Characterizing radiation-related laryngotracheal stenosis

Abstract

Background: Radiation-related laryngotracheal stenosis (RLTS) develops due to fibrosis of the airway after radiotherapy. We aim to characterize the presentation, management, and outcomes of patients with RLTS and compare these to patients with iatrogenic laryngotracheal stenosis (ILTS).

Methods: In a single-center retrospective cohort study, patients diagnosed with RLTS between 2017 and 2022 were identified. Demographic data, risk factors, cancer history and treatment, presentation of stenosis, primary stenosis intervention, and outcomes were extracted. Patients were compared to a cohort of patients with ILTS and no history of radiation therapy. Data were analyzed using Fisher's Exact Tests and paired t-tests.

Results: Seven patients with head and neck malignancies (six laryngeal, one thyroid) who developed RLTS after radiation therapy were included. One patient had supraglottic stenosis, three glottic, five subglottic, and two tracheal. Mean time to diagnosis of RLTS from initiation of radiation was 14.8 months (range: 2-46 months). Five patients were treated with laser ablation of stenosis. The patients with RLTS were compared to a cohort of 105 patients with ILTS. Patients with RLTS were less likely to have obesity (Odds Ratio (OR) = 0.06; 95 % Confidence Interval (CI) = 0.003-0.99) and more likely to have coronary vascular disease (OR = 5.5; 95 % CI = 1.04-29.6). No significant differences in interventions or outcomes were found.

Conclusions: Risk factors for RLTS and ILTS differ, but management strategies and treatment outcomes are comparable.

Level of evidence: IV.

Keywords: Head and neck cancer; Head and neck radiation; Laryngotracheal stenosis; Outcomes.