Re-irradiation of laryngeal carcinoma--techniques and results

Occasionally in the long-term survivors of early carcinoma of the larynx, following radiation therapy a second carcinoma may arise from the previously irradiated larynx. Traditionally, management of such lesions is by non-radiation means in the belief that a further full course of radiation therapy is not possible and may exceed the tolerance of the normal laryngeal structures. Unfortunately, surgical treatment of the second carcinoma is often either total or partial laryngectomy which may not be acceptable to the patients and therefore radiation therapy is used as an alternative.

This paper presents our experience in re-irradiation of laryngeal carcinomas arising from the previously irradiated larynx. As of October 1992 a total of 20 patients were available for evaluation. Most patients had Stage I and II laryngeal carcinoma and received high doses of re-irradiation ranging from 60 to 70 Gy either by conventional or accelerated hyperfractionation schemes.

The 5-year actuarial local control and survival rates were 60 to 93%, respectively. The majority of the survivors had relatively normal and functional larynges. Those who failed locally had total laryngectomy without significant postoperative complications.

With this information the radiation tolerance of laryngeal structures is found to be much higher than commonly believed and re-irradiation for early carcinoma of the larynx is possible and proved to be a useful alternative to surgery and laryngectomy is therefore reserved for failure. The techniques of re-irradiation will be discussed.