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Postoperative radiotherapy for adenoid cystic carcinomas of the head and neck: Results of a 30-year experience
234
Radiation Oncology, Biology, Physics
Volume 30, Supplement 1
140 THE VALUE OF POSTOPERATIVE RADIOTHERAPY FOR REGIONAL MEDULLARY CARCINOMA OF THE THYROID Mak, Albert C. M.D., Morrison, William H. M.D., Garden, Adam M.D., Ordonez Nelson G. M.D., Weber, Randal S. M.D., Peters, Lester J. M.D. The University of Texas M. D. Anderson Cancer Center Purpose/Objective: To analyze the outcome of patients with regional metastases from medullary carcinoma of the thyroid [MCTI who were treated either with surgery alone or with adjunctive postoperative irradiation. Materials and Methods: Patients were included in this study if they had regional nodal MCT without overt distant metastases, either at initial presentation or upon recurrence. These criteria were met in 62 of 176 MCT patients seen between l/67 and Q/89. Thirty-nine patients were treated by surgery alone [S] and 23 with combined treatment [S+X]. The S+X group had significantly more thyroid gland capsule and nodal extracapsular extension, a higher median number of involved nodes, larger median primary and nodal sixes, and a higher incidence of mediastinsJ disease. Six patients had gross disease at the time of irradiation. The neck and mediastinum received a nominal median dose of 59 Gy and 50 Gy, respectively, in a median of 30 fractions [range 21-401 over a median of 42 days [range 30-561. The median follow-up was 8.5 years. Results: Actuarial locoregional control for the S patients was 24% and 13% at 10 and 15 years, compared to 84% at both 10 and 15 years for the S+X group [p=.OOO4].Only 8 of 39 S patients were regionally controlled. For the S patients, the median number of sequential regional recurrences was 2 [range.l-81, with a median interval to initial regional relapse of 27 months [range+212 mo.] Despite the frequent occurrence of neck relapse, no S patient did as a direct consequence of progressive neck disease. Complications. in the S patients undergoing repeat surgeries included recurrent laryngeal nerve injury in 6 patients, chronic hypocalcemia in 5, and esophageal stricture in 1. Following recurrence, 12 S patients were given postoperative radiotherapy, and 1 I were locoregionally controlled Only 1 of 29 patients irradiated after gross total surgical resection recurred locceegionally. of the 6 patients who had gross residual disease after surgery, 3 failed in-field Complications in the S+X group included esophageal narrowing requiring dilatation in 2 patients and varying amounts of neck fibrosis. The distant metastasis-free survival for the whole group was 57% and 43% at 10 and 15 years. Survival at 10 and 15 years was 77% and 71% for the S patients, compared to 37% and 37% for the S+X group, reflecting their much higher disease burden at initial presentation.
Conclusions: Surgicaltherapy alone for regional MCT leads to a high long term rate of regional failure [87% at 15 years]. Patients treated with postoperative radiotherapy had a signiticantly reduced risk of locoregional failure [ 16% at 15 years], despite having mere unfavorable clinical characteristics.
141 OUTCOME FOLLOWING RADIOTHEKAPY JN VERRUCGUS CAKCINOMA OF THE LARYNX Brian O’Sullivan, Padmig Warde, Thomas Keane, Jonathan Irish and the ENT Site Group, The Princess Margaret Hospital, Toronto.
Purpose: Verrucous carcinoma of the larynx is a ram subtype of squamous carcinoma. This study was performed to describe the outcome following radiotherapy in terms of survival, local control and salvage treatment, and to evaluate the putative risk of anaplastic transformation following radiotherapy. Materials and Methods:
We retrospectively reviewed the records of all patients managed from the outset as verrucous carcinoma of the larynx at our institution (48 cases). These comprised 1.1% of 4233 laryngealcancer cases seen from l%l to 1990. Follow-up ranged from 36 months to 252 months (mean: 111 months) and was complete in all cases. Results: Initialneatment consisted of partial laryngectomy in 2 and total laryngectomy in 3 but the majority (43 cases) were treated with p&naryradiokrapyconsistingof50Gyin4week~or55Gyin5weeksinallbut4cases. TbelocalcontrolratcwithmdiotkapyinT1disease thecontrolratewas11of17cases,11of20in~,3of5iaT3anddresoleT4caseeeattdwithradiotherapyrequiredsalvage tlWment for local nxumxtce. Salvage by conservauon or total laryngectomy was universally succ~sful in all cases wbue they were attempted. One patient was medically unfit for surgical salvage and representsthe only death from disease. No patient failed after primary surgery. Anaplastic transformation following radiotherapywas not seen. Conclusion: These results cot&m the high survival but poorer initial local control rates with radiotherapy for vemxous carcinoma as compared to invasive squamous carcinoma of the larynx. Nevertheless primary radiation therapy witi surgery for salvage remains a reasonable txeatmentstrategyto pnxerve the naturalform and function of tbe larynx for patients with venucous carcinoma hlitial&MIItkllaryngectomyisalso an~~optionbutvoicequalityshouMbeconsidertdinthedacisional~ithmsiacethismaydiffirbetween~andconservation surgery.Evcninadvanccdcasts,~arytotal~~yrcmainsan~~primarytnatment as rixii&n thaapy may still be successful and surgical salvage is very likely to he curative. Finally, the results again discredit anaplastic transformation after radiotherapy which was not seen in this series.
Radiation Oncology, Biology, Physics
Volume 30, Supplement 1
140 THE VALUE OF POSTOPERATIVE RADIOTHERAPY FOR REGIONAL MEDULLARY CARCINOMA OF THE THYROID Mak, Albert C. M.D., Morrison, William H. M.D., Garden, Adam M.D., Ordonez Nelson G. M.D., Weber, Randal S. M.D., Peters, Lester J. M.D. The University of Texas M. D. Anderson Cancer Center Purpose/Objective: To analyze the outcome of patients with regional metastases from medullary carcinoma of the thyroid [MCTI who were treated either with surgery alone or with adjunctive postoperative irradiation. Materials and Methods: Patients were included in this study if they had regional nodal MCT without overt distant metastases, either at initial presentation or upon recurrence. These criteria were met in 62 of 176 MCT patients seen between l/67 and Q/89. Thirty-nine patients were treated by surgery alone [S] and 23 with combined treatment [S+X]. The S+X group had significantly more thyroid gland capsule and nodal extracapsular extension, a higher median number of involved nodes, larger median primary and nodal sixes, and a higher incidence of mediastinsJ disease. Six patients had gross disease at the time of irradiation. The neck and mediastinum received a nominal median dose of 59 Gy and 50 Gy, respectively, in a median of 30 fractions [range 21-401 over a median of 42 days [range 30-561. The median follow-up was 8.5 years. Results: Actuarial locoregional control for the S patients was 24% and 13% at 10 and 15 years, compared to 84% at both 10 and 15 years for the S+X group [p=.OOO4].Only 8 of 39 S patients were regionally controlled. For the S patients, the median number of sequential regional recurrences was 2 [range.l-81, with a median interval to initial regional relapse of 27 months [range+212 mo.] Despite the frequent occurrence of neck relapse, no S patient did as a direct consequence of progressive neck disease. Complications. in the S patients undergoing repeat surgeries included recurrent laryngeal nerve injury in 6 patients, chronic hypocalcemia in 5, and esophageal stricture in 1. Following recurrence, 12 S patients were given postoperative radiotherapy, and 1 I were locoregionally controlled Only 1 of 29 patients irradiated after gross total surgical resection recurred locceegionally. of the 6 patients who had gross residual disease after surgery, 3 failed in-field Complications in the S+X group included esophageal narrowing requiring dilatation in 2 patients and varying amounts of neck fibrosis. The distant metastasis-free survival for the whole group was 57% and 43% at 10 and 15 years. Survival at 10 and 15 years was 77% and 71% for the S patients, compared to 37% and 37% for the S+X group, reflecting their much higher disease burden at initial presentation.
Conclusions: Surgicaltherapy alone for regional MCT leads to a high long term rate of regional failure [87% at 15 years]. Patients treated with postoperative radiotherapy had a signiticantly reduced risk of locoregional failure [ 16% at 15 years], despite having mere unfavorable clinical characteristics.
141 OUTCOME FOLLOWING RADIOTHEKAPY JN VERRUCGUS CAKCINOMA OF THE LARYNX Brian O’Sullivan, Padmig Warde, Thomas Keane, Jonathan Irish and the ENT Site Group, The Princess Margaret Hospital, Toronto.
Purpose: Verrucous carcinoma of the larynx is a ram subtype of squamous carcinoma. This study was performed to describe the outcome following radiotherapy in terms of survival, local control and salvage treatment, and to evaluate the putative risk of anaplastic transformation following radiotherapy. Materials and Methods:
We retrospectively reviewed the records of all patients managed from the outset as verrucous carcinoma of the larynx at our institution (48 cases). These comprised 1.1% of 4233 laryngealcancer cases seen from l%l to 1990. Follow-up ranged from 36 months to 252 months (mean: 111 months) and was complete in all cases. Results: Initialneatment consisted of partial laryngectomy in 2 and total laryngectomy in 3 but the majority (43 cases) were treated with p&naryradiokrapyconsistingof50Gyin4week~or55Gyin5weeksinallbut4cases. TbelocalcontrolratcwithmdiotkapyinT1disease thecontrolratewas11of17cases,11of20in~,3of5iaT3anddresoleT4caseeeattdwithradiotherapyrequiredsalvage tlWment for local nxumxtce. Salvage by conservauon or total laryngectomy was universally succ~sful in all cases wbue they were attempted. One patient was medically unfit for surgical salvage and representsthe only death from disease. No patient failed after primary surgery. Anaplastic transformation following radiotherapywas not seen. Conclusion: These results cot&m the high survival but poorer initial local control rates with radiotherapy for vemxous carcinoma as compared to invasive squamous carcinoma of the larynx. Nevertheless primary radiation therapy witi surgery for salvage remains a reasonable txeatmentstrategyto pnxerve the naturalform and function of tbe larynx for patients with venucous carcinoma hlitial&MIItkllaryngectomyisalso an~~optionbutvoicequalityshouMbeconsidertdinthedacisional~ithmsiacethismaydiffirbetween~andconservation surgery.Evcninadvanccdcasts,~arytotal~~yrcmainsan~~primarytnatment as rixii&n thaapy may still be successful and surgical salvage is very likely to he curative. Finally, the results again discredit anaplastic transformation after radiotherapy which was not seen in this series.