Hypofractionated Radiotherapy for Patients with Early-Stage Glottic Cancer: Patterns of Care and Survival

Bledsoe, Turner; Park, Henry S.; Stahl, John M.; Yarbrough, Wendell G.; Burtness, Barbara; Decker, Roy H.; Husain, Zain

doi:10.1093/jnci/djx042

Cited by 39 publications

(23 citation statements)

References 20 publications

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“…Consequently, hypofractionation has gained favor in recent years because this schedule is more advantageous for both patients and staff. Therefore, the use of hyperfractionation and CF at our Institution have been decreasing over the past few years (Figure 1), which is consistent with a study in the United States that showed increased use of hypofractionation for EGSCC over the years, with more than half of patients choosing it recently (10,23). Moore et al and consensus guidelines strongly recommend hypofractionation as the standard of care.…”

Section: Discussionsupporting

confidence: 87%

Comparison of Three Fractionation Schedules in Radiotherapy for Early Glottic Squamous Cell Carcinoma

Suzuki

Yamazaki

Aibe

et al. 2020

In Vivo

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Background/Aim: Radiotherapy is widely accepted as the treatment of choice for early glottic squamous cell carcinoma (EGSCC), although it varies greatly with respect to dose, dose per fraction, and treatment techniques. The study aim was to evaluate the use of accelerated fractionation strategy (AFS) for EGSCC in standard clinical practice. Patients and Methods: Patients treated with definitive radiotherapy for EGSCC between 2008 and 2019 were retrospectively identified and received either conventional fractionation, hypofractionation, or hyperfractionation. Results: One hundred six patients were analyzed, and 19, 71, and 16 patients underwent conventional fractionation, hypofractionation, and hyperfractionation, respectively. The median follow-up was 56 months. The 5-year local control and overall survival rates were 79% and 83%; 78% and 79%; and 87% and 77%, respectively, and no significant difference was observed between the fractionation schedules. Conclusion: Our findings confirmed the utility of AFS in standard clinical practice and support its use for patients with EGSCC.

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Section: Discussionsupporting

confidence: 87%

Comparison of Three Fractionation Schedules in Radiotherapy for Early Glottic Squamous Cell Carcinoma

Suzuki

Yamazaki

Aibe

et al. 2020

In Vivo

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“…Consequently, the high patient numbers in the NCDB facilitate the detection of small differences in survival associated with different radiotherapy techniques. To this end, using the NCDB, we and others observed survival differences in patients treated with different fraction sizes which were not observed in the original randomized trials addressing this issue [22,[24][25][26]. Although the impact of IMRT on local control and toxicity is unknown, we did not find any difference in OS between IMRT and 3DCRT.…”

Section: Discussioncontrasting

confidence: 47%

Patterns of Care and Outcomes of Intensity-Modulated Radiotherapy and 3D Conformal Radiotherapy for Early Stage Glottic Cancer: A National Cancer Database Analysis

Korpics

Turchan

Rooney

et al. 2019

Cancers

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Early stage glottic cancer has traditionally been treated with 3D conformal radiotherapy (3DCRT). However, intensity-modulated radiotherapy (IMRT) has been recently adopted as an alternative to decrease toxicity. Here, we compared the usage and outcomes of IMRT and 3DCRT for patients with early stage squamous cell carcinoma (SCC) of the glottic larynx. Using the National Cancer Database, we identified patients with Stage I–II SCC of the glottis who received 55–75 Gy using IMRT (n = 1623) or 3DCRT (n = 2696). Median follow up was 42 months with a 5-year overall survival (OS) of 72%. Using a nominal logistic regression, race, ethnicity, year of diagnosis and fraction size were associated with the receipt of IMRT (p < 0.05). Using Kaplan–Meier methods and Cox proportional hazards models as well as a propensity matched cohort, there was no difference in OS for patients who received IMRT versus 3DCRT (hazard ratio (HR), 1.08; 95% confidence interval (95% CI), 0.93–1.26; p = 0.302). However, there was a survival benefit for patients receiving slight hypofractionation as compared to conventional fractionation (HR, 0.78; 95% CI, 0.69–0.92; p = 0.003). IMRT was associated with similar survival as 3DCRT, supporting the implementation of this potentially less toxic modality without compromising survival.

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“…Trevor et al. in the group of 10,212 patients with T1 glottic cancer noted a 2.2% improvement in 5‑year OS after hypofractionated radiotherapy [41]. Ermis et al.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors in patients with T1 glottic cancer treated with radiotherapy

et al. 2019

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Purpose Presentation of long-term results of radiation treatment in patients with T1 glottic cancer and evaluation of prognostic factors. Methods We performed a retrospective analysis in a group of 569 patients with T1 squamous cell glottic carcinoma treated with radiotherapy at the Center of Oncology in Cracow between 1977 and 2007. In all, 503 (88%) patients presented with T1a stage disease and 66 (12%) with T1b. Anterior commissure infiltration was present in 179 (31%) patients. Average hemoglobin level prior to therapy was 13.9 g/dl. Using the body mass index (BMI), 114 (20%) patients were underweight, and 91 (16%) were overweight. Median time between collecting tumor specimen and beginning of radiotherapy was 56 days (range 14–145 days). Treatment regimen was normofractionated with single fraction ≤2 Gy in 102 (18%) and hypofractionated in 467 (82%) patients. Results The 5‑ and 10-year overall survival (OS), disease-specific survival (DSS) and local control (LC) rates were 85 and 68%, 88 and 86%, 89 and 87%, respectively. Multivariate analysis showed that tobacco smoking, low hemoglobin level (<13 g/dl), anterior commissure infiltration, fraction dose ≤2 Gy and time from collecting specimen to beginning of therapy longer than 30 days had negative impact on LC and DSS. Patients’ age over 60 years, worse performance status and malnutrition (BMI <18.5) had negative impacts on OS. Conclusions Radiotherapy is a highly effective treatment method in patients with T1N0M0 glottic cancer. LC and DSS may be improved following hypofractionation, smoking cessation, and shortening of waiting-time until start of treatment. OS was mainly influenced by nutritional and performance status.

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Hypofractionated Radiotherapy for Patients with Early-Stage Glottic Cancer: Patterns of Care and Survival

Cited by 39 publications

References 20 publications

Comparison of Three Fractionation Schedules in Radiotherapy for Early Glottic Squamous Cell Carcinoma

Comparison of Three Fractionation Schedules in Radiotherapy for Early Glottic Squamous Cell Carcinoma

Patterns of Care and Outcomes of Intensity-Modulated Radiotherapy and 3D Conformal Radiotherapy for Early Stage Glottic Cancer: A National Cancer Database Analysis

Prognostic factors in patients with T1 glottic cancer treated with radiotherapy

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