Treatment of Supra-glottic Carcinomas by Telecobalt Therapy

Abstract

Telecobalt therapy already seems to have produced very encouraging results in the treatment of cancer of the laryngeal vestibule. Eighteen out of 33 patients were alive at the end of three years. Furthermore, no single case of local recurrence or lymph node involvement has been observed among the patients followed up during four years (four cures out of 13 cases), and during five years (four cures out ten cases). It should be noted that two patients survived four years after total laryngectomy for local recurrence. These results have been particularly favourable in the stages I and II (T1 NO; T1 N1; T2 N0) cases, where there were only two failures among 13 patients, one of which was successfully treated by surgery. In stages III and IV cases, the results were still worth while: seven survivals out of 20 cases, one of the failures being successfully treated by surgery. Among the patients presenting with mobile unilateral lymph node metastases (N1), where lymph node involvement was verified, usually by cytological examination, there was one failure due to persistent disease in the lymph nodes. In four cases disease persisted in both the primary site and lymph nodes, and four cases were successfully treated. The telecobalt technique used is described. A treatment schedule of 1,200 R tumour dose per week has been adopted recently, with five or six sessions in a week. The usual total tumour dose is of the order of 7,000–8,000 R, protracted over 40 to 50 days. The lymph node doses are more or less the same. At the end of treatment the treatment fields are progressively reduced in size so as to include any primary and lymph node residuum. Treatment is well tolerated, but it is important to keep the patient under regular observation. Laryngeal oedema is rarely seen when sterilisation of the tumour is achieved. It should be possible in the future to compare the results of telecobalt therapy used as a first treatment, followed by surgery in case of failure, with the results already published and following the use of surgery and radiotherapy in association.