ROLE OF PROPHYLACTIC TRACHEOSTOMY IN HEAD AND NECK CANCER PATIENTS TREATED WITH RADIOTHERAPY

Dr. Vijetha N., *Dr. Rashmi S., Dr. Richa Tiwari, Dr. Kiran Kumar

ABSTRACT

Purpose: To determine the severity of mechanical obstruction which is one of the important factors deciding the need for tracheostomy prophylactically, hence avoiding treatment breaks during radiotherapy. Material and Methods: All head and neck cancer patients who were referred for treatment with either concurrent chemoradiation/ definitive radiotherapy/ palliative radiotherapy between January 2009 and June 2017 were taken retrospectively into the study. Computed Tomotherapy(CT) scan taken at the time of first simulation of all patients were individually studied. The slice which shows the narrowest portion of the airway in the larynx was selected and airway was contoured in the same slice. The volume of this contour was measured automatically by the Eclipse treatment planning system version 11. This volume in cubic centimetre (cc) was divided by the slice thickness (in cm) which gives measurement of the area of narrowest airway contour (in cm2). We measured the area of the narrowest airway in plain simulation CT scan images of 22 patients who did not have laryngeal obstruction and used these values as reference. The results gave a median value of 2 cm2 with a range of 1.08- 2.92. Hence, all patients with narrowest airway contour lesser than 1 cm2 were classified as having radiologically significant airway narrowing Results: Total of 377 patients were analysed. Out of which a significant proportion of patients with head and neck cancer patients planned for definitive radiotherapy or chemoradiation require tracheostomy (14%). Identifying this subset would help in avoiding unnecessary tracheostomies for patients who may not require based on subjective evaluation and also avoiding gap during radiotherapy in patients who may benefit from prophylactic tracheostomy prior to start of radiation. Conclusion: Based upon the above results, it can be concluded that all highest (80% risk) and high risk (41.5% risk) patients would benefit from tracheostomy. All intermediate risk (23.5% risk) patients should be individually assessed and decision for prophylactic tracheostomy can be taken based upon other co-morbidities.

Keywords: Prophylactic tracheostomy, Head and neck cancer, Radiotherapy.