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American Head & Neck Society
Translational Research Meeting

April 21-22, 2015

AHNS Annual Meeting
April 22-23, 2015 during the
Combined Otolaryngology Spring Meetings


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Long Term Complications Of A Small Volume Radiotherapy Treatment Of Early Glottic Cancer, A Population Based Retrospective Study.

Presentation: C011
Topic: COSM POSTER SESSION
Type: COSM
Date: Thursday, April 23, 2015
Session: 9:00 AM - 7:00 PM
Authors: Michele Thomas, MRT1, Helene Vanasse, MRTT1, Samy El-Sayed, MD2
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Institution(s): 1The Ottawa Hospital Cancer Centre, 2University of Ottawa
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Introduction: Early Glottic cancer is highly curable disease with Radical Radiotherapy. Small volume and large dose per fraction is the standard of care.

Purpose:

To determine the overall survival and pattern of recurrence on long term follow up in our patient population diagnosed with early stage glottic cancer treated at The Ottawa Hospital Cancer Centre  
To determine whether there is a correlation between the dose received to organs at risk and the incidence of late complications.

 

Methods: This retrospective study consist of a chart review of all the patients diagnosed with TIS, T1 and T2N0 Glottic cancer that have been treated with either Cobalt-60 or a 6MV linear accelerator during the years 2006-2013. Information captured included demographics, acute and late complications, date and pattern of failure.The OAR( Organs At Risk) contoured on Elekta FocalSim were: the carotid arteries, trachea, thyroid and submandibular glands, spinal cord, esophagus, muscles involved in swallowing (cricopharyngeus, superior, middle, and inferior constrictor muscles), and skin of the anterior portion of the neck. This enabled the calculation of the dose delivered to these organs. A Multivariate statistical analysis have been carried out to  determine if there is a correlation between the dose received and the side effects observed.

Results: An initial review of our patients has been completed. The short-term post-treatment complications were: all patients experienced erythema and voice hoarseness, 91.3% dysphagia , 47.8% xerostomia, 34.8% laryngeal edema, 21.7% mucositis, and 8.7% dysgeusia. The long-term complications demonstrated were: 47.8% had a persistent hoarse voice, 21.7% mild xerostomia, 13% hyperpigmentation, 34.8% internal and 8.7% external telangiectasia. Rate and pattern of relapse will be presented at the meeting.      

Conclusion: Based on the preliminary results, the thyroid and submandibular glands receive a much larger dose than expected. Resulting in patients being diagnosed with hypothyroidism and subjectively suffering from xerostomia when compared to pre-treatment levels. The radiation field encompasses a large portion of the common carotid arteries however; the number of patients suffering from long term stenosis or a stroke is minimal. To date, only 1 patient has shown these complications. Of the muscles involved in swallowing, the cricopharyngeus and inferior constrictor received the highest dose. To date, very few patients have had long-term dysphagia. The findings of this study will result in modification of the treatment planning and treatment delivery technique in such a way as to reduce the risk of long term complications and to ensure the patients are receiving the proper post-treatment follow up care.




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