Factors predicting suitability of organ preservation with radiation therapy in laryngeal and hypopharyngeal cancer

Abstract

Objective: In the treatment of laryngeal and hypopharyngeal cancer, organ preservation is ideal as it allows for retained swallowing function and improved quality of life. We hypothesize that pretreatment patient and tumor characteristics can be used to create a predictive model to determine which patients will benefit most from organ preservation.

Methods: We performed a retrospective review of a prospectively maintained database for 58 patients with laryngeal and hypopharyngeal cancer treated with radiation therapy at our institution from 2006 to 2013. Patients were evaluated with a modified barium swallow test (MBS) before and after treatment. Additionally three scales were used to describe swallowing function: the Functional Oral Intake Scale (FOIS), the 8-point penetration/aspiration scale, and the Swallowing Performance Status Scale (SPSS). Stepwise regressions were used to explore possible predictors in the following four models:  demographics, disease characteristics, treatment characteristics, and initial swallowing function.

Results: Once significant predictors were established, a final predictive model was created controlling for transcutaneous neuromuscular electrical stimulation (TNMES) and pretreatment swallowing scores.  Black race (p=0.016) and those with poorer FOIS (p=0.002), SPSS (0.007), and 8-point (p=0.014) scores at baseline experienced worse swallowing and aspiration outcomes after completion of treatment. Those who were classified as g-tube dependent on the FOIS at baseline remained dependent at follow-up (p=0.008).

Conclusions: Initial swallowing dysfunction, as well as feeding tube placement, is highly predictive of poor swallowing outcome after organ preservation.  Additionally, black race may be related to worse outcome.