Vlad C Sandulache1, Laura J Vandelaar2, Heath D Skinner3, Juan Cata4, Katherine Hutcheson5, Clifton David Fuller3, Jack Phan3, Zuhair Siddiqui2, Stephen Y Lai5, Randal S Weber5, Mark E Zafereo5. 1. Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas. 2. The University of Texas Medical School at Houston, Houston, Texas. 3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 4. Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas. 5. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Abstract
BACKGROUND: The purpose of this study was to present our evaluation of the clinical and functional outcomes after salvage total laryngectomy (STL). METHODS: We conducted a retrospective review of 218 patients who underwent STL between 1994 and 2014. RESULTS: Seventy percent of patients originally had T1 or T2, N0 tumors and 73% had definitive external-beam radiotherapy (EBRT) alone. A majority utilized tracheoesophageal prosthesis (77%) and were gastrostomy free (80%) at last follow-up. The 5-year disease control and overall survival (OS) rates were 65% and 57%, respectively. Patients with a disease-free interval after initial treatment <2 years were more likely to develop a recurrence (p = .001) and die of disease (p = .032) after STL. The disease-free interval after EBRT impacted disease control (p < .001), with 5-year disease control of 92% for >5-year disease-free interval and 60% for <2-year disease-free interval. CONCLUSION: Most patients remain disease-free after STL, achieve intelligible tracheoesophageal speech, and maintain an oral diet. Delayed recurrence after initial treatment portends better survival and may indicate a distinct biological profile.
BACKGROUND: The purpose of this study was to present our evaluation of the clinical and functional outcomes after salvage total laryngectomy (STL). METHODS: We conducted a retrospective review of 218 patients who underwent STL between 1994 and 2014. RESULTS: Seventy percent of patients originally had T1 or T2, N0 tumors and 73% had definitive external-beam radiotherapy (EBRT) alone. A majority utilized tracheoesophageal prosthesis (77%) and were gastrostomy free (80%) at last follow-up. The 5-year disease control and overall survival (OS) rates were 65% and 57%, respectively. Patients with a disease-free interval after initial treatment <2 years were more likely to develop a recurrence (p = .001) and die of disease (p = .032) after STL. The disease-free interval after EBRT impacted disease control (p < .001), with 5-year disease control of 92% for >5-year disease-free interval and 60% for <2-year disease-free interval. CONCLUSION: Most patients remain disease-free after STL, achieve intelligible tracheoesophageal speech, and maintain an oral diet. Delayed recurrence after initial treatment portends better survival and may indicate a distinct biological profile.
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