The authors have no funding, financial relationships, or conflicts of interest to disclose.
Head and Neck
Comorbid predictors of poor response to chemoradiotherapy for laryngeal squamous cell carcinoma†
Article first published online: 17 JAN 2012
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 122, Issue 3, pages 565–571, March 2012
How to Cite
Hu, M., Ampil, F., Clark, C., Sonavane, K., Caldito, G. and Nathan, C.-A. O. (2012), Comorbid predictors of poor response to chemoradiotherapy for laryngeal squamous cell carcinoma. The Laryngoscope, 122: 565–571. doi: 10.1002/lary.22489
- Issue published online: 21 FEB 2012
- Article first published online: 17 JAN 2012
- Accepted manuscript online: 6 DEC 2011 03:51AM EST
- Manuscript Accepted: 14 NOV 2011
- Manuscript Revised: 27 OCT 2011
- Manuscript Received: 18 SEP 2011
- laryngeal cancer;
- Level of Evidence: 2b
To investigate whether a correlation exists between medical comorbidities and disease control following primary therapy of laryngeal squamous cell carcinoma.
Retrospective medical record review.
A retrospective chart review was performed on patients diagnosed with laryngeal carcinoma between 1997 and 2011. The Adult Comorbidity Evaluation 27 (ACE 27) index was used to evaluate severity of comorbid health. Ten-year disease-free survival rates and median disease-free intervals were calculated, and significant associations between disease recurrence and comorbid factors were determined using the log-rank test. Independent significant risk factors for disease recurrence were determined with the Cox proportional hazard regression model.
Of the 181 patients identified, 121 were treated nonsurgically with either primary radiotherapy (XRT) (49%) or chemoradiotherapy (CRT) (51%). Sixty patients (50%) experienced recurrence of their disease. The 10-year disease-free survival rate was 23.8%, and the median disease-free survival was 58 months (95% confidence interval, 12-108 months). Factors observed to be significantly associated with recurrence within 10 years after treatment were renal disease (P < .01), pulmonary disease (P < .01), malnutrition (P < .01), T size (P < .01), stage (P = .02), and ACE 27 Index (P < .01). Independent significant risk factors for recurrence were malnutrition (P < .01), T stage (P = .01), and ACE 27 (P < .01). Adjusted hazard ratios were 1.43 for T stage, 2.58 for ACE 27, and 2.15 for malnutrition.
The results of this study demonstrate that there is a significant association between increased comorbidity and recurrent disease in laryngeal carcinoma treated with XRT/CRT. The consideration of comorbid health in primary treatment planning may improve the success and survival of patients with laryngeal squamous cell carcinoma.