Organ Function Preservation Failure after (Chemo)Radiotherapy in Head and Neck Cancer: A Retrospective Cohort Analysis.
OBJECTIVE
The aim of the current study was to determine the incidence of organ function preservation failure (OFPF) in patients with head and neck squamous cell carcinoma (HNSCC) treated by (chemo)radiotherapy and to identify its risk factors.


STUDY DESIGN
Retrospective cohort analysis.


SETTING
Tertiary cancer care center.


SUBJECTS AND METHODS
A single-center retrospective cohort analysis was done (n = 703) in which OFPF after (chemo)radiotherapy was assessed. OFPF was defined as local failure or pure functional failure in the absence of local failure because of major surgical intervention (total laryngectomy, commando resection, permanent tracheostomy) or feeding tube dependence >2 years.


RESULTS
OFPF occurred in 153 patients (21.8%). Reasons for OFPF were local failure in 103 patients (14.6%) and functional failure in 50 patients (7.2%). Evidence of functional failure included need for total laryngectomy (n = 9, 1.3%), commando resection (n = 2, 0.3%), permanent tracheostomy (n = 16, 2.3%), and/or long-term feeding tube for functional reasons (n = 23, 3.3%). In a Cox proportional hazards model, OFPF was worse for patients with T4 tumors (hazard ratio [HR] <0.5 and P < .001 for all other stages), for laryngeal vs oropharyngeal cancer (HR, 1.83; 95% confidence interval [CI], 1.20-2.79, P = .005, hypopharyngeal not significant), and for smokers (HR, 1.68; 95% CI, 1.10-2.56, P = .015). Exploratory multivariate analysis by tumor site showed that T4 tumor and pretreatment tracheostomy were the strongest predictive factors for OFPF in laryngeal and hypopharyngeal carcinoma while T4 tumor and smoking were predictive for poor OFPF in oropharyngeal carcinoma.


CONCLUSION
This work shows a detrimental effect of smoking on functional outcomes after (chemo-)radiotherapy for HNSCC. Moreover, T4 tumor, laryngeal subsite, and pretreatment tracheostomy are strong predictors of OFPF.
['Heukelom|Jolien|J|', 'Navran|Arash|A|', 'Gouw|Zeno A R|ZAR|', 'Tesselaar|Margot E|ME|', 'Zuur|Charlotte L|CL|', 'van Werkhoven|Erik|E|', 'Sonke|Jan-Jakob|JJ|', 'Rasch|Coen R N|CRN|', 'Al-Mamgani|Abrahim|A|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002294:Carcinoma, Squamous Cell D059248:Chemoradiotherapy D015331:Cohort Studies D005260:Female D006801:Humans D007012:Hypopharyngeal Neoplasms D007822:Laryngeal Neoplasms D007825:Laryngectomy D008297:Male D008875:Middle Aged D009959:Oropharyngeal Neoplasms D012189:Retrospective Studies D012307:Risk Factors D014139:Tracheostomy D017211:Treatment Failure
organ function preservation head and neck cancer functional failure chemoradiation toxicity