Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 8/2013

01-08-2013 | Original article

High-dose radiotherapy alone for patients with T4-stage laryngeal cancer

Authors: A. Mucha-Małecka, MD, PhD, K. Składowski, MD, PhD

Published in: Strahlentherapie und Onkologie | Issue 8/2013

Login to get access

Abstract

Background and purpose

The purpose of this retrospective study was to report on the efficacy of radiotherapy alone in patients with T4-stage laryngeal cancer and to establish the prognostic value of (a) the size and location of the extralaryngeal tumor extensions and (b) of emergency tracheostomy.

Patients and methods

A group of 114 patients were treated with definitive radiotherapy between 1990 and 1996. The piriform recess was involved in 37 cases (33 %), the base of the tongue and glosso-epiglottic vallecula in 34 cases (30 %), and the hypopharyngeal wall in 10 cases (9 %). In 16 cases (14 %), emergency tracheostomy was performed before radiotherapy. The mean total dose was 68 Gy (range, 60–77.6 Gy). The mean treatment time was 49 days (range, 42–74 days).

Results

Actuarial 3-year local control (LC) was noted in 42 % of patients, disease-free survival (DFS) in 35 %, and overall survival (OS) in 40 %. The best prognosis was for the lesion suspected of cartilage infiltration: 56 % 3-year LC. The worst results were noted in the cases with massive infiltrations spreading from the larynx through the hypopharynx: 13 % 3-year LC. Emergency tracheostomy before radiotherapy was significantly connected with the worst treatment results (p = 0.000): 3-year LC in patients with tracheostomy was 0 % vs. 48 % in patients without tracheostomy.

Conclusion

Conventional radiotherapy of T4 laryngeal cancer is a method of treatment with limited effectiveness. The efficacy of radiotherapy is dependent on the location and extent of extralaryngeal infiltrations. Emergency tracheostomy is a prognostic factor connected with the worst prognosis.
Literature
1.
Bataini JP, Brugere J, Jaulerry CH et al (1984) Radiation treatment of lateral epilaryngeal cancer: prognostic factors and results. Am J Clin Oncol 7:641–645CrossRefPubMed
2.
Bonner JA, Harari PM, Giralt J (2006) Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 354:567–578CrossRefPubMed
3.
Bourhis J, Overgaard J, Audry H et al (2006) Hyperfractionated or acclelrated radiotherapy in head and neck cancer: a meta-analysis. Lancet 368:843–854CrossRefPubMed
4.
Casselman JW, Biebau G (1992) Imaging of laryngeal cancer. Acta Otorhinolaryngol Belg 46:161–174PubMed
5.
Chacko D, Hendrickson FR, Fisher A (1983) Definitive irradiation of T1-T4 N0 larynx cancer. Cancer 51:994CrossRefPubMed
6.
Cummings BJ, Keane T, Pintille M et al (1996) A prospective randomized trial of hyperfractionated versus conventional once daily radiation for advanced squamous cell carcinomas of the larynx and pharynx (abstract). Radiother Oncol 40(1):30CrossRef
7.
Cvek J, Kubes J, Skacelikova E et al (2012) Hyperfractionated accelerated radiotherapy with concomitant integrated boost of 70–75 Gy In 5 weeks for advanced head and neck cancer. A phase I dose escalation study. Strahlenther Onkol 188:666–670CrossRefPubMed
8.
Dische SA, Saunders M, Barret A et al (1997) A randomised multicentre trial of CHART versus conventional radiotherapy in head and neck cancer. Radiother Oncol 44:123–136CrossRefPubMed
9.
Fletcher GH, Jesse RH, Lindberg RD et al (1969) The place of radiotherapy in the management of the squamous cell carcinoma of the supraglottic larynx. Fifty-first Annual Meeting of the American Radium Society, Philadelphia
10.
Fletcher GH, Lindberg RD, Hamberger A et al (1975) Reasons for irradiation failure in sguamous cell carcinoma of the larynx. Laryngoscope 85:987–1003CrossRefPubMed
11.
Fletcher GH (1977) Place of irradiation in the managment of head and neck cancers. Semin Oncol 4:375PubMed
12.
Forastiere AA, Goepfert H, Maor M et al (2003) Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349:2091–2098CrossRefPubMed
13.
Garden AS, Morrison WH, Ang KK (2000) Laryngeal and hypopharyngeal cancer. In: Gunderson L, Tepper J, (eds) Clinical radiation oncology, 1st edn. Churchill Livingstone, New York, p 495
14.
Harwood AR, Beale FA, Cummings BJ et al (1981) T4N0M0 glottic cancer: an analisis of dose-time-volume factors. Int J Radiat Oncol Biol Phys 7:1507–1512CrossRefPubMed
15.
Harwood AR, Beale FA, Cummings BJ et al (1983) Supraglottic laryngeal carcinoma: an analysis of dose-time-volume factors in 410 patients. Int J Radiat Oncol Biol Phys 9:311–319CrossRefPubMed
16.
17.
Horiot JC, Le Fur R, N’Guyen T (1992) Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: final analysis of randomized trial of the EORTC ooperative group of radiotherapy. Radiother Oncol 25:231–241CrossRefPubMed
18.
Horiot JC, Bontemps P, Van den Bogaert W et al (1997) Accelerated fractionation (AF) compared to conventional fractionation (CF) improves loco-regional control in the radiotherapy of advanced head and neck cancers: results of the EORTC 22851 randomized trial. Radiother Oncol 44:111–121CrossRefPubMed
19.
Issa PY (1988) Cancer of the supraglottic larynx treated by radiotherapy exclusively. Int J Radiat Oncol Biol Phys 15:843–850CrossRefPubMed
20.
Karim AB, Kralendonk JH, Njo KH et al (1987) Radiation therapy for advanced (T3T4N0-N3M0) laryngeal carcinoma: the need for a change of straregy: a radiotherapeutic viewpoint. Int J Radiat Oncol Biol Phys 13:1625–1633CrossRefPubMed
21.
Kowalski LP, Batista BP, Santos CR et al (1996) Prognostic factors in T3N0-1 glottic and transglottic carcinoma. Arch Otolaryngol Head Neck Surg 122:77–82CrossRefPubMed
22.
Kramer S, Marcial VA, Pajak TF et al (1986) Prognostic factors for loco/regional control and metastasis and the impact on survival. Int J Radiat Oncol Biol Phys 12:573–578CrossRefPubMed
23.
Kubes J, Cvek J, Vondracek V et al (2011) Accelerated radiotherapy with concomitant boost technique (69,5/5 weeks). An alternative in the treatment of locally advanced head and neck cancer. Strahlenther Onkol 187:651–655CrossRefPubMed
24.
Lefebvre JL, Ang KK (2009) Larynx preservation clinical trial design: key issues and recommendations—a consensus panel summary. Head Neck 31:429–441CrossRefPubMed
25.
Levendag P, Vikram B (1987) The problem of neck relapse in early stage supraglottic cancer-results of different treatment modalities for the clinically negative neck. Int J Radiat Oncol Biol Phys 13:1621–1624CrossRefPubMed
26.
Maciejewski B, Preuss-Bayer G, Trott KR (1983) The influence of the number of fractions and of overall treatment time on local control and late complication rate in squamous cell carcinoma of the larynx. Int J Radiat Oncol Biol Phys 9(3):321CrossRefPubMed
27.
Mantravadi R, Katz AM, Skolik EM et al (1981) Stomal recurrence. A critical analysis of risk factors. Arch Otolaryngol Head Neck Surg 107:735–738CrossRef
28.
Mendenhall WM, Million RR, Cassisi NJ et al (1984) Squamous cell carcinoma of the supraglottic larynx treated with radical irradiation: analysis of treatment parameters and results. Int J Radiat Oncol Biol Phys 10:2223–2230CrossRefPubMed
29.
Mendenhall WM (1998) T3-4 squamous cell carcinoma of the larynx treated with radiation therapy alone. Semin Radiat Oncol 8(4):262–269CrossRefPubMed
30.
Million RR, Cassis NJ (rad.) (1994) Management of head and neck cancer. A multidisciplinary approach. J.B. Lippincott Company, Philadelphia, pp 431–360
31.
Overgaard J, Sand-Hansen HS, Jorgensen K et al (1986) Primary radiotherapy of larynx and pharynx carcinoma—an analysis of some factors influencing local control and survival. Int J Radiat Oncol Biol Phys 12:515CrossRefPubMed
32.
Overgaard J, Hansen HS, Specht L et al (2003) Five compared with six fractions per week of conventional radiotherapy of squamous-cellcarcinoma of head and neck: DAHANCA 6 and 7 randomised controlled trial. Lancet 20:933–940CrossRef
33.
Parsons JT, Mendenhall WM, Stringer SP et al (1998) T4 laryngeal carcinoma: radiotherapy alone with surgery reserved for salvage. Int J Radiat Oncol Biol Phys 40:549–552CrossRefPubMed
34.
Pignon JP, Bourhis J, Domenge C et al (2000) On behalf of the MACH-NC Collaborative Group. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. Lancet 355:949–955PubMed
35.
Rades D, Meyners T, Kazic N et al (2011) Comparison of radiochemotherapy alone to surgery plus radio(chemo)therapy for non-metastatic stage III/IV squamous cell carcinoma of the head and neck. Strahlenther Onkol 187:541–547CrossRefPubMed
36.
Rockley TJ, Powell J, Robin PE et al (1991) Post-laryngectomy stomal recurrence: tumour implantation or paratracheal lymphatic metastasis? Clin Otolaryngol Allied Sci 16:43–47CrossRefPubMed
37.
Rubin J, Johnson JT, Myers EN (1990) Stomal recurrence after laryngectomy: interrelated risk factors study. Otolaryngol Head Neck Surg 103:805–812PubMed
38.
Sadat F, Wienke A, Dunst J, Kuhnt T (2012) Survival of patients with head and neck cancer. Impact of physical status and comorbidities. Strahlenther Onkol 188:62–70CrossRefPubMed
39.
Sagerman RH, Chung CT, King GA et al (1979) High dose preoperative irradiation for advanced laryngeal-hypopharyngeal cancer. Ann Otol Rhinol Laryngol 88(2):178–182PubMed
40.
Schryver A (1992) Radiotherapy of laryngeal cancer. General principles and results in T1 and T4 cases. Acta Otorhinolaryngol Belg 46:187–195PubMed
41.
Semrau S, Waldfahrer F, Lell M et al (2011) Feasibility, toxicity, and efficacy of short induction chemotherapy of docetaxel plus cisplatin or carboplatin (TP) followed by concurrent chemoradiotherapy for organ preservation in advanced cancer of the hypopharynx, larynx, and base of tongue. Strahlenther Onkol 187:15–22CrossRefPubMed
42.
Silverman PM, Bossen EH, Fisher SR et al (1984) Carcinoma of the larynx and hypopharynx: computed tomographic—histopathologic correlations. Radiology 151:697–702PubMed
43.
Składowski K, Law M, Maciejewski B et al (1994) Planned and unplanned gaps in radiotherapy: the importance of gap position and gap duration. Radiother Oncol 30:109–120CrossRefPubMed
44.
Składowski K, Maciejewski B, Goleń M et al (2006) Continuous acclelrated 7-days-a-week radiotherapy for head-and-neck cancer: long-term results of phase III clinical trial. Int J Radiat Oncol Biol Phys 66:706–713CrossRefPubMed
45.
Skołyszewski J, Reinfuss M, Kowalska T (1988) Results of teletherapy of cancer of the larynx. Nowotwory 2:119–127
46.
Spaulding CA, Krochak RJ, Hahn SS et al (1986) Radiotherapeutic management of cancer of the supraglottis. Cancer 57:1292–1298CrossRefPubMed
47.
48.
Terhaard CH, Snippe K, Ravasz L.A et al (1991) Radiotherapy in T1 laryngeal cancer: prognostic factors for locoregional control and survival, uni- and multivariate analysis. Int J Radiat Oncol Biol Phys 21:1179–1186CrossRefPubMed
49.
Terhaard CH, Hordijk GJ, Ravasz LA (1992) Treatment of advanced laryngeal cancer (T3-4). Acta Otorhinolaryngol Belg 46:197–212PubMed
50.
Wygoda A (1998) Rak płaskonabłonkowy krtani—drogi miejscowego szerzenia się nowotworu. Naciekanie chrząstek. Nowotw 48:83–95
51.
Zemła B, Weryński M, Sowa Z et al (1996) The incidence of laryngeal cancer among males in the upper Silesia. Otolaryngol Pol 3:248–252
Metadata
Title
High-dose radiotherapy alone for patients with T4-stage laryngeal cancer
Authors
A. Mucha-Małecka, MD, PhD
K. Składowski, MD, PhD
Publication date
01-08-2013
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 8/2013
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-013-0396-0

Other articles of this Issue 8/2013

Strahlentherapie und Onkologie 8/2013 Go to the issue

Letter to the editor

Comment on the editorial of Sautter-Bihl et al. in Strahlentherapie und Onkologie 2013 189:105–110

Laudatio

Prof. Dr. Rolf Sauer mit der Karl-Heinrich-Bauer-Medaille 2013 ausgezeichnet

Literatur kommentiert

Keine Verbesserung der Behandlungsergebnisse von Operation und postoperativer Strahlentherapie durch eine neoadjuvante Chemotherapie mit TPF bei lokal fortgeschrittenen, primär resektablen Plattenepithelkarzinomen der Mundhöhle

Original article

Reirradiation for recurrent malignant brain tumor with radiotherapy or proton beam therapy

Laudatio

Professor Dr. Peter Vaupel zum 70. Geburtstag

Literatur kommentiert

Risiko von venösen Thromboembolien bei Tumorpatienten, die mit Cisplatin behandelt werden