Abstract
Purpose and Objective: To evaluate the disease-free survival, overall survival, dosimetric, and voice handicap index (VHI) results of T1a glottic invasive squamous cell carcinoma (SCC) patients who underwent hypofractionated single vocal cord irradiation (HSVCI).Materials and Methods: The data of 18 patients with stage T1a glottic SCC were collected prospectively and analyzed retrospectively between July 2016 and July 2019. Patients were immobilized using a custom-fitted thermoplastic face and shoulder mask in hyperextension position. The CT scan was performed with 1-mm-thick slices. A planned target volume (PTV) margin of 3 mm was given to clinical target volume (CTV) in all directions, and 13 organs at risk were identified. Patients were prescribed a total of 5760–5808 cGy in 15–16 fractions. Patients had daily cone-beam computed tomography (CBCT), and the treatment was carried out with the physician. VHI test was applied to patients before and at the end of radiotherapy (RT) and 1, 2, 3, 4, and 6 months after the completion of RT.Results: Local control and overall survival rate is 100% for a median of 18 months (6–44 months) of follow-up. A patient was diagnosed with 2nd primary lung cancer and active treatment still continues. All patients completed the treatment within the scheduled time. Grade 1–2 dysphagia and dermatitis occurred in all patients, and no grade 3 and above side effects were observed. The mean values of VHI were 37.00, 39.83, 38.28, 17.17, 12.22, 8.56, and 6.06 at the beginning of RT, at the end of RT, and 1, 2, 3, 4, and 6 months after RT, respectively.Conclusion: Compared to surgery and conventional laryngeal radiotherapy, HSVCI is an alternative treatment method for T1a glottic cancer by reducing the treatment time to 3 weeks, facilitating recurrence treatment, and providing effective sound quality without compromising local control. Considering that ~80% of recurrences in glottic cancer occur within the first 2 years, 100% local control in a median of 18 months is extremely successful, but long-term follow-up is essential to observe possible late side effects.
Highlights
The larynx plays an essential role in daily and social life as it is responsible for voice production and coordination of respiration and swallowing; the treatment aim of laryngeal cancer is not just for better oncologic outcome but has to offer good functional quality
Glottic cancer accounts for 65–70% of all laryngeal cancers and majority of those patients are diagnosed in the early stages [1]
With the development of transoral laser surgery (TLS), TLS replaced open partial laryngectomy (OPL) [4] and claims of lower laryngectomy rates started to be reported with initial surgery over radiotherapy [5, 6]
Summary
The larynx plays an essential role in daily and social life as it is responsible for voice production and coordination of respiration and swallowing; the treatment aim of laryngeal cancer is not just for better oncologic outcome but has to offer good functional quality. Glottic cancer accounts for 65–70% of all laryngeal cancers and majority of those patients are diagnosed in the early stages [1] Both laryngeal preservation surgery and radiotherapy are the standard treatment approach for early-stage glottic carcinoma with 5-year local control rates approaching 90% [2]. T1a glottic cancer has an excellent 5-year local control rate approaching 95% [1] Both surgery and radiotherapy are well-established treatment modalities for T1 glottic cancer [2, 3]. Radiotherapy has been found to enable slightly better voice quality compared to surgery in a randomized trial [8] and has a clear advantage over TLS in terms of VHI in a comparative study [9]
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