Abstract
(1) Background: The authors present the first results of active raster-scanned carbon ion radiotherapy (CIRT) for radioresistant laryngeal malignancies regarding efficacy and toxicity. (2) Methods: 15 patients with laryngeal adenoid cystic carcinoma (ACC; n = 8; 53.3%) or chondrosarcoma (CS; n = 7; 46.7%) who underwent radiotherapy with carbon ions (C12) at the Heidelberg Ion Beam Therapy Center (HIT) between 2013 and 2018 were identified retrospectively and analyzed for local control (LC), overall survival (OS), and distant progression-free survival using the Kaplan–Meier method. CIRT was applied either alone (n = 7, 46.7%) or in combination with intensity modulated radiotherapy (IMRT) (n = 8, 53.3%). The toxicity was assessed according to the Common Toxicity Terminology Criteria for Adverse Events (CTCAE) v4.03. (3). Results: the median follow-up was 24 months (range 5–61 months). Overall, the therapy was tolerated very well. No grade >3 acute and chronic toxicity could be identified. The most reported acute grade 3 side effects were acute dysphagia (n = 2; 13%) and acute odynophagia (n = 3; 20%), making supportive nutrition via gastric tube (n = 2; 13.3%) and via high caloric drinks (n = 1; 6.7%) necessary due to swallowing problems (n = 4; 27%). Overall, chronic grade 3 toxicity in the form of chronic hoarseness occurred in 7% of the patients (n = 1; 7%). At the last follow-up, all the patients were alive. No local or locoregional recurrence could be identified. Only one patient with laryngeal ACC developed lung metastases three years after the first diagnosis. (4) Conclusions: the accelerated hypofractionated active raster-scanned carbon ion radiotherapy for radioresistant laryngeal malignancies is feasible in practice with excellent local control rates and moderate acute and late toxicity. Further follow-ups are necessary to evaluate the long-term clinical outcome.
Highlights
In recent years, more aggressive therapy regimes in the treatment of head and neck cancers (HNC)were established to achieve improved tumor control and prolonged survival, with the consequence of high toxicity rates due to the close proximity of organs at risk and increased doses applied [1,2,3]
The total laryngectomy was applied in one patient before radiotherapy (6.7%)
The tracheostomy was obligatory for severe airway obstruction in 33.3%
Summary
More aggressive therapy regimes in the treatment of head and neck cancers (HNC)were established to achieve improved tumor control and prolonged survival, with the consequence of high toxicity rates due to the close proximity of organs at risk and increased doses applied [1,2,3]. Contrary to other tumors of the head and neck region, for laryngeal tumors, dose escalations, even with modern radiotherapy techniques—e.g., adapted intensity-modulated radiotherapy (IMRT)—seem to be limited by various critical structures and, the results in severe acute and chronic toxicity concerning airway obstruction, swallowing difficulties, and hoarseness [10,11,12]. The data for laryngeal carcinoma are missing to date The aim of this analysis is to demonstrate the first results of CIRT alone or in combination with intensity modulated radiotherapy (IMRT) in a primary or postoperative setting as a further therapy option in the cancer treatment of the head and neck region, regarding the efficacy and toxicity for laryngeal malignancies
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