Purpose The study aims to assess the feasibility of intensity-modulated and image-guided radiotherapy (IMRT, and IGRT, respectively) for functional preservation in locally advanced laryngeal cancer. A retrospective review of 27 patients undergoing concurrent chemoradiation for locally advanced laryngeal cancers (8 IMRT, 19 IGRT) was undertaken. In addition to regular clinical examinations, all patients had PET imaging at 4 months and 10 months after radiotherapy, then yearly. Loco-regional control, speech quality and feeding-tube dependency were assessed during follow-up visits. Results At a median follow-up of 20 months (range 6–57 months), four out of 27 patients (14.8%) developed local recurrence and underwent salvage total laryngectomy. One patient developed distant metastases following salvage surgery. Among the 23 patients who conserved their larynx with no sign of recurrence at last follow-up, 22 (95%) reported normal or near normal voice quality, allowing them to communicate adequately. Four patients (14.8%) had long-term tube feeding-dependency because of severe dysphagia (2 patients) and chronic aspiration (2 patients, with ensuing death from aspiration pneumonia in one patient). Conclusions and Clinical Relevance Functional laryngeal preservation is feasible with IMRT and IGRT for locally advanced laryngeal cancer. However, dysphagia and aspiration remain serious complications, due most likely to high radiation dose delivery to the pharyngeal musculatures.
Tupchong L, Scott CB, Blitzer PH, Marcial VA, Lowry LD, et al. (1991) Randomized study of preoperative versus postoperative radiation therapy in advanced head and neck carcinoma: long-term follow-up of RTOG study. Int J Radiat Oncol Biol Phys 20: 21–28.
Department of Veterans Affairs Laryngeal Cancer Study Group (1991) Induction chemotherapy plus radiation compared to surgery plus radiation in patients with advanced laryngeal cancer: The department of veterans affair laryngeal cancer study group (1991). N Engl J Med 324: 1685–1690.
Lefebvre JL, Rolland F, Tesselaar M, Bardet E, Leemans CR, et al. (2009) Phase III randomized trial on larynx preservation comparing sequential and alternating chemotherapy and radiotherapy. J Nat Cancer Inst 101: 142–152.
Posner MR, Norris CM, Wirth LJ, Shin DM, Cullen KJ, et al. (2009) Sequential therapy for the locally advanced larynx and hypopharyngeal cancer subgroup in TAX 324: survival, surgery, and organ preservation. Ann Oncol 20: 921–927.
Braaksma MMJ, Wijers OB, van Sornsen de Koste JR, van der Est H, Schmitz PI, et al. (2003) Optimisation of conformal radiation therapy by intensity-modulation: cancer of the larynx and salivary function. Radiother Oncol 66: 291–302.
Nguyen NP, Vos P, Vinh-Hung V, Ceizyk M, Smith-Raymond L, et al.. (2012) Feasibility of image-guided radiotherapy based on helical tomotherapy to reduce contralateral parotid dose in head and neck cancer. BMC Cancer, epublication.
Penagaricano JA, Ratanatharathorn V, Papanikolaou N, Yan Y (2004) Intensity-modulated radiation therapy reduces the dose to the normal tissue in T2N0M0 squamous cell carcinoma of the glottic larynx. Dosimetry 29: 254–257.
Chen AM, Farwell DG, Luu Q, Chen LM, Vijayakumar S, et al. (2011) Marginal misses after postoperative intensity-modulated radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 80: 1423–1429.
Gordin A, Daitzchman M, Doweck I, Yefremov N, Golz A, et al. (2006) Fluorodeoxyglucose-Positron emission Tomography/Computed Tomography imaging in patients with carcinoma of the larynx: diagnostic accuracy and impact on management. Laryngoscope 116: 273–278.
Salaun PY, Abgral R, Querellou S, Couturier O, Valette G, et al. (2007) Does 18fluoro-fluorodeoxyglucose positron emission tomography improve recurrence detection in patients treated for head and neck squamous cell carcinoma with negative clinical follow-up? Head Neck 29: 1125–1130.
van Hooren ACG, Brouwer J, de Bree R, Hoekstra OS, Leemans CR, et al. (2009) The cost effectiveness of FDG-PET in selecting patients with suspicion of recurrent laryngeal carcinoma after radiotherapy for direct laryngoscopy. Eur Arch Otorhinolaryngol 266: 1441–1448.
Zbaren P, Caversaccio M, Thoeny HC, Nuyens M, Curshmann J, et al. (2006) Radionecrosis or tumor recurrence after radiation of laryngeal hypopharyngeal carcinomas. Otolaryngol Head Neck Surg 135: 838–843.
Clark CH, Bidmead MA, Mubata CD, Harrington KJ, Nutting CM (2004) Intensity-modulated radiotherapy improves target coverage, spinal cord sparing and allows dose escalation in patients with locally advanced cancer of the larynx. Radiother Oncol 70: 189–198.