Local-regional control by conventional radiotherapy according to tumor volume in patients with squamous cell carcinoma of the pharyngolarynx.

BACKGROUND

To estimate the effect of tumor volume on local-regional control of pharyngolaryngeal cancer by radiotherapy (RT).

METHODS

Definitive RT for 48 patients with squamous cell carcinoma of the lateral wall of the oropharynx, pyriform sinus and supraglottic larynx was reviewed. Tumor volume was estimated from computed tomography and it was expressed as the diameter of a sphere the volume of which is equal to the primary tumor (Td) and sum of the volumes of metastatic adenopathies (Nd). All patients received > or =60 Gy (median 66 Gy) to the gross tumor by conventional fractionation with or without chemotherapy.

RESULTS

A median period of follow-up for survivors was 32.7 months (range, 12.4-68.6). The 2 year local control rate for T1/2 (n = 30) and T3/4 (n = 18) patients was 72 and 65%, respectively (P= 0.966), however, the rates for Td < 4 cm tumors (n = 37) and Td > or = 4 cm tumors (n = 11) were significantly different (80% vs 27%, P < 0.001). The 2 year regional control rates for Nd < 3 cm lesions (n = 29) and Nd > or = 3 cm (n = 19) lesions were 85 and 42%, respectively (P < 0.001). The 2 year ultimate regional control rates for N2/3 disease with Nd < 4 cm (n = 11) and Nd > or = 4 cm (n = 11) were 100 and 42%, respectively (P = 0.004).

CONCLUSIONS

Conventional radiotherapy may allow organ preservation and ultimate local control in patients with Td < 4 cm and Nd < 4 cm disease, but larger volume tumors should be considered candidates for the most intensive chemoradiotherapy.