Larynx Flashcards
VA Larynx preservation Trial
hase II randomized trial
Stage III/IV larynx patients
Surgery + adjuvant RT vs Induction chemo + RT
.
.
Surgery + RT
total laryngectomy followed by RT
2 year OS 68%
Distant Mets 17%
4 year Larynx preserved 12%
4 year patients alive 52%
.
.
.
Induction Chemotherapy + RT
Cisplatin + 5FU x 2 cycles
2 year OS 68%
Distant Mets 11%
4 year Larynx preserved 62%
4 year patients alive 38%
.
.
.
Induction chemotherapy followed by definitive radiation therapy provides comparable OS & DFS with improved rates of larynx preservation when compared to surgery + RT.
Also T4 tumors did worse than <T4 tumors, salvage laryngectomy rate was 56% for T4 tumors vs 29% for <T4 tumors
RTOG 91-11
Remember as 9-11; has 3 ones (3 arms in study)
Phase II randomized trial
Stage III/IV
3 arms
Induction chemotherapy vs CRT vs RT
.
.
Induction CT
Cisplatin 100mg/m2 + 5FU 1000mg/m2 x 2cycles
2 year DFS: 52%
2 year LC: 61%
2 year OS: 76%
5 year OS: 58%
5 year LC: 58%
Larynx preservation : 71%
.
.
CRT
2 year DFS: 61%
2 year LC: 78%
2 year OS: 74%
5 year OS: 55%
5 year LC: 71%
Larynx preservation : 82%
.
.
.
RT Alone
70Gy in 2 Gy/fx + 50Gy to neck nodes
2 year DFS: 61%
2 year LC: 78%
2 year OS: 74%
5 year OS: 55%
5 year LC: 71%
Larynx preservation : 82%
RTOG 90-03
Phase III randomized trial
Std fx vs altered fx
4 arms
.
.
Std Fx
70Gy in 35 fx
2 year LC: 46%
2 year OS: 46%
2 year DFS: 32%
2 year LF: 44%
2 year Distant met: 18%
.
.
Hyper fx
81.6Gy in 68 Fx given twice daily
2 year LC: 54%
2 year OS: 55%
2 year DFS: 38%
2 year LF: 38%
2 year Distant met: 17%
.
.
Accelerated Fx with split course
6702Gy in 42 fx given twice daily with a 2 week break after 38.4Gy
2 year LC: 48%
2 year OS: 46%
2 year DFS: 33%
2 year LF: 43%
2 year Distant met: 17%
.
.
Accelerated Fx with boost
72Gy in 42 fx including a boost
2 year LC: 55%
2 year OS: 51%
2 year DFS: 39%
2 year LF: 37%
2 year Distant met: 17%
Tax 324
NCCN recs for adjuvant chemotherapy
ENE
+ve margins
PNI
LVSI
PT3/T4
+ve LN
Subsites of Supraglottic Larynx
1) False cords
2) Arytenoids
3) AE fols
4) Suprahyoid epiglottis
5) Infrahyoid epiglottis
T classification: Supraglottic
Std lateral opposed fields borders
6cm x 6cm box
Isocenter at True vocal cords
15-30 degree wedges
If ant commissure is involved use bolus.
.
.
.
Sup: 1 cm Sup to thyroid notch
Inf: 1 tracheal ring below cricoid
Ant: flash to skin
Post: Ant vertebral border
,
,
RT Dose: 6525 cGy in 29 fractions
Larynx RT Dose
2.25Gy/fx showed to have superior tumor control for larynx
63Gy in 2.25Gy/fx is std of care for T1 lesions
T staging: Subglottic
