Outcomes of carotid sparing intensity‐modulated radiotherapy for early stage glottic cancer in 201 patients: Multicenter study of Turkish Radiation Oncology Society/TROD‐01‐007

Abstract

Background: To assess and report clinical outcomes after carotid sparing intensity-modulated radiotherapy for early stage laryngeal cancer. Methods:We retrospectively analyzed 201 patients with early stage glottic laryngeal cancer treated with carotid sparing intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) techniques in six TROD centers. Results: After a median follow-up of 31 months the actuarial 1-and 3-year local and locoregional control rates were 99.4% and 94.7%, 98.4% and 93%, respectively. T classification, anterior commissure involvement, IMRT technique, and type of fractionation were not found to be prognostic for local control. Overall, eight patients had lost their organ function due to recurrence or toxicity. Grade 3 and 4 acute laryngeal edema was seen in eight (4%) and one (0.5%) of patients, respectively. Grade 3 and 4 late laryngeal edema developed in two (1%) and one patient (0.5%), respectively. Conclusion:Oncologic outcomes of patients treated with carotid sparing IMRT were excellent; comparable with historical series, with acceptable side effects. Longer follow-up is needed to estimate long term effect on stroke.

Accelerated three‐dimensional conformal radiotherapy for early‐stage glottic cancer in reducing dose to the internal carotid artery and pharyngeal constrictor muscles

“…A retrospective multicenter study in Turkey reported that the most common dose constraint for CAs was a mean dose of <35 Gy. 8 Zumsteg et al reported that the mean CA dose should be reduced to <52 Gy. 16 Martin et al reported that the dose-response threshold for the intimal-medial thickness of the CAs was only significant at doses of >35-50 Gy.…”

“…Several clinical studies examining the efficacy of radiotherapy for head and neck cancer and the dose constraints for CAs or PCM have been published. A retrospective multicenter study in Turkey reported that the most common dose constraint for CAs was a mean dose of <35 Gy 8 . Zumsteg et al reported that the mean CA dose should be reduced to <52 Gy 16 .…”

“…[5][6][7] With the recent technological developments, several studies on the use of intensity-modulated radiotherapy (IMRT) to spare the OARs for ESGC treatment have been published. [8][9][10] However, the use of IMRT as treatment for ESGC remains controversial. In radiotherapy for ESGC, it is essential to consider the intrafractional motion of the glottis (internal target volume [ITV]), especially in the craniocaudal direction, due to coughing and swallowing.…”

“…With the recent technological developments, several studies on the use of intensity‐modulated radiotherapy (IMRT) to spare the OARs for ESGC treatment have been published 8–10 . However, the use of IMRT as treatment for ESGC remains controversial.…”

Role of radiotherapy in early head and neck cancer

“…En los tumores glóticos, estudios recientes han investigado su tratamiento mediante IMRT y IGRT, preservando la cuerda vocal contralateral a la afectada y las arterias carótidas, con el objeto de mejorar la funcionalidad de la cuerda vocal y de disminuir la incidencia de accidentes vasculares cerebrales. Los resultados de estos estudios concluyen con una distribución de dosis significativamente más favorable con IMRT (18)(19)(20).…”