Impaired vocal cord mobility in T2N0 glottic carcinoma: Suboptimal local control with Radiation alone

Bhateja, Priyanka; Ward, Matthew C.; Hunter, G.H.; Greskovich, J.F.; Reddy, Chandana A.; Nwizu, T.; Lamarre, Eric; Burkey, Brian B.; Adelstein, David J.; Koyfman, Shlomo A.

doi:10.1002/hed.24520

Cited by 24 publications

(19 citation statements)

References 25 publications

(43 reference statements)

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“…Patients with impaired vocal cord mobility are generally thought to do worse than those with intact vocal cord mobility 7,11,24,29,44‐46 . A meta‐analysis of 21 retrospective studies of patients with T2 glottic cancer showed impaired vocal cord mobility to be associated with a statistically significant decrease in LC 45 .…”

Section: Discussionmentioning

confidence: 99%

Outcomes after radiation therapy forT2N0/stageIIglottic squamous cell carcinoma

et al. 2020

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Background We report outcomes for patients with T2N0M0 glottic squamous cell carcinoma (SCC) treated with radiation therapy (RT). Methods Patients who received definitive RT for T2 glottic SCC from 2000 through 2013 were retrospectively reviewed. Results One hundred and thirteen patients were analyzed (median follow‐up time 91 months; 85 patients received three‐dimensional conformal radiotherapy [3D‐CRT] and 28 received intensity‐modulated radiation therapy [IMRT]). Fractionation was conventional (58%) or altered (42%); 20 patients (18%) received concurrent chemotherapy. Five‐year local control was 83% for the 3D‐CRT vs 81% for the IMRT group (P = .76). The ultimate locoregional control at 5 years was 100% for IMRT vs 91% for 3D‐CRT (P = .1). The 5‐year overall survival (OS) was 78% for 3D‐CRT vs 81% for IMRT (P = .83). On multivariate analysis, younger age was the only independent predictor of improved OS (P = .0002). Conclusions Oncologic and survival outcomes were excellent for patients with T2N0 glottic cancer. Patients treated with IMRT and 3D‐CRT had no statistically significant differences in all investigated endpoints.

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Section: Discussionmentioning

confidence: 99%

Outcomes after radiation therapy forT2N0/stageIIglottic squamous cell carcinoma

et al. 2020

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“…We suggest the subdivision of T2 glottic tumours into T2a (normal vocal cord mobility) and T2b (impaired mobility) should be included in the TNM classification. Synchronous platinum based chemotherapy with radical radiotherapy is now standard of care for T3 glottic cancers and has been shown to improve outcomes in T2 disease [ 33 – 35 ]. A retrospective review by Bhateja et al showed a trend towards inferior local control for T2b cancers treated with radiotherapy alone, compared to those with more advanced disease treated with chemoradiotherapy [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Conventional fractionation should not be the standard of care for T2 glottic cancer

et al. 2017

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BackgroundThe aim of this study was to report outcomes and late toxicity following hypofractionated accelerated radiotherapy for T2 glottic cancers. We highlight the importance of hypofractionated treatments with shorter overall treatment times, in improving outcomes for T2 glottic cancers. We also compare the biologically effective dose of hypofractionated regimes, with conventional fractionation.MethodsOne hundred twelve patients with T2 glottic cancer were treated between January 1999 and December 2005. All patients were prescribed a hypofractionated accelerated radiotherapy dose of 52.5 Gray in 3.28 Gray per fraction, delivered over 22 days. Radiobiological calculations were used to assess the relationship of fraction size and overall treatment time on local control outcomes and late toxicity.ResultsThe 5-year overall survival was 67%, the 5-year local control was 82%, and the 5-year disease-specific survival was 90%. The respective 5-year local control for T2a and T2b disease was 88.8 and 70.8% (p = 0.032). Severe late toxicity occurred in two patients (1.8%). Radiobiological calculations showed an increase in local control of nearly 12%, with a 10 Gray increase in biologically effective dose.ConclusionThis study has demonstrated that accelerated hypofractionated regimes have improved local control and similar late toxicity compared with conventional fractionation schedules. This supports the use of hypofractionated regimes as the standard of care for early glottic laryngeal cancers.

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“…Although it is difficult to compare these earlier results directly with our findings, the survival rates in our study tended to be favorable. Specifically, the nonsurgical treatments, including definitive RT and systemic CRT, yielded 5‐year local control (LC) or LRC rates of 62% to 65% and OS rates of 40 to 67% in patients with clinically advanced‐stage disease . Al‐Mamgani et al reported a 5‐year LRC rate of 64% in patients with advanced T2 (T2b) disease treated with definitive RT .…”

Section: Discussionmentioning

confidence: 99%

“…Al‐Mamgani et al reported a 5‐year LRC rate of 64% in patients with advanced T2 (T2b) disease treated with definitive RT . Additionally, Bhateja et al reported the 3‐year LRC rates of 73.2% and 91.5% in patients with (a) T2bN0 treated with RT or (b) T2b‐3N0‐2 treated with IV‐CRT, respectively, thereby demonstrating that CRT is a more favorable treatment for patients with T2b relative to RT alone . In a recent study of LP, Timme et al calculated a 2‐year LEDFS rate of 40% in patients with T3 disease treated with IV‐CRT .…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, for clinical stage II, III, and IVA disease, the 5-year LRC rates were 100%, 81.7%, and 71.4%, respectively, the 5-year DSS rates were 100%, 93.3%, and 53.6%, respectively, and the OS rates were 100%, 84.8%, and 53.6%, respectively.Table 4summarizes a literature review of the different therapeutic options. In several studies CRT, respectively, thereby demonstrating that CRT is a more favorable treatment for patients with T2b relative to RT alone 30. In a recent study of LP, Timme et al calculated a 2-year LEDFS rate of 40% in patients with T3 disease treated with IV-CRT 24.…”

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Organ preservation following radiation therapy and concurrent intra‐arterial low dose cisplatin infusion for advanced T2 and T3 laryngeal cancer: Long‐term clinical results from a pilot study

Ono

Tanaka

Tanoue

et al. 2020

Laryngoscope Investig Oto

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Background This pilot study evaluated the long‐term outcomes of patients with advanced T2 or T3 squamous cell carcinoma of the larynx (SCC‐L) who were treated with selective intra‐arterial cisplatin and concomitant radiotherapy (RADPLAT). Methods We retrospectively investigated the data of 49 patients with advanced T2 or T3 SCC‐L who received a RADPLAT regimen with low‐dose cisplatin. Results The 5‐year locoregional control, disease‐specific survival, and overall survival rates were 83.3%, 88.1%, and 82.6%, respectively, while the 5‐year freedom from laryngectomy, laryngectomy‐free survival, and laryngo‐esophageal dysfunction‐free survival rates were 89.6%, 79.4%, and 77.1%, respectively. The incidences of grade 3‐4 hematologic and nonhematologic toxicities were 18% and 6%, respectively. Although two patients (4%) developed late toxicities within 5 years following RADPLAT, no other events were noted beyond 5 years. Conclusion This pilot study demonstrated that RADPLAT is feasible and safe and yielded favorable survival outcomes and functional laryngeal preservation in patients with advanced T2 or T3 SCC‐L. Level of evidence 3

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Impaired vocal cord mobility in T2N0 glottic carcinoma: Suboptimal local control with Radiation alone

Cited by 24 publications

References 25 publications

Outcomes after radiation therapy forT2N0/stageIIglottic squamous cell carcinoma

Outcomes after radiation therapy forT2N0/stageIIglottic squamous cell carcinoma

Conventional fractionation should not be the standard of care for T2 glottic cancer

Organ preservation following radiation therapy and concurrent intra‐arterial low dose cisplatin infusion for advanced T2 and T3 laryngeal cancer: Long‐term clinical results from a pilot study

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