Airway management before chemoradiation for advanced head and neck cancer

• Published in: Head & neck Vol. 34; no. 2; pp. 254 - 259
• Main Authors: Langerman, Alexander, Patel, Riddhi M., Cohen, Ezra E. W., Blair, Elizabeth A., Stenson, Kerstin M.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.02.2012; Wiley
• Subjects: Adult; airway management; Airway Obstruction - surgery; Algorithms; Biological and medical sciences; Carcinoma, Squamous Cell - therapy; Chemoradiotherapy; Chemotherapy; debulking; Female; Head and Neck Neoplasms - therapy; Humans; Hypopharyngeal Neoplasms - therapy; Laryngeal Neoplasms - therapy; Male; Medical sciences; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; radiation; Radiotherapy Dosage; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck; Supraglottitis - pathology; Tomography, X-Ray Computed; Tongue Neoplasms - therapy; tracheostomy; Tracheotomy; Tumors; Stomatology; ENT; Malignant tumor; Radiotherapy; Tracheotomy; Chemoradiotherapy; tracheostomy; Respiratory tract; debulking; Chemotherapy; Treatment; radiation; Surgery; airway management; ENT disease; Head and neck cancer; Combined treatment; Cancer
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.21729

Background Patients with upper aerodigestive tract tumors can have development of airway compromise both before and during chemoradiotherapy (CRT). Tracheotomy is the classic method for securing a safe airway, but tumor debulking may also be used. Methods This was a retrospective review of locoregionally advanced tumors of the base of tongue, larynx, or hypopharynx undergoing CRT between 1995 and 2007. Results Forty‐two of the 109 patients presented with signs or symptoms of airway obstruction. Of these, 28 underwent tracheotomy before CRT, and 11 had tumor debulking. Two of the 11 patients who underwent debulking required tracheotomy within 1 year after CRT for persistent edema and fibrosis. Larynx tumors were more likely to require tracheotomy or debulking than other tumors (p = .01). Conclusions Debulking is a safe and effective alternative to tracheotomy in select patients with tumor‐related airway obstruction before CRT. Patients who undergo debulking should be monitored closely for recurrence of airway compromise during and after CRT. © 2011 Wiley Periodicals, Inc. Head Neck, 2012