Efficacy of the Repeated Course of Radiation Therapy Combined with Intratumoral Chemotherapy for Unresectable Regional Metastases from Cancer of the Larynx and Laryngopharynx
Purpose: We determine the advisability and efficacy of the repeated course of radiation therapy combined with intratumoral chemotherapy in the palliative treatment of inoperable recurrent metastases from cancer of the larynx and laryngopharynx. Material and methods: The present study included 32 patients with morphologically verified inoperable recurrent regional metastases from cancer of the larynx and laryngopharynx without signs of the recurrent primary tumor. All the patients were conditionally divided into two groups according to the size of the recurrent tumor: 12 patients had 2-6 cm metastases (rN <sub>2</sub>) and 20 patients had >6 cm metastases (rN <sub>3</sub>). The primary tumor was previously treated using radiation therapy in combination with chemotherapy or radiation therapy alone. Total tumor radiation dose of the pretreatment ranged from 40 to 60 Gy. Repeated courses of radiation therapy were given using a conventional dose fractionation schedule to a total tumor dose of 30-60 Gy. Taking into account previous radiation therapy, a total tumor radiation dose ranged from 80 to 120 Gy. Intratumoral chemotherapy was carried out 1-1.5 hours before the first radiation fraction was delivered. Injections were given at a dose which was sufficient for complete infiltration of metastasis 3-4 times a week up to 7 injections per therapy course until a total dose of 350 mg was delivered. As chemotherapy drug Cisplatin was used. Results: Complete regression of metastases was achieved in 78 % of cases. The repeated course of radiation therapy did not cause any significant complications, and a high concentration of the cytostatic agent in the tumor permitted to improve treatment results considerably. So, the overall two-year survival rate was 27.8 %, and it was 58.3 % in patients with metastases sized <6 cm. Conclusion: The method of the palliative treatment presented in our study was found to be highly efficient in patients with inoperable recurrent regional metastases of cancer of the larynx and laryngopharynx.