CHRONIC LARYNGEAL EDEMA AS A LATE REACTION AFTER RADIOCHEMOTHERAPY

In addition to mucositis and myelotoxicity as well known early reactio ns after radiotherapy or radiochemotherapy in advanced head and neck t umors, late toxicity following treatment is an often underestimated pr oblem. Between 1992 and 1995, 68 patients with advanced oro- and hypop haryngeal tumors were treated primarily with accelerated concomitant b oost radiochemotherapy (total dose irradiations of 66 Gy and carboplat in as chemotherapy). Ninety-three per cent of the patients had stage I V disease according to the UICC-TNM classification. Monitoring of foll ow-up included late toxicity with special attention given to laryngeal edema. In 37 patients (54%) edema of the larynx as a late complicatio n of radiochemotherapy was observed by clinical investigation and CT s can. The median onset of laryngeal edema was found 121 days after comp letion of thera py, with a median time of observation of 250 days. Obs ervations in these patients demonstrated the chronic character of this edema. An increase in the laryngeal edema in 5 cases resulted in trac heostomy. Laryngeal edema in 10 patients was associated with recurrenc e of tumor. These results show that after xerostomia laryngeal edema i s the main late toxicity in the head and neck after radiochemotherapy and should lead to further investigations to exclude possible recurren t tumor.