Impact of radiation therapy on positive margins after surgery in supraglottic carcinoma

264

Radiation Oncology, Biology, Physics

October 1990, Volume 19, Supplement

1

1077 IMPACT OF RADIATION THERAPY ON POSITIVE MARGINS AFTER SURGERY IN SUPRAGLOTTIC CARCINOMA V.R. Devineni, J. Fredrickson, 1 Radiation St. Louis,

2 ‘3D.R. Dickson, 1J.R. and B. Fineberg

0nc.3Center, MO; Dept.

Between postoperative pathological

of

Simpson,

1

1

V. Martial-Vega,

Univ. Medical Center, Wash. Otolaryngology, Wash. Univ.

3

D. Sessions,

St. Louis, MO; Medical Center,

2

G. Spector,

Student, Wash. Univ. St. Louis, MO.

1966 and 1985, 83 patients with supraglottic carcinoma were radiation therapy. All patients were staged postoperatively The 1983 AJC staging system was used. data.

treated with

3

R. Hayden,

Medical

with surgery the available

3

School,

and

Pathologically, 54 patients were NO, 15 Nl, 4 N2 There were 5 Tl, 38 T2, 24 T3 and 12 T4 patients. and 6 N3. The age of the patients ranged from 32-77 years with a median age of 60. The most common site The next most common site of involvement was the infrahyoid epiglottis (present in 60% of the patients). was the false vocal cord (present in 28% of the patients). Most patients received All patients underwent surgery followed by postoperative radiation therapy. Forty-five patients (57%) underwent subtotal supraglottic laryngectomy (SSL) and 31 doses over 5000 cGy. Thirty percent of the patients underwent ipsilateral neck total laryngectomy. patients (40%) underwent Extracapsular nodal Thirty-six percent of the patients had positive surgical margins. dissection. involvement was noted in 28%. The disease-free survival rate Median follow-up was 5 years (minimum 2 years, maximum 13 years). At five years the disease-free survival was 68% for Tl and T2, for all patients was 68% at five years. In spite of the significant number of positive margins and extracapsular 75% for T3 and 58% for T4. The major involvement the local control was 91% in the primary site and 77% in the nodal areas. whereas T stage and dose did not correlate with survival time or time to prognostic factor was N stage, The pattern of local failure by the type of surgery did not have a significant impact as 69% recurrence. of the patients who underwent SSL and 68% of the patients who underwent total laryngectomy were without evidence of disease. Other details involvement

nodal

of the stage of in nodal disease

the relevance the disease, and the impact of surgery

of the positive margins and extracapsular and radiation therapy will be presented.

1078 TOLERANCE OF GASTRIC l4UCOSAL FLAP TO POSTOPERATIVE RADIATION THERAPY. Richard 1

Dept. Center,

E.

Eayden,

U.D.,l

of Otolaryngology, St. Louis, l4issouri

V. 2

Rao Devineni,

Radiation

14.D.,2

Oncology

John

Center,

H. Fredrickson, 3

Dept.

of

Large tumors of the head and neck region required extensive attempted, reconstruction methods become very important. One of reconstruction methods has been the use of gastric mucosal flaps and hypopharyngeal areas.

Surgery

ti.D.,l

and

at

Washington

surgery. the more to cover

Gregorio

Further

details

and

discussion

about

the

gastric

and of

mucosal

neck after the gastric

tolerance

gastric mucosa

will

M.D.3 Medical

surgery

which was not The mucosa, Late reactions different from the end of the

mucosal flap placement is in the range of

be presented.

is

oropharynx

in the base of tongue from 58-70 years. Four therapy postoperatively. opposed right and left

Patients shoved only moderate mucositis towards the end of the radiation therapy markedly different from those patients who had not undergone similar reconstruction. however, appeared intensely red as vould gastric mucosa receiving radiation therapy. assessed as late as nine months after the treatment did not appear to be significantly those patients vithout gastric flaps. One patient suffered bleeding one month after radiation therapy but this was conservatively treated and subsided. the head tolerance

University

When such extensive recently attempted the defects in the

At our institution in 1987-88, six patients with tumors in the tonsil or underwent gastric mucosal flap placement after surgery. Patients’ ages ranged the six patients who underwent this type of reconstruction received radiation Treatment was delivered with 4 flV or 6 HV X-rays using equally loaded parallel lateral fields. The total tumor dose ranged from 5940-7200 cGy.

Our impression is that radiation therapy to is fairly safe even though the normally accepted 45OD-5DOO cGy vhen treated in situ.

Sicard,

of