A research report submitted to the faculty of Health Sciences University of Witwatersrand, in partial fulfilment for the degree of Master of Medicine (M.Med) Radiation Oncology. Johannesburg 2014 / Background
Larynx preservation is the standard recommended treatment approach for cancer of the larynx. We looked at results of patient treated with larynx preserving approach at our institution.
Objectives
The study objectives included describing the demographics of the population in the study and comparing characteristics and outcomes for patients in the different treatment groups. We also assessed waiting time for treatment, treatment completion rates and overall treatment time for all the patients in the study group. Outcomes of patients at last follow up and survival for different stages of disease were described.
Materials and Methods
A retrospective study of patients with cancer of the larynx treated at Charlotte Maxeke Academic Hospital department of radiation oncology between the year 2007 and 2009. All patients who received radiotherapy including palliative and radical cases were assessed. Outcomes were measured from end of treatment to 1 year and 2 years follow up for survival.
Results
We identified 106 eligible patients. The mean age was 58.6 years (standard deviation of 10.051).Two thirds (67%) of the patients presented with stage IVa disease, 14% had stage IVb, 13% had stage III, and very few patients had stage I and II disease 4% and 2% respectively. One third of patients were treated with radical chemotherapy plus radiotherapy and majority of them received only 1 cycle of chemotherapy. The other 26 % of patients treated with radical intent received radiotherapy alone. A significant number of our patients (42 %) were treated with palliative intent of which 13 % were patients who had disease progression while awaiting treatment. The majority of patients (53%) had an improvement in symptoms while (5.7%) had died and (17%) were lost to follow-up.
Conclusion
Waiting time prior to radiotherapy is a major problem in our institution as our overall mean waiting time was 98.5 days. Patients who had disease progression as defined by change in the treatment intent from radical to palliative treatment (13%) had a mean waiting time of 187.9 days which was almost double our overall mean waiting time and significantly worse than that recommended by standard of care. Although this waiting time was not statistically significant when compared with other patients treated with radical intent, it is a concern for the department to have such long waiting time prior to therapy and is probably a reflection of inadequate statistical power.
Of the radical cases those treated with chemotherapy and radiotherapy very few (2.9%) completed 3 cycles of chemotherapy therefore we had low treatment completion rates. Some patients did not receive their 2nd or 3rd cycle of chemotherapy due to low creatinine clearance other patients reasons for not completing chemotherapy was not documentation in their medical records. Although concurrent chemotherapy plus radiotherapy is the standard of care
for larynx preservation, most of our patients received suboptimal treatment to the recommended schedule and a significant number of our patients were treated with palliative intent.
Chemotherapy was not administered in some patients because of low CD4 count value. Unfortunately this was not recorded systematically and HIV status was not an entry or exclusion factor so no comparisons could be made. The chemotherapy schedule was not given to many patients at the recommended schedule of 3 cycles so we were not able to compare this with the literature.
Resources constraints with regards to diagnostic and radiological facilities resulted in us not having measurable tumour volume increase to evaluate disease progression during waiting time and to evaluate response to treatment at follow-up.
We have identified that patients are receiving inadequate treatment at the Department of Radiation Oncology with waiting times in excess of that recommended in the literature. Several reasons have been tentatively identified.
Additional research in a form of prospective study is required in our department to assess if we could improve the number of patients treated with radical intent by giving induction chemotherapy during the waiting time for patients with advanced stage III & IV disease who have a good performance status. Protocols in our department need to be reviewed for patients with early disease to be treated with shorter regimen and a higher dose fractionation schedule of 2.25Gy as this will also reduce our overall treatment time and waiting time for treatment while improving local control.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/15484 |
| Date | January 2014 |
| Creators | Mutsoane, Tsholofelo Desiree |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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