Complications and toxicity of re-irradiation following total laryngectomy for laryngeal cancer

Objectives Study outcomes of re-irradiation after salvage total laryngectomy (TL) for patients with recurrent laryngeal cancer. Determine overall survival (OS) and progression-free survival (PFS). Determine the incidence of severe complications associated with re-irradiation with a focus on carotid blowout (CB). Methods Patients previously irradiated, with recurrent or second primary cancer of the larynx status-post salvage TL who received a second course of radiation from 2000 to 2017 were identified. Toxicities were measured using the CTCAE 4.0. Major toxicities were defined as grade 3+. Survival data and Kaplan-Meier curves were computed in SAS 9.4. Results Twenty-six patients were included in the analysis. Seventeen had progression of disease and 16 died during the follow-up period. Nine patients had no evidence of disease (NED) at last follow-up. One-, two-, and five-year OS were 65.8%, 44.2%, and 23.2%. One-, two-, and five-year PFS were 48.4%, 24.7%, and 18.5%. The most common severe toxicities were fibrosis (61.5%), dysphagia (53.8%), and wound healing complication (23.1%). Four patients (15.4%) suffered carotid blowouts. Two blowouts were preceded by manipulation of the aerodigestive tract. Conclusion Patients undergoing re-irradiation for recurrent laryngeal cancer have a poor prognosis with high risk of progression or recurrence. Re-irradiation may offer survival benefit at the expense of significant toxicities. The incidence of severe toxicity is high enough to warrant pretreatment counseling. Carotid blowout was seen in 15% of patients unrelated to cancer progression. Caution should be exercised in re-irradiated patients before instrumentation of the aerodigestive tract.