Department of Radiation Oncology, University of Arizona, Tucson, Arizona, USA.
PLoS One. 2012;7(8):e42729. doi: 10.1371/journal.pone.0042729. Epub 2012 Aug 20.
The study aims to assess the feasibility of intensity-modulated and image-guided radiotherapy (IMRT, and IGRT, respectively) for functional preservation in locally advanced laryngeal cancer. A retrospective review of 27 patients undergoing concurrent chemoradiation for locally advanced laryngeal cancers (8 IMRT, 19 IGRT) was undertaken. In addition to regular clinical examinations, all patients had PET imaging at 4 months and 10 months after radiotherapy, then yearly. Loco-regional control, speech quality and feeding-tube dependency were assessed during follow-up visits.
At a median follow-up of 20 months (range 6-57 months), four out of 27 patients (14.8%) developed local recurrence and underwent salvage total laryngectomy. One patient developed distant metastases following salvage surgery. Among the 23 patients who conserved their larynx with no sign of recurrence at last follow-up, 22 (95%) reported normal or near normal voice quality, allowing them to communicate adequately. Four patients (14.8%) had long-term tube feeding-dependency because of severe dysphagia (2 patients) and chronic aspiration (2 patients, with ensuing death from aspiration pneumonia in one patient).
Functional laryngeal preservation is feasible with IMRT and IGRT for locally advanced laryngeal cancer. However, dysphagia and aspiration remain serious complications, due most likely to high radiation dose delivery to the pharyngeal musculatures.
本研究旨在评估调强放疗（IMRT）和图像引导放疗（IGRT）在局部晚期喉癌功能保留中的可行性。对 27 例接受同步放化疗的局部晚期喉癌患者（8 例 IMRT，19 例 IGRT）进行回顾性分析。除常规临床检查外，所有患者均在放疗后 4 个月和 10 个月以及每年进行 PET 成像。在随访期间评估局部区域控制、语音质量和饲管依赖情况。
在中位随访 20 个月（6-57 个月）期间，27 例患者中有 4 例（14.8%）出现局部复发并接受挽救性全喉切除术。1 例患者在挽救性手术后发生远处转移。在 23 例无复发迹象保留喉的患者中，22 例（95%）报告语音质量正常或接近正常，能够进行充分交流。4 例患者（14.8%）因严重吞咽困难（2 例）和慢性吸入（2 例，其中 1 例因吸入性肺炎死亡）需要长期饲管喂养。
IMRT 和 IGRT 可实现局部晚期喉癌的功能保留。然而，吞咽困难和吸入仍然是严重的并发症，这主要是由于咽肌接受高剂量放疗。
