Background:

The increasing incidence of laryngeal cancer is of greater concern because of its potential impact on interpersonal communication skills. Various radiotherapy fractionation regimens are in practice to improve control of disease. Concommitant boost radiiotherapy which is a type of modified hyperfractionation regimen has been perceived to provide better control over conventional schedule. This presemt study was conducted to analyse the effectiveness and superiority of concomitant boost radiotherapy over conventional fractionated radiotherapy in treatment of carcinoma larynx.

Materials and Method:

Patients with histologically proven squamous cell carcinoma of the larynx in Stage I – IV without distant metastasis were randomly allocated into two arms;Control Arm–A (n=26): conventional external beam radiotherapy (EBRT) of dose 60 Gy in 30#, 2Gy per fraction, 5# per week for 6 weeks. Study Arm–B (n=24): Conventional EBRT of dose 60 Gy/6 weeks + concomitant boost radiation of dose 1.2 Gy/#, 5# / week × 2 weeks during last 2 weeks of the 6 weeks period with total dose of 72 Gy. The two arms were then compared in terms of complete response, locoregional control, disease free survival, acute and chronic radiation induced toxicity with a median follow up period of 12 months.

Results:

Complete response seen in the study was 84% vs. 68%, the locoregional control after a median follow up of 12 months was 68% vs. 44% and the 2 year DFS was 67 % vs 43% in study arm–B versus control arm–A respectively. Acute toxicity including mucositis, dysphagia, dermatitis were increased but tolerable in the study arm but the significant late morbidity like persistent laryngeal edema was comparable in both arms.

Conclusions:

The response to radiotherapy, locoregional control, 2 year DFS of concomittant boost EBRT is better than conventional EBRT in carcinoma of larynx with acceptable local toxicities. Further analysis and follow–up are needed to evaluate if the benefit will translate into prolonged survival.