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Title: Pharyngo-cutaneous fistulae after laryngectomy. Influence of previous radiotherapy and prophylactic metronidazole

Abstract

The development of a pharyngocutaneous fistulae is a major complication after total laryngectomy. In Denmark radiotherapy is the primary treatment for all laryngeal carcinomas. Based on the experience with conventional daily irradiation, a split-course radiation schedule was introduced in 1978. The charts of 106 consecutive patients laryngectomized for recurrence in the years 1975 to 1984 were examined. Thirty-four patients developed a fistula. An evaluation of the different radiotherapy schedules used during this period allowed a dose-response curve to be constructed. It showed a pronounced increase of fistulae with high doses of radiotherapy. Split-course radiotherapy caused a rise in late complications and did not improve tumor control. Large field sizes increased the number of fistulae. High-dose fractions showed a surprisingly high incidence of late complications. Prophylactic metronidazole (introduced in 1980) resulted in a highly significant decrease in the frequency of postoperative fistulae. Patients in whom fistula formed were hospitalized for an average of 54 days, patients without, for 22 days.

Authors:
; ;
Publication Date:
Research Org.:
Aarhus Univ. Hospital (Denmark)
OSTI Identifier:
5350335
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cancer (Philadelphia); (United States); Journal Volume: 61:4
Country of Publication:
United States
Language:
English
Subject:
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.; CARCINOMAS; RADIOTHERAPY; LARYNX; METRONIDAZOLE; RADIOSENSITIVITY EFFECTS; SIDE EFFECTS; SKIN DISEASES; RADIOINDUCTION; DENMARK; DOSE-RESPONSE RELATIONSHIPS; FRACTIONATED IRRADIATION; LARYNGECTOMY; PATIENTS; RADIATION INJURIES; ALCOHOLS; ANTINEOPLASTIC DRUGS; AZOLES; BIOLOGICAL EFFECTS; BIOLOGICAL RADIATION EFFECTS; DISEASES; DRUGS; EUROPE; HETEROCYCLIC COMPOUNDS; HYDROXY COMPOUNDS; IMIDAZOLES; INJURIES; IRRADIATION; MEDICINE; NEOPLASMS; NITRO COMPOUNDS; NUCLEAR MEDICINE; ORGANIC COMPOUNDS; ORGANIC NITROGEN COMPOUNDS; RADIATION EFFECTS; RADIOLOGY; RADIOSENSITIZERS; RESPIRATORY SYSTEM; SCANDINAVIA; SURGERY; THERAPY; WESTERN EUROPE; 560151* - Radiation Effects on Animals- Man

Citation Formats

Johansen, L.V., Overgaard, J., and Elbrond, O. Pharyngo-cutaneous fistulae after laryngectomy. Influence of previous radiotherapy and prophylactic metronidazole. United States: N. p., 1988. Web. doi:10.1002/1097-0142(19880215)61:4<673::AID-CNCR2820610410>3.0.CO;2-C.
Johansen, L.V., Overgaard, J., & Elbrond, O. Pharyngo-cutaneous fistulae after laryngectomy. Influence of previous radiotherapy and prophylactic metronidazole. United States. doi:10.1002/1097-0142(19880215)61:4<673::AID-CNCR2820610410>3.0.CO;2-C.
Johansen, L.V., Overgaard, J., and Elbrond, O. Mon . "Pharyngo-cutaneous fistulae after laryngectomy. Influence of previous radiotherapy and prophylactic metronidazole". United States. doi:10.1002/1097-0142(19880215)61:4<673::AID-CNCR2820610410>3.0.CO;2-C.
@article{osti_5350335,
title = {Pharyngo-cutaneous fistulae after laryngectomy. Influence of previous radiotherapy and prophylactic metronidazole},
author = {Johansen, L.V. and Overgaard, J. and Elbrond, O.},
abstractNote = {The development of a pharyngocutaneous fistulae is a major complication after total laryngectomy. In Denmark radiotherapy is the primary treatment for all laryngeal carcinomas. Based on the experience with conventional daily irradiation, a split-course radiation schedule was introduced in 1978. The charts of 106 consecutive patients laryngectomized for recurrence in the years 1975 to 1984 were examined. Thirty-four patients developed a fistula. An evaluation of the different radiotherapy schedules used during this period allowed a dose-response curve to be constructed. It showed a pronounced increase of fistulae with high doses of radiotherapy. Split-course radiotherapy caused a rise in late complications and did not improve tumor control. Large field sizes increased the number of fistulae. High-dose fractions showed a surprisingly high incidence of late complications. Prophylactic metronidazole (introduced in 1980) resulted in a highly significant decrease in the frequency of postoperative fistulae. Patients in whom fistula formed were hospitalized for an average of 54 days, patients without, for 22 days.},
doi = {10.1002/1097-0142(19880215)61:4<673::AID-CNCR2820610410>3.0.CO;2-C},
journal = {Cancer (Philadelphia); (United States)},
number = ,
volume = 61:4,
place = {United States},
year = {Mon Feb 15 00:00:00 EST 1988},
month = {Mon Feb 15 00:00:00 EST 1988}
}
  • Total levels of thyroxine (T4) and thyroid-stimulating hormone (TSH) were measured in 37 patients who had previously had carcinoma of the larynx treated by radiotherapy and total laryngectomy with thyroid lobectomy. Ten percent of the patients had clinical features of hypothyroidism and 30% had total T4 levels below the lower limit of normal. A further 40% had results in the low normal range. Forty-four percent of patients had raised TSH levels, 90% of these having low or low normal T4 levels. The histology of the thyroid gland was normal in all 37 patients. Attention should be given to preserving intactmore » the vasculature of the contralateral thyroid lobe whenever it is necessary to remove the ipsilateral thyroid lobe during a laryngectomy. Proper postoperative assessment of thyroid gland function is desirable in all these patients to identify those at risk of hypothyroidism and to avoid unnecessary morbidity.« less
  • The incidence of carcinomas of the corpus uteri after radiation castration in the treatment of benign uterine bleeding is assessed, both from a review of the literature and a survey of cases treated between 1937 and 1957. Over the period such radiotherapy was carried out on 1138 women, 7 of whom later developed cancers of the corpus uteri, an incidence of 0.61%. The latent period for development of the cancers varied from 5 to 10 yr in 4 cases, 10 to 15 in 2, and was 26 hr in 1 case. A review of other studies showed an incidence ofmore » 0.3 to 0.6%. Development of uterine cervical cancer following such radiotherapy was 4 to 5 times more frequent than that of cancer of the body of the uterus. Since the incidence of cancer of the corpus uteri in unirradiated women is not significantly lower than the rates cited here and in the literature, it was concluded that no etiologic relation to irradiation is demonstrable. (H.H.D.)« less
  • Malignant neoplasms known to develop following external beam radiation include squamous cell carcinoma, osteosarcoma, chondrosarcoma, malignant fibrous histiocytoma, mixed mullerian tumors, malignant schwannoma, myelogenous leukemia and angiosarcoma. Latency periods of many years characterize the onset of these tumors following the exposure. Cutaneous angiosarcoma following radiotherapy for breast carcinoma has been rarely documented, occurring up to 13 years postirradiation. Two cases of this entity are reported occurring 37 months postradiotherapy at the site of mastectomy performed for mammary duct carcinoma.
  • Purpose: To explore whether certain glutathione S-transferase (GST) polymorphisms are associated with an increased risk of breast cancer or the level of radiation-induced adverse effects after two fractionation patterns of adjuvant radiotherapy. Methods and Materials: The prevalence of germline polymorphic variants in GSTM1, GSTP1, and GSTT1 was determined in 272 breast cancer patients and compared with that in a control group of 270 women from the general population with no known history of breast cancer. The genetic variants were determined using multiplex polymerase chain reaction followed by restriction enzyme fragment analysis. In 253 of the patients surveyed for radiotherapy-induced sidemore » effects after a median observation time of 13.7 years (range, 7-22.8 years), the genotypes were related to the long-term effects observed after two fractionation patterns (treatment A, 4.3 Gy in 10 fractions for 156 patients; and treatment B, 2.5 Gy in 20 fractions for 97; both administered within a 5-week period). Results: None of the GST polymorphisms conferred an increased risk of breast cancer, either alone or in combination. Compared with treatment B, treatment A was followed by an increased level of moderate to severe radiation-induced side effects for all the endpoints studied (i.e., degree of telangiectasia, subcutaneous fibrosis and atrophy, lung fibrosis, costal fractures, and pleural thickening; p <0.001 for all endpoints). A significant association was found between the level of pleural thickening and the GSTP1 Ile105Val variant. Conclusion: The results of this study have illustrated the impact of hypofractionation on the level of adverse effects and indicated that the specific alleles of GSTP1, M1, and T1 studied here may be significant in determining the level of adverse effects after radiotherapy.« less