Follow-up/Toxicity

Question 1

What are some acute and late toxicities with RT in the Tx of LCX?

Answer 1

Acute: hoarseness, sore throat, odynophagia, skin irritation

Late: laryngeal edema, glottic stenosis, hypothyroidism, xerostomia, L’hermitte syndrome, myelitis, laryngeal necrosis

Question 2

What are the main late toxicities after organ preservation with concurrent CRT for LCX?

Answer 2

Moderate speech impairment, dysphagia (25% of pts; <5% cannot swallow), and xerostomia (advanced/bilat cases)

Question 3

What are some approximate RT dose constraints for laryngeal edema?

Answer 3

Some data suggest that the incidence of laryngeal edema ↑ significantly with mean doses ≥44 Gy. (Sanguineti G et al., IJROBP 2007)

Question 4

What is the QOL impact of larynx preservation when compared to laryngectomy in the Tx of LCX?

Answer 4

VA data demonstrated better social, emotional, and mental health function with larynx preservation (swallowing and speech function were similar), which suggests that better QOL is not d/t preservation of speech but d/t freedom from pain, emotional well-being, and less depression.

Hanna et al. demonstrated that pts had worse social functioning, greater sensory disturbance, more use of pain meds, and coughing after total laryngectomy than those treated with CRT. (Arch Otolaryngol H&N Surg 2004)

Question 5

What is the follow-up paradigm for LCX pts?

Answer 5

LCX f/u paradigm: H&P + laryngoscopy (q1–3 mos for yr 1, q2–6 mos for yr 2, q4–8 mos for yrs 3–5, q12 mos if >5 yrs), imaging (for signs/Sx), TSH (if neck is irradiated), speech/hearing evaluation, and smoking cessation.