American college of radiology appropriateness criteria^® treatment of stage I T1 glottic cancer

Abstract

Best treatment for a particular cancer cannot be defined without consideration of the lesion's location, extent, depth of invasion, and quality of surgical exposure during direct laryngoscopy.

Patterns of Care for Patients With Early-Stage Glottic Cancer Undergoing Definitive Radiation Therapy: A National Cancer Database Analysis

“…An additional factor outside the scope of this analysis that may nevertheless underlie the persistent prevalence of CFxn is the ambiguity in clinical guidelines available to oncologists treating head and neck cancer. While radiotherapy-focused guidelines describe the Yamazaki trial in detail and explicitly rate HFxn as “usually appropriate” and CFxn as “usually not appropriate” [8], more general multidisciplinary cancer guidelines do not mention the local control advantage conferred by HFxn and permit either CFxn or HFxn for Tis-T2N0 glottic cancer [9]. Broadening utilization of HFxn will ultimately require heightened efforts to educate radiation oncologists and consistency among clinical guidelines in uniformly advocating HFxn for the radiotherapeutic management of early-stage glottic cancer.…”

“…Perhaps as a result of these comparable survival outcomes between conventional fractionation and hypofractionation, national guidelines for the radiotherapeutic management of early-stage glottic SCC are inconsistent, with the American College of Radiology’s Appropriateness Criteria favoring hypofractionation [8] and the National Comprehensive Cancer Network guidelines deeming either schedule suitable [9]. …”

Current treatment of T1N0 squamous cell carcinoma of the glottic larynx

“…In case RT is the selected treatment modality, a successful fractionation schedule for T1 glottic cancer is 63 Gy in 28 once-daily fractions [25, 26]. Despite the very low probability of a significant complication after this treatment, many radiation oncologists prefer a more protracted schedule [25].…”

“…The reimbursement schedule in some countries, including the United States, increases with the number of fractions (treatments) thus creating a potential conflict of interest. For whatever reason, many radiation oncologists (in North America and elsewhere) select a commonly employed fractionation schedule that consists of 66 Gy in 33 fractions, which produces a significantly inferior result [25, 26]. Recently, the American College of Radiology (ACR) Expert Panel on Radiation Oncology—Head and Neck Cancer developed consensus recommendations for treatment of T1 glottic SCC.…”

“…They concluded that “Treatment planning is complex and decisions nuanced”. And “Best treatment for a particular cancer cannot be defined without consideration of the lesion’s location, extent, depth of invasion, and quality of surgical exposure during direct laryngoscopy” [26]. But regardless of the modality chosen, physicians should track their own patient’s functional and disease-free survival data rather than rely on the best reported (published) results from the most experienced institutions.…”