EFFECT OF ARYTENOID SPARING DURING RADIATION-THERAPY OF EARLY-STAGE GLOTTIC CARCINOMA

Purpose: To retrospectively evaluate the effect of arytenoid shielding on local control and complications in the treatment of early stage gl ottic carcinomas. Materials and methods: The analysis concerns 71 pati ents treated with megavoltage photons for stages Tis, T1 and T2 glotti c carcinomas. In 31 patients the entire larynx was treated at 2 Gy/day to full dose (group 1, mean field area 41.5 cm(2)) and in 40 patients a posterior block was placed after a median dose of 54 Gy to protect the arytenoid cartilage (group 2, mean field area 38 cm(2)). The decis ion to shield 10-15 mm of the posterior aspect of the treatment volume was based on the presence or absence of involvement of the posterior third of the Vocal cords, Median total dose was 70 Gy in both groups. Results: RTOG grade 2 and 3 acute laryngeal complications were observe d in 77% and 62.5% of patients in groups 1 and 2, respectively (P = 0. 25). The rate of grade 2-3 late laryngeal complications (mostly aryten oid edema) was similar in the two groups (13.6% vs 20%, P = 0.83). Act uarial local control at 5 years was also similar in the two groups (T1 : 85% vs 96.6%, P = 0.13 and T2: 82% vs 87.5%, P = 0.86). Conclusion: No objective differences could be shown in terms of acute or late lary ngeal complications or in terms of local control related to the use of arytenoid shielding. As severe complications are rare and local contr ol is very satisfactory using standard techniques, it is difficult to attribute any advantage to the use of arytenoid blocking. (C) 1997 Els evier Science Ireland Ltd.