Potentials of Radiation Therapy for Retreatment of Recurrent Laryngeal Carcinoma
Purpose: To determine if the application of radiation and chemotherapy for retreatment of recurrent laryngeal carcinoma developed after radiation or combined therapy of the primary tumor is feasible. Material and methods: 235 patients with morphologically confirmed recurrent squamous cell laryngeal carcinoma were included in the study. In 18 patients the tumors were operable, in 217 patients tumors were inoperable. Radiation therapy or combined radiochemotherapy were used for treatment of the primary tumor. Integrated dose delivered to a focus in the primary treatment was ranged from 40-60 Gy. Three palliative treatment modalities were applied, including chemotherapy (33 patients), radiation therapy (115 patients), combined chemoradiation therapy (87 patients). Radiation therapy as retreament modality was performed in the regimen of conventional fractionation as for the primary treatment. Integrated dose to a focus was ranged from 30 to 60 Gy, overall dose delivered in the primary treatment and retreatment was 80-120 Gy. Results: Retreatment of 5 of 18 patients (28 %) with operable tumors with the use of radiation therapy allowed to preserve the organ function. Three-year disease-free survival was 28 %, overall survival was 72 %. One-year survival after palliative treatment with such therapeutic modalities as chemotherapy, radiation therapy and chemoradiation therapy was 6.1, 26.8, 19.5 % respectively. The difference between survival after chemotherapy and chemoradiation therapy was statistically significant. Conclusions: It was demonstrated that retreatment of recurrent limited laryngeal carcinoma with radiation therapy was feasible. However it is impossible to consider the retreatment as alternative to organ preserving surgery. It was found that the most effective modalities of palliative treatment are radiation and chemoradiation therapy, the use of chemoradiation therapy allowed threefold increase in survival of the patients. Palliative treatment with chemoradiation therapy permitted us to improve direct treatment outcome only, in contrast to radiation therapy it did not effect the lifetime. Retreatment with radiation therapy produces the highest effect at doses exceeding 40 Gy. The number of developed local radiation-induced injuries is insignificant. The relevant modality of palliative treatment for laryngeal carcinoma must be selected for each patient.