Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): We report the survival and toxicity outcomes in a population based cohort of patients treated with HCRT in a teaching institution
Materials/Methods: We retrospectively reviewed consecutive patients with T1-T2 glottic cancer seen between January 2006 to January 2013. 89%, received 52.5 Gy in 20 fractions over 4 weeks. 82%, were treated with 6MV photons and 18% with Cobalt. Patient information was collected and stored in our head and neck registry database. Descriptive statistics were calculated for all relevant demographic variables. Overall survival and relapse free survival was estimated using a Kaplan-Meier method. Cumulative incidence of second malignancy was calculated; death was a competing risk. Toxicity was defined as adverse effects present during and following treatment
Results: 114 patients were evaluated. Median follow-up was 4.6 years. Overall survival at 1, 2, 3, 4 and 5 years were 98, 96, 91, 88 and 83%. Relapse-free survival rates at 1,2,3,4 and 5 years were 91,90,88,85 and 85%. In total, 16 patients relapsed; 12 locally, 3 in regional lymph nodes and 1 with distant metastases. Mean time to relapse was 17.3 months Toxicity: Odynophagia was present in 97% at end of RT (58% severe), 23% at 1 month and 4% at 3 months post-RT. Xerostomia was present in 56% of patients at the end of RT, 25% at 1 month and 19% at 3 months and 12% 6 months and longer. 86% developed dysguesia during RT. 66% developed laryngeal mucositis by the end of RT. Dysphagia occurred in 49%, 18%, 8% and 6% of patients at end of RT , 1 and 3 and beyond 6 months respectively. Skin reaction was noted in 97% of patients, 65% had erythema, 15% had dry desquamation and 16% had moist desquamation at end of RT. 71% had no skin reaction at 1-month post-RT. Mild laryngeal edema was noted in 42% and persisted in 16% of patients beyond 3 months. Hoarse voice was noted at the end of RT in all patients, this decreased to 88% at 1 month, 70% at 3 months and 59% at 6 months. Voice quality recovered completely in 53%, improved mildly for 13%, and worsened in only 1%. Telangiectasia was noted in 60% of patients, of which 90% were noted along the laryngeal mucosa, 3% along skin surface and 3% on both skin and mucosa. Of 52 evaluated patients, 34 remained euthyroid, 2 were hypothyroid prior to RT, 6 developed hypothyroidism post-RT and 10 post salvage surgery. Second malignancies were identified in 21 of 114 (18%) patients and included bladder (2), CLL (1), colorectal (3), lung (9), prostate (3), and non-melanoma skin cancer (3). None were in-field and median time to second malignancy was 2.1 years, with cumulative incidence of developing second cancer of 17.3% (95% CI 0.100-0.264) at 5 years.
Conclusion: Our survival and relapse rates are comparable to that in the literature. In the absence of randomized controlled trials, Our reported Radiation induced side effects could serve as a baseline in comparison to new approaches. It remains to be seen whether IMRT could further improve outcome and reduce toxicity. HCRT remains an excellent treatment option for early laryngeal cancer.
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