Hyperfractionated irradiation for early laryngeal cancer

«Radiation and Risk», 2022, vol. 31, No. 1, pp.127-135

DOI: 10.21870/0131-3878-2022-31-1-127-135

Authors

Semenov A.V. – Researcher. Contacts: 4 Korolyov str., Obninsk, Kaluga region, Russia, 249035. Tel.: +7 (910) 604-09-24; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. .
Gordon K.B. – Sen. Researcher, C. Sc., Med.
Rozhnov V.A. – Sen. Researcher, MD
Gulidov I.A. – Head of Dep., MD, Prof.
Gogolin D.V. – Sen. Researcher, C. Sc., Med.
Radzhapova M.U. – Sen. Researcher C. Sc., Med.
Medvedeva K.E. – Researcher. A. Tsyb MRRC.
A. Tsyb MRRC, Obninsk

Abstract

The aim of the study was to evaluate the phenomena of early and late toxicity, immediate and long-term results of treatment of patients with localized laryngeal cancer who received a radical course of conformal radiation therapy in the hyperfractionation mode with a uniform fragmentation of the daily dose of 1+1 Gy to 64-66 Gy in an independent version. The material is presented by the results of treatment of 62 patients with newly diagnosed, histologically verified diagnosis of squamous cell car-cinoma of the larynx T1-2N0M0. 62 (100%) patients received the planned dose of radiation therapy. Grade 3 mucositis developed in 30 (48.3%) patients. In 32 (51.7%) patients, grade 1-2 mucositis was registered. The intragroup analysis revealed differences in the level of early toxicity depending on the T-stage of the disease, due to the volume of irradiation at the first stage of radiation therapy (p=0.03). Cutaneous toxicity in 60 (96.8%) patients was limited to grade 1-2. Wet epidermis was registered in 2 (3.2%) patients. The average follow-up period for the group was 4.4+-2.3 years. The overall 1-year survival rates were 96.7%, 2-year – 93.0%, 3-year – 90.9%. Local and / or regional relapse during the entire follow-up period was registered in 15 (24.1%) patients. The level of 1-year locoregional control was 83.3%, 2-year – 81.4%, 3-year – 79.1%. Subglottic spread of the tumor (p=0.07) and the initial tumor process T2 (p=0.12) were identified as worsening the prognosis of treatment. Late com-plications of radiation therapy were registered in 5 (8.0%) patients. Late xerostomia of the 2nd degree 12 months after completion of treatment was observed in 17 (27.4%) patients. All cases of late xero-stomia were observed when intact groups of the neck lymphatic collectors were included in the irra-diation volume. The findings suggest that radiation therapy in the hyperfractionation regimen is well tolerated, but more aggressive treatment options should be offered for patients with a relatively poor prognosis.

Key words
radiation therapy, head and neck tumors, hyperfractionation, unconventional fractionation, treatment results, toxicity of radiation therapy, quality of life of patients, conformal radiation therapy, mucositis, xerostomia.

References

1. Ferlito A. The natural history of early vocal cord cancer. Acta. Otolaryngol. 1995, vol. 115, no. 2, pp. 345-347.

2. The status of cancer care for the population in Russia in 2019. Eds.: A.D. Kaprin, V.V. Starinskiy, G.V. Petrova. Moscow, NMRRC, 2020. 221 p. (In Russian).

3. Mlynarek A., Kost K., Gesser R. Radiotherapy versus surgery for early T1-T2 glottic carcinoma. J. Otolaryngol., 2006, vol. 35, no. 6, pp. 413-419.

4. Laryngeal Cancer. Clinical Recommendations of the Russian Association of Oncologists. Moscow, Ministry of Health of the RF, 2018. 32 p. (In Russian).

5. Mendenhall W., Amdur R., Morris C., Hinerman R. T1-T2N0 squamous cell carcinoma of the glottic larynx treated with radiation therapy. J. Clin. Oncol., 2001, vol. 19, no. 20, pp. 4029-4036.

6. Chera B., Amdur R., Morris C., Kirwan J., Mendenhall W. T1N0 to T2N0 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy. Int. J. Radiat. Oncol. Biol. Phys., 2010, vol. 78, no. 2, pp. 461-466.

7. Cellai E., Frata P., Magrini S., Paiar F., Barca R., Fondelli S., Polli C., Livi L., Bonetti B., Vitali E., De Stefani A., Buglione M., Biti G. Radical radiotherapy for early glottic cancer: results in a series of 1087 patients from two Italian radiation oncology centers. I. The case of T1N0 disease. Int. J. Radiat. Oncol. Biol. Phys., 2005, vol. 63, no. 5, pp. 1378-1386.

8. Nakajima A., Nishiyama K., Morimoto M., Nakamura S., Suzuki O., Kawaguchi Y., Miyagu K., Fujii T., Yoshino K. Definitive radiotherapy for T1-2 hypopharyngeal cancer: a single-institution experience. Int. J. Radiat. Oncol. Biol. Phys., 2012, vol. 82, no. 2, pp. 129-135.

9. Lacas B., Bourhis J., Overgaard J., Zhang Q., Grégoire V., Nankivell M., Zackrisson B., Szutkowski Z., Suwiński R., Poulsen M., O'Sullivan B., Corvò R., Laskar S.G., Fallai C., Yamazaki H., Dobrowsky W., Cho K.H., Beadle B., Langendijk J.A., Viegas C.M., Hay J., Lotayef M., Parmar M.K., Aupérin A., van Herpen C., Maingon P., Trotti A.M., Grau C., Pignon J.P., Blanchard P., MARCH Collaborative Group. Role of radiotherapy fractionation in head and neck cancers (MARCH): an updated meta-analysis. Lancet Oncol., 2017, vol. 18, no. 9, pp. 1221-1237.

10. Biau J., Lapeyre M., Troussier I., Budach W., Giralt J., Grau C., Kazmierska J., Langendijk J.A., Ozsahin M., O'Sullivan B., Bourhis J., Grégoire V. Selection of lymph node target volumes for definitive head and neck radiation therapy: a 2019 Update. Radiother. Oncol., 2019, vol. 134, pp. 1-9.

11. Ridge J.A., Lawson J., Yom S.S., Garg M.K., McDonald M.W., Quon H., Saba N., Salama J.K., Smith R.V., Worden F., Yeung A.R., Beitler J.J. American College of Radiology Appropriateness Criteria (®) treatment of stage I T1 glottic cancer. Head Neck, 2014, vol. 36, no. 1, pp. 3-8.

12. Pfister D.G., Spencer S., Brizel D.M., Burtness B., Busse P.M., Caudell J.J., Cmelak A.J., Colevas A.D., Dunphy F., Eisele D.W., Foote R.L., Gilbert J., Gillison M.L., Haddad R.I., Haughey B.H., Hicks W.L.Jr., Hitchcock Y.J., Jimeno A., Kies M.S., Lydiatt W.M., Maghami E., McCaffrey T., Mell L.K., Mittal B.B., Pinto H.A., Ridge J.A., Rodriguez C.P., Sandeep S., Shah J.P., Weber R.S., Wolf G.T., Worden F., Yom S.S., McMillian N., Hughes M. Head and Neck Cancers, Version 1.2015. J. Nat. Comprehen. Cancer Network, 2015, vol. 13, no. 7, pp. 847-855.

13. Radzhapova M.U., Gulidov I.A., Sevryukov F.E., Mardynsky Yu.S., Panaseykin J.A., Semenov A.V., Ivanov S.A., Kaprin A.D. Chemoradiation therapy of patients with oral mucosal cancer using radiation dose hyperfractionation. Sibirskiy onkologicheskiy̆ zhurnal – Siberian Journal of Oncology, 2021, vol. 20, no. 2, pp. 29-36. (In Russian).

14. Nguyen C.T., Lin S., Clark H., Hovan A., Wu J. Salivary flow rate after conventional and intensity-modulated radiation therapy. J. Am. Dent. Assoc., 2018, vol. 149, no. 6, pp. 432-441.

15. Lambrecht M., Nevens D., Nuyts S. Intensity-modulated radiotherapy vs. parotid-sparing 3D conformal radiotherapy. Effect on outcome and toxicity in locally advanced head and neck cancer. Strahlenther Onkol. 2013, vol. 189, no. 3, pp. 223-229.

Full-text article (in Russian)