Abstract
PurposeTo report our 20 yr experience of definitive radiotherapy for early glottic squamous cell carcinoma (SCC).Methods and materialsRadiation records of 141 patients were retrospectively evaluated for patient, tumor, and treatment characteristics. Cox proportional hazard models were used to perform univariate (UVA) and multivariate analyses (MVA). Cause specific survival (CSS) and overall survival (OS) were plotted using cumulative incidence and Kaplan-Meir curves, respectively.ResultsOf the 91% patients that presented with impaired voice, 73% noted significant improvement. Chronic laryngeal edema and dysphagia were noted in 18% and 7%, respectively. The five year LC was 94% (T1a), 83% (T1b), 87% (T2a), 65% (T2b); the ten year LC was 89% (T1a), 83% (T1b), 87% (T2a), and 53% (T2b). The cumulative incidence of death due to larynx cancer at 10 yrs was 5.5%, respectively. On MVA, T-stage, heavy alcohol consumption during treatment, and used of weighted fields were predictive for poor outcome (p < 0.05). The five year CSS and OS was 95.9% and 76.8%, respectively.ConclusionsDefinitive radiotherapy provides excellent LC and CSS for early glottis carcinoma, with excellent voice preservation and minimal long term toxicity. Alternative management strategies should be pursued for T2b glottis carcinomas.
Highlights
Several institutions have reported long term outcomes of patients with T1-2N0 squamous cell carcinoma (SCC) of the glottis treated with definitive radiotherapy[1,2,3,4,5,6,7,8,9,10]
Of the 91% patients that presented with impaired voice, 73% noted significant improvement
On multivariate analyses (MVA), T-stage, heavy alcohol consumption during treatment, and used of weighted fields were predictive for poor outcome (p < 0.05)
Summary
We obtained institutional review board (IRB) approval to retrospectively review the charts of all patients treated with definitive radiotherapy at the Cleveland Clinic between 1986–2006. The neck nodes were treated only in cases where there was significant supragottic or sublgottic extension suggesting increased likelihood for subclinical nodal involvement This methodology has been kept consistent over the 20 yrs of this study, and is part of the routine practice at our institution. The following parameters were included in the UVA: age, gender, race, smoking status, heavy alcohol consumption, tumor bulk (amount of cord involved), grade, histology, T-stage (T2 vs T1 and T2b vs all T1/T2a), anterior commissure involvement, supraglottic/subglottic extension, daily dose ≤2 Gy, total dose ≤66 Gy, field weighting (unilateral vs bilateral weighted vs bilateral unequally weighted), and total treatment time. Anterior commissure involvement with extension beyond 1/3 of each cord was categorized as a bulky tumor (Figure 1B) This classification of tumor bulk is identical to that published by Reddy et al [12] Total dose and treatment time were modeled as continuous variables. Quality of life variables that were assessed to determine acute and late toxicity post radiation included: patient and physician reported voice quality pre- and post treatment, physician reported laryngeal edema as noted on direct laryngoscopy, patient reported symptomatic dysphagia requiring dilatations, pre and post treatment trismus, the need for salvage surgeries, and the patterns of failure
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