Radiotherapy for T3N0 glottic carcinoma without cord fixation: elective nodal irradiation or not?

Abstract

BackgroundAlthough the T3 category has been changed in the sixth edition of the TNM staging system proposed by the Union for International Cancer Control (UICC), the appropriate clinical target volume (CTV) of elective nodal irradiation (ENI) for T3N0 glottic carcinoma without cord fixation, which was formerly treated as a T1-2N0 disease, is not fully discussed.Materials and MethodsWe retrospectively analyzed 64 patients staged or restaged as T3N0 disease without cord fixation. All patients received irradiation to the primary lesion alone using opposed lateral fields. Surgery was performed in 10 patients without tumor regression after the delivery of 40 Gy. The other 54 patients received a median total dose of 66 Gy. Concurrent chemoradiotherapy (CRT) with low-dose cisplatin and UFT (low-dose CRT) and docetaxel, cisplatin, and 5-fluorouracil (TPF-CRT) were performed in 23 and 19 patients, respectively.ResultsEighteen (28.1%) patients suffered treatment failure; all were recorded as local failure alone. The 5-year local control rates for RT alone, low-dose CRT, and TPF-CRT groups were 51.7%, 61.6%, and 93.8%, respectively (p = 0.027). The 5-year laryngeal preservation rates for RT alone, low-dose CRT, and TPF-CRT groups were 57.4%, 81.6%, and 89.5%, respectively (p = 0.048).ConclusionsThe rate of regional failure was zero when irradiating the primary lesion alone using opposed lateral fields. This treatment technique covers the most level III regions; hence, CTV for ENI should include level III alone.

Concurrent chemoradiotherapy with docetaxel, cisplatin, and 5-fluorouracil for T3 N0 glottic carcinoma without vocal cord fixation

“…Regional failure after treatment completion was uncommon. We previously reported the recurrence pattern of staged or restaged T3 N0 disease without vocal cord xation by reviewing 64 cases treated with RT with or without chemotherapy [4]. Of the 64 patients, 22 (34%) underwent RT alone and 42 (66%) underwent CCRT with low-dose or TPF-chemotherapy.…”

“…RT was delivered with a once-daily fraction of 2 Gy. After the delivery of 40 Gy and one cycle of chemotherapy, the head and neck tumor board performed an interim assessment to evaluate the tumor regression on the basis of endoscopic examination and MR imaging ndings [4,11]. In the earlier period, ve patients (20%) were judged as having no tumor regression and underwent surgery: total laryngectomy (n = 3) and laryngeal preservation (n = 2).…”

“…The details of the follow-up are described elsewhere [4]. Brie y, after treatment completion, the patients were followed up every month during the rst year, every 3 months during the second year, and every 6 months thereafter.…”

“…T3 N0 glottic carcinoma without vocal cord xation had been categorized into early T1-T2 N0 disease before the introduction of the sixth edition of the UICC TNM staging system. Radiotherapy (RT) alone has been recognized as a standard treatment for the disease; however, its treatment outcome is not su cient, with a 5-year local control (LC) rate of 40-50% [3,4]. Chemoradiotherapy (CRT) has been used to improve treatment results and recommended in the current NCCN guidelines [5].…”

Concurrent Chemoradiotherapy With Docetaxel, Cisplatin, and 5-Fluorouracil for T3 N0 Glottic Carcinoma Without Vocal Cord Fixation

“…T3 N0 glottic carcinoma without vocal cord fixation had been categorized into early T1-T2 N0 disease before the introduction of the sixth edition of the UICC TNM staging system. Radiotherapy (RT) alone has been recognized as a standard treatment for the disease; however, its treatment outcome is not sufficient, with a 5-year local control (LC) rate of 40%-50% (3,4). Chemoradiotherapy (CRT) has been used to improve treatment results and recommended in the current NCCN guidelines (5).…”