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

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)171-176
Number of pages6
JournalOral Oncology
Volume78
DOIs
StatePublished - Mar 2018

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Tracheotomy
Squamous Cell Carcinoma
Gastrostomy
Survival
Organ Preservation
Disease-Free Survival
Laryngeal Neoplasms
Tertiary Healthcare

Keywords

  • Head and neck cancer
  • Laryngeal neoplasms
  • Laryngology
  • Quality of life
  • Trachea
  • Treatment outcomes

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research

Cite this

Oncologic and functional outcomes of pretreatment tracheotomy in advanced laryngeal squamous cell carcinoma : A multi-institutional analysis. / Byrd, Serena A.; Xu, Mary J.; Cass, Lauren M.; Wehrmann, Daniel J.; Naunheim, Matthew; Christopher, Kara; Dombrowski, John J.; Walker, Ronald J.; Wirth, Lori; Clark, John; Busse, Paul; Chan, Annie; Deschler, Daniel G.; Emerick, Kevin; Lin, Derrick T.; Varvares, Mark A.

In: Oral Oncology, Vol. 78, 03.2018, p. 171-176.

Research output: Contribution to journalArticle

Byrd, SA, Xu, MJ, Cass, LM, Wehrmann, DJ, Naunheim, M, Christopher, K, Dombrowski, JJ, Walker, RJ, Wirth, L, Clark, J, Busse, P, Chan, A, Deschler, DG, Emerick, K, Lin, DT & Varvares, MA 2018, 'Oncologic and functional outcomes of pretreatment tracheotomy in advanced laryngeal squamous cell carcinoma: A multi-institutional analysis', Oral Oncology, vol. 78, pp. 171-176. https://doi.org/10.1016/j.oraloncology.2018.01.018
Byrd, Serena A. ; Xu, Mary J. ; Cass, Lauren M. ; Wehrmann, Daniel J. ; Naunheim, Matthew ; Christopher, Kara ; Dombrowski, John J. ; Walker, Ronald J. ; Wirth, Lori ; Clark, John ; Busse, Paul ; Chan, Annie ; Deschler, Daniel G. ; Emerick, Kevin ; Lin, Derrick T. ; Varvares, Mark A. / Oncologic and functional outcomes of pretreatment tracheotomy in advanced laryngeal squamous cell carcinoma : A multi-institutional analysis. In: Oral Oncology. 2018 ; Vol. 78. pp. 171-176.
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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.",
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author = "Byrd, {Serena A.} and Xu, {Mary J.} and Cass, {Lauren M.} and Wehrmann, {Daniel J.} and Matthew Naunheim and Kara Christopher and Dombrowski, {John J.} and Walker, {Ronald J.} and Lori Wirth and John Clark and Paul Busse and Annie Chan and Deschler, {Daniel G.} and Kevin Emerick and Lin, {Derrick T.} and Varvares, {Mark A.}",
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T1 - Oncologic and functional outcomes of pretreatment tracheotomy in advanced laryngeal squamous cell carcinoma

T2 - A multi-institutional analysis

AU - Byrd, Serena A.

AU - Xu, Mary J.

AU - Cass, Lauren M.

AU - Wehrmann, Daniel J.

AU - Naunheim, Matthew

AU - Christopher, Kara

AU - Dombrowski, John J.

AU - Walker, Ronald J.

AU - Wirth, Lori

AU - Clark, John

AU - Busse, Paul

AU - Chan, Annie

AU - Deschler, Daniel G.

AU - Emerick, Kevin

AU - Lin, Derrick T.

AU - Varvares, Mark A.

PY - 2018/3

Y1 - 2018/3

N2 - 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.

AB - 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.

KW - Head and neck cancer

KW - Laryngeal neoplasms

KW - Laryngology

KW - Quality of life

KW - Trachea

KW - Treatment outcomes

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