Abstract
Early stage glottic cancer has traditionally been treated with 3D conformal radiotherapy (3DCRT). However, intensity-modulated radiotherapy (IMRT) has been recently adopted as an alternative to decrease toxicity. Here, we compared the usage and outcomes of IMRT and 3DCRT for patients with early stage squamous cell carcinoma (SCC) of the glottic larynx. Using the National Cancer Database, we identified patients with Stage I–II SCC of the glottis who received 55–75 Gy using IMRT (n = 1623) or 3DCRT (n = 2696). Median follow up was 42 months with a 5-year overall survival (OS) of 72%. Using a nominal logistic regression, race, ethnicity, year of diagnosis and fraction size were associated with the receipt of IMRT (p < 0.05). Using Kaplan–Meier methods and Cox proportional hazards models as well as a propensity matched cohort, there was no difference in OS for patients who received IMRT versus 3DCRT (hazard ratio (HR), 1.08; 95% confidence interval (95% CI), 0.93–1.26; p = 0.302). However, there was a survival benefit for patients receiving slight hypofractionation as compared to conventional fractionation (HR, 0.78; 95% CI, 0.69–0.92; p = 0.003). IMRT was associated with similar survival as 3DCRT, supporting the implementation of this potentially less toxic modality without compromising survival.
Highlights
Laryngeal cancer has a global incidence of 238,150 cases per year with glottic cancer representing approximately one-half of all laryngeal cancers [1,2]
Stage squamous cell carcinoma (SCC) of the glottis is often treated with radiotherapy (RT) alone [3] and has traditionally been treated with
A total of 4319 patients with cTis-2, N0, M0 glottic SCC who were treated with external beam RT
Summary
Laryngeal cancer has a global incidence of 238,150 cases per year with glottic cancer representing approximately one-half of all laryngeal cancers [1,2]. Stage squamous cell carcinoma (SCC) of the glottis is often treated with radiotherapy (RT) alone [3] and has traditionally been treated with. The goal of IMRT in glottic cancer is to prevent long-term toxicity without compromising already. Cancers 2019, 11, 1996 excellent oncologic outcomes. The implementation and outcomes of IMRT for glottic cancers remains unresolved. In this work we compare the usage and outcomes of patients with early stage glottic SCC treated with IMRT and 3DCRT in the United States (US) using the National Cancer Database (NCDB).
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