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Volume 9, Number 1, 2004

Adjuvant radiotherapy in laryngeal cancer over the last few decades: the evolution of treatment policy in the Great Poland Cancer Centre

Milecki P, Kruk-Zagajewska A, Żmijewska-Tomczak M, Stryczyńska G.

Summary:

Aim: to evaluate changes in the treatment trends of the larynx cancer over the last few decades concerning the time factor in postoperative radiotherapy (OTT) after total laryngectomy and defining the target in adjuvant radiotherapy after partial laryngectomy with the reconstruction of the larynx.
Material and methods: The first part of the analysis was based on the comparison of OTT in two groups of patients (group A and B) irradiated postoperatively after total laryngectomy. Group A consisted of 311 patients who were treated between 1986 and 1990. The postoperative radiotherapy (RT) was given 5 times a week at the daily dose of 2 Gy per fraction to the mean total dose of 61.2 Gy range: 57-66 Gy), the mean time of the RT course was 47 days (range: 40-74 days). Group B encompassed 270 patients treated with a similar technique in the years 2000-2002 with the same fraction and total dose.
The second part of the analysis concerning the change of strategy in relation to the indication for adjuvant radiotherapy after partial laryngectomy (supracricoid laryngectomy with cricohyoidopexy, cricohyoidoepiglottopexy, horizontal laryngectomy, and fronto-lateral laryngectomy) during the last decade. The analysis was based on the review of patients who were treated between 1996 and 2002 at our department. One of the main aims of radiotherapy technique was to avoid the irradiation of a newly reconstructed larynx. All patients were irradiated postoperatively in a conventional way to elective dose of 50 Gy to the neck with a boost dose from 10 to 16 Gy to the bed of the removed lymph nodes. Acute and late morbidities were evaluated according to the RTOG/EORTC morbidity scoring system.
Results and conclusion: In group A gaps were observed in 52% of all the treated patients and their mean time was 8.2 days (range: 1-16 days). In group B gaps occurred in 26% of all treated patients with the mean gaps duration of 4.2 days (range: 1-15 days). The first part of the analysis revealed a significant time reduction in gap duration (4.2 days) and their frequency (26%) in the last decade (p=0.002).
The second part of the analysis showed that the protection of the newly reconstructed larynx led to |avoidance of significant side effects. Combined treatment, which consisted of partial laryngectomy and adjuvant RT of the neck with the protection of larynx, plays an important role in the decrease of treatment morbidity and makes it possible to preserve laryngeal function.

Signature: Rep Pract Oncol Radiother, 2004; 9(1) : 13-18

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http://www.sciencedirect.com/science/journal/15071367/19/2