Skip to main content Accessibility help

Intensity-modulated radiotherapy (55 Gy in 20 fractions) for high-grade laryngeal dysplasia: report of acute toxicity and functional outcome

  • J Kovarik (a1), M Bhabra (a2), A W Tin (a1), G Shaikh (a1) and M S Iqbal (a1)...



Radiotherapy is an option to treat high-grade laryngeal dysplasia. This study aimed to evaluate the use of intensity-modulated radiotherapy, 55 Gy in 20 daily fractions, in treating this disease.


Acute toxicity was evaluated in all 14 patients treated. In 10 patients, functional voice outcome was measured using the Voice Handicap Index, and the Grade, Roughness, Breath, Asthenia, Strain (‘GRBAS’) scale. These measurements were performed pre-treatment and three months after intensity-modulated radiotherapy.


All but one patient managed to complete radiotherapy. Acute toxicity was significant (one patient developed grade 4 and three patients developed grade 3 dysphagia). Four patients required hospital admission. In 9 out of 10 patients, radiotherapy improved voice quality.


This radiotherapy regimen using intensity-modulated radiotherapy for laryngeal dysplasia is feasible and provided excellent functional outcome, but acute toxicity was significant. Dose de-escalation can be considered in the framework of clinical trials.


Corresponding author

Author for correspondence: Dr Muhammad Shahid Iqbal, Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK E-mail:


Hide All

Dr M S Iqbal takes responsibility for the integrity of the content of the paper



Hide All
1Karatayli-Ozgursoy, S, Pacheco-Lopez, P, Hillel, AT, Best, SR, Bishop, JA, Akst, LM. Laryngeal dysplasia, demographics, and treatment: a single-institution, 20-year review. JAMA Otolaryngol Head Neck Surg 2015;141:313–18
2Weller, MD, Nankivell, PC, McConkey, C, Paleri, V, Mehanna, HM. The risk and interval to malignancy of patients with laryngeal dysplasia; a systematic review of case series and meta-analysis. Clin Otolaryngol 2010;35:364–72
3Mehanna, H, Paleri, V, Robson, A, Wight, R, Helliwell, T. Consensus statement by otorhinolaryngologists and pathologists on the diagnosis and management of laryngeal dysplasia. Clin Otolaryngol 2010;35:170–6
4Sadri, M, McMahon, J, Parker, A. Management of laryngeal dysplasia: a review. Eur Arch Otorhinolaryngol 2006;263:843–52
5Small, W, Mittal, BB, Brand, WN, Shetty, RM, Rademaker, AW, Beck, GG et al. Role of radiation therapy in the management of carcinoma in situ of the larynx. Laryngoscope 1993;103:663–7
6Garcia-Serra, A, Hinerman, RW, Amdur, RJ, Morris, CG, Mendenhall, WM. Radiotherapy for carcinoma in situ of the true vocal cords. Head Neck 2002;24:390–4
7Le, QT, Takamiya, R, Shu, HK, Smitt, M, Singer, M, Terris, DJ et al. Treatment results of carcinoma in situ of the glottis: an analysis of 82 cases. Arch Otolaryngol Head Neck Surg 2000;126:1305–12
8MacLeod, PM, Daniel, F. The role of radiotherapy in in-situ carcinoma of the larynx. Int J Radiat Oncol Biol Phys 1990;18:113–17
9Barnes, L, Eveson, JW, Reichart, P, Sidransky, D, eds. World Health Organization Classification of Tumours. Pathology and Genetics of Head and Neck Tumours. Lyon: IARC Press, 2005
10Common Terminology Criteria for Adverse Events v4.0. In:×7.pdf [30 January 2019]
11Rosen, CA, Lee, AS, Osborne, J, Zullo, T, Murry, T. Development and validation of the voice handicap index-10. Laryngoscope 2004;114:1549–56
12Arffa, RE, Krishna, P, Gartner-Schmidt, J, Rosen, CA. Normative values for the Voice Handicap Index-10. J Voice 2012;26:462–5
13Omori, K. Diagnosis of voice disorders. JMAJ 2011;54:248–53
14De Bodt, MS, Wuyts, FL, Van de Heyning, PH, Croux, C. Test-retest of the GRBAS scale: influence of experience and professional background on perceptual rating of voice quality. J Voice 1997;11:7480
15Rigual, NR, Thankappan, K, Cooper, M, Sullivan, M, Dougherty, T, Popat, SR et al. Photodynamic therapy for head and neck dysplasia and cancer. Arch Otolaryngol Head Neck Surg 2009;135:784–8
16Mimikos, C, Shafirstein, G, Arshad, H. Current state and future of photodynamic therapy for the treatment of head and neck squamous cell carcinoma. World J Otorhinolaryngol Head Neck Surg 2016;2:126–9
17Huang, G, Luo, M, Zhang, J, Liu, H. The voice quality after laser surgery versus radiotherapy of T1a glottis carcinoma: systematic review and meta-analysis. Onco Targets Ther 2017;10:2403–10
18Higgins, KM. What treatment for early-stage glottis carcinoma among adult patients: CO2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility? Laryngoscope 2011;121:116–34
19Higgins, KM, Shah, MD, Ogaick, MJ, Enepekides, D. Treatment of early-stage glottis cancer: meta-analysis comparison of laser excision versus radiotherapy. J Otolaryngol Head Neck Surg 2009;38:603–12
20Aaltonen, LM, Rautiainen, N, Sellman, J, Saarilahti, K, Makitie, A, Laranne, J et al. Voice quality after treatment of early vocal cord cancer: a randomized trial comparing laser surgery with radiation therapy. Int J Radiat Oncol Biol Phys 2014;90:255–60
21Greulich, MT, Parker, NP, Lee, P, Merati, AL, Misono, S. Voice outcomes following radiation versus laser microsurgery for T1 glottic carcinoma: systematic review and meta-analysis. Otolaryngol Head Neck Surg 2015;152:811–19



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed