Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-23T08:54:27.609Z Has data issue: false hasContentIssue false
  • English
  • Français

Intensity-modulated radiotherapy (55 Gy in 20 fractions) for high-grade laryngeal dysplasia: report of acute toxicity and functional outcome

Published online by Cambridge University Press:  22 February 2019

J Kovarik ,
M Bhabra ,
A W Tin ,
G Shaikh  and
M S Iqbal
J Kovarik
Affiliation:
Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
M Bhabra
Affiliation:
ENT Department, Sunderland Royal Hospital, UK
A W Tin
Affiliation:
Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
G Shaikh
Affiliation:
Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
M S Iqbal*
Affiliation:
Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
*
Author for correspondence: Dr Muhammad Shahid Iqbal, Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Radiotherapy is an option to treat high-grade laryngeal dysplasia. This study aimed to evaluate the use of intensity-modulated radiotherapy, 55 Gy in 20 daily fractions, in treating this disease.

Methods

Acute toxicity was evaluated in all 14 patients treated. In 10 patients, functional voice outcome was measured using the Voice Handicap Index, and the Grade, Roughness, Breath, Asthenia, Strain (‘GRBAS’) scale. These measurements were performed pre-treatment and three months after intensity-modulated radiotherapy.

Results

All but one patient managed to complete radiotherapy. Acute toxicity was significant (one patient developed grade 4 and three patients developed grade 3 dysphagia). Four patients required hospital admission. In 9 out of 10 patients, radiotherapy improved voice quality.

Conclusion

This radiotherapy regimen using intensity-modulated radiotherapy for laryngeal dysplasia is feasible and provided excellent functional outcome, but acute toxicity was significant. Dose de-escalation can be considered in the framework of clinical trials.

Keywords

Intensity-Modulated RadiotherapyLaryngeal Dysplasia
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 3 , March 2019 , pp. 241 - 244
Copyright
Copyright © JLO (1984) Limited, 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr M S Iqbal takes responsibility for the integrity of the content of the paper

References

1Karatayli-Ozgursoy, S, Pacheco-Lopez, P, Hillel, AT, Best, SR, Bishop, JA, Akst, LM. Laryngeal dysplasia, demographics, and treatment: a single-institution, 20-year review. JAMA Otolaryngol Head Neck Surg 2015;141:313–18Google Scholar
2Weller, MD, Nankivell, PC, McConkey, C, Paleri, V, Mehanna, HM. The risk and interval to malignancy of patients with laryngeal dysplasia; a systematic review of case series and meta-analysis. Clin Otolaryngol 2010;35:364–72Google Scholar
3Mehanna, H, Paleri, V, Robson, A, Wight, R, Helliwell, T. Consensus statement by otorhinolaryngologists and pathologists on the diagnosis and management of laryngeal dysplasia. Clin Otolaryngol 2010;35:170–6Google Scholar
4Sadri, M, McMahon, J, Parker, A. Management of laryngeal dysplasia: a review. Eur Arch Otorhinolaryngol 2006;263:843–52Google Scholar
5Small, W, Mittal, BB, Brand, WN, Shetty, RM, Rademaker, AW, Beck, GG et al. Role of radiation therapy in the management of carcinoma in situ of the larynx. Laryngoscope 1993;103:663–7Google Scholar
6Garcia-Serra, A, Hinerman, RW, Amdur, RJ, Morris, CG, Mendenhall, WM. Radiotherapy for carcinoma in situ of the true vocal cords. Head Neck 2002;24:390–4Google Scholar
7Le, QT, Takamiya, R, Shu, HK, Smitt, M, Singer, M, Terris, DJ et al. Treatment results of carcinoma in situ of the glottis: an analysis of 82 cases. Arch Otolaryngol Head Neck Surg 2000;126:1305–12Google Scholar
8MacLeod, PM, Daniel, F. The role of radiotherapy in in-situ carcinoma of the larynx. Int J Radiat Oncol Biol Phys 1990;18:113–17Google Scholar
9Barnes, L, Eveson, JW, Reichart, P, Sidransky, D, eds. World Health Organization Classification of Tumours. Pathology and Genetics of Head and Neck Tumours. Lyon: IARC Press, 2005Google Scholar
10Common Terminology Criteria for Adverse Events v4.0. In: https://www.eortc.be/services/doc/ctc/CTCAE_4.03_2010-06-14_QuickReference_5×7.pdf [30 January 2019]Google Scholar
11Rosen, CA, Lee, AS, Osborne, J, Zullo, T, Murry, T. Development and validation of the voice handicap index-10. Laryngoscope 2004;114:1549–56Google Scholar
12Arffa, RE, Krishna, P, Gartner-Schmidt, J, Rosen, CA. Normative values for the Voice Handicap Index-10. J Voice 2012;26:462–5Google Scholar
13Omori, K. Diagnosis of voice disorders. JMAJ 2011;54:248–53Google Scholar
14De Bodt, MS, Wuyts, FL, Van de Heyning, PH, Croux, C. Test-retest of the GRBAS scale: influence of experience and professional background on perceptual rating of voice quality. J Voice 1997;11:74–80Google Scholar
15Rigual, NR, Thankappan, K, Cooper, M, Sullivan, M, Dougherty, T, Popat, SR et al. Photodynamic therapy for head and neck dysplasia and cancer. Arch Otolaryngol Head Neck Surg 2009;135:784–8Google Scholar
16Mimikos, C, Shafirstein, G, Arshad, H. Current state and future of photodynamic therapy for the treatment of head and neck squamous cell carcinoma. World J Otorhinolaryngol Head Neck Surg 2016;2:126–9Google Scholar
17Huang, G, Luo, M, Zhang, J, Liu, H. The voice quality after laser surgery versus radiotherapy of T1a glottis carcinoma: systematic review and meta-analysis. Onco Targets Ther 2017;10:2403–10Google Scholar
18Higgins, KM. What treatment for early-stage glottis carcinoma among adult patients: CO2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility? Laryngoscope 2011;121:116–34Google Scholar
19Higgins, KM, Shah, MD, Ogaick, MJ, Enepekides, D. Treatment of early-stage glottis cancer: meta-analysis comparison of laser excision versus radiotherapy. J Otolaryngol Head Neck Surg 2009;38:603–12Google Scholar
20Aaltonen, LM, Rautiainen, N, Sellman, J, Saarilahti, K, Makitie, A, Laranne, J et al. Voice quality after treatment of early vocal cord cancer: a randomized trial comparing laser surgery with radiation therapy. Int J Radiat Oncol Biol Phys 2014;90:255–60Google Scholar
21Greulich, MT, Parker, NP, Lee, P, Merati, AL, Misono, S. Voice outcomes following radiation versus laser microsurgery for T1 glottic carcinoma: systematic review and meta-analysis. Otolaryngol Head Neck Surg 2015;152:811–19Google Scholar