331 cases of clinically node-negative supraglottic carcinoma of the larynx: A study of a modest size fixed field radiotherapy approach

Purpose: For node-negative supraglottic carcinoma of the larynx, radiothera py with surgery in reserve commonly provides very good results in terms of both local control and survival, while preserving function. However uncerta inty exists over the treatment of the node-negative neck. Elective whole ne ck radiotherapy, while effective, may be associated with significant morbid ity, The purpose of this study was to examine our practice of treating a mo dest size, fixed field to a high biologically effective dose and compare it with the patterns of recurrence from other centers that use different dose /volume approaches. Methods and Materials: Over a 10-year period 331 patients with node-negativ e supraglottic carcinoma of the larynx were treated with radiotherapy at th e Christie Hospital Manchester. Patients were treated with doses of 50-55 G y in 16 fractions over 3 weeks, Data were collected retrospectively for loc al and regional control, survival, and morbidity, Results: Overall local control, after surgical salvage in 17 cases,was 79% (T1-92%, T2-81%, T3-67%, T4-73%). Overall regional lymph node control, afte r surgical salvage in 13 cases, was 84% (T1-91%, T2-88%, T3-81%, T1-72%). F ive-year crude survival was 50%, but after correcting for intercurrent deat hs was 70% (T1-83%, T2-78%, T3-53%, T4-61%). Serious morbidity requiring su rgery was seen in 7 cases (2.1%) and was related to prescribed dose (50 Gy- 0%, 52.5 Gy-1.3%, 55 Gy-3.4%). Discussion: Our results confirm that treating a modest size, fixed field to a high biologically effective dose is highly effective. It enables preserv ation of the larynx in most cases, with acceptable regional control and no loss of survival compared to whole neck radiotherapy regimes. (C) 2000 Else vier Science Inc.