Role of brachytherapy in treatment of epidermoid carcinomas of the vallecula after conservative supraglottic laryngectomy followed by irradiation.
OBJECTIVE
To evaluate survival and functional results of the treatment of carcinomas of the vallecula using surgery, irradiation, and interstitial brachytherapy.


METHODS
Between 1990 and 1998, 36 patients with squamous cell carcinoma of the vallecula were treated with horizontal supraglottic functional laryngectomy, external beam radiotherapy (median dose 54 Gy), and additional interstitial brachytherapy (median dose 16 Gy). Results were compared with a previous series of 22 patients treated without brachytherapy.


RESULTS
The median follow-up was 44 months. The 5-year actuarial overall survival rate was 61.3%. The 5-year specific survival rate was 86%, with 2 local failures (local control rate 94.4%) and 4 isolated distant metastases. Ten patients developed a second primary. The overall survival was 34% for 22 patients previously treated without brachytherapy. Severe toxicities occurred in 9 patients: death (related to larynx edema or inhalation, n = 1), soft tissue necrosis (n = 1), aspiration pneumonia (n = 1), mandibular necrosis (n = 2), pharyngocutaneous fistula (n = 2), and laryngeal edema (n = 2). All the patients fed orally with no definitive gastrostomy or tracheotomy.


CONCLUSIONS
Additional brachytherapy for vallecula carcinoma seems to improve locoregional control and overall survival dramatically. Functional results were also excellent. To our knowledge, this original therapeutic schedule has never been previously described.
Clippe
Sébastien
S
Department of Radiotherapy, Centre Léon Bérard, 28 rue Laennec, Lyon 69008, France. clippe@lyon.fnclcc.fr
Pommier
Pascal
P
Poupart
Marc
M
Céruse
Philippe
P
Rosenbusch
Thomas
T
Ramade
Antoine
A
Montbarbon
Xavier
X
Gérard
Jean Pierre
JP
Carrie
Christian
C
Ardiet
Jean Michel
JM
D000328:Adult; D000368:Aged; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000209:etiology; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011183:Postoperative Complications; D011832:Radiation Injuries / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate