Primary Radiotherapy of Tl and T2 Glottic Carcinoma: Analysis of treatment results and prognostic factors in 223 patients

Klintenberg, Claes; Lundgren, Jan; Adell, Gunnar; Tytor, Maciej; Norberg‐Spaak, Lena; Edelman, Rolf; Carstensen, John

doi:10.3109/02841869609098524

Cited by 24 publications

(14 citation statements)

References 33 publications

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“…Because of the efficient salvage treatment, 5-year causespecific survival is generally considered equivalent for early squamous cell carcinoma of the glottic larynx after radiotherapy or surgery. 4,7,13,16,22,26 Five-year cause-specific survival was identical for both treatments, but multivariate analysis showed a significant decrease in survival among the radiotherapy treated group when there was extension to the supraglottis (T2) (p ‫ס‬ .02).…”

Section: Discussionmentioning

confidence: 98%

“…4,7,13,16,22,23 Thus, the optimal treatment strategy for early glottic carcinoma should offer the best functional results preserving a safe oncological situation. In comparing two groups of patients with T1-T2 glottic carcinoma treated either by initial radiotherapy or surgery, our attempt was to identify clinical situations that would assist in the choice of the treatment modality.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of early stage squamous‐cell carcinoma of the glottic larynx: Endoscopic surgery or cricohyoidoepiglottopexy versus radiotherapy

et al. 2001

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The treatment of laryngeal cancer is always a compromise between oncological efficiency and preservation of function. Our data suggest that, assuming proper selection of patients, radiation therapy and surgery yield similar local control and survival rates. The functional disadvantages after surgery are moderate and clearly counterbalanced by a significant decrease in long-term laryngeal preservation rate after radiotherapeutic treatment.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Treatment of early stage squamous‐cell carcinoma of the glottic larynx: Endoscopic surgery or cricohyoidoepiglottopexy versus radiotherapy

et al. 2001

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“…One should be sensitive to the fact that the hardship to the patient is considerable, due to the length of radiotherapy (usually 6 weeks) as well as the numerous short-and longterm side effects such as dysphagia, skin burns, postradiotherapy edema, and in the worst cases necrotic perichondritis. Radiotherapy is advisably avoided in younger subjects due to the increased possibility of metachronous second primary malignancies in radiated patients, usually appearing several years following the initial treatment [15,24].…”

Section: Introductionmentioning

confidence: 99%

How often is total laryngectomy necessary for the treatment of T1 failures after radiotherapy or cordectomy?

Markou

Nikolaou

Nalbadian

et al. 2002

European Archives of Oto-Rhino-Laryngology

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Between 1992 and 1998, 547 patients (pts) with laryngeal SCC were diagnosed and treated in our department, 145 (27%) of whom presented with glottic tumors T1N0M0 (125 T1a and 20 T1b). Seventy-eight (54%) were treated surgically with cordectomy and 67 (46%) with radiotherapy. After a median follow-up time of 43 months, 22 (15.2%) of the 145 pts presented with recurrent disease. In more detail, 16 (13%) of the 125 T1a pts and 6 (30%) of the 20 T1b pts had recurrences. Among the 78 surgically treated patients only 4 (5%) had recurrence, while 18 (27%) of the radiotherapy group relapsed. The difference is statistically significant (log rank test, P = 0.0001 < 0.05). After salvage treatment, of the 67 pts of the radiotherapy group 57 (85%) remain disease-free, 49 (73%) retaining their larynx intact and 1 only having undergone cordectomy. Among the cordectomy group 75 (96%) pts remain disease-free with only 1 having had a total laryngectomy. Using the Kaplan-Meier method and calculating the disease-free survival regardless of salvage treatment, there is no doubt that surgical treatment statistically is more successful than radiotherapy (log rank test, P = 0.01 < 0.05). Analysis of parameters such as tumor differentiation and T1a or T1b staging, which indeed influence the overall recurrence rate, did not alter the favorable outcome after surgical treatment.

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“…Unfortunately, treatment failures do occur; between 5 and 10% of stage I and up to 25% of stage II laryngeal cancers are resistant to radiotherapy (Fernberg et al, 1989;Klintenberg et al, 1996;Johansen et al, 2002). Patients then require salvage surgery, typically involving removal of the larynx, in order to achieve tumour control.…”

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confidence: 99%

Bcl-2 expression predicts radiotherapy failure in laryngeal cancer

et al. 2005

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Early stage laryngeal cancer can be effectively cured by radiotherapy or conservative laryngeal surgery. In the UK, radiotherapy is the preferred first line treatment. However, up to 25% of patients with T2 tumours will demonstrate locally persistent or recurrent disease at the original site, requiring salvage surgery to achieve a definitive cure. Patients experiencing treatment failure have a relatively poor prognosis. A retrospective analysis was conducted consisting of 124 patients with early stage (T1 -T2, N0) laryngeal squamous cell carcinoma. In total, 62 patients who failed radiotherapy were matched for T stage, laryngeal subsite and smoking history to a group of 62 patients successfully cured by radiotherapy. Using immunohistochemistry the groups were compared for expression of apoptotic proteins: bcl-2, bcl-X L , bax, bak and survivin. Radioresistant laryngeal cancer was associated with bcl-2 (Po0.001) and bcl-X L (P ¼ 0.005) expression and loss of bax expression (P ¼ 0.012) in pretreatment biopsies. Bcl-2 has an accuracy of 71% in predicting radiotherapy outcome. The association between expression of bcl-2, bcl-X L and bax with radioresistant cancer suggests a potential mechanism by which cancer cells avoid the destructive effects of radiotherapy. Predicting radioresistance, using bcl-2, would allow the clinician to recommend conservative laryngeal surgery as an alternative first line treatment to radiotherapy.

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Primary Radiotherapy of Tl and T2 Glottic Carcinoma: Analysis of treatment results and prognostic factors in 223 patients

Cited by 24 publications

References 33 publications

Treatment of early stage squamous‐cell carcinoma of the glottic larynx: Endoscopic surgery or cricohyoidoepiglottopexy versus radiotherapy

Treatment of early stage squamous‐cell carcinoma of the glottic larynx: Endoscopic surgery or cricohyoidoepiglottopexy versus radiotherapy

How often is total laryngectomy necessary for the treatment of T1 failures after radiotherapy or cordectomy?

Bcl-2 expression predicts radiotherapy failure in laryngeal cancer

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