Massive rhabdomyolysis and acute renal failure after acetonitrile exposure.

A case of systemic rhabomyolysis after acetonitrile exposure is reported. A 35-year-old previously healthy man suffered from vomiting, convulsion and consciousness loss 15 hours after exposure to acetonitrile. Since acetonitrile is known to be metabolized into cyanide, antidote therapy against cyanide poisoning was given. On admission, pain and all-over muscle swelling were marked. Although the initial therapy was effective, rhabdomyolysis and then acute renal failure developed. Renal function improved very slowly after six weeks of hemodialysis, but atrophy of the muscles remained. The rhabdomyolysis may have been caused by toxicity of the cyanide itself in combination with hypoxia and convulsion.

[Light-wand (Trachlight) guided nasotracheal intubation].

We report that Trachlight-guided nasotracheal intubation might be achieved successfully and traumatically without removal of a stiff internal stylet. Endotracheal tube was mounted on a Trachlight with the stylet in position and bent to form a less sharp curvature than a right angle, namely 40-60 degree, at 7 cm proximal to the endotracheal tube tip. Forty-six patients scheduled for nasal intubation were studied to measure the intubation time and the success rate with the use of Trachlight. The tracheas were successfully intubated in 89% of patients. We suggest that Trachlight-guided nasotracheal intubation could be clinically feasible without traumatic complication when applied with a stiff stylet in position and this approach is a useful method for nasal intubation.

[Equilibration period for PaO2 following alteration of FIO2 in mechanically ventilated patients].

To determine arterial oxygen tension (PaO2) in mechanically ventilated patients, we repeatedly measured arterial blood gas (ABG) to examine changes in PaO2 until equilibration following alteration of fractional concentrations of oxygen in inspired gas (FIO2). Forty anesthetized patients with normal arterial oxygenation were randomly assigned to one of four groups. Group 1 (n = 10): Arterial blood samples were drawn every one minute during a 15-min period of equilibration after change of FIO2 from 1.0 to 0.21. Then FIO2 was returned to 1.0 and the similar sampling was repeated. Group 2 (n = 10): The protocol was same as in Group 1 except for FIO2 targeted for 0.8 and 0.4. Group 3 (n = 10): Blood sampling was every two minutes during a 14-min period and repeated while FIO2 was altered as in Group 1. Group 4 (n = 10): The protocol was same as in Group 3 except for the target FIO2 similar to Group 2. PaO2 was stabilized in 4 min at earliest and in 6 min at latest after change of FIO2 in every settings of this study. In mechanically ventilated patients with normal arterial oxygenation, PaO2 could be stabilized after a 6-min period of equilibration following alteration of FIO2.

[Propofol-air-oxygen anesthesia reduces the incidence of sore throat after laryngeal mask anesthesia].

We investigated the effects of the presence or absence of N2O in propofol anesthesia using a laryngeal mask on the incidence of postoperative sore throat. In the N2O-combined anesthesia group (n = 25), score 0 (no sore throat) was observed in 11 patients; score 1 (slight pain and discomfort that improved on the next day of operation) in 9; and score 2 (persistent pain on the next day) in 5. In the non-N2O-combined anesthesia group (n = 25), score 0 was observed in 21 patients, score 1 in 3; and score 2 in 1, showing a significantly lower incidence of sore throat and milder sore throat than in the N2O-combined anesthesia group. These results suggest that propofol anesthesia using a laryngeal mask not combined with N2O reduces the incidence of postoperative sore throat.

Radiation therapy for early glottic carcinoma (T1N0M0). The adverse effect of treatment interruption.

PURPOSE: Clarification of the adverse effects of treatment interruption on the local control of early glottic carcinoma. PATIENTS AND METHODS: From May 1982 through February 1992, 273 patients with early glottic carcinoma (T1N0M0) were treated at this department. Of 253 patients administered 60 Gy in 30 fractions 77 patients had no treatment interruption and treatment was completed within 6 weeks (group I), overall treatment time was prolonged for 176 patients: 141 patients 43 to 49 days (group II) and 35 patients 50 to 62 days (group III). Treatment was interrupted due to public holidays (156 cases), patients convenience (13 cases) and severe mucosal reactions (seven cases). The major reason was public holidays, 91% in group II and 80% in group III. RESULTS: The 3-year recurrence-free survival rates were for group I 95%, group II 89% and group II 80%. Survivals for groups I and II, groups II and III and groups I and III were essentially the same. At 40 Gy tumor clearance was more than 50% in the 3-groups. For complete clearance cases at 40 Gy, recurrence-free survival was essentially the same for the 3 groups although for incomplete clearance cases, statistically significant difference for groups I and III (log-rank test p = 0.0004; Wilcoxon test p = 0.0004) and marginally significant difference for groups II and III (p = 0.0157, p = 0.0045) but no difference for groups I and II (p = 0.0669, p = 0.0853) were noted by adjusting the p-value. CONCLUSION: Prolongation of overall treatment time and tumor clearance at 40 Gy appeared to be a factor of the local control.

High-dose rate intracavitary irradiation for carcinoma of the uterine cervix. The adverse effect of treatment prolongation.

AIM: To investigate the adverse effect of treatment prolongation on the local control and survival of the cervical carcinoma of the uterus. PATIENTS AND METHOD: Two hundred and sixteen patients with stage IIB and III cervical carcinoma treated with a combination of external radiation and high-dose rate (HDR) intracavitary irradiation between 1978 and 1989 were retrospectively studied. A multivariate analysis was used to determine the effect of treatment time on local control and survival. RESULTS: Overall treatment time was the most highly significant factors for local control in the multivariate analysis (p = 0.0005). The 5-year cumulative relapse rates were significantly different with the treatment times 35 to 42 days: 9% versus 43 to 49 days: 19% versus 50 to 62 days: 42% (p = 0.001). The second most significant parameter was stage classification (p = 0.02). Concerning relapse-free survival, stage classification (p = 0.0001), overall treatment time (p = 0.0035) and hemoglobin level (p = 0.0174) were the 3 most important prognostic factors, although there was no relationship between treatment time and late complications. CONCLUSION: These results suggest that prolongation of treatment time is associated with decreased local control and survival in patients treated with external radiation and HDR intracavitary irradiation.

[Aprotinin 2 million KIU reduces perioperative blood loss in patients undergoing primary total hip replacement].

We investigated consecutive patients undergoing primary total hip replacement surgery who were randomly assigned into two groups; those who received a blinded solution of aprotinin 2 million KIU (kallikrein inactivation units) (n = 11) and those who received an equivalent volume of normal saline placebo (n = 10) throughout the surgical procedure. Anesthesia and surgical techniques were standardized. All patients received spinal anesthesia combined with general anesthesia. There was no significant difference in blood loss during operation between the two groups. However, postoperative blood loss in the aprotinin group (284 +/- 155g, mean +/- SD) was significantly less compared with that in the control group (723 +/- 334g). Total blood loss in the aprotinin group (820 +/- 255g) was also significantly less than in control group (1265 +/- 389g). We conclude that the use of aprotinin 2 million KIU during total hip replacement results in significantly less perioperative blood loss, especially during the postoperative period.

[Adjuvant therapies in combination with pancreatectomy for carcinoma of the pancreas].

In the treatment of adenocarcinoma of the pancreas, surgical resection is the only curative strategy. However, the long-term survival rate after pancreatectomy remains poor, and most patients died of loco-regional and/or hepatic recurrence. Thus, we should perform effective adjuvant therapies in combination with surgery, in order to completely prevent these two types of cancer relapse. The present article is designed to introduce the recent reports on the adjuvant chemo-and/or radio-therapies for this cancer. As for loco-regional control, extended pancreatectomy plus chemoradiation seems to be most promising, and preoperative chemoradiation will be more popular in the near future. In order to decrease hepatic metastasis, our "2-channel chemotherapy", a continuous infusion of 5-FU via both hepatic artery and portal vein, is very promising. If postoperative survival is improved by combining these two types of regional therapy, the role of pancreatectomy will be enlarged and more widely understood in the near future.

Morphologic changes in intercostal muscle tissue associated with a viper (Agkistrodon halys blomhoffi) bite.

This study examined a 73-year-old woman who had been bitten in the right thumb by a viper (Agkistrodon halys blomhoffi). She suffered acute renal failure and respiratory failure after the bite. On the 20th day, respiratory failure persisted, although she had recovered from renal failure. Intercostal muscles were obtained by biopsy on the 40th day after the bite. Specimens were observed with enzyme-histochemical and electron microscopic techniques. The size of muscle fibers varied. Most of the smaller muscle fibers were enzyme-histochemically type 2C fibers. This was considered to be the regenerative stage of acute rhabdomyolysis. Ultrastructurally, two opposite types of changes, degeneration and regeneration, were mixed in the same areas. Muscle fibers might be continuously degenerated, and the regenerative fibers might also be degenerated. This study suggests that some slow allergic reactions to snake venom might bear some relation to the degenerative changes.

Prophylactic irradiation of para-aortic lymph nodes in carcinoma of the uterine cervix. A prospective randomized study.

PURPOSE: For assessment of the advantages and side effects of para-aortic lymph nodes irradiation under the evaluation by computer tomography, a prospective randomized study was started in 1986. The results for survival, local control and late complications are presented in the following. PATIENTS AND METHODS: From November 1986 to October 1990, 93 patients with cervical carcinoma were randomly allocated for treatment with either pelvic irradiation (pelvic group) or pelvic plus para-aortic lymph nodes irradiation (para-aortic group). Thirty-six patients underwent external irradiation and intracavitary therapy (RT arm) and 57 patients, extended radical hysterectomy and external irradiation (OP-RT arm). Para-aortic lymph nodes irradiation delivered 45 Gy in 1.8 Gy per day for 5 days per week through anterior-posterior fields. RESULTS: The 3-year cause specific survival rates were para-aortic group: 57% and pelvic group: 89% in RT arm group, and para-aortic group: 70% and pelvic group: 86% in OP-RT arm group. Differences for the 2 groups in each treatment arm were not significant. In pelvic failure, para-aortic lymph nodes metastases and distant metastases showed no statistically significant differences for the 2 groups in each treatment arm. In the para-aortic group, complications were more frequent than in the pelvic group (13/45 vs. 2/48, p < 0.025). As an enteric complication ileus was found in 7% (3/45) of the para-aortic group while 2% (1/48) in the pelvic group. Compression fractures of the lumber vertebral body were apparent in 9% (4/45) and 0%, respectively. CONCLUSION: Routine para-aortic lymph nodes irradiation delivered through anterior-posterior fields for high risk patients with cervical carcinoma is of limited value occurring to the high incidence of late complications and this treatment fails to improve no survival rates.

[Radiation therapy for brain metastases from lung carcinoma: the second prospective randomized trial].

Since September 1980 we have been conducting a prospective randomized trial to determine the best treatment schedule for radiation therapy (XRT) of brain metastasis from lung carcinoma. The first trial (September 1980 to December 1984) used random allocation of two different time-dose radiotherapy schemes: 30 Gy/10 fractions/2 weeks versus 50 Gy/20 fr./4 wks. Treatment results showed no significant difference in neurological improvement or survival between the two arms or in lactate dehydrogenase (LDH) as the most important prognostic factor. The current study (January 1985 to April 1992) examined two sequential trials stratified according to the level of LDH and included 162 patients with brain metastasis from lung carcinoma. Whole brain doses were 30 Gy/10 fr./2 wks (group A, n = 46) or 50 Gy/20 fr./4 wks. (group B, n = 46) in the normal LDH group and 30 Gy/10 fr./2 wks (group C, n = 35) or 20 Gy/5 fr./1 wk. (group D, n = 35) in the high LDH group, while the treatment field was lessened to 30 Gy in group B if possible. The final results showed that 1) the most important prognostic factor as determined by Cox's multivariate analysis was also LDH in the second trial; 2) the incidence of acute side effects tended to depend upon a single dose, i.e., group A (3 Gy) 35% versus group B (2.5 Gy) 21% (p = 0.165), and group C (3 Gy) 23% versus group D (4 Gy) 46% (p = 0.044); 3) median survival time and 1-year survival rates were 5.4 months and 21% in group A, 4.8 months and 17% in group B; 3.4 months and 6% in group C; and 2.4 months and 4% in group D, respectively, and survival curves showed no statistically significant difference between the two treatment groups in each LDH group; 4) improvement in neurological function appeared to increase with total dosage escalation, i.e., 41% in group A versus 45% in group B, and 35% in group C versus 21% in group D (not significant). In conclusion, a short intensive course (30 Gy/10 fr./2 wks) is advantageous for XRT because of the short treatment time and minor acute toxicity in spite of stratification by the level of LDH.

A prospective randomized study concerning the point A dose in high-dose rate intracavitary therapy for carcinoma of the uterine cervix. The final results.

PURPOSE: High-dose rate (HDR) remote afterloading intracavitary therapy has been recognized as an effective and safe treatment modality for carcinoma of the uterine cervix. Since 1983, a prospective randomized study was started in order to investigate the more advantageous treatment schedule with keeping the local control rate. This paper reports the final results in terms of survival, local control and complications. PATIENTS AND METHODS: Between January 1983 and February 1989, a total of 165 patients with carcinoma of the uterine cervix was entered in a prospective randomized study concerning the point A dose of HDR therapy (6 Gy/fraction vs 7.5 Gy/fraction) and external irradiation dose at Department of Radiation Therapy, The Center for Adult Diseases, Osaka. UICC [20] stage distribution of patients was as follows: stage IA = 4, stage IB = 33, stage IIA = 18, stage IIB = 38, stage III = 57, stage IV = 15. RESULTS: Overall 5-year cause specific survivals were as follows: stage IA = 100%, stage IB = 96%, stage IIA = 92%, stage IIB = 79%, stage III = 57%, stage IV = 27%. In each stage, 5-year survival rates in groups A and B were 100%, 93% in stage I, 82% and 85% in stage II, 62% and 52% in stage II and 22% and 31% in stage IV, respectively. There were no statistically significant differences among these survival curves in each stage. Five-year local failure rates were 16% in group A and 16% in group B (p = 0.9096), and corresponding distant failure rates were 23% in group A and 19% in group B (p = 0.2955). Moderate-to-severe complications requiring treatment (Kottmeier's grade 2 or more) were noted in 6 patients (7%) in group A and 6 patients (7%) in group B. All of the bladder and rectal complications needed medical treatment (Kottmeier's grade 2). Severe complications receiving surgery were noted in 4 patients (A: 1; B: 3), i.e., small intestine 3 and sigmoid colon 1 patient. Another 1 patient (A) was dead of ileus. CONCLUSIONS: There were no statistically significant differences between 2 treatment schedules in survival rates, failure patterns and complications rates. This fact suggests that small number of fractions (7.5 Gy/fraction) may be advantageous because of short duration and a low load of treatment.

Is the long-term survival rate improved by preoperative irradiation prior to Whipple's procedure for adenocarcinoma of the pancreatic head?

OBJECTIVE: To determine whether or not both regional control and long-term survival rate were improved by preoperative irradiation prior to curative pancreatectomy for adenocarcinoma of the pancreatic head. DESIGN: Retrospective study of recorded medical data from 1985 to 1989. SETTING: The Center for Adult Diseases, Osaka, one of the major cancer centers in Japan. PATIENTS AND INTERVENTION: Fifty-four consecutive patients in whom pancreatic head cancer had been judged to be resectable by preoperative diagnostic techniques. A total of 50 Gy per 10 MeV of x-ray was irradiated preoperatively to the wide field, including the pancreatic head area, in 23 patients (group A) but not in the 31 remaining patients (group B). The background factors before treatment did not differ between these two groups. OUTCOME MEASURES: Resectability, postoperative survival, and modes of cancer recurrence. RESULTS: At laparotomy, curative pancreatectomy was possible in 17 patients (74%) in group A and 19 (61%) in group B (not significant). In patients undergoing resection, the 1-year survival rate was 75% in group A and 43% in group B (P < .05). However, 3- and 5-year survival rates were almost the same in both groups (28% vs 32% and 22% vs 26%, respectively). With regard to the cause of death after pancreatectomy, group A had a significantly lower incidence of deaths due to regional recurrence within 1.5 postoperative years compared with group B, whereas deaths due to hepatic metastasis were markedly higher after 1 postoperative year in group A compared with group B. CONCLUSIONS: Preoperative irradiation prior to pancreatectomy succeeded in reducing the incidence of early deaths due to regional recurrence. However, owing to the next barrier--death due to hepatic metastasis after 1 postoperative year--long-term (3- and 5-year) survival rate was not improved at all.

Long term follow-up results of high-dose rate remote afterloading intracavitary radiation therapy for carcinoma of the uterine cervix.

PURPOSE: High-dose rate remote afterloading intracavitary radiation therapy (HDR) has been used as more safety system by the dose calculation using computer system before treatment and dose monitoring system using semiconductor dosimeter (ICD-5). This study shows our long-term follow-up results concerning survival, prognostic factor and late complications. MATERIAL AND METHODS: Between August 1978 and December 1982, a total of 200 patients with carcinoma of the intact uterine cervix were treated using HDR. According to the staging system of UICC (1987), 8 patients were classified into Stage Ia, 22 Ib, 22 IIa, 53 IIb, 85 III, and 10 IV. RESULTS: Cause specific five- and ten-year survival rates by Stage were 100%, 100% in Stage Ia, 90%, 90% in Stage Ib, 76%, 76% in Stage IIa, 86%, 84% in Stage IIb, 54%, 46% in Stage III and 20%, 20% in Stage IV, respectively. Significant prognostic factors by Cox's multivariate analysis were stage (p = 0.0001), the value of hemoglobin (p = 0.0005) and older age (p = 0.0114). Concerning stage classification the value of hemoglobin was the most important prognostic factor in Stage II (p = 0.032) and Stage III (p = 0.0015). Late complications requiring medical treatment after RALS developed in 24 patients (12%), i.e., rectum 14 (7), bladder 8 (4), small intestine 5 (3), sigmoid colon 1 (1). Severe complications requiring surgery were noted in 9 patients (5%). CONCLUSION: HDR yields good results of survival with a low risk of severe side effects for the treatment of carcinoma of uterine cervix based on our long-term follow-up results.

Radiation therapy for brain metastases from lung carcinoma. Prospective randomized trial according to the level of lactate dehydrogenase.

PURPOSE: Since September 1980 we have been conducting a prospective randomized trial to determine the best treatment schedule for radiation therapy (XRT) on brain metastasis from lung carcinoma. The first trial (September 1980 to December 1984) was randomly allocated by two different time-dose radiotherapy schemes, i.e., 30 Gy/ten fractions/two weeks versus 50 Gy/20 fractions/four weeks. Treatment results showed no significant difference in neurological improvement and survival between the two arms and lactate dehydrogenase (LDH) as the most important prognostic factor. The present study (January 1985 to April 1992) examines two sequential trials stratified by the level of LDH enrolled 162 patients with brain metastasis from lung carcinoma. PATIENTS AND METHODS: Whole brain dose was selected for 30 Gy/ten fractions/two weeks (group A, n = 46) or 50 Gy/20 fractions/four weeks (group B, n = 46) in the group with normal LDH and 30 Gy/ten fractions/two weeks (group C, n = 35) or 20 Gy/five fractions/one week (group D, n = 35) in the group with high LDH, while the treatment fields were shrunk at 30 Gy in group B if possible. RESULTS: The final results showed the facts that 1. the most important prognostic factor, according to Cox's multivariate analysis, was also the level of LDH in the second trial, 2. the incidence of acute side effects showed the trend toward depending upon a single dose, i.e., group A (3 Gy/fraction); 35% versus group B (2.5 Gy/fraction); 21% (p = 0.165) and group C (3 Gy/fraction); 23% versus group D (4 Gy/fraction); 45% (p = 0.044), 3. median survival time and one-year survival rates were 5.4 months and 21% in group A; 4.8 months and 17% in group B; 3.4 months and 6% in group C; and 2.4 months and 4% in group D, respectively, and survival curves showed no statistically significant difference between the two treatment groups in each LDH group, 4. improvement in neurologic function appeared to increase with total dosage escalation, i.e., 41% in group A versus 45% in group B and 35% in group C versus 21% in group D (p = 0.13). CONCLUSION: A short course (30 Gy/ten fractions/two weeks) is an advantageous XRT because of the short treatment time for normal LDH and neurological improvement and minor toxicity for the high LDH group, while an optional treatment may be necessary for the selected patients.

Radiation therapy for early glottic carcinoma: indication for the wedge filter.

From 1977 to the end of 1987, 244 patients with early glottic carcinoma (T1N0M0) were treated with radiation therapy. For 95 patients (group A), a styrofoam head holder and band were used to ensure immobilization during treatment without a wedge filter and for 149 patients (group B) a shell fixing devise and wedge filter were used. Total radiation dose administered was 50 to 70 Gy over a period of five to seven weeks with fields of 5 x 5 cm (group A) and 5 x 5 cm (group B1: n = 74) or 6 x 6 cm (group B2: n = 75). The five-year relapse-free survival (RFS) rates for group A and B were 85% and 90%, respectively, and RFS was essentially the same (p = 0.241). In group B, RFS was also basically the same for groups B1 and B2 (p = 0.78). According to tumor size, however, in patients with large T1a lesions (total length of one vocal cord) five-year RFS rates for groups A and B were 62% and 88%, respectively, and RFS was statistically significantly different (p = 0.003). Up to five years, seven patients (9%) of group A and 23 patients (17%) of group B showed minor chronic complication. As a minor chronic complication, arytenoid edema was found more frequently in group B (n = 15) than group A (n = 0). Eleven of these 15 cases were treated with large field (6 x 6 cm). For large T1a lesions of glottic carcinoma, a wedge filter was useful. A small field (5 x 5 cm) with an appropriate angle of wedge filter is recommended to avoid late arytenoid edema and achieve a more homogeneous dose distribution.

Radiation therapy of the nasopharyngeal carcinoma. Treatment results and prognostic factors.

Between September 1977 and December 1989, 89 consecutive patients of nasopharyngeal carcinoma were treated with radiation therapy. The study comprised of 66 males and 23 females; their ages ranged from 17 to 80 years (mean 55 years). Five-year survival rates according to stage were as follows: stages I and II (n = 10), 90%; stage III (n = 10), 43%; stage IV (n = 69), 47%. The important prognostic factors for predicting poor prognostic in this series, which were shown by stepwise proportional hazard (Cox) model, were the level of lactate dehydrogenase (LDH) and neck node involvement. LDH level also influenced nodal failure (p = 0.0002) and distant metastasis (p = 0.006).

[Radiation therapy of nasopharyngeal carcinoma: treatment results and prognostic factors].

Between September 1977 and December 1989, 89 consecutive patients with nasopharyngeal carcinoma were treated with radiation therapy. The study included 66 men and 23 women whose ages ranged from 17 to 80 years (mean, 55 years). Five-year survival rates according to stage were as follows: Stage I + II (n = 10), 90%; Stage III (n = 10), 43%; Stage IV (n = 65), 47%. Important factors for predicting poor prognosis in this series, as were shown by the stepwise proportional hazard (Cox) model, were the level of lactate dehydrogenase (LDH) and neck node involvement (Ho's classification). LDH level also influenced nodal failure (p = 0.0002) and distant metastasis (p = 0.006).

Prognostic factors in telecobalt therapy for early supraglottic carcinoma.

BACKGROUND: The local control rates of T1 and T2 supraglottic carcinoma treated with radiation alone were reported as 71% to 92% and 59% to 83%, respectively. The factors that affect the local control rate for early supraglottic carcinoma were investigated. METHODS: From 1967 through 1985, 100 cases with early supraglottic carcinoma (T1N0, 51; T2N0, 49) were treated with telecobalt therapy at the Department of Radiology, Osaka University Hospital. RESULTS: The 5-year actuarial survival rates of cases with T1 and T2 were 69% and 74%, respectively. The 5-year local control rates of cases with T1 and T2 were 77% and 62%, respectively. The local control rate for the epilarynx (94%) was significantly better than that for the lower supraglottis (66%; P < 0.05). For the lower supraglottis, the local control rates of 24 tumors that disappeared at 40 Gy and 58 tumors that persisted at 40 Gy were 88% and 55%, respectively (P < 0.05). CONCLUSIONS: The tumor site was an important prognostic factor in radiation therapy for the supraglottis, as was the tumor response at 40 Gy for the lower supraglottis.

Radiation therapy for larynx carcinoma: long-term results of stage I glottic carcinoma.

From November 1977 through March 1982, 95 patients with early glottic carcinoma (T1N0M0) were treated with radiation therapy. Total radiation dose administered was 50 to 70 Gy over five to seven weeks period with fields of 5 x 5 cm2. Actuarial five- and ten-year survival rates were 81% and 76%, and five- and ten-year relapse free survival rates were 85% and 83%, respectively. Radiation failures were surgically salvaged in 93% (14/15) and ultimate locoregional control rate was 97% (92/95). The rate of voice preservation was 86% (82/95). As a minor chronic complication polypoid lesion and impaired mobility of vocal cord was found in 9% (seven cases) and 5% (four cases) of patients without local recurrence. We need long-term follow-up after radiation therapy for the locoregional control and keeping the quality of voice.