High-dose, pulsed-dose BRT feasible palliative options in laryngeal cancer

By Sarah Guy, medwireNews Reporter

High-dose (HD) and pulsed-dose (PD) brachytherapy (BRT) are feasible options for laryngeal cancer patients with recurrent or residual stomal tumor after total laryngectomy, report Polish researchers.

They both provide "acceptable toxicity and good palliative effect" in a very difficult therapeutic issue, treatment of which can "often only be of a symptomatic and palliative nature," writes the team in The Laryngoscope.

One-fifth of the 22 patients in the study cohort achieved a complete or partial remission after treatment with HDBRT or PDBRT, and their mean survival was 12 months, note Anna Bartochowska (Poznań University of Medical Sciences) and colleagues who explain that stomal recurrence is usually associated with survival rates of approximately 6 months.

The team analyzed 20 men and two women aged a mean 59 years who had stomal recurrence of laryngeal cancer and had all undergone failed curative surgery.

A median 4 days after surgery to place the interstitial BRT catheter, 16 patients underwent PDBRT with a median 0.7 Gy per pulse, and a median total dose of 20 Gy delivered in 20-24 hours with 1 hour between doses; and six patients received HDBRT, with a median single dose of 5 Gy applied in twice-daily fractions to a median total dose of 25 Gy.

The researchers explain that PDBRT combines the physical advantages of HDBRT - isodose optimization, planning flexibility, and radiation safety - with radiobiologic advantages of low-dose BRT, or, "repair advantages."

Bartochowska and co-workers report an estimated 2-year survival of 22% for the cohort, with significantly longer survival among the eight patients who underwent salvage laryngectomy as part of their treatment (13.0 vs 4.5 months in those who did not).

Overall, 20% of patients achieved complete remission, defined as complete disappearance of the recurrent or residual tumor, or partial remission, defined as at least 50% reduction in tumor diameter, report the authors.

Two patients experienced serious side effects (graded according to the Common Terminology Criteria for Adverse Events), one of whom required further surgery.

There was no correlation between local complications and radiation dose, and neither age, gender, initial treatment method, nor BRT treatment method had a significant effect on development of complications.

The current standard of care for patients such as those in this study is surgical salvage, write Bartochowska et al; "however, surgery is often not feasible and carries high risk of complications and morbidity," they conclude.

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