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Is Radiotherapy for Early Laryngeal Caner in Elderly a Safe and Effective Treatment Method

Issue: Vol.10, No.4 - October 2011

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Article Type: Manuscript

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  1. Dr Tomasz Skóra
    M.D
    Centre of Oncology, Maria Skłodowska-Curie Memorial Institute,
  2. Dr Bogumila Szyszka-Charewicz
    M.D
    Centre of Oncology, Maria Skłodowska-Curie Memorial Institute,
  3. Dr Katarzyna Pudelek
    MD
    Centre of Oncology, Maria Skłodowska-Curie Memorial Institute,
  4. Dr Jan Skolyszewski
    MD
    Centre of Oncology, Maria Skłodowska-Curie Memorial Institute,

Purpose

Evaluation of the results of radiotherapy in elderly patients with early laryngeal cancer, the relation between comorbidities and the overall treatment time, and the influence of treatment interruptions on the outcome of treatment.

Materials and methods

A clinical retrospective analysis of a group of 153 patients (≥70 years old) with laryngeal cancer stage I and II was carried out. Patients were irradiated between the years 1980
and 2005 in the Centre of Oncology in Cracow.

The analysed group consisted of 134 men (88%) and 19 women (12%). Patients’ age ranged from 70 to 87 years, median – 74 years. Most of them had various comorbidities. Three different irradiation techniques and fractionation schemes were used according to the site, stage and grade of cancer: two oblique beams including the larynx with total dose of 60 Gy in 24 fractions (67 patients), two opposed parallel Cobalt 60 beams including the larynx and cervical lymph nodes with total dose of 60 Gy in 30 fractions (50 patients), and mixed photon-electron unilateral beam including the larynx with total dose of 60 Gy in 30 fractions (36 patients).

Results

The median follow-up was 52 months. During the followup period 105 patients (68.6%) died. Among them 31 patients (29,6%) died of laryngeal cancer, 13 (12,4%) patients of other malignancy, and 61 (58%) patients died of concomitant diseases without evidence of cancer.

The actuarial 5/10-year overall survival (OS), disease specific survival (DSS) and local control (LC) were 48%/21% and 79%/72% and 75%/71% respectively.

The overall tolerance of radiation therapy was good; only 6 patients had G3 early mucosal reaction, and 2 patient had G3 early skin reaction were observed. Comorbidities were not demonstrated to have statistically significant influence on
DSS rate.

In 10 (6,5%) from 153 patients complete tumor regression was not achieved after radiotherapy. During the follow-up period loco-regional relapse were observed in 31 patients (19,6%), and distant metastases in 4 patients (2,6%).

Conclusions
Radiotherapy of the elderly patients with laryngeal cancer is effective and well tolerated method. Comorbidities do not significantly influence the treatment results. T stage, age over 73 years, fractionation dose under 2 Gy and overall treatment time over 43 days are statistically significant negative prognostic factor for DSS rate.

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