Complications of postoperative radiation therapy after partial laryngectomy in supraglottic cancer: A long-term evaluation

This retrospective study, based on a series of 90 patients with invasive sq uamous cell carcinoma of the supraglottis, was designed to document the fun ctional outcome and complications after postoperative radiation therapy fol lowing partial laryngeal surgery. The surgical procedure was a standard sup raglottic laryngectomy in 62 patients and a supracricoid partial laryngecto my in 28 patients. All of the patients had an unremarkable postoperative co urse and achieved locoregional control. The average dose delivered to the r emaining larynx was 51.2 Gy (range 25-71 Gy). The average dose delivered to the neck was 50.6 Gy (range 22-70 Gy). The patients were treated at 180-cG y per fractions in a continuous course technique with a cobalt 60 beam. In 5 patients (5.5%) complications led to cessation of postoperative radiation therapy, and the total dose delivered to the remaining larynx and neck was less than 40 Gy. All patients were followed up for a minimum of 10 years o r until death. The 5-, 10-, and 15-year actuarial survival estimates were 7 1.5%, 44.3%, and 36.3%, respectively. The 5-, 10-, and 15-year actuarial se vere complication estimates were all 11.2%. Overall, severe complications o ccurred in 15 patients. Severe complications led to death in 3 patients (3. 3%), permanent gastrostomy in 3 (3.3%), and permanent tracheostomy in 1 (1. 1%). A severe complication never resulted in completion of total laryngecto my. In univariate analysis, the mean dose delivered to the larynx was the o nly variable statistically related to the incidence of a severe complicatio n. The mean dose delivered to the larynx was statistically higher (P = 0.01 4) in patients who had severe complications (60 Gy) than in patients who di d not (50 Gy).