Search

Purpose: Our aim was to determine the dose to the clinical target volume (CTV) required for solitary extramedullary plasmacytoma (EMP) in the head and neck (HN). Methods and Materials: Seventeen patients (15 Stage I and 2 Stage II) were treated for HN EMP at our institution between 1979 and 2003. The mean International Commission on Radiation Units (ICRU) dose prescribed to the CTV was 52.6 Gy (range, 40–65 Gy) over 24 fractions (range: 20–30). The Stage II patients received neck irradiation doses of 40 and 60 Gy. A mean dose of 36.4 Gy was used for 5 Stage I patients who received elective neck irradiation. Dose administrated to the CTV was evaluated from dosimetric data or from planning films when dosimetric data were not available. Two groups of patients were distinguished: CTV covered with a dose greater than 40 Gy and CTV covered with a dose greater than 45 Gy. Results: The 5-year local control was 72.8%. It was 100% for patients who received dose to the CTV ≤ 45 Gy vs. 50% for dose to the CTV p = 0.034). The prognostic factor for 5-year disease-specific survival (81.6%) was local control ( p = 0.058). The prognostic factors for disease-free survival (64.1%) were monoclonal immunoglobulin secretion ( p = 0.008) and a CTV dose ≤ 45 Gy ( p = 0.056) Conclusions: Local control of EMP in the HN seems to be improved when the dose to the CTV is ≤ 45 Gy. A minimum dose of 45 Gy should be recommended to the CTV.

Seventy-six cases of squamous cell carcinoma of the supraglottic larynx treated by radiotherapy exclusively and followed for at least 3 years are reported. High doses, close to the maximum tolerable, were used with the shrinking field technique with no attempt at prophylactic whole neck irradiation. T1 and T2 cases represented 40% of the whole group and 40% of the patients presented clinically positive neck disease. This latter group had a significantly lower cure rate (42.8%) than the NO patients (88.3%). Disease control depended also on the T stage: all 30 T1 and T2 lesions, 18 22 (81.8%) of the T3, and 6 17 (35.3%) of the T4 lesions were controlled. Cord fixation and early cartilage destruction were not a major obstacle for tumor control. Base of tongue involvement and especially the T4 and N3 association were indications of poor prognosis. Adenopathies smaller than 3 cm were controlled in 14 16 cases while nodes ≥3 cm were controlled in 5 11 cases. Failures in neck nodes outside the treatment field were encountered in 7% of the cases but as the sole element of failure they represented 5.6%. Absolute survival at 3 years was 69.7% for the whole series while loco-regional control was 74.6%. No patient was salvaged by surgery. Three loco-regional recurrences occurred 3 years after the treatment. Although no lethal complications were encountered severe late reactions were noted in about 20% of the patients with controlled primary lesion, requiring tracheostomy in 4 cases (7%). Treatment guidelines are suggested: T1, T2, & T3 lesions associated with adenopathy smaller than 3 cm should be treated by radiotherapy. Limited extra laryngeal extension especially to cartilage can still be controlled by irradiation. More advanced cases, especially the subcategory of T4 N3 patients, should have a multidisciplinary approach. After high doses of irradiation only limited surgery is permissible.

This is an analysis of 190 patients who were treated with radiation therapy alone at the University of Florida, between October 1964 and December 1982, for T1-4 NO squamous cell carcinoma of the head and neck, in all patients, the primary lesion was permanently controlled and the neck was evaluable for at least 2 years following radiation therapy. The control of neck node disease is analyzed as a function of elective neck irradiation, the dose of radiation delivered to the first-echelon lymph nodes, and the likelihood that occult disease was present in the neck prior to treatment.