(A740) Upfront Tracheostomy for Laryngeal Cancer Affords Worse Survival Than Endoscopic Debulking Despite Similar Tumor Burden

Introduction: Advanced laryngeal squamous cell carcinoma (LSCC) is a devastating disease. Patients typically require surgical intervention to stabilize the airway prior to definitive chemoradiotherapy (CRT). Prior work has shown that Upfront Tracheostomy (UT) yields worse overall survival when compared to patients that have undergone Endoscopic Debulking (ED) to address the airway. The reasons for this and characteristics of tumor burden between cohorts has not been previously delineated. We hypothesize that this finding persists when controlling for tumor size and seek to identify if the difference in survival is reflected in the late term effects of CRT as determined through the lens of dysphagia.

Methods: We reviewed UCMC institutional records of 48 patients diagnosed with T4 LSCC from 2009 to 2019 who received either CRT alone, CRT following UT, or CRT following ED. Patients were stratified based on maximum tumor length. Patients received pre- and post-CRT Video Fluoroscopic Swallow Studies (VFSS) which were evaluated over time. Descriptive statistics and logistic regression were run to determine significant differences between CRT, UT, and Debulking groups.

Results: Previously presented data showed that patients receiving UT had decreased overall survival (aHR=5.5[1.7-18.1];p=0.005) compared to those who received ED. In total, 8 cases in our cohort received CRT alone, 13 received ED, and 27 received UT (n=48). No significant difference was discovered in terms of tumor size (p=0.272), though Black patients were more likely to undergo UT than ED (p=0.03). In evaluating VFSSs before and after CRT, no significant difference in Aspiration (p=0.408), Penetration (p=0.420), or Hyolaryngeal Movement (p=0.420) were found between treatment groups.

Conclusions: Upfront tracheostomy is associated with poor 5-year survival as previously shown. This was not due to difference in tumor size. Additionally, decreased survival was not associated with more significant dysphagia/aspiration before and after definitive CRT. More work is necessary to determine why patients who undergo endoscopic debulking have a survival benefit.