[Radiotherapy in T1 epidermoid carcinomas of the vocal cords]

In the last years radiotherapy has become the methodology of choice in the treatment of initial T1a and T1b glottis neoplasias, the reason being-it is as successful in controlling the disease as demolition surgery, but it saves the phonation function. Our experience in the "O. Alberti" Institute of "Spedali Civili" di Brescia from January 1, 1970 to December 31, 1984 is here reported. Out of the total figure of 195 patients treated with radiotherapy, 154 were T1a, and 41 T1b. Global survival rate after 5 years is 76,25%. Loco-regional relapses were on the whole 28: 24 on T, and 4 on N. Saving therapy allowed the retrieval of 15 patients (62,5%) with relapse on T. The total dose administered (greater than 60 Gy or 60 less than Gy), TDF values (greater than 95 or less than 95 on minimum), and field dimensions (greater than 5 x 5 cm2 or less than 5 x 5 cm2) were considered, in order to evaluate the chance of relapse. The only statistical data concerning the significant difference between the two groups of patients irradiated with fields less than 5 x 5 cm2 and more than 5 x 5 cm2, both with a total dose of more than 60 Gy. In the group of patients irradiated with smaller fields, the percentage of relapses is lower. This is probably due to the fact that the patients had more superficial lesions. The treatment had no severe side-effects, and never affected the quality of the voice. In order to obtain a high recovery-rate, in the meantime reducing side-effects and keeping a good phonation function, small fields and dose ranging between 64 and 68 Gray with 32-34 fractions, 5 per week, are thought to be the best. It is necessary, however, to watch out for penumbra and inaccuracy by immobilizing the patient with containing systems.