Feasibility of intensity-modulated and image-guided radiotherapy for functional organ preservation in locally advanced laryngeal cancer.
OBJECTIVE
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
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.
Department of Radiation Oncology, University of Arizona, Tucson, Arizona, USA. namphong.nguyen@yahoo.com
Nam P
NP
Nguyen
Alexander
A
Chi
Michael
M
Betz
Fabio
F
Almeida
Paul
P
Vos
Rick
R
Davis
Benjamin
B
Slane
Misty
M
Ceizyk
Dave
D
Abraham
Lexie
L
Smith-Raymond
Michelle
M
Stevie
Siyoung
S
Jang
Steven
S
Gelumbauskas
Vincent
V
Vinh-Hung
D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000503:physiopathology / Q000532:radiotherapy*; D008297:Male; D011878:Radiotherapy / Q000379:methods*; D012189:Retrospective Studies