The results of salvage surgery combined with reirradiation in nodal recurrence of larynx cancer

The recurrence in the regional lymph nodes of patients after total laryngectomy and postoperative radiotherapy is a still serious therapeutic problem. The conditions that are altered following the combined primary treatment make it difficult to achieve satisfactory results of the second surgical treatment.The aim of our study was to evaluate the outcome of a salvage operation (lymphadenectomy) and reirradiation in 50 patients with recurrence in regional lymph nodes (rN). Beetwen 1991 and 1996, 650 patients with larynx carcinoma were treated in our institiutions. All patients during the primary irradiation received a total dose of about 60 Gy. In the case of regional recurrence (rN) patients had selective lymphadenectomy and reirradiation (total dose 40 Gy) when capsulae were found to be infiltrated. The survival rates were for 1, 2 and 3 years : 34 (68%), 22 (44%), only 9 (18%) respectivly. This strategy of a second combined treatment had a good tolerance level, without any unacceptable side effects (complications)

45. Impact of Hb level during postoperative radiotherapy of patients with larynx cancer

AimAssessment the influence of low level of Hgb on the locoregional outcome of postoperative radiotherapy patients with advanced cancer of larynx.Material and methodsAn retrospective analysis of two hundred fifty four patients with larynx carcinoma with stage III or IV squamous cell carcinoma of larynx who were treated between January 1993 and December 1996 was performed. Postoperative radiotherapy was performed in coventional way to total dose of 60 Gy, 5 times a week. Of 254 patients, 86 patients (34%) were considered to have a low level of hemoglobin (below 13 g/dl) prior the beginning of radiotherapy and 56 patients (22%) at the end of treatment. We have noted also 38 patients (15%) of 254 patients, with deacresing hemoglobin level during treatment higher than 1 g/dl.ResultsNo impact on outcome of treatment was observed in the group of patients with low level of Hgb before irradiation. Inrease of locoregional failure of postoperative radiotherapy was noted in group of patients with Hgb level at the end of irradiation below 13 g/dl (p = 0,004) and also in group of patients with decreasing of Hgb level during treatment (p = 0,038).ConclusionsLow Hgb levels at the end of postoperative irradiation and decreasing during irradiation were associated with a statistically significant an increase in locoregional failure of patients with advanced carcinoma of larynx

58. Influence of total time of surgery and postoperative radiotherapy on the outcome patients with advanced laryngeal carcinoma

AimTo evaluate influence of total time of combined treatment on locoregional outcome of treatment in group patients with larynx cancer.Material/MethodsWe performed retrospective analysis of 254 patients with with stage III or IV squamous cell carcinoma of larynx who were treated between 1993 and 1996. There were 236 men, 18 women, median age was 56.3 years. Surgery consisted of total laryngectomy and elective/selective neck dissection. Patients postoperativly were irradiated in coventional way with total dose of 60 Gy. We used shrinking field technique with lateral opposed photon fields to tumor bed and upper-mid neck nodes. Supraclavicular regions (lower neck lymph nodes) were treated with an anterior field. Total time of combined treatment (from the surgery to the end of radiotherapy) was an average 92 days (range, 65–131 days). The interval between surgery and the beginning of radiotherapy was an average 45 days (range, 22–78 days) and time of irradiation was an average 45 day (range, 40–74 days).ResultsProlongation overall time of combined treatment beyond 90 days is strongly correlated with decreasing of locoregional outcome of treatment (p=0.00036). Also decreasing in outcome of treatment was noted when interval time between surgery and beginning of radiotherapy was more than 50 days (p=0.022) and when the time of irradiation was longer than 44 days (p=0.0026).ConclusionsDecreasing of total time of combined treatment (surgery and postoperative radiotherapy) is crucial in patients with advanced cancer of larynx

88. Comparison results of different strategies of radiotherapy in nasopharyngeal carcinoma

Aim: Evaluation results of radiotherapy in nasopharyngeal carcinoma in years; 1980–1990 (before CT era) vs 1991–1995.Material/methods: One hundred eighty eight patients treated in our centre were included in this analysis. Two groups of patients were distinguished: I-st – 128 patients (treated between 1980–1990) and II-nd – 60 (treated between 1991–1995). The possibilities of diagnosis and radiotherapy techniques were diffrent in both groups. In the II-nd group; the shrinking field technique, CT in diagnosis and target delineation and also higher total dose (mean 66 Gy) were applied.Results: For all patients 5-years disease free-survival was 30%. During follow-up the first two years were crucial, because 80% of failures occured. The causes of failures were as follow: the local recurrence (43%), metastases to lymph nodes (39%) and distant metastases (18%).Conclusions: Introducing CT into diagnosis and target delineation, the shrinking field technique and higher total dose of irradiation caused in improvement of results of radiotherapy in nasopharyngeal carcinoma