Erken evre glottik larenks kanserinde radyoterapi sonuçları: Tek merkez deneyimi

Abstract

Erken evre glottik larenks kanseri tanisi ile kuratif radyoterapi uygulanmis olgularda geriye donuk olarak tedavi sonuclarinin ve prognostik faktorlerin degerlendirilmesi amaclandi. 1993-2010 yillari arasinda klinigimizde radyoterapi uygulanan, biyopsi ile histopatolojik olarak kanser tanisi dogrulanmis ve RT oncesi herhangi bir tedavi uygulanmamis erken evre (T1-2N0) glottik larenks kanserli 73 olgu geriye donuk olarak incelendi. Tum olgularin verileri guncellenerek hasta, tumor ve tedaviye ait parametrelerin lokal-bolgesel kontrol ve sagkalim uzerine olan etkileri arastirildi. Hastalarin medyan yasi 60 (37-83) olup 69’u erkek, 4’u kadindir. Evrelere gore dagilim; 41’i (% 56,2) T1a, 8’i (% 10,9) T1b, 24’u (% 32,9) T2 seklindedir. Hastalara medyan 66 Gy (58,5-72) eksternal radyoterapi uygulanmistir. Radyoterapiye bagli olarak, 1 olguda (% 1,4) grade 3-4 erken ve gec larengeal odem gelismis, bu olgu disinda diger olgularin hicbirinde grade 3-4 erken ve gec toksisite ile karsilasilmamistir. Medyan 73 (5-209) aylik takipte toplam 10 (% 13,7) hastada lokal-bolgesel nuks saptanmis, hicbir olguda uzak metastaz saptanmamistir. Hastalarin 5 yillik lokal-bolgesel kontrol, hastaliga ozgu sagkalim ve genel sagkalim orani sirasi ile % 85, % 92 ve % 78’dir. Incelenen faktorlerden “tedaviye 5 gun ve daha fazla ara verilmesi” lokal-bolgesel kontrol ve hastaliga ozgu sagkalimi anlamli olarak azaltirken (sirasi ile p=0,008, p=0,036), “tedavi oncesi ses kisikligi suresinin 5 aydan az olmasinin” sadece lokal-bolgesel kontrolu anlamli olarak azalttigi (p=0,036) saptanmistir. Sonuc olarak, erken evre glottik larenks kanserinde primer tedavi olarak radyoterapi yuksek lokal kontrol oranlarina sahip etkin bir tedavi seklidir. Radyoterapiye cesitli nedenlerden dolayi verilen aralar lokal-bolgesel kontrolu ve hastaliga ozgu sagkalimi olumsuz etkileyen prognostik bir faktordur. Bu nedenle tedavi aralarindan mumkun oldugunca kacinilmalidir. Results of radiotherapy in early stage glottic laryngeal carcinoma: A single center experience Patients with early stage glottic laryngeal cancer treated with curative radiotherapy were aimed to evaluate retrospectively for their treatment results and prognostic factors. In between 1993-2010, early stage (T1-2N0) 73 glottic laryngeal cancer cases which were treated with radiotherapy in our department that histopathological diagnosis of cancer was confirmed by biopsy and without any treatment prior to RT, were retrospectively analyzed. Patient, tumor and treatment parameters of all cases were updated and their effects on the local-regional control and survival were investigated. The median age of patients was 60 (37-83) and 69 patients were male and 4 were female. The distributions of patients according to stages were as follows: 41 (56.2% ) T1a, 8 (10.9% ) T1b and 24 (32.9% ) T2. Median of 66 Gy (58.5-72) of external beam radiotherapy was delivered to patients. In a patient (1.4% ), grade 3-4 early and late laryngeal edema depending on radiotherapy was developed. In other patients except from this patient, early and late grade 3-4 toxicity was not observed. During a median 73 months (5-209) follow-up, local recurrence was detected in 10 (13.7% ) cases and no distant metastasis was observed. Five year local-regional control, disease-specific and overall survival rates were 85% , 92% and 78% , respectively. From the investigated factors, while 5 or more days treatment interruption was found to decrease significantly local-regional control and disease-specific survival (p=0.008, p=0.036, respectively), less than 5 months duration of hoarseness was found to decrease significantly only local-regional control (p=0.036). In conclusion, radiotherapy as primary treatment modality in the early stage laryngeal cancer is an effective form of treatment with high rates of local control. Radiotherapy interruption due to various reasons is a prognostic factor which adversely effects loco-regional control and disease-specific survival. Therefore, interruptions during the radiotherapy should be avoided as much as possible. J. Exp. Clin. Med., 2012; 29:141-147