Treatment of keloids by surgical excision and immediate postoperative single-fraction radiotherapy

The authors report the outcomes of patients with keloid scars treated with a protocol of extralesional excision and immediate single-fraction adjuvant radiotherapy. The design of the study was a retrospective analysis with up to 5-year outcome data. The setting was a single treatment team, University Teaching Hospital in London, United Kingdom. Participants (n = 80) were treated for 80 keloid scars (59 percent female patients, 76 percent nonwhite), and 44 percent of keloids were located on earlobes. For all patients, prior treatment without radiotherapy had failed. The salvage treatment reported in this article is combined extralesional excision and immediate postoperative external-beam radiotherapy. A 10-Gy dose of superficial 60-kV or 100-kV photon irradiation was given within 24 hours of the operation. The main outcome measure was freedom from recurrence of keloid scars. Results were that all keloid scars were controlled at 4-week follow-up. Probability of relapse at 1 year was 9 percent; at 5 years, probability of relapse was 16 percent. The earlobe showed no greater chance of relapse than other sites on the body. The authors' report shows that extralesional excision of keloid followed by early, single-fraction, postoperative radiotherapy is both simple and effective in preventing recurrence at excision sites.     

Changes in potential denitrification and respiration during the cold storage of soils

The denitrification potential in moderately fertilized soil sampled four times during 1995 decreased significantly after cold storage, at 4 +/- 2 degrees C for 1 week. Prolonged storage (up to 24 weeks) resulted in a further decrease of denitrification potential which dropped to 38-54% of the original values. Similarly, denitrification potential decreased substantially during the first week of storage in differently fertilized soils. After 24 weeks of storage, denitrification potential dropped to 29-55% of that in fresh soils. The effects of storage at 4 +/- 2 degrees C on denitrification potential and respiration (determined as carbon dioxide evolution) were in general the same in moderately fertilized soils from four different sites: in all soils, depression of both the denitrification potential and potential respiration was found after 8 weeks. However, the extent to which the parameters were decreased differed from case to case. Not only the duration and storage conditions but also unidentified soil parameters are important for the persistence of biological activity in stored soils.     

Extrasellar prolactinomas: successful management of 24 patients using bromocriptine

24 patients with an extrasellar prolactinoma (mean prolactin 4,722 ng/ml), 8 of whom had previously had surgery, received 5-40 mg bromocriptine daily for 13-252 weeks. The mean prolactin level had fallen 89% at 2 days, 95% at 6 weeks, and 15 patients achieved normal values. Tumor shrinkage occurred in all 9 patients rescanned within 2 weeks and later was documented in 23; in 18 the extrasellar tumour disappeared. 12 patients had visual abnormalities; 7, including 2 who had been completely blind, improved within 1 week. 2 patients had normal prolactin levels after withdrawal of bromocriptine, 1 following radiotherapy and the other during two uncomplicated pregnancies. Bromocriptine is safe and effective. We conclude that medical treatment should always precede surgery unless pituitary apoplexy causes sudden deterioration of vision. Most patients will subsequently require radiotherapy or surgery for permanent cure.     

Nephroblastoma in infants, 1969-75: variations in treatment and survival.

In a series of 79 infants aged under 1 year with nephroblastoma diagnosed during 1969-75 all the patients underwent nephrectomy, 33 (42%) received a course of radiotherapy, and 49 (62%) received chemotherapy. The overall three-year survival rate for patients who survived at least one week after diagnosis was 65%. The corresponding rate for infants with stage I tumours was 76%. The survival rate in children with early-stage tumours was significantly higher in those who were treated by nephrectomy and chemotherapy alone compared with those who also received radiotherapy. In a large proportion of cases nephrectomy and chemotherapy together constituted sufficient treatment for the cure of infants with nephroblastoma, and in some instances nephrectomy alone proved adequate. There was no general tendency for children under 1 year old to be unable to withstand chemotherapy.     

Efficacy and safety of propolis mouthwash in management of radiotherapy induced oral mucositis; A randomized,double blind clinical trial

Aim and BackgroundPropolis has been used for the management of oral mucositis in a number of studies. Due to lack of sufficient evidence especially in radiotherapy induced oral mucositis, the present study was designed to evaluate the efficacy and safety of propolis mouthwash in oral mucositis and dysphagia in patients undergoing head and neck radiotherapy.Materials and methodsThis study was a prospective, randomised, double-blind, placebo-controlled trial. The patients randomly divided into two groups receiving either the propolis or the placebo mouthwash. Patients were advised to rinse their mouth with 15 mL three times daily for four weeks. Severity of mucositis and dysphagia were evaluated by the National Cancer Institute Common Toxicity Criteria (NCI-CTC) and Common Terminology Criteria for Adverse Events (CTCAE), respectively.ResultsThirty patients completed the study. Each group consisted of 15 patients. Although, there is not any significant difference between two groups in the first week of radiotherapy, a significant difference was seen in the second, the third and the fourth week (p = 0.03, 0.02, 0.02, respectively). Dysphagia reported as a mild score in the propolis group only in the fourth week which is significant compared with the placebo group (p = 0.01). There is not any serious adverse effect related to propolis or placebo during the study.ConclusionIt seems that propolis mouthwash is an effective and safe medication for alleviation of oral mucositis and dysphagia in patients under head and neck radiotherapy.     

Escalated hyperfractionation in radiotherapy for head and neck cancer – 5-year results

PurposeTo evaluate 5-year results of escalated hyperfractionation schedule in aspect of local tumour control (LTC) and late radiation toxicity.Material and methodsForty eight patients with squamous cell carcinoma of oral cavity (34 pts), oropharynx (11 pts) and larynx (3) in stage T1-4N0-1 have been treated at Centre of Oncology in Gliwice, between the years 1988–92. There were four patients with T1 primary tumour, 27 with T2, 11 with T3 and 2 with T4; in 4 patients the tumour stage remains unknown (TX). All the patients were treated by radiation therapy alone, using the technique of two opposed parallel fields and hyperfractionation with escalation of the dose per fraction during the second part of the treatment schedule. The total dose ranged between 62,2 and 74 Gy. The median follow-up was 62 months.ResultsDespite of the relative high proportion of complete local regressions (75%), the 5-year LTC rate of 54% was noted in the whole group of patients. Stage-related LTC rates were as follows: 100% for TX tumours, 50% for T1, 55% for T2, 45% for T3 and 0% for T4. Acute radiation reactions were more intensive than those usually observed during conventional radiotherapy; all patients experienced a confluent mucositis and two waves of acute mucosal reaction because of treatment gap were observed during the radiation course. Severe late radiation toxicity (grade IV) was noted in two patients (4%).ConclusionsLong-term tumour control results of escalated hyperfractionation radiotherapy may suggest that there is no benefit of a such regimen. However, in the majority of patients the treatment course differed markedly from protocol assumptions.     

Randomised controlled trial of short term treatment to eradicate Helicobacter pylori in patients with duodenal ulcer.

OBJECTIVE--To determine whether one week''s drug treatment is sufficient to eradicate Helicobacter pylori in patients with duodenal ulcer. DESIGN--Single blind, randomised controlled trial. SETTING--Specialised ulcer clinic in a teaching hospital. PATIENTS--155 patients with H pylori and a duodenal ulcer verified endoscopically which had either bled within the previous 24 hours or was causing dyspepsia. INTERVENTIONS--Patients were allocated randomly to receive either omeprazole for four weeks plus bismuth 120 mg, tetracycline 500 mg, and metronidazole 400 mg (all four times a day) for the first week (n = 78), or omeprazole alone for four weeks (n = 77). Further endoscopy was performed four weeks after cessation of all drugs. MAIN OUTCOME MEASURES--Presence or absence of H pylori (by urease testing, microscopy, and culture of antral biopsy specimens), duodenal ulcer, and side effects. RESULTS--Eradication of H pylori occurred in 70 (95%) patients taking the four drugs (95% confidence interval 86% to 97%) compared with three (4%) patients taking omeprazole alone (1% to 11%). Duodenal ulcers were found in four (5%) patients taking the four drugs (2% to 12%) and in 16 (22%) patients taking omeprazole alone (14% to 32%). Mild dizziness was the only reported side effect (six patients in each group) and did not affect compliance. CONCLUSIONS--A one week regimen of bismuth, tetracycline, and metronidazole is safe and effective in eradicating H pylori and reduces the number of duodenal ulcers four weeks after completing treatment.     

Prolonged low dose IL-2 and thalidomide in progressive metastatic renal cell carcinoma with concurrent radiotherapy to bone and/or soft tissue metastasis: a phase II study

Metastatic renal cell cancer is one of the immuno-sensitive tumors. Apart from the immuno-modulating agents IFN and IL-2, thalidomide has been reported to be effective in this type of cancer. However, bone metastases and bulky metastases, show limited response to immunotherapy, are often site of recurrent disease and are therefore often treated later with radiotherapy. In this phase II study, we evaluated toxicity and efficacy of the combination of continuous low dose (1 mIU/m²) s.c. IL-2 and thalidomide (200 mg once daily) in 22 patients with progressive metastatic renal cell cancer. In addition, 13 soft tissue lesions and two bone metastases in 13 patients were concurrently treated with fractionated radiotherapy. T cell number and activation in blood was measured by immunoflowcytometry. Nearly all patients developed grade 1–2 toxicity consisting of fatigue, sensory neuropathy, constipation and dizziness. Five patients had a grade 3–4 toxic event: four patients with deep venous thrombosis requiring anticoagulant therapy, and one patient who developed radiation myelopathy. On systemic response evaluation ten patients showed ongoing SD with a mean progression free survival of 9 months. One patient showed a PR (at an irradiated site). Regarding local response to irradiation, seven lesions showed a PR for a mean time period of 8.7 months, whereas seven were stable for 6 months. The radiation response of one lesion was not evaluable. Immunoflowcytometry showed an increase in number and activation of lymphocytes (mainly Natural Killer—NK-cells), which was absent or even decreased in irradiated patients. The combination of sc. low dose IL-2, thalidomide and radiotherapy is feasible, but relatively toxic and does not lead to higher responses at non-irradiated sites. The combination of immunotherapy and concurrent radiotherapy is effective at 60% of the relatively large evaluable sites. Progressive myelopathy developed in one patient, possibly due to radiotherapy in combination with thalidomide.     

Radiotherapy applications of patients with malignant mesothelioma: A single center experience

Background

In the management of malignant pleural mesothelioma, radiotherapy has been used for the purpose of prophylaxis to reduce the incidence of recurrence at surgical insertion sites or palliate the symptoms.

Aim

The purpose of the study was to evaluate the techniques and effectiveness of radiotherapy in malignant pleural mesothelioma.

Materials and methods

Forty-four (18 female, 26 male) patients diagnosed with malignant pleural mesothelioma were retrospectively evaluated. All patients had surgery or thoracoscopic biopsy for diagnosis, staging or treatment and all received palliative or prophylactic radiotherapy. Fifty-seven percent of the patients received chemotherapy.

Results

Prophylactic radiation was applied to 27 patients with 4–15 MeV electron energies. The median radiotherapy dose was 30 Gy with 3 Gy daily fraction dose. During treatment, 12 patients had grade 1 erythema according to the RTOG scale. In 3 (12%) patients, a local failure at treatment field was observed. Palliative radiotherapy was applied to 17 patients for pain palliation. The median radiation dose was 40 Gy with 2 Gy daily fraction dose by using 6–18 MV photon and/or 4–12 MeV electron energies. Two patients had grade 1 erythema and one patient had grade 2 odynophagy according to the RTOG scale. For 10 (59%) patients, palliation of chest pain was delivered. No late toxicity was observed for all cases.

Conclusion

Our experience showed that prophylactic and palliative radiotherapy are effective and safe therapy modalities in malignant pleural mesothelioma in preventing seeding metastasis at intervention sites or relieving pain. Prospective randomized studies are still needed to determine the benefits of radiotherapy application and to indicate optimum dose schemes.     

The role of fine needle aspiration cytology in the management of gynecologic malignancies

Between 1978 and 1983, 317 diagnostic fine needle aspirations (FNA) were procured at Indiana University by the Cytology, Radiology or Gynecology services for initial evaluation or follow-up of proven gynecologic malignancies. The primary sites of the neoplasms included the cervix, uterus, ovary, vagina and vulva. Totals of 199 samples were procured from superficial sites, including parametrium, vagina, subcutaneous tissue and superficial lymph nodes, and 118 were obtained from deep soft tissues, abdominal organs, pelvis and deep lymph nodes. Of the FNA specimens, 146 (46%) were cytologically diagnosed as malignant and 171 (54%) were reported as benign. Of the specimens initially given negative diagnoses, 35 (11%) were inadequate samples. No complications occurred as a result of FNA biopsy. All cases were reclassified using strict criteria for an inadequate specimen. After review, 79 biopsies were considered either scant (22%) or inappropriate (0.03%) for the target lesion. Scant specimens were obtained more often in superficial than in deep sites. No significant differences were found in the false-negative rate between superficial and deep sites; all false positives were from superficial sites. The use of strict criteria for adequacy of a sample (two groups of appropriate cells on two separate slides) yielded a specificity of 95%, an increased sensitivity from 73% to 91%, a predictive value for a positive result of 98% and a predictive value for a negative result of 84%. Use of strict criteria for specimen adequacy served to reemphasize two points regarding negative FNA results: that rebiopsy should be suggested and that on-site assessment of the specimen adequacy should be made during the aspiration.     

复方环丙酮胺治疗浅部真菌病的疗效观察

观察复方环丙酮胺喷剂治疗浅部真菌病的疗效。第Ⅰ批给予复方环丙酮胺喷剂,1次/d喷于患处,用药4周后观察疗效;第Ⅱ批随机入A、B组,A组给予复方环丙酮胺喷剂+曲安奈德喷剂,B组给予复方环丙酮胺喷剂,均1次/d喷于患处,用药2周、4周后观察疗效。第Ⅰ批治疗4周总有效率为80%;第Ⅱ批A、B组治疗2周总有效率分别为75%及82.35%,治疗4周总有效率分别为94.74%及100%。复方环丙酮胺喷剂和复方环丙酮胺喷剂+曲安奈德喷剂治疗浅部真菌病的疗效相似(P>0.05),且疗效显著、局部刺激小、瘙痒缓解明显、安全性较高。     

多西紫杉醇与紫杉醇联合顺铂同步放化疗治疗晚期宫颈癌的疗效比较

目的:比较多西紫杉醇与紫杉醇联合顺铂同步放化疗治疗晚期宫颈癌的疗效。方法:选择2006年6月至2012年6月我院收治的宫颈癌晚期患者180例作为研究对象,依据随机数字表将患者分为紫杉醇组(n=90)和多西紫杉醇组(n=90),两组患者在放疗基础上分别接受紫杉醇135 mg/m~2,每周1次,多西紫杉醇25 mg/m~2,每周1次,4周一疗程,维持两个疗程,比较两组患者的近期疗效、生存时间和毒副作用发生情况。结果:紫杉醇和多西紫杉醇组近期治疗的总有效率分别为81.11%和87.78%,差异无统计学意义(P=0.217);且均未出现进展期的病例。紫杉醇组3年生存率为58.89%,明显低于多西紫杉醇组的75.56%,差异有统计学意义(P=0.017);紫杉醇组骨髓抑制和消化道反应的发生率分别为35.56%和37.78%,明显高于多西紫杉醇组的22.22%和26.67%,差异有统计学意义(均P0.05)。结论:多西紫杉醇联合顺铂同步放化疗治疗晚期宫颈癌能显著提高患者3年生存率,降低毒副作用发生率,且用药量更少,相对安全、合理,患者可耐受,值得进一步临床研究。     

Corynebacterium Pseudotuberculosis Infection in Goats IV.

Adult animals from 2 herds were examined clinically and serologically, 5 (Herd A) and 4 (Herd B) times during the same period of 3% years. Serum samples were examined for antibodies against Gorynebac-terium pseudotuberculosis using the bacterial agglutination test (BAT) and the hemolysis inhibition test (HIT). The results of the first examination showed that no animal in Herd A was seropositive, while in Herd B 1 animal showed a high positive titre in BAT. The prevalence of animals with superficial swellings was then 2 % in Herd A and 4 % in Herd B. In both herds, the prevalence of animals with superficial swellings and seropositive reactions increased during the following 1–2 yeairs. About 30 % of animals had superficial lesions and close to 100 % were seropositive. The proportion, of animals with superficial swellings and seropositive reactions was almost constant on subsequent examinations. In some of the animals, superficial swellings were found during 2 or more of the examinations, a few animals having such lesions at the same site on both or all occasions. Animals in Herd A became infected through grazing together with goats from infected herds. Caseous lymphadenitis was introduced into Herd B by animals obtained from infected herds.     

Adjuvant radiotherapy for early breast cancer: patterns of practice in Ontario.

OBJECTIVE: To determine the number of different radiation schedules used in Ontario to treat women with node-negative breast cancer after lumpectomy and axillary dissection. DESIGN: Retrospective survey. SETTING: Princess Margaret Hospital, Toronto, and regional centres of the Ontario Cancer Treatment and Research Foundation (in Hamilton, London, Ottawa, Windsor and Thunder Bay). PATIENTS: A total of 551 of 1624 consecutive patients with node-negative breast cancer having undergone lumpectomy and axillary dissection who were eligible but did not participate in the Ontario Clinical Oncology Group randomized clinical trial and who received adjuvant breast irradiation between April 1984 and February 1989. OUTCOME MEASURES: Schedules of radiotherapy received. RESULTS: Forty-eight different radiotherapy schedules were identified. Total doses ranged from 4000 to 6600 cGy and the number of fractions from 15 to 30. Several different schedules were preferred: 322 patients (58.5%) received 4000 cGy in 15 or 16 fractions to the whole breast over 3 weeks plus a local boost of 1250 cGy to the primary site in 5 fractions over 1 week; 66 patients (12.0%) received 4000 cGy in 15 or 16 fractions over 3 weeks to the whole breast plus a local boost of 1000 cGy to the primary site in 4 or 5 fractions over 1 week; and 63 patients (11.5%) received 5000 cGy in 25 fractions to the whole breast in 5 weeks, without a boost. CONCLUSIONS: The practice of adjuvant radiotherapy for early breast cancer in Ontario varies. The optimal radiation regimen for patients after lumpectomy should be determined through randomized clinical trials.     

Performance of Two HCV RNA Assays during Protease Inhibitor-Based Triple Therapy in Patients with Advanced Liver Fibrosis and Cirrhosis

Introduction

On-treatment HCV RNA measurements are crucial for the prediction of a sustained virological response (SVR) and to determine treatment futility during protease inhibitor-based triple therapies. In patients with advanced liver disease an accurate risk/benefit calculation based on reliable HCV RNA results can reduce the number of adverse events. However, the different available HCV RNA assays vary in their diagnostic performance.

Aim

To investigate the clinical relevance of concordant and discordant results of two HCV RNA assays during triple therapy with boceprevir and telaprevir in patients with advanced liver fibrosis/cirrhosis.

Methods

We collected on-treatment samples of 191 patients with advanced liver fibrosis/cirrhosis treated at four European centers for testing with the Abbott RealTime (ART) and COBAS AmpliPrep/COBAS TaqMan HCV v2.0 (CTM) assays.

Results

Discordant test results for HCV RNA detectability were observed in 23% at week 4, 17% at week 8/12 and 9% at week 24 on-treatment. The ART detected HCV RNA in 41% of week 4 samples tested negative by the CTM. However, the positive predictive value of an undetectable week 4 result for SVR was similar for both assays (80% and 82%). Discordance was also found for application of stopping rules. In 27% of patients who met stopping rules by CTM the ART measured levels below the respective cut-offs of 100 and 1000 IU/ml, respectively, which would have resulted in treatment continuation. In contrast, in nine patients with negative HCV RNA by CTM at week 24 treatment would have been discontinued due to detectable residual HCV RNA by the ART assay. Importantly, only 4 of these patients failed to achieve SVR.

Conclusion

Application of stopping rules determined in approval studies by one assay to other HCV RNA assays in clinical practice may lead to over and undertreatment in a significant number of patients undergoing protease inhibitor-based triple therapy.     

Smoking during radiotherapy for head and neck cancer and acute mucosal reaction

AimWe compared the incidence of RTOG/EORTC grade III and higher acute mucositis in patients with head and neck cancer who continued to smoke during radiotherapy with those who quit smoking.BackgroundThere are conflicting data on the relationship between smoking during radiotherapy and the severity of acute mucosal reaction. More studies dealing with this issue are needed.Materials and methodsAmong 136 patients receiving curative radio(chemo)therapy, 37 (27%) declared that they had not quit smoking during radiotherapy. The intensity of mucositis was scored daily by a nurse and weekly by a physician using the RTOG/EORTC scale. The main end-point of the study was the highest observed RTOG/EORTC grade of mucositis.ResultsPatients who smoked during radiotherapy (smokers) were younger than their counterparts who quit smoking (non-smokers), p = 0.06. There were no other differences in the baseline characteristics between smokers and non-smokers. Grade III/IV acute mucositis was observed in 43.5% of all patients. The percentage of patients with grade III/IV acute mucositis was similar in smokers and non-smokers (46% vs. 42%, p = 0.71). Nine patients (smokers [13.5%]; non-smokers [4%], p = 0.05) required prolonged hospitalization to heal mucositis.ConclusionsIn the whole group, smoking during radiotherapy was not related to acute mucosal toxicity evaluated as the rate of the highest observed grade of mucositis.     

Comparison of terbinafine and clotrimazole in treating tinea pedis.

OBJECTIVE--To compare the efficacy and safety of terbinafine 1% cream and clotrimazole 1% cream in the treatment of tinea pedis. DESIGN--Multicentre, double blind parallel group study. SETTING--32 general practices and one hospital. PATIENTS--256 patients with mycologically confirmed tinea pedis. Of the 211 patients evaluable, 107 were randomised to terbinafine (75 male, 32 female; mean (range) age 40 (12-81) years) and 104 to clotrimazole (79 male, 25 female; mean (range) age 36 (12-71) years). INTERVENTIONS--Terbinafine 1% cream applied twice daily for one week and inert cream applied twice daily for the next three weeks. Clotrimazole 1% cream applied twice daily for four weeks. MAIN OUTCOME MEASURES--Mycological cure (negative results on microscopy and culture) and effective treatment (mycological cure plus no or minimal signs and symptoms) measured at weeks 1, 2, 3, 4, and 6. RESULTS--At week four rates of mycological cure were 93.5% for terbinafine and 73.1% for clotrimazole (p = 0.0001); and at week six 97.2% for terbinafine and 83.7% for clotrimazole (p = 0.001). Rates of effective treatment at week 4 were 89.7% for terbinafine and 58.7% for clotrimazole (p = 0.0001); and 89.7% for terbinafine and 73.1% for clotrimazole (p = 0.002) at week 6. CONCLUSION--These results indicate that a one week course of terbinafine 1% cream is more effective in the treatment of tinea pedis than a four week course of clotrimazole 1% cream, both in terms of mycological cure and effective treatment.     

Photodynamic Therapy in the Treatment of Superficial Mycoses: An Evidence-based Evaluation

Photodynamic therapy (PDT) is effective in the destruction of fungi. In order to evaluate the efficacy and safety of PDT for superficial mycoses, we performed an evidence-based review of published literature. Database of MEDLINE, EMBASE, and Cochrane Library was searched until March 2010. English-language articles evaluating the efficacy and safety of PDT for superficial mycoses were included. No randomized clinical trials were found. Seven reports described the antifungal effect of PDT against 63 superficial mycoses patients. Eight of 10 (80%) tinea cruris patients and 6 of 10 (60%) tinea pedis were led to mycological cure after 1–3 treatments. Unfortunately, only 4 (40%) tinea cruris patients and 3 (30%) tinea pedis had a persist healing at the 8-week follow-up. Six of the 9 (66.7%) foot-interdigital mycoses patients recovered clinically and microbiologically after 1 or 4 treatments. Only 2 patients (22.2%) had a persist healing at the 8-week follow-up. Eleven of 30 (36.6%) onychomycosis patients were cure for 18 months after treatment, and 3 onychomycosis patients were all cure in other 2 reports. The therapeutic effect of PDT for one pityriasis versicolor patients was well. Overall tolerability of PDT was good. Therefore, it is unclear what PDT’s place for superficial mycoses will be. Further clinical trials are needed to evaluate the efficacy of PDT to treat superficial mycoses. It is also important to optimize treatment protocols in order to cope with recurrence.     

Feasibility of intensity-modulated and image-guided radiotherapy for functional organ preservation in locally advanced laryngeal cancer

Purpose

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.

Results

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).

Conclusions and Clinical Relevance

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.