title: Surviving hypopharynx-larynx carcinoma in the era of IMRT.
abstract: OBJECTIVE
  Outcome in locoregionally advanced laryngeal carcinoma and hypopharyngeal carcinoma after conventional radiation techniques is known for modest disease control and considerable late toxicity. Considering the lack of standardization in prescription dose for intensity-modulated radiotherapy (IMRT), we aimed to compare the results after our methods of simultaneously integrated boost IMRT with published results.
  
  
  METHODS
  Between March 2002 and December 2008, 65 hypopharyngeal, 31 supraglottic, and 27 locoregionally advanced glottic tumor patients underwent definitive IMRT (with simultaneous chemotherapy in 86%). Of these, 64% presented with locoregionally advanced disease. Mean follow-up was 26 months (range, 3-83 months), with a median of 21 months. Treatment (2.0-2.2 Gy per fraction, 66-72.6 Gy) followed a prospectively defined protocol. If the boost volume included more than half of the larynx or a substantial part of the pharynx, dose was limited to 2.0 Gy per fraction.
  
  
  RESULTS
  The 2-year local, nodal, and locoregional control (LRC) rates for the entire cohort were 82%, 90%, and 77%, respectively; the disease-free and overall survival rates were 75% and 83%, respectively. The ultimate 2-year LRC rate, including salvage surgery, was 86%. Laryngectomy was required in 2 LRC patients needing tracheostoma already before; 2 further LRC patients needed tracheostomy before IMRT and remained tracheostoma dependent, and 3 patients remained feeding tube dependent after IMRT. Salvage laryngectomy was successful in 8 of 11. Of all 123 patients, 91 patients (74%) are locoregionally controlled and live with a functional laryngopharynx.
  
  
  CONCLUSIONS
  Simultaneously integrated boost IMRT with limited acceptance of dose inhomogeneity resulted in very satisfactory disease control despite a slight left shift of planning target volume curves on the dose-volume histogram. Considering the treatment tolerance, a careful increase in dose in our patients seems possible. Dose-volume comparisons remain difficult because no international standards have been defined for contouring and volume-related dose distribution.
authors.affiliation: Department of Radiation Oncology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland. gabriela.studer@usz.ch
authors.forename: Gabriela
authors.initials: G
authors.lastname: Studer
authors.forename: Evangelia
authors.initials: E
authors.lastname: Peponi
authors.forename: Stephan
authors.initials: S
authors.lastname: Kloeck
authors.forename: Thomas
authors.initials: T
authors.lastname: Dossenbach
authors.forename: Gerhard
authors.initials: G
authors.lastname: Huber
authors.forename: Christoph
authors.initials: C
authors.lastname: Glanzmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods* / Q000401:mortality; D016879:Salvage Therapy / Q000379:methods; D015996:Survival Rate; D014139:Tracheostomy; D016896:Treatment Outcome