of Variance; Biological and medical sciences; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Chemotherapy; Chemotherapy, Adjuvant; Combined Modality Therapy; Dermatology; Female; Head & neck cancer; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Laryngeal Neoplasms - mortality; Laryngeal Neoplasms - pathology; Laryngeal Neoplasms - therapy; Male; Medical prognosis; Medical sciences; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Staging; Original Paper; Otolaryngology; Otorhinolaryngology. Stomatology; Predictive Value of Tests; Probability; Prognosis; Proportional Hazards Models; Prospective Studies; Radiation therapy; Radiotherapy, Adjuvant; Risk Assessment; Survival Analysis; Tracheotomy - adverse effects; Tracheotomy - methods; Tumors; Tumors of the skin and soft tissue. Premalignant lesions; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Tracheotomy, prognostic factor; Chemotherapy; Radiation; Carcinoma, larynx; Human; Larynx carcinoma; Skin disease; Squamous cell carcinoma; Basal cell carcinoma; Prognosis; ENT; Tracheotomy, prognostic factor; Carcinoma, larynx; Malignant tumor; Tracheotomy; Treatment; Surgery; ENT disease; Chemotherapy; Radiation; Larynx; Larynx disease; Cancer
• ISSN: 0301-1569; 1423-0275
• DOI: 10.1159/000163034

Hypothesis: The combination of chemotherapy and radiotherapy is a standard nonsurgical treatment for locally advanced laryngeal cancer. Nevertheless, there are no validated markers to predict the outcome of nonsurgical therapies. The impact of previous tracheotomy is not clear in patients submitted to concomitant chemoradiotherapy. Study Design: A non-randomized prospective study. Prognostic factors such as stage, age, performance status, number of chemotherapy cycles, radiotherapy dose, stage VIb disease, and previous tracheotomy were analyzed using the Cox’s proportional hazard model. The Kaplan-Meier and log rank tests were used to evaluate the progression-free and overall survival. Patients and Methods: Patients with stage III/IV laryngeal carcinoma were prospectively selected. Treatment consisted of cisplatin 100 mg/m 2 every 3 weeks for 3 cycles, radiotherapy to a total dose of 70.2 Gy and salvage surgery. Results: Forty-nine patients were analyzed; tracheotomy was performed in 12 patients (24.5%) before therapy. Patients who had previous tracheotomy had a lower rate of complete response (41.7 vs. 75%, p = 0.034, HR 0.55, CI 95% 0.27–1.11), shorter progression free-survival (HR 2.83, CI 95% 1.60–4.88, p < 0.001), and median overall survival (12 vs. 56 months, HR 2.37, CI 95% 1.43–3.93, p < 0.001), in comparison to those without a tracheotomy. Moreover a significant difference was observed in 3-year survival rates (6 vs. 61%, p = 0.001), in favor of the group without tracheotomy. Interestingly, the impact of previous tracheotomy was not altered when adjusted by other prognostic factors (HR 8.7, CI 95% 3.1–24.0, p < 0.001). Conclusions: Previous tracheotomy is a negative prognostic factor for patients submitted to chemotherapy combined with radiotherapy and should be considered as a negative clinical prognostic factor in the selection of patients for more aggressive treatment strategies.