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Complications and toxicity of re-irradiation following total laryngectomy for laryngeal cancer

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objectives

Study outcomes of re-irradiation after salvage total laryngectomy (TL) for patients with recurrent laryngeal cancer. Determine overall survival (OS) and progression-free survival (PFS). Determine the incidence of severe complications associated with re-irradiation with a focus on carotid blowout (CB).

Methods

Patients previously irradiated, with recurrent or second primary cancer of the larynx status-post salvage TL who received a second course of radiation from 2000 to 2017 were identified. Toxicities were measured using the CTCAE 4.0. Major toxicities were defined as grade 3+. Survival data and Kaplan-Meier curves were computed in SAS 9.4.

Results

Twenty-six patients were included in the analysis. Seventeen had progression of disease and 16 died during the follow-up period. Nine patients had no evidence of disease (NED) at last follow-up. One-, two-, and five-year OS were 65.8%, 44.2%, and 23.2%. One-, two-, and five-year PFS were 48.4%, 24.7%, and 18.5%. The most common severe toxicities were fibrosis (61.5%), dysphagia (53.8%), and wound healing complication (23.1%). Four patients (15.4%) suffered carotid blowouts. Two blowouts were preceded by manipulation of the aerodigestive tract.

Conclusion

Patients undergoing re-irradiation for recurrent laryngeal cancer have a poor prognosis with high risk of progression or recurrence. Re-irradiation may offer survival benefit at the expense of significant toxicities. The incidence of severe toxicity is high enough to warrant pretreatment counseling. Carotid blowout was seen in 15% of patients unrelated to cancer progression. Caution should be exercised in re-irradiated patients before instrumentation of the aerodigestive tract.

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, FL, USA

    Brent D. Waldron, Ariel B. Grobman, Mikhaylo Szczupak & Zoukaa Sargi

  2. Department of Radiation Oncology, University of Miami, Miami, FL, USA

    Benjamin S. Farnia & Michael Samuels

  3. Division of Biostatistics, Department of Public Health Sciences, Biostatistics Collaboration and Consulting Core, University of Miami, Miami, FL, USA

    Kaming Lo

  4. Sylvester Comprehensive Cancer Center, Miami, FL, USA

    Zoukaa Sargi & Michael Samuels

Authors
  1. Brent D. Waldron
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  2. Ariel B. Grobman
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  3. Mikhaylo Szczupak
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  4. Benjamin S. Farnia
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  5. Kaming Lo
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  6. Zoukaa Sargi
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Correspondence to Michael Samuels.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Waldron, B.D., Grobman, A.B., Szczupak, M. et al. Complications and toxicity of re-irradiation following total laryngectomy for laryngeal cancer. J Radiat Oncol 8, 369–377 (2019). https://doi.org/10.1007/s13566-019-00407-w

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  • DOI: https://doi.org/10.1007/s13566-019-00407-w

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