Laryngeal edema after radiotherapy in patients with squamous cell carcinomas of the larynx and hypopharynx
- Laryngeal edema after radiotherapy in patients with squamous cell carcinomas of the larynx and hypopharynx
- 배지선; 노종렬; 이상욱; 김성배; 김재성; 이정현; 최승호; 남순열; 김상윤
- Laryngeal edema; Radiotherapy; Risk factors; Treatments; Recurrences; 18F-FDG PET/CT
- Issue Date
- Oral oncology
- VOL 48, NO 9, 853-858
- Objectives: Significant laryngeal edema (SLE) after radiotherapy for squamous cell carcinoma of the larynx
and hypopharynx may be associated with upper airway obstruction or tumor recurrence. We
assessed the risk factors predictive of SLE and those differentiating tumor recurrence from SLE.
Patients and methods: We evaluated 127 patients with laryngohypopharyngeal squamous cell carcinomas
who were primarily treated with radiotherapy with/without chemotherapy, had no previous major head
and neck surgery, and underwent laryngoscopic examinations after radiotherapy. SLE was defined as
RTOG grades P2 and patient characteristics and imaging, treatment and survival results were compared
in patients with and without SLE.
Results: Of the 127 patients, 56 (44%) had SLE. Univariate analyses showed that tumor location, T and N
classifications, overall stage, pathologic differentiation, and chemotherapy were significantly predictive
of SLE (P < 0.05). Multivariate analysis revealed that T classification remained an independent predictor
of SLE (T1 vs. T2–4; odds ratio = 5.070, 95% confidence interval = 1.999–12.857; P = 0.001). Twenty-seven
(21%) patients had tumor recurrences, diagnosed by PET/CT (sensitivity 88%; specificity 92%) and CT (sensitivity
68%; specificity 88%). Twenty-seven patients with severe SLE were treated but only 9 (33%) had
improvement. Tumor recurrence rate was higher (39% vs. 7%, P < 0.001) and 3-year overall survival rate
lower (54% vs. 87%, P < 0.001) in patients with than without SLE.
Conclusion: Patients with T2–4 laryngohypopharyngeal cancers are at higher risk of SLE development and
tumor recurrence after radiotherapy that can be properly detected by 18F-FDG PET/CT.
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