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The Laryngoscope

Comorbid predictors of poor response to chemoradiotherapy for laryngeal squamous cell carcinoma

Authors

  • Melissa Hu MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health–Shreveport, Shreveport, Louisiana, U.S.A.
    2. Feist-Weiller Cancer Center, Louisiana State University Health–Shreveport, Shreveport, Louisiana, U.S.A.
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  • Fred Ampil MD,

    1. Department of Radiation Oncology, Louisiana State University Health–Shreveport, Shreveport, Louisiana, U.S.A.
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  • Cheryl Clark PhD,

    1. Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health–Shreveport, Shreveport, Louisiana, U.S.A.
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  • Kunal Sonavane MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health–Shreveport, Shreveport, Louisiana, U.S.A.
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  • Gloria Caldito PhD,

    1. Department of Biometry, Louisiana State University Health–Shreveport, Shreveport, Louisiana, U.S.A.
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  • Cherie-Ann O. Nathan MD

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health–Shreveport, Shreveport, Louisiana, U.S.A.
    2. Feist-Weiller Cancer Center, Louisiana State University Health–Shreveport, Shreveport, Louisiana, U.S.A.
    • Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Shreveport, Feist-Weiller Cancer Center, 1501 Kings Highway, Shreveport, LA 71130-3932
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

To investigate whether a correlation exists between medical comorbidities and disease control following primary therapy of laryngeal squamous cell carcinoma.

Study Design:

Retrospective medical record review.

Methods:

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.

Results:

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.

Conclusions:

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.

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