Role of accelerated fractionated irradiation for supraglottic carcinoma: assessment of results.

PURPOSE: We evaluated the results of locoregional control, patients' relapse-free survival, and voice preservation in patients with supraglottic carcinoma treated with accelerated radiation therapy.

PATIENTS AND

METHODS

The records of 164 patients undergoing accelerated fractionated radiation therapy for carcinoma of the supraglottis from 1981 to 1992 were reviewed and evaluated for locoregional control, disease-specific survival, and rates of voice preservation. All patients were treated with 1.6 Gy per fraction two fractions a day (BID) for 67.2 to 70.0 Gy in 6 weeks. The median follow-up was 56 months. Due to severe acute mucosal toxicity, all patients were given a short treatment break after 38.4 to 48.0 Gy.

RESULTS

For T1, T2, T3, and T4 tumors, the 5-year actuarial local control rates were 96%, 86%, 76%, and 43%, respectively, and relapse-free survival rates were 78%, 82%, 64%, and 40%, respectively. With surgical salvage, the corresponding ultimate local control rates for the T1, T2, T3, and T4 tumors were 96%, 93%, 88%, and 51%, respectively. Regional control by T and N stage was non-significant. Voice preservation rates for the T1, T2, T3, and T4 tumors were 96%, 80%, 72%, and 43%, respectively, and for the entire group the rate was 79%.

CONCLUSIONS

Accelerated fractionated radiation therapy resulted in excellent locoregional control, relapse-free survival, and voice preservation rates for patients with supraglottic carcinoma. The T stage and N stage were significant predictors of outcome. T4 tumors and node-positive neck disease portended a poor prognosis. These results as compared to our historical control and the published data in the literature with conventional once-daily radiation therapy (QD) suggested improved local control and patient survival after accelerated fractionated BID radiation therapy. For confirmation of these results, a prospective randomized trial is needed.