Abstract
Objective: To evaluate the outcomes of radical intent radiation therapy in early glottic carcinoma (EGC), including local control rate (LCR), disease-free survival (DFS), death specific free survival (DSFS), and overall survival (OS) rates, in Saudi patients treated at a single institution. Materials and methods: This is an institutional review board (IRB) approved, retrospective study of 27 patients with T1-2 N0 M0, early glottic carcinoma (EGC) who were treated from 2010 to 2015 at our institution with different radiotherapy (RT) fractionation regimens. The regimens included six different fractionation schedules of radiotherapy (RT): 50 Gy (20 x 2.5 Gy) dose prescribed to 95% isodose line, 52.4 Gy (20 x 2.52 Gy), 63 Gy (28 x 2.25 Gy), 66 Gy (33 x 2 Gy), and 70 Gy (35 x 2 Gy). The cohort was stratified into two groups, ≤ 52.5 Gy (n=15) and > 52.5 Gy (n=12). The median follow-up of all patients was 31.7 months (range 7-82).Results: The mean age of the cohort was 64.5 years (median 65, range: 41-83). Eleven patients (40.7%) had a history of smoking. The majority of the cohort was with T1a EGC (70.4%, n=19), and anterior commissure invasion was seen in three patients (11.1%). The mean RT doses were 55.6 Gy (range: 50-70). The five-year LCR, DFS, DSFS, and OS rates were 83.1%, 80.0%, 96.2%, and 92.6%, respectively. The LCR rates for those receiving a dose of 52.5 Gy or less were 61.3 months compared to 89.5 months for those who received more than 52.5 Gy (p=0.994). Non-smokers and patients with an unknown smoking history achieved a five-year LCR of 100%, while patients with a positive smoking history achieved a five-year LCR of 60.6% (p=0.044).Conclusion: Radiation therapy for EGC in our patients showed reasonable five-year LCR with larynx preservation at 83.1%, DFS 80.0%, five-year OS rate 92.6%, and DSFS rate 96.2%. We found that smoking had a significant correlation with LCR. However, large prospective trials are warranted to evaluate the efficacy of overall treatment time, dose per fraction of above 2 Gy, and smoking effect.
Highlights
Compared to the rest of the world, the incidence of laryngeal squamous cell carcinoma is much lower in the Kingdom of Saudi Arabia, likely due to the recent adoption of smoking habits in the population over the last three decades [1]
The majority of the cohort was with T1a early glottic carcinoma (EGC) (70.4%, n=19), and anterior commissure invasion was seen in three patients (11.1%)
The local control rate (LCR) rates for those receiving a dose of 52.5 Gy or less were 61.3 months compared to 89.5 months for those who received more than 52.5 Gy (p=0.994)
Summary
Compared to the rest of the world, the incidence of laryngeal squamous cell carcinoma is much lower in the Kingdom of Saudi Arabia, likely due to the recent adoption of smoking habits in the population over the last three decades [1]. In one of the retrospective reviews of head and neck (H&N) malignancies conducted between 1987 and 2000 at King Fahad Specialist Hospital (KFSH) and Prince Faisal Oncology Center (PFOC), Buraidah, Saudi Arabia, it is reported that nine out of 135 (6.7%) H&N cancer patients were diagnosed with laryngeal carcinoma [2]. The true vocal cords (TVC) or glottic larynx is the most commonly involved subsite, depicting approximately two-thirds of laryngeal carcinoma [4]. Glottic carcinoma typically presents early, and unlike many other H&N malignancies, lack of lymphatic drainage in the glottis mucosa fetches small risk of lymph node involvement [5]. Glottic carcinoma (EGC) is defined as tumor confined to one TVC (T1a), both vocal cords (T1b), or tumor that extends to supraglottic or subglottic with minimal functional impairment of TVC (T2) [6]. Radical radiation therapy is the appropriate initial modality for T1 and T2 lesions, with surgery reserved for salvage after failure
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