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Treatment results of definitive radiotherapy in 144 early stage larynx carcinoma

Yıl 2006, Cilt: 21 Sayı: 3, 143 - 150, 01.04.2006

Öz

OBJECTIVES The aim of this study was to evaluate the treatment results retrospectively in early stage larynx carcinoma treated with definitive radiotherapy (RT) according to the treatment protocol of Dokuz Eylül Head and Neck Cancer Group (DEHNCG). METHODS Between July 1991 and June 2004, 144 patients (138 males (%96), 6 (%4) females; median age 61; range 27 to 87 years) with early stage squamous-cell carcinoma of the larynx were treated with definitive RT at our institution. According to DEHNCG protocol stage I and inoperabl (poor performance status, comorbidity or patient choice) stage II larynx carcinomas are treated with definitive radiotherapy. Definitive RT is applied with megavoltage (6 MV-X or Co60), parallel- opposed beams with wedge filters. Before RT all patients were simulated and a computerized system was used for treatment planning. RTOG/EORTC scale was used for documentation of early and late side effects. Survival analysis have been calculated with Kaplan- Meier method. RESULTS The majority of the patients were men (96%). One hundred and eleven (77%) patients had squamous cell carcinoma and 32 (22%) had carcinoma in situ. Clinically 32 (22%), 86 (60%) and 26 (%18) patients were evaluated as Tis, T1 and T2 larynx carcinoma respectively. All patients completed the planned treatment. Median dose was 66 (50-70) Gy. There were no grade III or IV early side effects. Grade III skin, larynx and cartilage late side effects were seen in 3 (2%) patients. Median follow up was 68 (4–162) months. Two, 5 and 10 years overall survival rates were 94%, 85% and 65% respectively. Loco-regional progression free survivals for 2, 5 and 10 years were 90%, 87% and 87% respect ively. Eighteen (12.5%) of 144 patients had loco-regional failure and 14 of them had salvage surgery. Five years disease spesific survival for Tis, T1 and T2 were 95%, 96% and 94% respectively. Five years voice preserving rates for Tis and T1 were 97% and 89% for T2 patients. CONCLUSION Definitive RT is an organ preserving and an effective treatment method in patients with early stage glottic carcinoma. High local control and survival rates can be obtained with salvage treatments after the locoregional failures after definitive RT.

Kaynakça

  • 1. Rosai J. Larynx and trachea. In: Rosai J, editor. Ackerman's surgical pathology. St. Louis: Mosby; 1996. p. 314-32.
  • 2. Mendenhall WM, Werning JW, Hinerman RW, Amdur RJ, Villaret DB. Management of T1-T2 glottic carcinomas. Cancer 2004;100(9):1786-92.
  • 3. Harwood AR, Hawkins NV, Rider WD, Bryce DP. Radiotherapy of early glottic cancer--I. Int J Radiat Oncol Biol Phys 1979;5(4):473-6.
  • 4. Harwood AR, Tierie A.Radiotherapy of early glottic canc e r-II. Int J Radiat Oncol Biol Phys 1979;5(4):477-82.
  • 5. Horiot JC, Fletcher GH, Ballantyne AJ, Lindberg RD. Analysis of failures in early vocal-cord cancer. Radiology 1972;103(3):663-5.
  • 6. Johansen LV, Overgaard J, Hjelm-Hansen M, Gadeberg CC. Primary radiotherapy of T1 squamous cell carcinoma of the larynx: analysis of 478 patients treated from 1963 to 1985. Int J Radiat Oncol Biol Phys 1990;18(6):1307-13.
  • 7. Lindelov B, Lauritzen AF, Hansen HS. Stage I glottic carcinoma: an analysis of tumour recurrence after primary radiotherapy. Clin Oncol (R Coll Radiol) 1990;2(2):94-6.
  • 8. Lusinchi A, Dube P, Wibault P, Kunkler I, Luboinski B, Eschwege F. Radiation therapy in the treatment of early glottic carcinoma: the experience of Villejuif. Radiother Oncol 1989;15(4):313-9.
  • 9. Mendenhall WM, Parsons JT, Million RR, Fletcher GH. T1-T2 squamous cell carcinoma of the glottic larynx treated with radiation therapy: relationship of dose-fractionation factors to local control and complications. Int J Radiat Oncol Biol Phys 1988;15(6):1267-73.
  • 10.Johansen LV, Grau C, Overgaard J. Glottic carcinoma- -patterns of failure and salvage treatment after curative radiotherapy in 861 consecutive patients. Radiother Oncol 2002;63(3):257-67.
  • 11. Stalpers LJ, Verbeek AL, van Daal WA. Results of radiotherapy and surgery for glottic carcinoma. Cancer Treat Rev 1987;14(2):131-41.
  • 12. Nguyen C, Naghibzadeh B, Black MJ, Rochon L, Shenouda G. Carcinoma in situ of the glottic larynx: excision or irradiation? Head Neck 1996;18(3):225-8.
  • 13. Garcia-Serra A, Hinerman RW, Amdur RJ, Morris CG, Mendenhall WM. Radiotherapy for carcinoma in situ of the true vocal cords. Head Neck 2002;24(4):390-4.
  • 14. Thariat J, Bruchon Y, Bonnetain F, Barillot I, Truc G, Peignaux K, et al. Conservative treatment of early glottic carcinomas with exclusive radiotherapy. Cancer Radiother 2004;8(5):288-96.
  • 15. Lee JH, Machtay M, McKenna MG, Weinstein GS, Markiewicz DA, Krisch RE, et al. Radiotherapy with 6-megavolt photons for early glottic carcinoma: potential impact of extension to the posterior vocal cord. Am J Otolaryngol 2001;22(1):43-54.
  • 16. Peretti G, Nicolai P, Redaelli De Zinis LO, Berlucchi M, Bazzana T, Bertoni F, et al. Endoscopic CO2 laser excision for tis, T1, and T2 glottic carcinomas: cure rate and prognostic factors. Otolaryngol Head Neck Surg 2000;123(1 Pt 1):124-31.
  • 17. Nur DA, Oguz C, Kemal ET, Ferhat E, Sulen S, Emel A, et al. Prognostic factors in early glottic carcinoma implications for treatment. Tumori 2005;91(2):182-7.
  • 18. Franchin G, Minatel E, Gobitti C, Talamini R, Vaccher E, Sartor G, et al. Radiotherapy for patients with early-stage glottic carcinoma: univariate and multivariate analyses in a group of consecutive, unselected patients. Cancer 2003;98(4):765-72.
  • 19. Schwaibold F, Scariato A, Nunno M, Wallner PE, Lustig RA, Rouby E, et al. The effect of fraction size on control of early glottic cancer. Int J Radiat Oncol Biol Phys 1988;14(3):451-4.
  • 20. Le QT, Fu KK, Kroll S, Ryu JK, Quivey JM, Meyler TS, et al. Influence of fraction size, total dose, and overall time on local control of T1-T2 glottic carcinoma. Int J Radiat Oncol Biol Phys 1997;39(1):115-26.
  • 21. Yamazaki H, Nishiyama K, Tanaka E, Koizumi M, Chatani M. Radiotherapy for early glottic carcinoma (T1N0M0): results of prospective randomized study of radiation fraction size and overall treatment time. Int J Radiat Oncol Biol Phys 2006;64(1):77-82.
  • 22. Warde P, O'Sullivan B, Bristow RG, Panzarella T, Keane TJ, Gullane PJ, et al. T1/T2 glottic cancer managed by external beam radiotherapy: the influence of pretreatment hemoglobin on local control. Int J Radiat Oncol Biol Phys 1998;41(2):347-53.
  • 23. Fein DA, Lee WR, Hanlon AL, Ridge JA, Curran WJ, Coia LR. Do overall treatment time, field size, and treatment energy influence local control of T1-T2 squamous cell carcinomas of the glottic larynx? Int J Radiat Oncol Biol Phys 1996;34(4):823-31.
  • 24. Kaplan MJ, Johns ME, Clark DA, Cantrell RW. Glottic carcinoma. The roles of surgery and irradiation. Cancer 1984;53(12):2641-8.
  • 25. Dinshaw KA, Sharma V, Agarwal JP, Ghosh S, Havaldar R. Radiation therapy in T1-T2 glottic carcinoma: influence of various treatment parameters on local control/complications. Int J Radiat Oncol Biol Phys 2000;48(3):723-35.
  • 26. Ganly I, Patel SG, Matsuo J, Singh B, Kraus DH, Boyle JO, et al. Results of surgical salvage after failure of definitive radiation therapy for early-stage squamous cell carcinoma of the glottic larynx. Arch Otolaryngol Head Neck Surg 2006;132(1):59-66.
  • 27.Chatani M, Matayoski Y, Masaki N, Teshima T, Inoue T. Radiation therapy for early glottic carcinoma (T1N0M0). The final results of prospective randomized study concerning radiation field. Strahlenther Onkol 1996;172(3):169-72.
  • 28. Fu KK, Woodhouse RJ, Quivey JM, Phillips TL, Dedo HH. The significance of laryngeal edema following radiotherapy of carcinoma of the vocal cord. Cancer 1982;49(4):655-8.

Erken evre larenks karsinomlu 144 hastada radikal radyoterapi sonuçlarımız

Yıl 2006, Cilt: 21 Sayı: 3, 143 - 150, 01.04.2006

Öz

AMAÇ Bu çalışmanın amacı Dokuz Eylül Baş-Boyun Kanserleri Grubu'nun (DEBBTG) tedavi protokolü uyarınca radikal radyoterapi (RT) uygulanmış erken evre larenks karsinomlu hastaların tedavi sonuçlarının geriye dönük olarak incelenmesidir. GEREÇ VE YÖNTEM Temmuz 1991-Haziran 2004 tarihleri arasında kliniğimizde erken evre larenks karsinomu tanılı 144 hasta (138 erkek (%96), 6 (%4) kadın; ort. yaş 61; dağılım 27-87 yaş) radikal RT ile tedavi edildi. DEBBTG protokolüne göre evre I hastalıkta ve ameliyat edilemeyen (performansı düşük, komorbid hastalık veya hasta tercihi) evre II glottik karsinomlu hastalara radikal radyoterapi uygulanmaktadır. Radikal RT karşılıklı paralel eşmerkezli iki yan alanla ve “wedge” kullanılarak, megavoltaj (6 MV-X veya Co-60) ışınlar ile uygulandı. Tüm hastalar radikal RT öncesi simüle edildi, tedavi planlaması bilgisayarlı planlama sistemi ile yapıldı. Erken ve geç yan etkiler RTO G / E O RTC kriterlerine göre değerlendirildi. Sağkalım analizleri Kaplan-Meier yöntemi kullanılarak yapıldı. BULGULAR Histopatolojik tanı 111 (%77) olguda skuamöz hücreli karsinom, 32'sinde (%22) karsinoma in situ, 1'inde küçük hücreli karsinomdu. Klinik evrelemede, 32 (%22) olgu Tis, 86 (%60) T1, 26 (%18) T2 olarak değerlendirildi. Tüm olgular planlanan tedaviyi tamamladılar. Medyan doz 66 (50-70) Gy'di. Hiçbir hastada ciddi erken yan etki saptanmadı, 3 (%2) hastada geç dönem derece 3 cilt, larenks ödemi ve kıkırdak hasarı izlendi. Medyan izlem 68 (4-162) aydı. İki, 5, 10 yıllık genel sağkalımlar sırasıyla %94, %85 ve %65 idi. Yerel-bölgesel yinelemesiz sağkalımlar 2, 5 ve 10 yıllık sırasıyla %90, %87 ve %87 olarak hesaplandı. Toplam 18 (%12.5) olguda yerel ve/veya bölgesel başarısızlık saptandı ve 14'üne kurtarma cerrahisi uygulandı. Tis, T1 ve T2 olgularda 5 yıllık hastalığa özgü sağkalım sırasıyla %95, %96 ve %94 olarak, 5 yıllık ses koruma oranları ise Tis ve T1'lerde %97, T2 hastalarda %89 hesaplandı. SONUÇ Erken evre larenks kanserlerinde radikal radyoterapi fonksiyon koruyucu etkin bir tedavi yöntemidir. Yerel bölgesel tedavi başarısızlıklarında radyoterapi sonrası kurtarma tedavileri ile yüksek oranda ses korunması ile yerel kontrol ve sağkalım oranları elde edilebilmektedir.

Kaynakça

  • 1. Rosai J. Larynx and trachea. In: Rosai J, editor. Ackerman's surgical pathology. St. Louis: Mosby; 1996. p. 314-32.
  • 2. Mendenhall WM, Werning JW, Hinerman RW, Amdur RJ, Villaret DB. Management of T1-T2 glottic carcinomas. Cancer 2004;100(9):1786-92.
  • 3. Harwood AR, Hawkins NV, Rider WD, Bryce DP. Radiotherapy of early glottic cancer--I. Int J Radiat Oncol Biol Phys 1979;5(4):473-6.
  • 4. Harwood AR, Tierie A.Radiotherapy of early glottic canc e r-II. Int J Radiat Oncol Biol Phys 1979;5(4):477-82.
  • 5. Horiot JC, Fletcher GH, Ballantyne AJ, Lindberg RD. Analysis of failures in early vocal-cord cancer. Radiology 1972;103(3):663-5.
  • 6. Johansen LV, Overgaard J, Hjelm-Hansen M, Gadeberg CC. Primary radiotherapy of T1 squamous cell carcinoma of the larynx: analysis of 478 patients treated from 1963 to 1985. Int J Radiat Oncol Biol Phys 1990;18(6):1307-13.
  • 7. Lindelov B, Lauritzen AF, Hansen HS. Stage I glottic carcinoma: an analysis of tumour recurrence after primary radiotherapy. Clin Oncol (R Coll Radiol) 1990;2(2):94-6.
  • 8. Lusinchi A, Dube P, Wibault P, Kunkler I, Luboinski B, Eschwege F. Radiation therapy in the treatment of early glottic carcinoma: the experience of Villejuif. Radiother Oncol 1989;15(4):313-9.
  • 9. Mendenhall WM, Parsons JT, Million RR, Fletcher GH. T1-T2 squamous cell carcinoma of the glottic larynx treated with radiation therapy: relationship of dose-fractionation factors to local control and complications. Int J Radiat Oncol Biol Phys 1988;15(6):1267-73.
  • 10.Johansen LV, Grau C, Overgaard J. Glottic carcinoma- -patterns of failure and salvage treatment after curative radiotherapy in 861 consecutive patients. Radiother Oncol 2002;63(3):257-67.
  • 11. Stalpers LJ, Verbeek AL, van Daal WA. Results of radiotherapy and surgery for glottic carcinoma. Cancer Treat Rev 1987;14(2):131-41.
  • 12. Nguyen C, Naghibzadeh B, Black MJ, Rochon L, Shenouda G. Carcinoma in situ of the glottic larynx: excision or irradiation? Head Neck 1996;18(3):225-8.
  • 13. Garcia-Serra A, Hinerman RW, Amdur RJ, Morris CG, Mendenhall WM. Radiotherapy for carcinoma in situ of the true vocal cords. Head Neck 2002;24(4):390-4.
  • 14. Thariat J, Bruchon Y, Bonnetain F, Barillot I, Truc G, Peignaux K, et al. Conservative treatment of early glottic carcinomas with exclusive radiotherapy. Cancer Radiother 2004;8(5):288-96.
  • 15. Lee JH, Machtay M, McKenna MG, Weinstein GS, Markiewicz DA, Krisch RE, et al. Radiotherapy with 6-megavolt photons for early glottic carcinoma: potential impact of extension to the posterior vocal cord. Am J Otolaryngol 2001;22(1):43-54.
  • 16. Peretti G, Nicolai P, Redaelli De Zinis LO, Berlucchi M, Bazzana T, Bertoni F, et al. Endoscopic CO2 laser excision for tis, T1, and T2 glottic carcinomas: cure rate and prognostic factors. Otolaryngol Head Neck Surg 2000;123(1 Pt 1):124-31.
  • 17. Nur DA, Oguz C, Kemal ET, Ferhat E, Sulen S, Emel A, et al. Prognostic factors in early glottic carcinoma implications for treatment. Tumori 2005;91(2):182-7.
  • 18. Franchin G, Minatel E, Gobitti C, Talamini R, Vaccher E, Sartor G, et al. Radiotherapy for patients with early-stage glottic carcinoma: univariate and multivariate analyses in a group of consecutive, unselected patients. Cancer 2003;98(4):765-72.
  • 19. Schwaibold F, Scariato A, Nunno M, Wallner PE, Lustig RA, Rouby E, et al. The effect of fraction size on control of early glottic cancer. Int J Radiat Oncol Biol Phys 1988;14(3):451-4.
  • 20. Le QT, Fu KK, Kroll S, Ryu JK, Quivey JM, Meyler TS, et al. Influence of fraction size, total dose, and overall time on local control of T1-T2 glottic carcinoma. Int J Radiat Oncol Biol Phys 1997;39(1):115-26.
  • 21. Yamazaki H, Nishiyama K, Tanaka E, Koizumi M, Chatani M. Radiotherapy for early glottic carcinoma (T1N0M0): results of prospective randomized study of radiation fraction size and overall treatment time. Int J Radiat Oncol Biol Phys 2006;64(1):77-82.
  • 22. Warde P, O'Sullivan B, Bristow RG, Panzarella T, Keane TJ, Gullane PJ, et al. T1/T2 glottic cancer managed by external beam radiotherapy: the influence of pretreatment hemoglobin on local control. Int J Radiat Oncol Biol Phys 1998;41(2):347-53.
  • 23. Fein DA, Lee WR, Hanlon AL, Ridge JA, Curran WJ, Coia LR. Do overall treatment time, field size, and treatment energy influence local control of T1-T2 squamous cell carcinomas of the glottic larynx? Int J Radiat Oncol Biol Phys 1996;34(4):823-31.
  • 24. Kaplan MJ, Johns ME, Clark DA, Cantrell RW. Glottic carcinoma. The roles of surgery and irradiation. Cancer 1984;53(12):2641-8.
  • 25. Dinshaw KA, Sharma V, Agarwal JP, Ghosh S, Havaldar R. Radiation therapy in T1-T2 glottic carcinoma: influence of various treatment parameters on local control/complications. Int J Radiat Oncol Biol Phys 2000;48(3):723-35.
  • 26. Ganly I, Patel SG, Matsuo J, Singh B, Kraus DH, Boyle JO, et al. Results of surgical salvage after failure of definitive radiation therapy for early-stage squamous cell carcinoma of the glottic larynx. Arch Otolaryngol Head Neck Surg 2006;132(1):59-66.
  • 27.Chatani M, Matayoski Y, Masaki N, Teshima T, Inoue T. Radiation therapy for early glottic carcinoma (T1N0M0). The final results of prospective randomized study concerning radiation field. Strahlenther Onkol 1996;172(3):169-72.
  • 28. Fu KK, Woodhouse RJ, Quivey JM, Phillips TL, Dedo HH. The significance of laryngeal edema following radiotherapy of carcinoma of the vocal cord. Cancer 1982;49(4):655-8.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Makaleler
Yazarlar

Özlem Uruk Ataman Bu kişi benim

Fadime Akman Bu kişi benim

Nihal Dağ Bu kişi benim

Ahmet Ömer İkiz Bu kişi benim

Mehmet Şen Bu kişi benim

Sülen Sarıoğlu Bu kişi benim

Kerim Ceyran Bu kişi benim

Münir Kınay Bu kişi benim

Yayımlanma Tarihi 1 Nisan 2006
Yayımlandığı Sayı Yıl 2006 Cilt: 21 Sayı: 3

Kaynak Göster

APA Ataman, Ö. U., Akman, F., Dağ, N., İkiz, A. Ö., vd. (2006). Erken evre larenks karsinomlu 144 hastada radikal radyoterapi sonuçlarımız. Türk Onkoloji Dergisi, 21(3), 143-150.
AMA Ataman ÖU, Akman F, Dağ N, İkiz AÖ, Şen M, Sarıoğlu S, Ceyran K, Kınay M. Erken evre larenks karsinomlu 144 hastada radikal radyoterapi sonuçlarımız. Türk Onkoloji Dergisi. Nisan 2006;21(3):143-150.
Chicago Ataman, Özlem Uruk, Fadime Akman, Nihal Dağ, Ahmet Ömer İkiz, Mehmet Şen, Sülen Sarıoğlu, Kerim Ceyran, ve Münir Kınay. “Erken Evre Larenks Karsinomlu 144 Hastada Radikal Radyoterapi sonuçlarımız”. Türk Onkoloji Dergisi 21, sy. 3 (Nisan 2006): 143-50.
EndNote Ataman ÖU, Akman F, Dağ N, İkiz AÖ, Şen M, Sarıoğlu S, Ceyran K, Kınay M (01 Nisan 2006) Erken evre larenks karsinomlu 144 hastada radikal radyoterapi sonuçlarımız. Türk Onkoloji Dergisi 21 3 143–150.
IEEE Ö. U. Ataman, F. Akman, N. Dağ, A. Ö. İkiz, M. Şen, S. Sarıoğlu, K. Ceyran, ve M. Kınay, “Erken evre larenks karsinomlu 144 hastada radikal radyoterapi sonuçlarımız”, Türk Onkoloji Dergisi, c. 21, sy. 3, ss. 143–150, 2006.
ISNAD Ataman, Özlem Uruk vd. “Erken Evre Larenks Karsinomlu 144 Hastada Radikal Radyoterapi sonuçlarımız”. Türk Onkoloji Dergisi 21/3 (Nisan 2006), 143-150.
JAMA Ataman ÖU, Akman F, Dağ N, İkiz AÖ, Şen M, Sarıoğlu S, Ceyran K, Kınay M. Erken evre larenks karsinomlu 144 hastada radikal radyoterapi sonuçlarımız. Türk Onkoloji Dergisi. 2006;21:143–150.
MLA Ataman, Özlem Uruk vd. “Erken Evre Larenks Karsinomlu 144 Hastada Radikal Radyoterapi sonuçlarımız”. Türk Onkoloji Dergisi, c. 21, sy. 3, 2006, ss. 143-50.
Vancouver Ataman ÖU, Akman F, Dağ N, İkiz AÖ, Şen M, Sarıoğlu S, Ceyran K, Kınay M. Erken evre larenks karsinomlu 144 hastada radikal radyoterapi sonuçlarımız. Türk Onkoloji Dergisi. 2006;21(3):143-50.