Clancy K, et al. - The outcomes of tracheoesophageal puncture voice prosthesis (TEP) placement in twice-radiated patients were investigated. After Institutional Review Board approval, researchers retrospective reviewed 80 patients that underwent TEP from 2006 to 2017 at a single institution; of these 16 patients had undergone two courses of radiation. TEP removal was reported in half of the twice-radiated patients, with removal occurring at a median of 24.9 months after placement. Prosthesis removal was undertaken in correlation to widening tracheoesophageal fistula, local recurrence, and dysphagia/esophageal stenosis. Furthermore, the twice-radiated patient cohort more frequently required surgical intervention for a voice prosthesis-related complication as compared with a once-radiated cohort.