Chondroradionecrosis of the larynx in patients treated with organ preservation therapy (original) (raw)

Otolaryngology - Head and Neck Surgery, 2004

Abstract

ABSTRACT Objectives: In recent years, there is increasing emphasis on organ-sparing treatment paradigms for advanced head and neck cancer patients for whom the surgical treatment option would otherwise include total laryngectomy. However, there may be increased complications of therapy such as loss of voice, airway, and aspiration control due to chondroradionecrosis. The purpose of this study is to determine the incidence of chondroradionecrosis in a population of patients treated with organ-sparing intent and to analyze the risk factors and management issues.Methods: A total of 129 patients with Stage III and IV squamous cell carcinoma of the larynx or hypopharynx were treated with concurrent radiotherapy and targeted with intra-arterial infusion of cisplatin for definitive curative treatment and larynx preservation over a 9-year period. The research database pertaining to these patients and their hospital and outpatient charts was reviewed.Results: Twelve of 129 patients (9.3%) developed Chandler Grade III or IV chondroradionecrosis of the larynx in the posttreatment period; 3/12 (25%) required total laryngectomy for resolution of the necrosis and 1/12 (8.3%) underwent a surgical procedure for aspiration control. This represents an overall need for nonmalignant laryngectomy in this treatment population of 2.3%.Conclusions: The percentage of chemoradiotherapy patients with chondroradionecrosis appears increased as compared to previous patients treated with radiotherapy alone. However, the risk (2.3%) of total laryngectomy for chondroradionecrosis may be acceptable to many or most individuals with advanced head and neck cancer. It is imperative that this issue be discussed in advance to allow patients to make informed treatment decisions.

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