The assessment of pharyngocutaneous fistula rate in patients treated primarily with definitive radiotherapy followed by salvage surgery of the larynx and hypopharynx

• Published in: The Laryngoscope 2009-09, Vol.119 (9), p.1691-1695
• Main Authors: Dirven, Richard, Swinson, Brian D., Gao, Kan, Clark, Jonathan R.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - surgery; chemoradiation; Combined Modality Therapy; Cutaneous Fistula - etiology; definitive radiotherapy; dose; Female; flap reconstruction; Humans; Hypopharyngeal Neoplasms - radiotherapy; Hypopharyngeal Neoplasms - surgery; hypopharyngectomy; Hypopharynx - surgery; Laryngeal Neoplasms - radiotherapy; Laryngeal Neoplasms - surgery; Laryngectomy; Male; Medical sciences; Middle Aged; Oral Fistula - etiology; Otorhinolaryngology. Stomatology; Pharyngeal Diseases - etiology; Pharyngocutaneous fistula; Radiotherapy Dosage; salvage surgery; Salvage Therapy; timing
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.20521

Objectives/Hypothesis: To determine whether definitive radiotherapy prior to surgery increases the rate of pharyngocutaneous fistula (PCF) following laryngectomy or hypopharyngectomy and to determine if differences in duration of time between definitive radiotherapy and surgery alters PCF rate. Study Design: A retrospective review of 152 patients treated surgically for primary laryngeal or hypopharyngeal squamous cell carcinoma. Methods: Following previous definitive radiotherapy treatment 38 patients underwent salvage surgery and 114 patients underwent primary surgery with curative intent. The PCF rate was assessed in both groups. Results: The rate of PCF was found to be significantly higher in the salvage surgery group than those undergoing primary surgery (34.2% vs. 15.7%) (P < .05). Fistula rate was also higher in the subgroup that received concurrent chemoradiation to radiotherapy alone (P = .002). The patients who developed PCF in the salvage surgery group had significantly lower median time to surgery (5.8 months) than the nonfistula group (9.8 months) (P = .032). PCF rate was 75% within 4 months of radiotherapy to salvage surgery compared to 25% after 4 months (P = .034). Within 12 months of radiotherapy this percentage was 48% compared to 0% after 12 months (P = .014). The median radiotherapy dose was significantly higher in those whose surgery was complicated by PCF (70 Gy) compared to patients who did not develop a fistula (64 Gy) (P = .001). Conclusions: Patients undergoing salvage surgery within 12 months, and in particular within 4 months, who have received high dose radiotherapy (>64 Gy) or concurrent chemoradiation are at high risk of developing PCF.