Mehmet ŞEN, Sülen SARIOĞLU, Fadime AKMAN, Münir KINAY, Uruk Özlem ATAMAN, Nihal DAĞ, Kerim CEYRAN, Ahmet Ömer İKİZ

Erken evre larenks karsinomlu 144 hastada radikal radyoterapi sonuçlarımız

AMAÇ Bu çalışmanın amacı Dokuz Eylül Baş-Boyun Kanserleri Grubu'nun (DEBBTG) tedavi protokolü uyarınca radikal radyoterapi (RT) uygulanmış erken evre larenks karsinomlu hastaların tedavi sonuçlarının geriye dönük olarak incelenmesidir.GEREÇ VE YÖNTEM Temmuz 1991-Haziran 2004 tarihleri arasında kliniğimizde erken evre larenks karsinomu tanılı 144 hasta (138 erkek (%96), 6 (%4) kadın; ort. yaş 61; dağılım 27-87 yaş) radikal RT ile tedavi edildi. DEBBTG protokolüne göre evre I hastalıkta ve ameliyat edilemeyen (performansı düşük, komorbid hastalık veya hasta tercihi) evre II glottik karsinomlu hastalara radikal radyoterapi uygulanmaktadır. Radikal RT karşılıklı paralel eşmerkezli iki yan alanla ve “wedge” kullanılarak, megavoltaj (6 MV-X veya Co-60) ışınlar ile uygulandı. Tüm hastalar radikal RT öncesi simüle edildi, tedavi planlaması bilgisayarlı planlama sistemi ile yapıldı. Erken ve geç yan etkiler RTO G / E O RTC kriterlerine göre değerlendirildi. Sağkalım analizleri Kaplan-Meier yöntemi kullanılarak yapıldı.BULGULAR Histopatolojik tanı 111 (%77) olguda skuamöz hücreli karsinom, 32'sinde (%22) karsinoma in situ, 1'inde küçük hücreli karsinomdu. Klinik evrelemede, 32 (%22) olgu Tis, 86 (%60) T1, 26 (%18) T2 olarak değerlendirildi. Tüm olgular planlanan tedaviyi tamamladılar. Medyan doz 66 (50-70) Gy'di. Hiçbir hastada ciddi erken yan etki saptanmadı, 3 (%2) hastada geç dönem derece 3 cilt, larenks ödemi ve kıkırdak hasarı izlendi. Medyan izlem 68 (4-162) aydı. İki, 5, 10 yıllık genel sağkalımlar sırasıyla %94, %85 ve %65 idi. Yerel-bölgesel yinelemesiz sağkalımlar 2, 5 ve 10 yıllık sırasıyla %90, %87 ve %87 olarak hesaplandı. Toplam 18 (%12.5) olguda yerel ve/veya bölgesel başarısızlık saptandı ve 14'üne kurtarma cerrahisi uygulandı. Tis, T1 ve T2 olgularda 5 yıllık hastalığa özgü sağkalım sırasıyla %95, %96 ve %94 olarak, 5 yıllık ses koruma oranları ise Tis ve T1'lerde %97, T2 hastalarda %89 hesaplandı.SONUÇ Erken evre larenks kanserlerinde radikal radyoterapi fonksiyon koruyucu etkin bir tedavi yöntemidir. Yerel bölgesel tedavi başarısızlıklarında radyoterapi sonrası kurtarma tedavileri ile yüksek oranda ses korunması ile yerel kontrol ve sağkalım oranları elde edilebilmektedir.

Treatment results of definitive radiotherapy in 144 early stage larynx carcinoma

OBJECTIVES The aim of this study was to evaluate the treatment results retrospectively in early stage larynx carcinoma treated with definitive radiotherapy (RT) according to the treatment protocol of Dokuz Eylül Head and Neck Cancer Group (DEHNCG).METHODS Between July 1991 and June 2004, 144 patients (138 males (%96), 6 (%4) females; median age 61; range 27 to 87 years) with early stage squamous-cell carcinoma of the larynx were treated with definitive RT at our institution. According to DEHNCG protocol stage I and inoperabl (poor performance status, comorbidity or patient choice) stage II larynx carcinomas are treated with definitive radiotherapy. Definitive RT is applied with megavoltage (6 MV-X or Co60), parallel- opposed beams with wedge filters. Before RT all patients were simulated and a computerized system was used for treatment planning. RTOG/EORTC scale was used for documentation of early and late side effects. Survival analysis have been calculated with Kaplan- Meier method.RESULTS The majority of the patients were men (96%). One hundred and eleven (77%) patients had squamous cell carcinoma and 32 (22%) had carcinoma in situ. Clinically 32 (22%), 86 (60%) and 26 (%18) patients were evaluated as Tis, T1 and T2 larynx carcinoma respectively. All patients completed the planned treatment. Median dose was 66 (50-70) Gy. There were no grade III or IV early side effects. Grade III skin, larynx and cartilage late side effects were seen in 3 (2%) patients. Median follow up was 68 (4–162) months. Two, 5 and 10 years overall survival rates were 94%, 85% and 65% respectively. Loco-regional progression free survivals for 2, 5 and 10 years were 90%, 87% and 87% respect ively. Eighteen (12.5%) of 144 patients had loco-regional failure and 14 of them had salvage surgery. Five years disease spesific survival for Tis, T1 and T2 were 95%, 96% and 94% respectively. Five years voice preserving rates for Tis and T1 were 97% and 89% for T2 patients.CONCLUSION Definitive RT is an organ preserving and an effective treatment method in patients with early stage glottic carcinoma. High local control and survival rates can be obtained with salvage treatments after the locoregional failures after definitive RT.

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