Early Laryngeal Cancer Research Articles

Impact of Continuous Positive Airway Pressure (CPAP) on Vocal Cord Separation and its Potential Application for Unilateral Vocal Cord Irradiation

<h3>Purpose/Objective(s)</h3> Unilateral vocal cord (VC) irradiation may be indicated in selected cases of early larynx cancer and may offer improved voice quality compared to bilateral VC irradiation or cordectomy. The proximity of the involved VC to the normal VC in the confined thyroid cartilage space and the need to account for motion and set-up errors may limit the dose reduction obtained from unilateral VC irradiation. We hypothesized that use of CPAP, which hyperinflates the upper airway would increase separation between the VC's and reduce the dose to the contralateral VC and larynx. <h3>Materials/Methods</h3> Archived planning CT-datasets that included larynx images from a previous CPAP trial between 2014-2021 for lung SBRT were selected for analysis. Planning CT scans were performed first with free breathing (FB) and then with CPAP. The CPAP protocol included a full-face mask covering both mouth and nose. Air pressure was increased gradually over 30 minutes from 6 cmH₂O to 15 cmH₂O and kept at this level for the duration of the planning CT. The VC's and larynx were contoured using soft tissue windows (50-350 HU). The separation between the VCs on FB and CPAP CT-scans were measured on axial planes at the anterior and posterior thirds. One VC was used for the GTV and then expanded 2 mm and 3 mm for the CTV and PTV respectively. Synthetic plans were generated in selected cases using identical optimization parameters. Doses to the contralateral VC and larynx were compared. Paired Students t-test was used to compare VC separations. <h3>Results</h3> Thirty cases were available for analysis. The distance between VC's increased in 19/30 (63.3%). The 19 cases showing increased VC spacing with CPAP use were used for analysis. Compared to FB, CPAP use increased the mean separation between the anterior third of the VCs by 67.3% (IQR 38-228) from 5.7mm (SD 0.25) to 8.6mm (SD 0.2), (p<.001) and the posterior third of the VCs by 28% (IQR 20-59) from 9.2mm (SD 0.2) to 11mm (SD 0.22), (p<.001). Plans generated in 5 cases showed use of CPAP decreased mean dose to the contralateral VC and larynx from 47 Gy to 38 Gy and 32.6 to 27.7 Gy respectively. The V50's of the contralateral VC and larynx decreased from 48.5% to 23% and 19% to 7.8% respectively. <h3>Conclusion</h3> This hypothesis generating study demonstrated CPAP use increased the distance between the VCs in most patients and when using unilateral radiation, reduced dose to the contralateral VC and larynx. The use of CPAP warrants further study for potential use in unilateral VC radiation.

Effect of transoral laser microsurgery vs open partial laryngectomy on the prognosis of patients with early laryngeal carcinoma: propensity score-based analysis.

To evaluate the effect of surgical procedures (transoral laser microsurgery (TLM) and open partial laryngectomy (OPL)) on the prognosis of patients with early laryngeal cancer. A total of 760 patients diagnosed with early laryngeal cancer (T1-2N0M0) and treated with TLM (n = 416) or OPL (n = 344) between 2004 and 2015 were abstracted from the SEER database. Propensity score matching (PSM) and stabilized inverse probability of treatment weighting (SIPTW) were performed to obtain comparable cohorts. The survival rates were estimated by the Kaplan-Meier method, and compared using the log-rank test. Univariate and multivariate Cox regression analyses with a false discovery rate (FDR) correction were applied to contrast the association between two surgical approaches and overall survival (OS) and disease-specific survival (DSS). The 5-year OS for the TLM group was 79.5% versus 77.7% for the OPL group (P = 0.619). Similar results were revealed for the comparison of 5-year DSS rates (91.1% versus 91.5%, P = 0.891). After PSM and SIPTW balance the confounding factors, no significant difference was observed in the OS and DSS of patients treated with TLM compared to patients treated with OPL. The consistent results were still yielded (all P > 0.05), when stratified by gender, age, year of diagnosis, residence, household income, tumor site, T stage, differentiation, and adjuvant therapy. This study provides strong evidence that there is no significant difference in the prognosis of early laryngeal carcinoma between the treatment of TLM and OPL, which may be helpful to guide the clinical decision-making of these patients.

NOTCH1 mutation associates with impaired immune response and decreased relapse-free survival in patients with resected T1-2N0 laryngeal cancer.

BackgroundPatients with early-stage laryngeal cancer, even stage T1-2N0, are at considerable risk of recurrence and death. The genetic and immunologic characteristics of recurrent laryngeal cancer remain unclear.MethodsA total of 52 T1-2N0 laryngeal cancer patients were enrolled. Of these, 42 tissue samples were performed by targeted DNA sequencing, and 21 cases were performed by NanoString immuno-oncology targeted RNA sequencing to identify the distinct molecular bases and immunologic features associated with relapse in patients with early laryngeal cancer, respectively.ResultsTo the best to our knowledge, we present for the first time an overview of the genomic mutation spectrum of early-stage laryngeal cancers. A total of 469 genomic alterations were detected in 211 distinct cancer-relevant genes, and the genes found to be mutated in more than five patients (>10%) included tumor protein p53 (TP53, 78.5%), FAT atypical cadherin 1 (FAT1, 26%), LDL receptor related protein 1B (LRP1B, 19%), cyclin dependent kinase inhibitor 2A (CDKN2A, 17%), tet methylcytosine dioxygenase 2 (TET2, 17%), notch receptor 1 (NOTCH1, 12%) and neuregulin 1 (NRG1, 12%). Recurrent laryngeal cancer demonstrated a higher tumor mutation burden (TMB), as well as higher LRP1B mutation and NOTCH1 mutation rates. Univariate and multivariate analyses revealed that high TMB (TMB-H) and NOTCH1 mutation are independent genetic factors that are significantly associated with shorter relapse-free survival (RFS). Simultaneously, the results of the transcriptome analysis presented recurrent tumors with NOTCH1 mutation displayed upregulation of the cell cycle pathway, along with decreased B cells score, T cells score, immune signature score and tumor-infiltrating lymphocytes (TILs) score. The Cancer Genome Atlas (TCGA)-laryngeal cancer dataset also revealed weakened immune response and impaired adhesion functions in NOTCH1-mutant patients.ConclusionsGenomic instability and impaired immune response are key features of the immunosurveillance escape and recurrence of early laryngeal cancer after surgery. These findings revealed immunophenotypic attenuation in recurrent tumors and provided valuable information for improving the management of these high-risk patients. Due to the small number of patients in this study, these differences need to be further validated in a larger cohort.

Diagnostic Accuracy of Preoperative CT and Endoscopy Staging in Early Laryngeal Cancer.

This study aims to evaluate the diagnostic accuracy of preoperative computed tomography (CT) and intraoperative endoscopic tumor staging with regard to histopathologic staging in patients with early laryngeal cancer. A retrospective nonrandomized single-institution comparative cohort study including 109 patients. A tertiary surgical center. Patients were treated for T1a, T1b, and T2a laryngeal squamous cell carcinoma by endoscopic laser surgery. The outcome measures were the presence of under- or overstaging in endoscopic and CT findings and positive postoperative margins. Endoscopic overstaging as compared with histopathologic T category correlated with rising tumor category (P = .001; odds ratio [OR], 69.1) and CT findings showing anterior commissure involvement (P = .002; OR, 9.54), while endoscopic understaging correlated with rising tumor histologic grade (P = .039; OR, 4.28) and smaller tumor size (P = .011; OR, 6.39). CT overstaging vs histopathologic T category correlated with CT findings showing anterior commissure involvement (P = .001; OR, 21.76), supraglottic involvement (P = .001; OR, 59.98), subglottic involvement (P = .001; OR, 39.94), rising clinical T category (P = .01; OR, 9.11), and rising tumor histologic grade (P = .004; OR, 10.95). CT understaging as compared with histopathologic T category correlated with smaller clinical T categories (P = .002; OR, 12.72) and smaller tumor histologic grade (P = .030; OR, 7.02). Rising age, rising tumor size, anterior commissure involvement on CT, and tumor extension into the supraglottis were risk factors for positive margins. Our results indicate that CT adds little valuable information in differentiating small superficial lesions in the glottis, while systematically overstaging cases of early laryngeal cancer. In T1a and T1b glottic tumors, endoscopy should be the preferred diagnostic method.

Outcomes of carotid sparing intensity-modulated radiotherapy for early stage glottic cancer in 201 patients: Multicenter study of Turkish Radiation Oncology Society/TROD-01-007.

To assess and report clinical outcomes after carotid sparing intensity-modulated radiotherapy for early stage laryngeal cancer. We retrospectively analyzed 201 patients with early stage glottic laryngeal cancer treated with carotid sparing intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) techniques in six TROD centers. After a median follow-up of 31 months the actuarial 1- and 3-year local and locoregional control rates were 99.4% and 94.7%, 98.4% and 93%, respectively. T classification, anterior commissure involvement, IMRT technique, and type of fractionation were not found to be prognostic for local control. Overall, eight patients had lost their organ function due to recurrence or toxicity. Grade 3 and 4 acute laryngeal edema was seen in eight (4%) and one (0.5%) of patients, respectively. Grade 3 and 4 late laryngeal edema developed in two (1%) and one patient (0.5%), respectively. Oncologic outcomes of patients treated with carotid sparing IMRT were excellent; comparable with historical series, with acceptable side effects. Longer follow-up is needed to estimate long term effect on stroke.

Comparison of Oncologic Outcomes Between Radiation Therapy and Transoral Laser Microsurgery for Early Glottic and Supraglottic Squamous Cell Carcinoma; a Retrospective Cohort Study with Literature Review

Background: Laryngeal cancer is known as the second most common airway cancer. These tumors are usually diagnosed early; thus, it is important to choose the optimal treatment modality. Several studies are comparing transoral laser microsurgery (TLM) and radiotherapy in early-stage laryngeal cancer. Due to a paucity of high-quality research and the lack of conclusive randomized prospective studies, standard care for early glottic cancer is still a matter of controversy. Methods: In this retrospective cohort study, T1-T2N0M0 laryngeal cancer patients who underwent TLM or radiotherapy were compared with statistical methods in terms of Recurrence Rate, Organ (Larynx) Preservation Rate, Mortality Rate, and Overall Survival. Results: A total of 123 patients were evaluated in this study, 65 of whom underwent TLM and 58 underwent radiotherapy. There was no significant difference in demographic and medical characteristics of patients. The rate of recurrence was 27.3% in the TLM group and 43.6% in the radiotherapy group. There was no significant difference between the two groups (P = 0.114). Overall mortality rate (5.4% vs 39.6%, P = 0.001), Disease-specific mortality rate (5.5% vs 39.9%, P = 0.001), and aorgan preservation rate (98.5%vs 89.7%, P = 0.035) were all in favor of TLM. Conclusions: TLM appears to be the treatment of choice in patients with early laryngeal cancer due to a better overall survival rate, lower disease-specific mortality rate, and better organ preservation rate than definitive radiotherapy.

Effect of Laser Vocal Cord Surgery under Laryngeal Microscope Combined with Nano-silver Dressing Antibacterial Nursing on Efficacy and Quality of Life of Patients with Laryngeal Cancer.

To explore the adoption effect of nano-silver medical antibacterial dressing in the perioperative treatment of patients with laryngeal cancer, 120 patients with early laryngeal cancer were selected as the research objects. According to the different treatments, they were averagely divided into the test group (laser vocal cord surgery under a laryngeal microscope and nano-silver medical antibacterial dressing) and the control group (laser vocal cord surgery under a laryngeal microscope and sterilized vaseline gauze). The results showed that there were considerable differences in dressing-change times, dressing-change cost, hospital stay, and recovery time between both groups (P<0.05). The number of mild pain cases in the test group was more than that in the control group at 1, 3, and 5 days after surgery, with statistically considerable differences (P<0.05). There were substantial differences in wound area between the two groups at 3 and 5 days after surgery, and the test group was larger than the control group (P<0.05). In the test group, 0 patients had postoperative reinfection, wound dehiscence, and wound hernia. In the control group, 3 patients had postoperative reinfection, 1 had wound dehiscence, and 1 had wound hernia. In summary, compared with traditional sterilized vaseline gauze, the nano-silver medical antibacterial dressing could reduce postoperative dressing pain and promote the recovery of wounds, thus shortening the hospital stay and improving the quality of life of patients after surgery.

Standard but Not Equal: Disparities in Advanced Radiotherapy Techniques for Head and Neck Cancer in the United States

<h3>Purpose/Objective(s)</h3> Advanced radiotherapy techniques (ART), including intensity-modulated radiotherapy (IMRT) and proton beam therapy (PBT), offer enhanced conformality, can reduce acute and late toxicities from radiotherapy for head and neck cancers (HNC), and are considered standard-of-care by consensus guidelines. This study aims to characterize implementation of ART and corresponding patterns of care in the United States since 2004. <h3>Materials/Methods</h3> Data for patients treated with external beam radiotherapy for primary HNC (any histology) were extracted from the National Cancer Database (2004-2017). Cases with metastatic disease and early stage glottic larynx cancer (Tis-T2,N0) were excluded. ART was defined as radiotherapy delivery with either IMRT or PBT, while non-ART encompassed 2D or 3D-conformal techniques. Sociodemographic, facility-specific, and clinical associations with receipt of ART were assessed by logistic regression. <h3>Results</h3> 177,373 patients with HNC were eligible for analysis; 94.2% received ART (IMRT: 93.3%, PBT: 0.9%), and 5.8% received non-ART. ART utilization increased substantially from 3,317 (78.0%) in 2004 to 14,088 (96.0%) in 2012 (p<0.001), largely driven by adoption of IMRT (77.0% to 95.7%). Use of ART increased slightly between 2012 and 2017 (96.0% to 96.9%; p<0.001), driven by growth in PBT (0.3% to 2.7%; p<0.001). On multivariable logistic regression, black patients were less likely to receive ART (OR 0.87; 95%CI 0.80-0.94), as were older patients (continuous OR 0.95; 95%CI 0.93-0.96), the uninsured (OR 0.70; 95%CI 0.63-0.78), and those with Medicaid (OR 0.80; 95%CI 0.74-0.87). Patients undergoing care at treatment facilities in the Northeast or Midwest, of non-academic affiliation, and with lower HNC volume were also less likely to receive ART. Census-tract level measures of income and educational attainment were directly correlated with receipt of ART. Likewise, nasopharyngeal or oropharyngeal primary site, advanced T- or N-classification, and receipt of chemotherapy or surgery were each independently associated with receipt of ART. <h3>Conclusion</h3> ART utilization has increased since the early 2000's, driven initially by IMRT and more recently by PBT. Despite the near-ubiquity of ART today, we identified racial, socioeconomic, and geographic disparities in their adoption, potentially exposing disadvantaged patients to preventable toxicity and quality-of-life insults from non-ART.

Functional outcomes of early laryngeal cancer - endoscopic laser surgery versus external beam radiotherapy: a systematic review

Background: In 2020 an estimated 184,615 new cases of laryngeal cancer were diagnosed worldwide1. Current evidence suggests no difference between endoscopic laser surgery (ELS) and radiotherapy (RT) with regards to oncological outcomes of early laryngeal cancer2. Patient management may therefore be directed towards voice and quality of life (QOL) outcomes.

Current Status of Transoral Surgery for Patients With Early-Stage Pharyngeal and Laryngeal Cancers in Japan.

As the laryngopharynx is closely related to swallowing, speech, and phonation, it is necessary to consider not only disease control but also a minimally invasive approach for the treatment of laryngopharyngeal cancer. Transoral surgery has been reported to be a minimally invasive method for treating these diseases. Transoral videolaryngoscopic surgery (TOVS) and endoscopic laryngo-pharyngeal surgery (ELPS) have been developed in Japan and recently emerged as treatments for patients with early stage pharyngeal and laryngeal cancers. However, securing an appropriate field of view and a narrow operating space during TOVS or ELPS are critical issues to be resolved for these surgeries. The clinical significance and safety of transoral robotic surgery (TORS) using the da Vinci Surgical System have been widely reported to provide surgeons with increased visualization and magnification, resulting in precise surgical margins and rapid functional recovery. In this context, a multi-institutional clinical study was conducted to evaluate the treatment outcomes of TORS for the treatment of laryngopharyngeal cancer in Japan, and the da Vinci Surgical System for oral robot-assisted surgery for these diseases was approved by the Pharmaceutical Affairs Agency in August 2018. This review provides an overview of the therapeutic effects of TOVS, ELPS, and TORS, with a particular focus on these therapeutic results in Japan.

MR-Guided Radiotherapy (MRgRT) for Laryngeal Cancer With Real-Time Visualization of Intrafraction Larynx Motion

Although early larynx cancers require treatment of only the vocal cord(s), radiation for early larynx cancer historically consisted of opposed lateral portals that included the entire larynx. Treatment techniques have advanced to 3D conformal and intensity modulated radiotherapy (IMRT), but the treatment target has remained the entire larynx. One concern preventing volume reduction in these patients is periodic swallowing that occurs during treatment delivery due to normal patient physiology. Such intrafraction swallowing can displace the treatment target up to 2 cm and could lead to tumor underdosing. Treatment with real-time target tracking could greatly mitigate this concern. Herein, we describe our initial experience using MR-guided radiotherapy (MRgRT) to visualize and understand the impact of intrafraction larynx motion.Three patients with cT1-2 laryngeal cancer were treated using an MRgRT Linac. Treatment volume included the entire larynx to evaluate feasibility of setup, immobilization, patient tracking, and treatment planning. A commercial MR-compatible head-and-heck immobilization system was developed and utilized, consisting of an indexable baseplate with integrated MR receiver coils affixed to a head cradle, with an open-face thermoplastic mask and head-mold cushion. Treatment plans were inversely planned utilizing 5 anterior IMRT fields to eliminate entrance dose to posterior organs at risk (OARs). The tracking structure consisted of patients' intrinsic larynx muscles delineated by a head and neck radiation oncologist on a 35cm x 35cm x 0.70cm sagittal MR plane. Patients were instructed not to swallow during setup imaging and during treatment. Continuous real-time tracking was performed at 4 frames per second with automatic beam hold if > 5% of the area of the tracking structure exceeded the 3mm isotropic boundary limit.Images were taken during patient treatment, and movement of the intrinsic muscles of the larynx was apparent in all patients due to periodic deglutition. At the time of analysis, 63 fractions have been delivered. The average total in-room time for the three patients in the study was 27:22 minutes (range 18:00 - 45:00 minutes), while the average beam-on time was 8:44 minutes (range 4:00 - 30:00 minutes).MR real-time visualization of the patient's intrinsic laryngeal muscles during MRgRT provides a method of gating treatment during patient swallowing. Robust intrafraction target tracking appears to enable higher confidence in reducing the treatment volume for early larynx cancers such that improvements in preservation of voice quality and deglutition capabilities are possible without sacrificing local control. A clinical trial is planned to examine such volume reduction and its effect on patient quality of life and function.

Functional outcomes of early laryngeal cancer – endoscopic laser surgery versus external beam radiotherapy: a systematic review

Current evidence suggests there is no difference between endoscopic laser surgery and radiotherapy with regards to oncological outcomes of early laryngeal cancer. Patient management may therefore be directed towards voice and quality of life outcomes. This systematic review compares functional outcomes with respect to voice character, swallowing outcomes and quality of life for endoscopic laser surgery versus radiotherapy for T1 and T2 stage laryngeal carcinoma. Search terminology was designed by both authors and used in Cochrane, PubMed and Web of Science databases. Studies of adult patients treated for primary T1 and T2 laryngeal squamous cell carcinoma utilising one objective (validated) measure of quality of life, swallowing or voice were included. Initial searches identified 1767 studies. After inclusion and exclusion criteria were applied, 42 studies were identified for full-text review. This review concluded that neither treatment is clearly advantageous. Future research should be composed of further prospective studies that use a standardised assessment regime to allow valid comparison.

Diagnostic accuracy of in vivo early tumor imaging from probe-based confocal laser endomicroscopy versus histologic examination in head and neck squamous cell carcinoma

Probe-based confocal laser endomicroscopy (pCLE) is a noninvasive and real-time imaging technique allowing acquisition of in situ images of the tissue microarchitecture during oral surgery. We aimed to assess the diagnostic performance of pCLE combined with patent blue V (PB) in improving the management of early oral cavity, oro/hypopharyngeal, and laryngeal cancer by imaging squamous cell carcinoma in vivo. The prospective study enrolled 44 patients with early head and neck lesions. All patients underwent white-light inspection or panendoscopy depending on the lesion's location, followed by pCLE imaging of the tumor core and its margins after topical application of PB. Each zone imaged by pCLE was interpreted at distance of the exam by three pathologists blinded to final histology. Most imaged zones could be presented to pathologists; the final sensitivity and specificity of pCLE imaging in head and neck cancers was 73.2-75% and 30-57.4%, respectively. During imaging, head and neck surgeons encountered some challenges that required resolving, such as accessing lesions with the flexible optical probe, achieving sufficiently precise imaging on the targeted tissues, and heterogeneous tissue staining by fluorescent dye. Final sensitivity scores were reasonable but final specificity scores were low. pCLE zones used to calculate specificity were acquired in areas of tumor margins, and the poor quality of the images acquired in these areas explains the final low specificity scores. Practical adjustments and technical training are needed to analyze head and neck lesions in various anatomical sites in real-time by pCLE.

Patient-Reported Toxicity and Quality-of-Life Profiles in Patients With Head and Neck Cancer Treated With Definitive Radiation Therapy or Chemoradiation.

Radiation therapy is an effective but burdensome treatment for head and neck cancer (HNC). We aimed to characterize the severity and time pattern of patient-reported symptoms and quality of life in a large cohort of patients with HNC treated with definitive radiation therapy, with or without systemic treatment. A total of 859 patients with HNC treated between 2007 and 2017 prospectively completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Head and Neck Cancer module (QLQ-HN35) and Core Quality of Life Questionnaire (QLQ-C30) at regular intervals during and after treatment for up to 5 years. Patients were classified into 3 subgroups: early larynx cancer, infrahyoideal cancer, and suprahyoideal cancer. Outcome scales of both questionnaires were quantified per subgroup and time point by means of average scores and the frequency distribution of categorized severity (none, mild, moderate, and severe). Time patterns and symptom severity were characterized. Toxicity profiles were compared using linear mixed model analysis. Additional toxicity profiles based on age, human papillomavirus status, treatment modality, smoking status, tumor site, and treatment period were characterized as well. The study population consisted of 157 patients with early larynx cancer, 304 with infrahyoideal cancer, and 398 with suprahyoideal cancer. The overall questionnaire response rate was 83%. Generally, the EORTC QLQ-HN35 symptoms reported showed a clear time pattern, with increasing scores during treatment followed by a gradual recovery in the first 2 years. Distinct toxicity profiles were seen across subgroups (P < .001), with generally less severe symptom scores in the early larynx subgroup. The EORTC QLQ-C30 functioning, quality-of-life, and general symptoms reported showed a less evident time pattern and less pronounced differences in mean scores between subgroups, although differences were still significant (P < .001). Differences in mean scores were most pronounced for role functioning, appetite loss, fatigue, and pain. We established patient-reported toxicity and quality-of-life profiles that showed different patterns for 3 subgroups of patients with HNC. These profiles provide detailed information on the severity and persistence of various symptoms as experienced by patients during and after definitive radiation therapy. These profiles can be used to inform treatment of future patients and may serve as a benchmark for future studies.

English

BACKGROUND The standard conventional radiation schedule for early laryngeal cancer is 64 - 70 Gy in 2 Gy per fraction over 6.5 - 7 weeks. Hypofractionated radiotherapy in early laryngeal cancer allows delivery of larger dose per fraction (fraction size) in decreased overall treatment time with improved local control and similar survival rates. Reduction in treatment time also optimizes the usage of radiotherapy resources. The purpose of this study was to estimate the local control rates, survival rates and toxicity profile of hypofractionated radiotherapy of 52.5 Gy in 15 fractions for early glottic cancer. METHODS Twenty-eight patients with early glottic squamous cell carcinoma (SCC) treated with hypofractionated definitive radiotherapy from June 2015 to December 2019 were analyzed. The median age was 61 years. Total dose of 52.5 Gy in 15 fractions was delivered over three-four weeks with a fraction size of 3.5 Gy. The median follow-up period was 23.8 months. RESULTS The 5-year local control rates were 96.4 % with one recurrence. The 5-year overall survival rate was 100 % and cause specific survival at 5 years was 100 %. There was no association of T1 sub staging, T2 (P - 0.40) and no significant association of anterior commissure involvement (P = 0.408, chi square value = 3.982) and pretreatment haemoglobin (P - 0.480) on local control. Late complications include laryngeal oedema (21.5 %), altered thyroid function (3.6 %), cardiac complication (3.6 %) and altered voice quality (14.3 %).There was no association of local control with field size (FS) (P = 0.812), beam energy (P = 0.098 ) overall treatment time of less than thirty days (P - 0.747). CONCLUSIONS Local control with hypofractionated radiotherapy for early laryngeal glottis squamous cell carcinoma is excellent with no severe complications. The short overall treatment time enables channelling of radiotherapy resources in low budget countries with long wait list for radiation. KEYWORDS Early Laryngeal Cancer, Glottic Cancer, Hypofractionated Radiotherapy, Overall Treatment Time.

Management of Laryngeal Dysplasia and Early Invasive Cancer.

Dysplasia and early laryngeal cancer lie on a spectrum of cellular changes. These start with early changes to the cells including epithelial hyperplasia and expand to dysplasia, squamous cell carcinoma in situ and finally developing in to invasive cancer. Dysplasia can range from low to high grade, with each being treated in a different manner. Treatment options are typically determined by where the dysplasia/invasive cancer lie on this spectrum along with the site within the larynx. Hyperkeratosis, mild dysplasia and moderate dysplasia typically involve primary endoscopic excision. Severe dysplasia and squamous cell carcinoma in situ involve primary endoscopic resection with the addition of possible laser resection and/or ablation. At this stage, surgery will be followed by close surveillance. Finally, early laryngeal cancer such as T1 and T2 lesions is typically more involved. Treatment depends on the site and degree of involvement of the structures, along with spread to surrounding structures. Typical treatment options of more involved early laryngeal cancer can range from radiation therapy, endoscopic transoral laser resection, endoscopic transoral robotic resection to open resection. Often times, my choice of treatment will be aimed at voice preservation but patient preference will also play a role in the decision making between treatment modalities. Chemotherapy and immunotherapy are typically not used in early stage laryngeal cancer.

Organ preservation and oncological outcomes in early laryngeal cancer: a propensity score-based study.

SUMMARYBackgroundThe rates of laryngeal preservation according to therapeutic modality in patients with initial laryngeal squamous cell carcinoma (LSCC) are still controversial. This study evaluated the rates of laryngeal preservation in patients who underwent treatment with surgery or radiotherapy.MethodsThis retrospective cohort study evaluated 151 patients with stage I or II LSCC. Ninety-six patients were matched using a propensity-score and outcomes were compared within this group.ResultsRegarding overall, cancer-specific survival and larynx preservation, no differences were observed according to the therapeutic modalities, but patients who underwent radiotherapy had a higher rate of local recurrence than those who underwent surgery. Patients classified as ASA 3 or 4 and treated with radiotherapy showed a tendency of higher risk of larynx loss.ConclusionsPatients with stage I or II laryngeal tumours can be submitted to surgery or radiotherapy with similar rates of laryngeal preservation.

Feasibility and efficacy of a thyroid cartilage window technique for transoral CO₂ laser resection of early glottic cancer involving the anterior commissure

Objective:To evaluate the feasibility and efficacy of a thyroid cartilage window resection（TCWR） technique for transoral CO₂ laser resection of early glottic cancer with involvement of the anterior commissure. Methods:Twenty-one patient who underwent a TCWR technique for transoral CO₂ laser resection early glottic carcinoma involving the anterior commissure, were retrospectively analyzed. Indices including margin status, perioperative comorbidities, voice outcomes, local control rate and recurrence free survival, were assessed. Results:All 21 patients underwent a TCWR technique for resection, the organ preservation rate and negative margin achieved 100%. The local control rate achieved 100%. For two patients with subglottic involvement（9.5%）, regional recurrence with confirmation of a positive pre-laryngeal lymph node was subsequently observed; and the 5 years recurrence free survival was 90.5%. Postoperative granulomas were detected in all 21 patients in 4 weeks postoperatively, 13 of which（61.9%） spontaneously disappeared; whereas the remaining 8 patients（38.1%） demonstrated consistent presence of granuloma more than 12 weeks and underwent an additional surgical extirpation under topical anesthesia. Despite the laryngeal web developed in all 21 patients, no dyspnea and laryngeal stenosis occurred at the time of analysis. By comparison with preoperative baseline, postoperative self-assessment voice demonstrated a significant improvement（P=0.01）, while objective voice indices were not significantly altered（P>0.05）. Conclusion:TCWR technique is a valuable means for transoral CO₂ laser resection of early glottic laryngeal cancer involving the anterior commissure, with favorable voice quality and seemingly low comorbidities, which can effectively improve the safety of the anterior resection margin.

Twenty-year experience with salvage total laryngectomy: lessons learned.

The purpose of this study was to evaluate the outcome of salvage total laryngectomy and identify areas for further improvement. A retrospective analysis of all patients who underwent salvage total laryngectomy between January 1999 and December 2018 was performed. Thirty-one patients were identified. The most common primary tumour site was the glottis (83.8 per cent). Early stage (T1-T2) disease was identified in 83.9 per cent of cases. Overall survival at 2 and 5 years post-salvage total laryngectomy was 71 per cent and 45 per cent, respectively. Disease-free survival at 2 and 5 years post-salvage total laryngectomy was 65 per cent and 42 per cent, respectively. The rate of post-salvage total laryngectomy pharyngocutaneous fistula was 29 per cent. More than half of patients will not survive beyond five years after salvage total laryngectomy. Regional recurrence was the most common form of failure and death. From this study, elective lateral and central neck dissection is advocated in patients with early laryngeal cancer who present with an advanced recurrence.

Erken Evre Glottik Larenks Kanserli Hastalarda Radyoterapi Tekniğinin Karotis Arter Dozu Üzerine Etkisi

Objective: The aim of this study was to compare two radiotherapy techniques in early stage glottic laryngeal cancer patients in terms of radiotherapy dose applied to the carotid artery.Material - Methods: In this study, we included 10 early-stage (T1/2) glottic larynx cancer patients. Both intensity-modulated radiotherapy (IMRT) and 3-dimension conformal radiotherapy (3DCRT) treatment plans were prepared for each patient. Treatment volumes (CTV, PTV) were created for all patients. The entire larynx was described as CTV to include both false and true vocal cords, anterior-posterior commissures, arytenoids, aryepiglottic folds, subglottic region. For planning target volüme (PTV), while 5-mm was added to CTV in all directions, 3-mm margin was given to protect the carotid artery and spinal cord in posterolaterally. Spinal cord and carotid artery were contoured as the organ at risk (OAR). The doses of the target volumes, the OAR volumes, the homogeneity index (HI) were compared. Results: PTV parameters (Dmin, Dmean, Dmax, D90, D95) was compared in the 2 different technique. IMRT in comparison to 3DCRT significantly reduced the high-dose volumes (V30, V35, V50) of carotid artery (p &amp;lt; 0.001), but not to the low dose volume (V10). CI was similar (0.9 vs. 0.9, p = 0.3) compared to 3DCRT. However, HI was significantly improved with IMRT (0.1 vs. 0.08, p &amp;lt; 0.001). The maximum dose of the spinal cord was lower in 3DCRT compared to IMRT (18 Gy vs. 44Gy). Conclusion: IMRT is a superior radiotherapy (RT) technique in patients with T1/T2 glottic cancer in terms of protecting carotid artery.