Early-Stage Glottic Squamous Cell Carcinoma in the Era of Image-Guided Radiotherapy

Abstract

Early-stage squamous cell cancer (SCC) of the glottis has a good prognosis. Therefore, patients have long survival outcomes and may potentially suffer from late toxicities of radiotherapy. Radiotherapy with a conventional parallel-opposed-pair or anterior-oblique beam arrangements for stage 1 and 2 glottic SCC have field borders that traditionally cover the entire larynx, exposing organs-at-risk (e.g. carotid arteries, contralateral vocal cord, contralateral arytenoid and inferior pharyngeal constrictor muscles) to high radiation doses. The potential long-term risk of cerebrovascular events has attracted much attention to the dose that carotid arteries receive. Swallow and respiratory motion of laryngeal structures has been an important factor that previously limited reduction of the radiation treatment volume. Motion has been evaluated using multiple imaging modalities and this information has been used to calculate PTV margins for generation of more limited target volumes. This review discusses the current literature surrounding dose-effect relationships for various organs-at-risk and the late toxicities that are associated with them. This article also reviews the currently available data and effects of laryngeal motions on dosimetry to the primary target. We also review the current limitations and benefits of a more targeted approach of radiotherapy for early-stage glottic SCCs and the evolution of CT-based IGRT and MR-guided radiotherapy techniques that may facilitate a shift away from a conventional 3D-conformal radiotherapy approach.

Machine learning approach to predict tracheal necrosis after total pharyngolaryngectomy

“…Of note, laryngeal cancer is more likely to be diagnosed at an early stage compared to other cancers, which do not require elective nodal irradiation of the neck. [28][29][30] The suprasternal region where the tracheostoma is created can therefore be spared from irradiation. Although our data lacked detailed information on the prior laryngeal cancer stage, there is a possibility that patients with a history of RT for early-stage laryngeal cancer might have a low incidence of tracheal necrosis.…”

“…Among patients with a history of RT, there was no significant difference in the incidence of tracheal necrosis at the irradiated sites (Figure 3). Of note, laryngeal cancer is more likely to be diagnosed at an early stage compared to other cancers, which do not require elective nodal irradiation of the neck 28–30 . The suprasternal region where the tracheostoma is created can therefore be spared from irradiation.…”

Epidemiological, Clinical and Oncological Outcomes of Laryngeal Verrucous Carcinomas: A Systematic Review

“…However, most case-series of patients treated with radiotherapy included data from 1970 to 2000. The radiotherapy techniques have considerably improved since the seventies, which led to higher OS, DSS, and RFS rates in patients treated after 2000 for laryngeal malignancies [ 33 , 34 ]. Thus, the lowest effectiveness of radiotherapy in the management of LVC must be considered with prudence according to the lack of recent controlled study, the low number of patients treated with radiation in the past decade and the potential differences in patient profiles treated with radiotherapy versus surgery.…”

Change in Voice Quality after Radiotherapy for Early Glottic Cancer

“…Thus, it is recommended that voice therapy begins immediately after the resolution of radiomucositis. Moreover, with more sophisticated RT techniques that have an improved control over the dose delivery, additional laryngeal tissue will be spared from higher radiation doses, which will likely further improve the voice quality after RT for early glottic cancer [ 34 ]. Therefore, we assumed that, in our patients, voice therapy would reduce excessive laryngeal muscle activity during phonation and consequently vocal fatigue, especially in those with a normal voice quality.…”