Risk-adapted partial larynx and/or carotid artery sparing modulated radiation therapy of glottic cancer

Glanzmann, Christoph; Huber, Gerhard; Studer, Gabriela

doi:10.1186/1748-717x-9-136

Cited by 16 publications

(12 citation statements)

References 34 publications

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“…In common with other series, late toxicity is patchily documented. There is current interest in the potential for intensity modulated radiotherapy techniques to offer carotid artery sparing [ 36 ]; it was not possible to reliably document the long term risk of cerebrovascular events with conventional radiotherapy in this series.…”

Section: Discussionmentioning

confidence: 99%

Definitive hypofractionated radiotherapy for early glottic carcinoma: experience of 55Gy in 20 fractions

et al. 2015

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IntroductionA wide variety of fractionation schedules have been employed for the treatment of early glottic cancer. The aim is to report our 10-year experience of using hypofractionated radiotherapy with 55Gy in 20 fractions at 2.75Gy per fraction.MethodsPatients treated between 2004 and 2013 with definitive radiotherapy to a dose of 55Gy in 20 fractions over 4 weeks for T1/2 N0 squamous cell carcinoma of the glottis were retrospectively identified. Patients with prior therapeutic minor surgery (eg. laser stripping, cordotomy) were included. The probabilities of local control, ultimate local control (including salvage surgery), regional control, cause specific survival (CSS) and overall survival (OS) were calculated.ResultsOne hundred thirty-two patients were identified. Median age was 65 years (range 33–89). Median follow up was 72 months (range 7–124). 50 (38 %), 18 (14 %) and 64 (48 %) of patients had T1a, T1b and T2 disease respectively. Five year local control and ultimate local control rates were: overall - 85.6 % and 97.3 % respectively, T1a - 91.8 % and 100 %, T1b - 81.6 and 93.8 %, and T2 - 80.9 % and 95.8 %. Five year regional control, CSS and OS rates were 95.4 %, 95.7 % and 78.8 % respectively. There were no significant associations of covariates (e.g. T-stage, extent of laryngeal extension, histological grade) with local control on univariate analysis. Only increasing age and transglottic extension in T2 disease were significantly associated with overall survival (both p <0.01). Second primary cancers developed in 17 % of patients. 13 (9.8 %) of patients required enteral tube feeding support during radiotherapy; no patients required long term enteral nutrition. One patient required a tracheostomy due to a non-functioning larynx on long term follow up.ConclusionsHypofractionated radiation therapy with a dose of 55Gy in 20 fractions for early stage glottic cancer provides high rates of local control with acceptable toxicity.

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Section: Discussionmentioning

confidence: 99%

Definitive hypofractionated radiotherapy for early glottic carcinoma: experience of 55Gy in 20 fractions

et al. 2015

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“…Due to the local infiltration and growth of carcinoma and the advancement of treatment methods, the disease is characterized by a low probability of metastasis. Because EBRT is characterized by a lack of trauma, a good curative effect, and minimal effects on vocal function and quality of life, it is becoming more widely applied for patients with early glottic laryngeal cancer 12 , 13 . Because of its relatively non-invasive nature, good curative effect and minimal influence on vocal function and quality of life, TLM has progressively replaced the use of total laryngectomy/hemi-laryngectomy for early glottic laryngeal cancer patients 4 , 7 .…”

Section: Discussionmentioning

confidence: 99%

Clinical analysis of EBRT vs TLM in the treatment of early (T1-T2N0) glottic laryngeal cancer

Shen

et al. 2020

J. Cancer

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Objective: To analyze the clinical efficacy of external beam radiation therapy (EBRT) vs transoral laser microsurgery (TLM) in patients with early glottic laryngeal carcinoma (T1-T2N0) and the effect of treatment choice on vocal function. Methods: A retrospective analysis of patients with T1-T2N0 glottic laryngeal carcinoma who underwent EBRT or TLM between January 2012 and December 2018 in PUMCH. The Kaplan-Meier method was used to analyze local control, progression-free survival and overall survival, and the VHI-30 scale was used to evaluate the effects of EBRT and TLM on vocal function. Results: A total of 185 patients, all with pathologically confirmed squamous cell carcinoma, were enrolled. The median age was 62 years (38-88). N0 disease was confirmed by imaging: 142/185 (76.76%) patients had T1N0 disease, and 43/185 patients (23.24%) had T2/N0 disease. A total of 91/195 (49.19%) patients received an EBRT dose of 66-70 Gy/30-35f, at 2.0-2.3 Gy/f. 94/185 (50.81%) patients received TLM. The median follow-up time was 42 months (12-92), and the 3-year LC, PFS, and OS rates for the EBRT and TLM groups were 96.9% vs 94.1%(p=0.750), 95.3% vs 93.1%(p=0.993) and 93.3% vs 95.4%(p=0.467), respectively. The VHI-30 scales were used at the baseline showed no significant difference between the two groups 19.20±3.324 vs 21.65±9.80 (p=0.250), but the EBRT group had a low voice handicap after treatment, 10.24±6.093 vs 19.45±5.112 (p=0.001) (6 months) and 9.45±5.112 vs 14.97±7.741 (12 months). No CTCAE grade 3 or above side effects were observed in the EBRT group, but 3 cases of vocal cord stenosis were observed in the TLM group. Conclusion: The application of EBRT for early glottic laryngeal carcinoma (T1-T2N0) had an obvious curative effect with high LC and OS rates, no serious side effects, and a low voice handicap rate.

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“…20 For example, Janssen and colleagues recently reported excellent local control rates in 39 patients with T1-2N0 glottic carcinoma treated with IMRT, including 21 patients that underwent ipsilateral vocal cord irradiation with bilateral carotid sparing resulting in a mean contralateral carotid dose of 20.2 Gy. 21 Since the time period of this study, we have chosen to employ an intermediate approach, using daily image guidance and decreasing our circumferential margin to 0.5cm, with as little as 0.3cm margin allowable near the carotid arteries in order to achieve a more significant reduction in carotid dose. Notably, in this study we found that the benefit of carotid sparing IMRT varied significantly based on a given patient’s anatomy, with mean carotid artery doses ranging from 20.5 Gy to 61.5 Gy.…”

Section: Discussionmentioning

confidence: 99%

Carotid sparing intensity-modulated radiation therapy achieves comparable locoregional control to conventional radiotherapy in T1-2N0 laryngeal carcinoma

et al. 2015

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Background Although intensity-modulated radiotherapy (IMRT) is a standard of care for many head and neck cancers, its use for carotid-sparing (CS) therapy in early-stage laryngeal carcinoma is controversial. Methods 330 consecutive patients with early-stage laryngeal carcinoma were treated from 1/1989 to 5/2011, including 282 CRT and 48 CS-IMRT patients. The median follow-up was 43 (CS-IMRT) and 66 (CRT) months. Results There was no difference in local failure rates comparing patients undergoing CS-IMRT with CRT, with 3-year local control rates of 88% vs. 89%, respectively (p=0.938). Using a 1cm circumferential margin, the average dose to the left and right carotid arteries was 48.3 and 47.9 Gy, respectively. 88% of locoregional recurrences involved the ipsilateral true vocal cord, including all local recurrences in the IMRT group. Conclusions These results warrant further prospective evaluation of CS-IMRT for early-stage glottic larynx cancer.

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Risk-adapted partial larynx and/or carotid artery sparing modulated radiation therapy of glottic cancer

Abstract: Background: To evaluate outcome in patients with glottic cancer treated with intensity-modulated radiotherapy (IMRT) and to show effectiveness of partial laryngeal-and/or carotid artery sparing in low to intermediate risk tumors. Study design: Retrospective analysis.

Cited by 16 publications

References 34 publications

Definitive hypofractionated radiotherapy for early glottic carcinoma: experience of 55Gy in 20 fractions

Definitive hypofractionated radiotherapy for early glottic carcinoma: experience of 55Gy in 20 fractions

Clinical analysis of EBRT vs TLM in the treatment of early (T1-T2N0) glottic laryngeal cancer

Carotid sparing intensity-modulated radiation therapy achieves comparable locoregional control to conventional radiotherapy in T1-2N0 laryngeal carcinoma

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