Dosimetric Predictors of Laryngeal Edema

Giuseppe Sanguineti, Prashanth Adapala, Eugene J. Endres, Collin Brack, Claudio Fiorino, Maria Pia Sormani, Brent Parker

Research output: Contribution to journalArticle

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Abstract

Purpose: To investigate dosimetric predictors of laryngeal edema after radiotherapy (RT). Methods and Materials: A total of 66 patients were selected who had squamous cell carcinoma of the head and neck with grossly uninvolved larynx at the time of RT, no prior major surgical operation except for neck dissection and tonsillectomy, treatment planning data available for analysis, and at least one fiberoptic examination of the larynx within 2 years from RT performed by a single observer. Both the biologically equivalent mean dose at 2 Gy per fraction and the cumulative biologic dose-volume histogram of the larynx were extracted for each patient. Laryngeal edema was prospectively scored after treatment. Time to endpoint, moderate or worse laryngeal edema (Radiation Therapy Oncology Group Grade 2+), was calculated with log rank test from the date of treatment end. Results: At a median follow-up of 17.1 months (range, 0.4- 50.0 months), the risk of Grade 2+ edema was 58.9% ± 7%. Mean dose to the larynx, V30, V40, V50, V60, and V70 were significantly correlated with Grade 2+ edema at univariate analysis. At multivariate analysis, mean laryngeal dose (continuum, hazard ratio, 1.11; 95% confidence interval, 1.06-1.15; p < 0.001), and positive neck stage at RT (N0-x vs. N +, hazard ratio, 3.66; 95% confidence interval, 1.40-9.58; p = 0.008) were the only independent predictors. Further stratification showed that, to minimize the risk of Grade 2+ edema, the mean dose to the larynx has to be kept ≤43.5 Gy at 2 Gy per fraction. Conclusion: Laryngeal edema is strictly correlated with various dosimetric parameters; mean dose to the larynx should be kept ≤43.5 Gy.

Original languageEnglish (US)
Pages (from-to)741-749
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume68
Issue number3
DOIs
StatePublished - Jul 1 2007

Fingerprint

Laryngeal Edema
edema
larynx
Larynx
Radiotherapy
radiation therapy
dosage
predictions
grade
Edema
hazards
confidence
Confidence Intervals
rank tests
Radiation Oncology
Tonsillectomy
Neck Dissection
intervals
dissection
stratification

Keywords

  • Dosimetric predictors
  • Laryngeal edema
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Sanguineti, G., Adapala, P., Endres, E. J., Brack, C., Fiorino, C., Sormani, M. P., & Parker, B. (2007). Dosimetric Predictors of Laryngeal Edema. International Journal of Radiation Oncology Biology Physics, 68(3), 741-749. https://doi.org/10.1016/j.ijrobp.2007.01.010

Dosimetric Predictors of Laryngeal Edema. / Sanguineti, Giuseppe; Adapala, Prashanth; Endres, Eugene J.; Brack, Collin; Fiorino, Claudio; Sormani, Maria Pia; Parker, Brent.

In: International Journal of Radiation Oncology Biology Physics, Vol. 68, No. 3, 01.07.2007, p. 741-749.

Research output: Contribution to journalArticle

Sanguineti, G, Adapala, P, Endres, EJ, Brack, C, Fiorino, C, Sormani, MP & Parker, B 2007, 'Dosimetric Predictors of Laryngeal Edema', International Journal of Radiation Oncology Biology Physics, vol. 68, no. 3, pp. 741-749. https://doi.org/10.1016/j.ijrobp.2007.01.010
Sanguineti G, Adapala P, Endres EJ, Brack C, Fiorino C, Sormani MP et al. Dosimetric Predictors of Laryngeal Edema. International Journal of Radiation Oncology Biology Physics. 2007 Jul 1;68(3):741-749. https://doi.org/10.1016/j.ijrobp.2007.01.010
Sanguineti, Giuseppe ; Adapala, Prashanth ; Endres, Eugene J. ; Brack, Collin ; Fiorino, Claudio ; Sormani, Maria Pia ; Parker, Brent. / Dosimetric Predictors of Laryngeal Edema. In: International Journal of Radiation Oncology Biology Physics. 2007 ; Vol. 68, No. 3. pp. 741-749.
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abstract = "Purpose: To investigate dosimetric predictors of laryngeal edema after radiotherapy (RT). Methods and Materials: A total of 66 patients were selected who had squamous cell carcinoma of the head and neck with grossly uninvolved larynx at the time of RT, no prior major surgical operation except for neck dissection and tonsillectomy, treatment planning data available for analysis, and at least one fiberoptic examination of the larynx within 2 years from RT performed by a single observer. Both the biologically equivalent mean dose at 2 Gy per fraction and the cumulative biologic dose-volume histogram of the larynx were extracted for each patient. Laryngeal edema was prospectively scored after treatment. Time to endpoint, moderate or worse laryngeal edema (Radiation Therapy Oncology Group Grade 2+), was calculated with log rank test from the date of treatment end. Results: At a median follow-up of 17.1 months (range, 0.4- 50.0 months), the risk of Grade 2+ edema was 58.9{\%} ± 7{\%}. Mean dose to the larynx, V30, V40, V50, V60, and V70 were significantly correlated with Grade 2+ edema at univariate analysis. At multivariate analysis, mean laryngeal dose (continuum, hazard ratio, 1.11; 95{\%} confidence interval, 1.06-1.15; p < 0.001), and positive neck stage at RT (N0-x vs. N +, hazard ratio, 3.66; 95{\%} confidence interval, 1.40-9.58; p = 0.008) were the only independent predictors. Further stratification showed that, to minimize the risk of Grade 2+ edema, the mean dose to the larynx has to be kept ≤43.5 Gy at 2 Gy per fraction. Conclusion: Laryngeal edema is strictly correlated with various dosimetric parameters; mean dose to the larynx should be kept ≤43.5 Gy.",
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