Definitive irradiation of T1-T4N0 larynx cancer

Abstract

The use of definitive irradiation in T1‐T4N0 larynx cancer was reviewed in 236 patients at Rush‐Presbysterian‐St. Luke's Medical Center in Chicago. Recurrence‐free survival for all stages was 86% at five years. Ultimate recurrence‐free survival, including successful surgical salvage, was 91% at five years. The data described herein and the literature reviewed support the recommendation for definitive radiation therapy for T1 and T2N0 larynx cancer of any site. T3 lesions may also be reasonably treated with radiation therapy initially, reserving surgery for salvage. However, more data are needed to accurately identify the T3 larynx cancer patients most suited for radiation therapy.

Meta-analysis of Impaired Vocal Cord Mobility as a Prognostic Factor in T2 Glottic Carcinoma

“…Fourteen studies were excluded from analysis. Three studies [27][28][29] that used primary radiotherapy reported outcomes with stratification by vocal fold mobility but included both glottic le-sions and other subsites in a single group. One study 30 that used primary radiotherapy reported combined outcomes for T2b and T3 lesions.…”

“…Our review of the literature reveals that no prospective clinical studies have been reported in the Englishlanguage literature to date that assess treatment outcomes of T2 glottic carcinoma with regard to vocal fold mobility. Many authors conducting retrospective studies 2,11,[22][23][24]26,27 have noted significant differences between the 2 subgroups with respect to clinical course, response to radiation therapy, and local control rates. Currently, most centers report treatment of T2 glottic carcinoma with primary radiotherapy alone, with surgical salvage reserved for persistent or recurrent disease.…”

Management of Dysphonia After Radiation Therapy

“…Radiation is often chosen as a treatment modality for early laryngeal primary squamous cell carcinoma (T1 or T2 disease) given its excellent cure rates but usually requires doses in excess of 65 Gy. [2][3][4][5] Resultantly, between 14% and 92% of patients report dysphonia after radiotherapy for early laryngeal malignancies. [6][7][8][9][10] The timing of the development of dysphonia after RT is variable.…”

Twelve cases of glottic carcinoma in situ treated by radiotheraphy: an observation on clinical course versus response

“…There are two cases in the literature of postradiotherapy chondrosarcoma of the larynx (Glaubiger et al, 1991). These are highly likely to be radiogenic in origin, but as 17 per cent of laryngeal carcinomas are associated with metachronous or synchronous neoplasia (Chacko et al, 1983) it would be difficult to ascribe perilaryngeal neoplasia in an irradiated larynx to the radiotherapy. Two other arguments against this as a criticism are that skin lesions (the most common radiogenic neoplasia) are rarely seen and in long-term follow-up of early radiotherapy (external beam) of thyrotoxicosis, de novo neoplasia manifested between 20 and 44 years after treatment (Garrett, 1959).…”