Laryngeal glottic carcinoma outcome : retrospective study on 150 patients

الملخص EN

Background : Radiation therapy for early laryngeal glottic carcinoma offers an excellent probability of cure.

The objective of treatment controlling the malignant tumor and preserving a functionally useful voice is best optimized by the use of radiotherapy in early stages.

Although surgery can undoubtedly offer equal good results, it is best reserved in the event of radiation failure.

Definitive radiation therapy is associated with persistent disease or tumor recurrence in a minority of patients.

Aim : To define this subgroup at high risk of failure of primary treatment , we retrospectively analyzed the influence of different clinical and treatment variables on local control results.

Subjects and Methods : Between 1985 and 2002, a total of 150 consecutive patients with squamous cell carcinoma of the laryngeal glottis were managed by definitive radiation therapy.

These patients were evaluated for local control rate, overall survival and their correlation with different prognostic variable.

The treatment target was the entire larynx with limited safety margins, without lymph nodal irradiation and sparing the spinal cord from the start of radiation course.

Results : Seventy three percent of patients received <60 Gy (range 56-60 Gy) as a total irradiation dose and twenty seven percent received > 60Gy (range 62-66 Gy).

Early radiation reactions in the form of laryngitis and pharyngitis in 88% and 81% of patients, respectively and treatment delay recommenaded in only 16% of cases while late reactions happened in 21% of cases.Complete disappearance of the laryngeal glottic lesion (CR) was achieved in 83% of patients and partial response (PR) in 10% of patients while 7% of patients had no response or progression of the disease in spite of radiation therapy.

Univariate and multivariate analysis of the 10-year local control rate and the patients, tumor and treatment characteristics showed that only tumor stage and involvement of anterior commissure of the vocal cord were independent prognostic factors.

While the 10-years overall survival was not influenced by the tumor stage or the commissure involvement.

Conclusion : Clinicians should consider anterior commissure in-volvement and stage T2 disease as important factors for increased local failure.

Other prognostic factors in significantly influence the definitive treatment of glottic carcinoma by radiotherapy.