Concurrent chemotherapy and intensity-modulated radiotherapy for locoregionally advanced laryngeal and hypopharyngeal cancers Journal Article


Authors: Lee, N. Y.; O'meara, W.; Chan, K.; Della-Biancia, C.; Mechalakos, J. G.; Zhung, J.; Wolden, S. L.; Narayana, A.; Kraus, D.; Shah, J. P.; Pfister, D. G.
Article Title: Concurrent chemotherapy and intensity-modulated radiotherapy for locoregionally advanced laryngeal and hypopharyngeal cancers
Abstract: Purpose: To perform a retrospective review of laryngeal/hypopharyngeal carcinomas treated with concurrent chemotherapy and intensity-modulated radiotherapy (IMRT). Methods and Materials: Between January 2002 and June 2005, 20 laryngeal and 11 hypopharyngeal carcinoma patients underwent IMRT with concurrent platinum-based chemotherapy; most patients had Stage IV disease. The prescription of the planning target volume for gross, high-risk, and low-risk subclinical disease was 70, 59.4, and 54 Gy, respectively. Acute/late toxicities were retrospectively scored using the Common Toxicity Criteria scale. The 2-year local progression-free, regional progression-free, laryngectomy-free, distant metastasis-free, and overall survival rates were calculated using the Kaplan-Meier method. Results: The median follow-up of the living patients was 26 months (range, 17-58 months). The 2-year local progression-free, regional progression-free, laryngectomy-free, distant metastasis-free, and overall survival rate was 86%, 94%, 89%, 92%, and 63%, respectively. Grade 2 mucositis or higher occurred in 48% of patients, and all experienced Grade 2 or higher pharyngitis during treatment. Xerostomia continued to decrease over time from the end of RT, with none complaining of Grade 2 toxicity at this analysis. The 2-year post-treatment percutaneous endoscopic gastrostomy-dependency rate for those with hypopharyngeal and laryngeal tumors was 31% and 15%, respectively. The most severe late complications were laryngeal necrosis, necrotizing fascitis, and a carotid rupture resulting in death 3 weeks after salvage laryngectomy. Conclusion: These preliminary results have shown that IMRT achieved encouraging locoregional control of locoregionally advanced laryngeal and hypopharyngeal carcinomas. Xerostomia improved over time. Pharyngoesophageal stricture with percutaneous endoscopic gastrostomy dependency remains a problem, particularly for patients with hypopharyngeal carcinoma and, to a lesser extent, those with laryngeal cancer. Strategies using IMRT to limit the dose delivered to the esophagus/inferior constrictor musculature without compromising target coverage might be useful to further minimize this late complication. © 2007 Elsevier Inc. All rights reserved.
Keywords: adult; cancer chemotherapy; clinical article; controlled study; aged; disease-free survival; middle aged; survival rate; retrospective studies; disease course; intensity modulated radiation therapy; percutaneous endoscopic gastrostomy; salvage therapy; laryngeal neoplasms; cisplatin; fluorouracil; advanced cancer; cancer growth; paclitaxel; radiation dose; combined modality therapy; chemotherapy; cancer staging; follow up; follow-up studies; carboplatin; multiple cycle treatment; antineoplastic combined chemotherapy protocols; radiotherapy dosage; radiotherapy; patient monitoring; oncology; risk assessment; imrt; radiotherapy, intensity-modulated; dosimetry; xerostomia; neck; platinum complex; toxicity; larynx cancer; larynx; hypopharynx cancer; hypopharynx; hypopharyngeal neoplasms; head; intensity-modulated radiotherapy (imrt); hypopharyngeal carcinoma; intensity-modulated
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 69
Issue: 2
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2007-10-01
Start Page: 459
End Page: 468
Language: English
DOI: 10.1016/j.ijrobp.2007.03.013
PUBMED: 17493769
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 39" - "Export Date: 17 November 2011" - "CODEN: IOBPD" - "Source: Scopus"
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MSK Authors
  1. William Patrick O'meara
    12 O'meara
  2. Dennis Kraus
    259 Kraus
  3. Suzanne L Wolden
    424 Wolden
  4. Nancy Y. Lee
    550 Lee
  5. David G Pfister
    251 Pfister
  6. Jatin P Shah
    544 Shah
  7. Joanne Zhung
    12 Zhung
  8. Kelvin Chan
    19 Chan