Radiotherapy as the primary approach in the treatment of laryngeal cancer.

At the Institute of Radiology, University of Belgrade, in close collaboration with ENT Hospital, a group of 772 patients were treated at various stages of laryngeal cancer with telecobalt therapy during the 1960-68 period. The supervoltage was consistently the primary approach in the treatment with curative intent, while surgery was resorted to for the failures only. One hundred and thirteen patients with recurrences following their exposure to irradiation, unfit for an operation or refusing surgery, were re-irradiated with telecobalt therapy. The authors studied several overall time, dose and fractionation schemes. The NSD concept of Ellis was employed to compare the biological effects of the different treatment factors. The optimum results were obtained with the doses fractioned over five or six weeks and NSD amounting to 1950. The five year absolute survival rate obtained at glottic cancer was 60.9 per cent. All stages of supraglottic cancer had a survival rate of 39.2 per cent. The five year survival after the second course of irradiation (113 patients) was 22.1 per cent, including 25 patients operated on after two series of irradiation. The authors consider that the risk of a radical re-irradiation has to be accepted in spite of possible complications because it is the only possibility to save a limited number of the patients unfit for an operation or who have a negative attitude to surgical treatment, especially to laryngectomy.