title: Boron Neutron Capture Therapy in the Treatment of Recurrent Laryngeal Cancer.
abstract: OBJECTIVE
  To investigate the safety and efficacy of boron neutron capture therapy (BNCT) as a larynx-preserving treatment option for patients with recurrent laryngeal cancer.
  
  
  METHODS
  Six patients with locally recurrent squamous cell laryngeal carcinoma and 3 patients with persistent laryngeal cancer after prior treatment were treated with BNCT at the FiR1 facility (Espoo, Finland) in 2006 to 2012. The patients had received prior radiation therapy with or without concomitant chemotherapy to a cumulative median dose of 66 Gy. The median tumor diameter was 2.9 cm (range, 1.4-10.9 cm) before BNCT. Boron neutron capture therapy was offered on a compassionate basis to patients who either refused laryngectomy (n=7) or had an inoperable tumor (n=2). Boronophenylalanine-fructose (400 mg/kg) was used as the boron carrier and was infused over 2 hours intravenously before neutron irradiation.
  
  
  RESULTS
  Six patients received BNCT once and 3 twice. The estimated average gross tumor volume dose ranged from 22 to 38 Gy (W) (mean; 29 Gy [W]). Six of the 8 evaluable patients responded to BNCT; 2 achieved complete and 4 partial response. One patient died early and was not evaluable for response. Most common side effects were stomatitis, fatigue, and oral pain. No life-threatening or grade 4 toxicity was observed. The median time to progression within the target volume was 6.6 months, and the median overall survival time 13.3 months after BNCT. One patient with complete response is alive and disease-free with a functioning larynx 60 months after BNCT.
  
  
  CONCLUSIONS
  Boron neutron capture therapy given after prior external beam radiation therapy is well tolerated. Most patients responded to BNCT, but long-term survival with larynx preservation was infrequent owing to cancer progression. Selected patients with recurrent laryngeal cancer may benefit from BNCT.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. Electronic address: aaro.haapaniemi@hus.fi.
authors.forename: Aaro
authors.initials: A
authors.lastname: Haapaniemi
authors.affiliation: Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Leena
authors.initials: L
authors.lastname: Kankaanranta
authors.affiliation: Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Riste
authors.initials: R
authors.lastname: Saat
authors.affiliation: Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Koivunoro
authors.affiliation: Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Kauko
authors.initials: K
authors.lastname: Saarilahti
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Mäkitie
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Atula
authors.affiliation: Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Joensuu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001896:Boron Compounds / Q000627:therapeutic use; D016754:Boron Neutron Capture Therapy / Q000009:adverse effects / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy*; D057176:Compassionate Use Trials; D018450:Disease Progression; D005260:Female; D005931:Glottis; D006801:Humans; D007822:Laryngeal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy*; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000379:methods*; D010649:Phenylalanine / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D000069475:Re-Irradiation / Q000009:adverse effects / Q000379:methods; D013997:Time Factors; D047368:Tumor Burden
chemical_list: D001896:Boron Compounds; D010649:Phenylalanine