Airway obstruction as curable oncologic emergency in treatment-naïve head and neck cancer patients

Oncologic emergencies at the initial presentation of treatment-naïve head and neck cancer patients are understudied. In particular, whether airway obstruction may identify a subgroup with favorable outcomes after prompt management has not been fully evaluated.

We retrospectively reviewed consecutive patients who presented to our institution within 3 days of their first visit and required emergency admission for symptoms caused by head and neck malignancies. Demographics, tumor site, symptoms, diagnostic delay, interventions, and survival outcomes were analyzed. Disease-specific survival (DSS) was estimated using the Kaplan-Meier method and compared between groups using the log-rank test.

Among 639 newly diagnosed patients, 22 (3.3%) presented with an oncologic emergency, including airway obstruction (n = 9), dysphagia (n = 7), pain (n = 2), bleeding (n = 1), syncope (n = 1), severe fatigue (n = 1), tumor-related systemic symptoms (n = 1). All airway obstruction cases underwent urgent tracheostomy (n = 7) or steroid therapy for lymphoma (n = 2). DSS was significantly better in the airway obstruction group, with only one cancer-specific death (1/9), compared with 10 cancer-specific deaths among 13 patients in the other-emergency group. Long-term survival beyond 70 months was observed in several airway obstruction cases after definitive treatment. Diagnostic delay varied widely (0.3-36 months) depending on tumor site and symptom type.

Airway obstruction at initial presentation may identify a subgroup of treatment-naïve head and neck cancer patients who can still achieve favorable outcomes when prompt airway stabilization enables subsequent definitive treatment. In contrast, other emergency presentations were more often associated with poor outcomes and palliative treatment pathways. Symptom-specific triage and early airway stabilization may help optimize management.