Hostname: page-component-848d4c4894-cjp7w Total loading time: 0 Render date: 2024-07-04T20:53:27.688Z Has data issue: false hasContentIssue false
  • English
  • Français

Definitive concurrent chemoradiation versus laryngectomy and postoperative radiation using IMRT in locally advanced laryngeal cancer: experience from a regional cancer centre of Eastern India

Published online by Cambridge University Press:  07 January 2020

Subhadip Das ,
Debarshi Lahiri Open the ORCID record for Debarshi Lahiri [Opens in a new window] ,
Aniruddha Dam ,
Tapas Maji ,
Sanjoy Roy ,
Dilip Kumar Ray  and
Syamsundar Mandal
Subhadip Das
Affiliation:
Department of Radiation Oncology, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
Debarshi Lahiri*
Affiliation:
Department of Radiation Oncology, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
Aniruddha Dam
Affiliation:
Department of Head & Neck Oncology, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
Tapas Maji
Affiliation:
Department of Radiation Oncology, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
Sanjoy Roy
Affiliation:
Department of Radiation Oncology, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
Dilip Kumar Ray
Affiliation:
Department of Medical Physics, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
Syamsundar Mandal
Affiliation:
Department of Epidemiology and Biostatistics, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
*
Author for correspondence: Debarshi Lahiri, Chittaranjan National Cancer Institute, Kolkata, West Bengal700026, India. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

For patients with locally advanced laryngeal cancer, two main treatment options are either up-front surgery [total laryngectomy (TL)] followed by postoperative adjuvant radiation therapy (RT) or definitive concurrent chemoradiation (CCRT) with surgery retained as salvage. The objectives were to study the feasibility of CCRT using intensity-modulated radiation therapy (IMRT) in locally advanced laryngeal cancer with respect to response, toxicities, and quality of life (QoL) and comparison with other modality—TL with post-operative RT.

Material and Methods:

The records of 48 patients with locally advanced laryngeal cancer (T3/T4aN0-2), registered between years 2014 and 2017, treated with IMRT (definitive or adjuvant postoperative IMRT) were analysed from the hospital database. The patients received RT either as definitive CCRT or as adjuvant treatment after TL. RT in all patients was delivered with IMRT-SIB(simultaneous integrated boost) technique and concurrent chemotherapy with weekly cisplatin. The response was assessed at 12 weeks. Toxicities and QoL were assessed and compared between patients receiving definitive CCRT and adjuvant RT.

Results:

92·3% patients who received definitive CCRT achieved complete response. Toxicities were of low grade in patients receiving both definitive and adjuvant treatments. All the patients (except two partial responders of CCRT) remained disease-free at the last follow-up. At 2 years of follow-up of each patient—Global QoL, emotional and social functioning were better in definitive CCRT patients. Laryngectomy patients had more dyspnoea, insomnia and financial difficulties. Although the problems of dry mouth, sticky saliva and swallowing were comparable, laryngectomy patients faced more problems with speech, senses, social eating, social contact and cough.

Conclusions:

Definitive CCRT using IMRT-SIB with weekly cisplatin is a feasible option for patients of locally advanced laryngeal cancer with acceptable response rate. IMRT yields better toxicity outcomes with sparing of organs at risk. CCRT patients have better QoL than laryngectomy patients in several parameters.

Keywords

concurrent chemoradiation (CCRT)intensity-modulated radiation therapy (IMRT)laryngectomylocally advanced laryngeal cancerquality of life (QoL)
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 20 , Issue 1 , March 2021 , pp. 71 - 77
Check for updates
Copyright
© The Author(s) 2020. Published by Cambridge University Press

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.)

References

Forastiere, A A, Goepfert, H, Maor, M et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003; 349: 2091–2098.CrossRefGoogle ScholarPubMed
Forastiere, A A, Maor, M, Weber, R S et al. Long-term results of Intergroup RTOG 91–11: a phase III trial to preserve the larynx—induction cisplatin/5FU and radiation therapy versus concurrent cisplatin and radiation therapy versus radiation therapy. Proceedings of ASCO Annual Meeting; 2006 Jun 2–6; Atlanta, Georgia. J Clin Oncol 2006; 24 (suppl 18): 5517.CrossRefGoogle Scholar
Forastiere, A A, Zhang, Q, Weber, R S et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol 2013; 31: 845–852.CrossRefGoogle ScholarPubMed
Fung, K, Lyden, T H, Lee, J et al. Voice and swallowing outcomes of an organ-preservation trial for advanced laryngeal cancer. Int J Radiat Oncol Biol Phys 2005; 63 (5): 1395–1399.CrossRefGoogle ScholarPubMed
The Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991; 324: 1685–1690.CrossRefGoogle Scholar
Mendenhall, W M, Amdur, R J, Palta, J R. Intensity-modulated radiotherapy in the standard management of head and neck cancer: promises and pitfalls. J Clin Oncol 2006; 24 (17): 2618–2623.CrossRefGoogle ScholarPubMed
Vergeer, M R, Doornaert, P A, Rietveld, D H, Leemans, C R, Slotman, B J, Langendijk, J A. Intensity-modulated radiotherapy reduces radiation-induced morbidity and improves health-related quality of life: results of a nonrandomized prospective study using a standardized follow-up program. Int J Radiat Oncol Biol Phys 2009; 74 (1): 1–8.CrossRefGoogle ScholarPubMed
Vokes, E E. Competing roads to larynx preservation. J Clin Oncol 2013; 31 (7): 833–835.CrossRefGoogle ScholarPubMed
Lee, N Y, O’Mearu, W, Chan, K et al. Concurrent Chemo radiotherapy and Intensity Modulated Radiotherapy for locoregionally advanced laryngeal and hypopharyngeal cancers. Int J Radiat Oncol Biol Phys 2007; 69 (2): 459–468. doi:10.1016/j.ijrobp.2007.03.013.CrossRefGoogle Scholar
Adelstein, D J, Li, Y, Adams, G L et al. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 2003; 21 (1): 92–98.CrossRefGoogle ScholarPubMed
Al-Sarraf, M, Pajak, T F, Byhardt, R W, Beitler, J J, Salter, M M, Cooper, J S. Postoperative radiotherapy with concurrent cisplatin appears to improve locoregional control of advanced, resectable head and neck cancers: RTOG 88-24. Int J Radiat Oncol Biol Phys 1997; 37 (4): 777–782.CrossRefGoogle ScholarPubMed
Al-Sarraf, M, LeBlanc, M, Giri, P G et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized intergroup study 0099. J ClinOncol 1998; 16 (4): 1310–1317.CrossRefGoogle ScholarPubMed
Bensadoun, R J, Benezery, K, Dassonville, O et al. French multicenter phase III randomized study testing concurrent twice-a-day radiotherapy and cisplatin/5-fluorouracil chemotherapy (BiRCF) in unresectable pharyngeal carcinoma: results at 2 years (FNCLCC-GORTEC). Int J Radiat Oncol Biol Phys 2006; 64 (4): 983–994.CrossRefGoogle Scholar
Bernier, J, Domenge, C, Ozsahin, M et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004; 350 (19): 1945–1952.CrossRefGoogle ScholarPubMed
Cooper, J S, Pajak, T F, Forastiere, A A et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004; 350 (19): 1937–1944.CrossRefGoogle ScholarPubMed
Ang, K K. Concurrent radiation chemotherapy for locally advanced head and neck carcinoma: are we addressing burning subjects? J Clin Oncol 2004; 22: 4657–4659.CrossRefGoogle ScholarPubMed
Loong, H H, Ma, B, Mo, F et al. The effect of cisplatin dose administered during concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma. J Clin Oncol 2011; 29 (suppl 15): 5532.CrossRefGoogle Scholar
Nagai, N, Ogata, H. Quantitative relationship between pharmacokinetics of unchanged cisplatin and nephrotoxicity in rats: importance of area under the concentration-time curve (AUC) as the major toxicodynamic determinant in vivo. Cancer Chemother Pharmacol 1997; 40 (1): 11–18.CrossRefGoogle ScholarPubMed
Kurihara, N, Kubota, T, Hoshiya, Y et al. Pharmacokinetics of cis-diamminedichloroplatinum (II) given as low-dose and high-dose infusions. J Surg Oncol 1996; 62 (2): 135–138.3.0.CO;2-7>CrossRefGoogle ScholarPubMed
Oken, M M, Creech, R H, Tormey, D C et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649–655.CrossRefGoogle ScholarPubMed
Edge, S B, Byrd, D R, Compton, C C, Fritz, A G, Greene, F L, Trotti, A. (eds.). AJCC Cancer Staging Manual, Chapter 5, 7th edition. New York: Springer, 2010: 57–67.Google ScholarPubMed
Grégoire, V, Levendag, P, Ang, K K et al. CT-based delineation of lymph node levels and related CTVs in the node-negative neck: DAHANCA, EORTC, GORTEC, NCIC, RTOG consensus guidelines. Radiother Oncol 2003; 69 (3): 227–236.CrossRefGoogle ScholarPubMed
Grégoire, V, Eisbruch, A, Hamoir, M, Levendag, P. Proposal for the delineation of the nodal CTV in the node-positive and the post-operative neck. Radiother Oncol 2006; 79 (1):15–20. Epub 2006; April 17.CrossRefGoogle ScholarPubMed
Eisenhauer, E, Therasse, P, Bogaerts, J et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45 (2): 228–247.CrossRefGoogle Scholar
Franchin, G, Vaccher, E, Talamini, R et al. Intensity-modulated radiotherapy with a simultaneous integrated boost combined with chemotherapy in stages III-IV hypopharynx-larynx Cancer: treatment compliance and clinical outcomes. J Radiother 2014; 2014: 1–7.CrossRefGoogle Scholar
Hanna, E, Sherman, A, Cash, D et al. Quality of life for patients following total laryngectomy vs chemoradiation for laryngeal preservation. Arch Otolaryngol Head Neck Surg 2004; 130: 875–879.CrossRefGoogle ScholarPubMed
Boscolo-Rizzo, P, Maronato, F, Marchiori, C, Gava, A, Mosto, M C D. Long-term quality of life after total laryngectomy and postoperative radiotherapy versus concurrentchemoradiotherapy for laryngeal preservation. Laryngoscope 2008; 118 (2): 300–306.CrossRefGoogle ScholarPubMed
Terrell, J E, Fisher, S G, Wolf, G T, for the Veterans Affairs Laryngeal Cancer Study Group. Long-term quality of life after treatment of laryngeal cancer. Arch Otolaryngol Head Neck Surg 1998; 124 (9): 964–971.CrossRefGoogle ScholarPubMed