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Intensity-modulated radiotherapy for laryngeal and hypopharyngeal cancer

Minimization of late dysphagia without jeopardizing tumor control

Intensitätsmodulierte Strahlentherapie von Plattenepithelkarzinomen des Kehlkopfes und Hypopharynx

Verringerung der späten Dysphagie ohne Gefährdung der Tumorkontrolle

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Abstract

Purpose

The purpose of this work was to retrospectively determine the value of intensity-modulated radiotherapy (IMRT) in patients with laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC), on outcome and treatment-related toxicity compared to 3-dimensional conformal radiotherapy (3D-CRT).

Materials and methods

A total of 175 consecutive patients were treated between 2007 and 2012 at our institution with curative intent RT and were included in this study: 90 were treated with 3D-CRT and 85 with IMRT. Oncologic outcomes were estimated using Kaplan–Meier statistics; acute and late toxicities were scored according to the Common Toxicity Criteria for Adverse Events scale v 3.0.

Results

Median follow-up was 35 months (range 32–42 months; 95% confidence interval 95 %). Two-year disease-free survival did not vary, regardless of the technique used (69 % for 3D-CRT vs. 72 %; for IMRT, p = 0.16). Variables evaluated as severe late toxicities were all statistically lower with IMRT compared with 3D-CRT: xerostomia (0 vs. 12 %; p < 0.0001), dysphagia (4 vs. 26 %; p < 0.0001), and feeding-tube dependency (1 vs 13 %; p = 0.0044). The rates of overall grade ≥ 3 late toxicities for the IMRT and 3D-CRT groups were 4.1 vs. 41.4 %, respectively (p < 0.0001).

Conclusion

IMRT for laryngeal and hypopharyngeal cancer minimizes late dysphagia without jeopardizing tumor control and outcome.

Zusammenfassung

Ziel

Das Ziel dieser Studie war es, retrospektiv den Nutzen der intensitätsmodulierten Strahlentherapie (IMRT) in der Behandlung von Patienten mit Plattenepithelkarzinom von Kehlkopf und Hypopharynx (LHSCC) zu bewerten und mit dem Outcome und den Spätfolgen der 3-D-konformalen Strahlentherapie (3D-CRT) zu vergleichen.

Material und Methoden

Insgesamt wurden zwischen Januar 2007 und Dezember 2012175 LHSCC-Patienten mit einer RT behandelt und in die Studie aufgenommen: 85 Patienten wurden mit 3D-CRT und 90 Patienten mit IMRT behandelt.Das onkologische Outcome wurde mittels Kaplan-Meier-Statistik ermittelt und Akut- und Spättoxizitäten anhand der CTCAE v.3 (Common Toxicity Criteria for Adverse Events v 3.0) bewertet.

Ergebnisse

In Dreiviertel der Fälle lag eine lokal fortgeschrittene Erkrankung vor. Die durchschnittliche Nachbeobachtungszeit lag bei35 Monaten (32–42 Monate, 95%-Konfidenzintervall 95 %). Unabhängig von der angewandten RT-Technik betrug das krankheitsfreie 2-Jahres-Überleben 71 % (69 % für 3D-CRT vs. 72 % für IMRT; p = 0,16). Alle bezüglich der Spättoxizität evaluierten Parameter zeigten nach IMRT signifikant günstigere Werte als nach 3D-CRT: Xerostomie (0 vs. 12 %; p < 0,0001), Dysphagie (4 vs. 26 %; p < 0,0001) und PEG-Abhängigkeit (1 vs. 13 %; p = 0,0044). Die Langzeittoxizität (Grad ≥ 3) war nach IMRT bedeutend geringer ausgeprägt als nach 3D-CRT (4,1 vs. 41,4 %; p < 0,0001).

Schlussfolgerung

Die IMRT von LHSCC führt zu einer vergleichbaren Tumorkontrolle wie 3D-CRT und verringert die Inzidenz und den Schweregrad von Spätfolgen wie Dysphagie deutlich.

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Correspondence to Anouchka Modesto M.D..

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Acknowledgments

The authors would like to thank Newmed publishing for English editing and Ursula Nestle for German editing.

Conflict of interest

A. Modesto, A. Laprie, L. Vieillevigne, P. Graff, J. Sarini, S. Vergez, J.-P. Delord, J.-C. Farenc, E. Vigarios, T. Filleron, and M. Rives state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Modesto, A., Laprie, A., Vieillevigne, L. et al. Intensity-modulated radiotherapy for laryngeal and hypopharyngeal cancer. Strahlenther Onkol 191, 225–233 (2015). https://doi.org/10.1007/s00066-014-0767-1

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  • DOI: https://doi.org/10.1007/s00066-014-0767-1

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