Tennant Paul A, Cash Elizabeth, Bumpous Jeffrey M, Potts Kevin L
Division of Otolaryngology, Department of Surgery, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky.
Head Neck. 2014 Nov;36(11):1628-33. doi: 10.1002/hed.23508. Epub 2013 Dec 18.
Despite the demonstrated survival equivalence between chemoradiation and ablative surgery as primary treatment for advanced laryngeal and hypopharyngeal cancers, a subset of patients who undergo organ-preservation therapy have persistent tracheostomy requirement after completion of treatment.
Patients who received primary chemoradiation for advanced laryngeal or hypopharyngeal cancer in a 3-year interval were identified. Rate of persistent posttreatment tracheostomy requirement was evaluated. The 12-month overall mortality rate was compared between patients who did and did not receive a tracheostomy before treatment.
In 60 patients identified for this study, T3/T4 status and hemilarynx fixation at the time of presentation were associated with persistent tracheostomy requirement 6 and 12 months posttreatment (p = .022; p < .001; and p = .032; p = .0495, respectively). Twelve-month mortality was higher in T3/T4 patients who received pretreatment tracheostomy (p = .034).
Patients with advanced laryngeal or hypopharyngeal cancer who require tracheostomy before treatment have low rates of decannulation and higher short-term mortality than those who do not require tracheostomy before organ-preservation therapy.
尽管放化疗与根治性手术作为晚期喉癌和下咽癌的主要治疗方法已证明具有生存等效性，但接受器官保留治疗的一部分患者在治疗结束后仍持续需要气管造口术。
确定在3年期间接受晚期喉癌或下咽癌初次放化疗的患者。评估治疗后持续需要气管造口术的发生率。比较治疗前接受和未接受气管造口术的患者的12个月总死亡率。
在本研究确定的60例患者中，就诊时的T3/T4状态和半喉固定与治疗后6个月和12个月持续需要气管造口术相关（分别为p = 0.022；p < 0.001；以及p = 0.032；p = 0.0495）。接受治疗前气管造口术的T3/T4患者的12个月死亡率更高（p = 0.034）。
与在器官保留治疗前不需要气管造口术的患者相比，在治疗前需要气管造口术的晚期喉癌或下咽癌患者拔管率低且短期死亡率高。
