Intensity‐modulated radiotherapy for early‐stage glottic cancer

Berwouts, Dieter; Swimberghe, Martijn; Duprez, Frédéric; Boterberg, Tom; Bonte, Katrien; Deron, Philippe; Gersem, Werner De; Neve, Wilfried De; Madani, Indira

doi:10.1002/hed.23967

Cited by 18 publications

(18 citation statements)

References 25 publications

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“…The use of 3DCRT with parallel opposing fields has been the standard technique. IMRT is as efficient as 3DCRT in terms of disease control and overall survival [11] and is a widely favored technique in the treatment of head and neck cancer [12][13][14][15]. The 5-year local control rate was reported as 94% in T1a and 93% in T1b glottic squamous cell carcinoma, respectively [4,16].…”

Section: Discussionmentioning

confidence: 99%

“…Zumsteg et al [7] retrospectively analyzed 330 T1 and T2 patients and reported a 3-year local control rate of 88% with carotid-sparing IMRT and 89% with conventional RT, with no statistically significant differences. Berwouts et al [11] reported a study that compared 40 patients with T1-T2 disease treated with IMRT without dose constraint for the carotid artery and 81 patients treated with conventional 3DCRT. There was no significant difference in 5-year local control between the groups, and significantly less skin toxicity in the IMRT group.…”

Section: Discussionmentioning

confidence: 99%

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Intensity-modulated radiotherapy for stage I glottic cancer: a short-term outcomes compared with three-dimensional conformal radiotherapy

et al. 2019

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To investigate the differences in treatment outcomes between two radiation techniques, intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT). Materials and Methods: We retrospectively analyzed 160 (IMRT = 23, 3DCRT = 137) patients with stage I glottic cancer treated from January 2005 through December 2016. The IMRT was performed with TomoTherapy (16 patients), volumetric-modulated arc therapy (6 patients), and step-and-shoot technique (1 patient), respectively. The 3DCRT was performed with bilateral parallel opposing fields. The median follow-up duration was 30 months (range, 31 to 42 months) in the IMRT group and 65 months (range, 20 to 143 months) in the 3DCRT group. Results: The 5-year overall survival and 3-year local control rates of the 160 patients were 95.7% and 91.4%, respectively. There was no significant difference in 3-year local control rates between the IMRT and 3DCRT groups (94.4% vs. 91.0%; p = 0.587). Thirteen of 137 patients in the 3DCRT group had recurrences. In the IMRT group, one patient had a recurrence at the true vocal cord. Patients treated with IMRT had less grade 2 skin reaction than the 3DCRT group, but this had no statistical significance (4.3% vs. 21.2%; p = 0.080). Conclusion: IMRT had comparable outcomes with 3DCRT, and a trend of less acute skin reaction in stage I glottic cancer patients

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intensity-modulated radiotherapy for stage I glottic cancer: a short-term outcomes compared with three-dimensional conformal radiotherapy

et al. 2019

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“…This is consistent with other reports, which have not identified improvement in voice outcomes. Alternatively, IMRT planning has been shown to reduce the severity of acute radiation dermatitis and to spare dose to the carotid vessels (34, 35). Intriguingly, preliminary reports from a prospective study examining the feasibility of IMRT-based single vocal cord irradiation for T1a glottic tumors has demonstrated promising 2-year local control rates and a modest, transient decline in voice quality by voice handicap index.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Post-Radiotherapy Laryngeal Function with Laryngeal Videostroboscopy in Early Stage Glottic Cancer

et al. 2017

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ObjectiveDysphonia is common among patients with early stage glottic cancer. Laryngeal videostroboscopy (LVS) has not been routinely used to assess post-radiotherapy (RT) voice changes. We hypothesized that LVS would demonstrate improvement in laryngeal function after definitive RT for early-stage glottic cancer.Study designBlinded retrospective review of perceptual voice and stroboscopic parameters for patients with early glottic cancer and controls.SettingHigh-volume, single-institution academic medical center.Subjects and methodsFifteen patients underwent RT for Tis-T2N0M0 glottic cancer and were evaluated with serial LVS exams pre- and post-RT. Stroboscopic assessment included six parameters: vocal fold (VF) vibration, VF mobility, erythema/edema, supraglottic compression, glottic closure, and secretions. Grade, roughness, breathiness, asthenia, strain (GRBAS) voice perceptual scale was graded in tandem with LVS score. Assessments were grouped by time interval from RT: pre-RT, 0–4, 4–12, and >12 months post-RT.Results60 LVS exams and corresponding GRBAS assessments were reviewed. There were significant improvements in ipsilateral VF motion (P = 0.03) and vibration (P = 0.001) and significant worsening in contralateral VF motion (P < 0.001) and vibration (P = 0.008) at >12 months post-RT. Glottic closure significantly worsened, most prominent >12 months post-RT (P = 0.01). Composite GRBAS scores were significantly improved across all post-RT intervals.ConclusionLVS proved to be a robust tool for assessing pre- and post-RT laryngeal function. We observed post-RT improvement in ipsilateral VF function, a decline in contralateral VF function, and decreased glottic closure. These results demonstrate that LVS can detect meaningful changes in VF and glottic function and support its use for post-RT evaluation of glottic cancer patients.

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“…This finding indicates that techniques using RT for uniform dose distribution to the target volume, such as intensity-modulated RT (IMRT), may improve the local control rate for early-stage glottic carcinoma treated with definitive RT. Only a limited number of studies have evaluated the treatment outcomes of IMRT for early-stage squamous cell carcinoma of the glottis (27,28). In these studies, the local control rate did not differ significantly between patients treated with IMRT and those treated with RT.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors for local control of early glottic squamous cell carcinomas after definitive radiotherapy

et al. 2020

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The aim of the present study was to retrospectively investigate the risk factors of local failure for T1 glottic carcinoma irradiated with a prescription dose of 66 Gy. Between July 2006 and December 2017, 64 patients with T1 glottic squamous cell carcinoma treated with 66 Gy/33 fractions were analyzed for risk factors of local failure. The sex, age, performance status, T stage, overall treatment time, anterior commissure involvement, smoking status during/after treatment, histological tumor grade and pretreatment hemoglobin level were investigated. The maximum, mean and minimum doses, and the homogeneity index for the glottic larynx were calculated for dosimetric risk factors of local failure. The median follow-up duration was 51 months. Local failure was observed in 6 patients (9.5%). Among all risk factors, only the minimum dose to the glottic larynx was found to be significantly associated with local failure (P=0.025). The 5-year local control rates for a minimum dose to the glottic larynx of <65 and ≥65 Gy were 79 and 95%, respectively, with a statistically significant difference (P= 0.015). No patients exhibited grade ≥3 late adverse effects. The minimum dose to the glottic larynx was the only factor significantly associated with local failure. Thus, local control of T1 glottic carcinoma may improve with a minimum dose of ≥65 Gy to the glottic larynx. In conclusion, radiotherapy with a minimum prescription dose of ≥65 Gy to the glottic larynx appears to be safe and achieves a high local control rate for T1 glottic carcinoma.

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Intensity‐modulated radiotherapy for early‐stage glottic cancer

Abstract: IMRT is as efficient as conventional radiotherapy in terms of disease control and overall survival. It has the potential to reduce toxicity as compared to conventional radiotherapy. © 2015 Wiley Periodicals, Inc. Head Neck 38: E179-E184, 2016.

Cited by 18 publications

References 25 publications

Intensity-modulated radiotherapy for stage I glottic cancer: a short-term outcomes compared with three-dimensional conformal radiotherapy

Intensity-modulated radiotherapy for stage I glottic cancer: a short-term outcomes compared with three-dimensional conformal radiotherapy

Evaluating Post-Radiotherapy Laryngeal Function with Laryngeal Videostroboscopy in Early Stage Glottic Cancer

Predictive factors for local control of early glottic squamous cell carcinomas after definitive radiotherapy

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