Treatment of Supra-glottic Carcinomas by Telecobalt Therapy

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Abstract
Tele-cobalt 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 3 years. No single case of local recurrence or lymph node involvement has been observed among the patients followed up during 4 years (4 cures out of 13 cases), and during 5 years (4 cures out of 10 cases). It should be noted that 2 patients survived 4 years after total laryngectomy for local recurrence. These results have been particularly favorable in the stages I and II (T1 N0; T1 N1; T2 N0) cases, where there were only 2 failures among 13 patients, one of which was successfully treated by surgery. In stages III and IV cases, the results were still worth while 7 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 involement was verified, usually by cytological examination, there was 1 failure due to persistent disease in the lymph nodes. In 4 cases disease persisted in both the primary site and lymph nodes, and 4 cases were successfully treated. The telecobalt technique used is described. A treatment schedule of 1,200 R tumor dose/week has been adopted recently, with 5 or 6 sessions in a week. The usual total tumor dose is of the order of 7000-8000 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 edema is rarely seen when sterilisation of the tumor 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.

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