Early-stage Glottic Cancer Research Articles

Outcomes between intensity-modulated radiation therapy versus 3D-conformal in early stage glottic cancer.

The purpose of this study is to evaluate practice patterns and outcomes between intensity-modulated radiation therapy (IMRT) and 3D-conformal radiation (3D-CRT) in early stage glottic cancer. The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify and compare patient and disease profiles, mortality, and toxicity in patients with T1-2 larynx cancer undergoing definitive radiation (RT). A total of 1520 patients underwent definitive radiation with 3D-CRT (n=1309) or IMRT (n=211). Non-white race, those with a Charlson Comorbidity Index ≥2, T2 disease, and those treated at community practices were more likely to undergo IMRT. Rates of IMRT increased from 2006 to 2015, while relative rates of 3D-CRT decreased. Two-year CSS was superior with 3D-CRT (hazard ratio [HR], 0.38; 95% confidence interval [CI], 0.22-0.65; p < 0.001). There was no difference in OS between 3D-CRT and IMRT (p=0.119). Patients receiving 3D-CRT had improved CSS compared to IMRT with no difference in OS.

PD-0773 Update of the results of single vocal cord irradiation for early-stage glottic cancer

PD-0773 Update of the results of single vocal cord irradiation for early-stage glottic cancer

Clinical Effect of Transoral Laser Surgery in the Treatment of Early Glottic Carcinoma

To investigate the therapeutic effect of transoral laser surgery in patients with early-stage glottic laryngeal cancer. 72 patients were randomly divided into an observation group (n=36) and a control group (n=36), who were diagnosed with early stage portal laryngeal carcinoma by pathological biopsy in our hospital from May 2017 to November 2019. The control group underwent conventional laryngectomy, while the observation group underwent carbon dioxide laser treatment under microscopic supported laryngoscopy. The patients’ treatment status and complications during the 6 mo postoperative follow-up period were also recorded. The results showed that 30 patients in the observation group and 6 patients in the control group had vocal cord neovascularization 6 mo after surgery and 20 patients in the control group had vocal cord neovascularization and 16 patients in the control group had vocal cord neovascularization. There were no statistically significant differences in the preoperative levels of vascular endothelial growth factor, Nitric oxide and tumor necrosis factor-alpha between the two groups (p>0.05), while the postoperative levels of vascular endothelial growth factor, Nitric oxide and tumor necrosis factor-alpha were statistically significant (p<0.05). The effective rate of treatment in the observation group was significantly higher than that in the control group, and the complication rate was lower than that in the control group (p<0.05). The application of micro-supported laryngoscopic carbon dioxide laser for the treatment of early glottic laryngeal carcinoma can improve the clinical treatment effect and reduce postoperative complications, which is worthy of application.

Outcomes Of Carotid Sparing Radiotherapy For Early Stage Glottic Cancer: Turkish Society For Radiation Oncology Group (TROD) Retrospective Study

To report clinical outcomes after on carotid-sparing intensity modulated radiotherapy for early stage laryngeal cancer. We retrospectively analyzed disease, and treatment characteristics for 201 patients with early-stage glottic laryngeal cancer treated in 6 TROD centers between 2012-2019. Using AJCC 8th., TNM staging system, 28 (14%) patients were classified as Tis, 153 (76%) as T1 and 20 (10%) as T2. Dosimetric parameters and local-regional control results of patients treated with carotid sparing IMRT / VMAT (Intensity-modulated radiation therapy / volumetric modulated arc therapy) techniques were evaluated. Median follow-up time was 31 (6-88) months. Median age was 64 (range 39-87) and 188 (93.5%) of the cases were male and 13 (6.5%) female. Anterior commissure involvement was detected in 47 (23.4%) cases. A total of 174 (87%) cases were treated with VMAT and 27 (13%) with IMRT. Total dose ranged from 63 to 70 Gy (median 66Gy) in 28 to 35 fractions using 2 to 2.25 Gy (Median: 2.25 Gy) daily fractions. Local recurrence was detected in six patients (3%), regional recurrence in 3 patients (1.5%), and local and regional recurrence in 1 patient (0.5%). The actuarial 1- and 3-year local control rates were 99.4% and 94.7%, respectively. The actuarial 1 and 3 year local-regional control rates were 98.4% and 93%. Five of seven local recurrences were observed in patients treated with hypofractionation. Stage, anterior commissure involvement, IMRT technique and type of fractionation were not found to be prognostic factor on local control. Nine patients experienced Grade 3-4 acute laryngeal edema (Gr 3; 8 patients, Gr 4; 1 patient), and 3 patients experienced grade 3-4 late laryngeal edema (Gr 3; 2 patients, Gr 4; 1 patients). The second primary cancer was seen in 18 (9%) cases. No transient ischemic attack or stroke was observed. Oncologic outcomes of patients treated with carotid sparing IMRT were excellent with acceptable side effect. Long-term follow-up is needed to demonstrate outcomes for long-term toxicity.

Outcomes of Salvage Radiotherapy after Laser Surgery for Early Stage Glottic Cancer

Outcomes of Salvage Radiotherapy after Laser Surgery for Early Stage Glottic Cancer

Dosimetric comparison of three-dimensional conformal radiotherapy and static and dynamic intensity-modulated radiotherapy for the treatment of early-stage glottic cancer

The aim of this study was to compare dosimetric variations using the three-dimensional conformal radiotherapy (3DCRT), dynamic intensity-modulated radiation therapy (D-IMRT), and static intensity-modulated radiation therapy (S-IMRT) techniques for glottic cancer. Ten patients with early-stage glottic cancer were retrospectively selected and evaluated. The 3DCRT and IMRT treatment plans were performed using the solution commercialized by Varian with the Eclipse treatment planning system (TPS). For each patient, five different treatment plans were created and compared with respect to the doses received by the organs at risk (OARs) including the carotid arteries, thyroid gland, and spinal cord; the dose homogeneity index (DHI); conformity indexes (CI); and total monitor unit (MU) counts required for the treatment. The Mann-Whitney U test was used for statistical analyses. Statistically significant differences for the 3DCRT, D-IMRT, and S-IMRT techniques were observed for the planning target volume (PTV) mean and maximum doses. The results of this study indicated an increase in DHI for 3DCRT compared with D-IMRT and S-IMRT. Furthermore, the S-IMRT technique led to the superior decreased dose to the OAR. The 3DCRT plans performed better at the Dmax of the spinal cord and MU counts. The D-IMRT and S-IMRT techniques allowed more homogeneous dose distributions in PTV. Considering the dose to OAR, S-IMRT was more appropriate rather than 3DCRT and D-IMRT.

Dose-Volume Comparison of IMRT and PSPT Treatment Plans for Early-Stage Glottic Cancer.

PurposeTo clarify the dose distribution characteristics for early-stage glottic cancer by comparing the dose distribution between intensity-modulated radiation therapy (IMRT) and passive scattering proton therapy (PSPT) and to examine the usefulness of PSPT for early-stage glottic cancer.Materials and MethodsComputed tomography datasets of 8 patients with T1-2 glottic cancer who had been treated by PSPT were used to create an IMRT plan in Eclipse with 7 fields and a PSPT plan in XiO-M with 2 fields. Organs at risk (OARs) included the carotid arteries, arytenoids, inferior constrictor muscles, strap muscles, thyroid cartilage, cricoid cartilage, and spinal cord. The prescription dose was 66 GyRBE in 33 fractions to the planning target volume (PTV). All plans were optimized such that 95% of the PTV received 90% of the prescription dose considering that the skin was slightly spared.ResultsThe superiority of the PSPT was confirmed in all OARs. In the PSPT, the dose to the contralateral carotid artery and the spinal cord, which is slightly distant from the PTV, was dramatically reduced while maintaining the dose distribution uniformity of the PTV by comparison with IMRT.ConclusionPSPT for early-stage glottic cancer resulted in good target dose homogeneity and significantly spared the OARs as compared with the IMRT. PSPT is expected to be effective in reducing late effects and particularly useful for young people.

Occult Lymph Node Metastasis in Early-Stage Glottic Cancer in the National Cancer Database.

Early-stage glottic cancer (cT1-T2 cN0) may be treated by primary surgery or radiation. Elective treatment of the neck in clinically N0 disease is usually not performed due to low rates of regional lymph node metastasis. This study examines the role of elective neck dissection (END) and rate of occult nodal metastasis in cT1-T2 cN0 glottic cancer treated with primary surgery. Retrospective cohort study. The National Cancer Database was used to identify patients treated for early-stage glottic cancer. Demographic variables, disease characteristics, and overall survival were compared between the subgroups of patients who did and did not receive END. Factors predictive of occult lymph node metastasis were also identified using a multivariate logistic regression model. Thirty-eight percent of the 991 patients in this cohort underwent END. Younger age, treatment at an academic facility, advanced T-stage, and higher tumor grade were associated with receiving END. Sixteen percent of the 372 patients undergoing END had occult nodal metastasis. Higher tumor histopathologic grade was associated with occult metastasis (P = .004). While undergoing END did not affect significantly survival, those with occult metastasis had poorer survival (P < .001). END should be considered in cT1-T2 N0 glottic cancers with poorly differentiated or undifferentiated tumor histopathology. While END itself may not improve overall survival, identification of occult nodal metastasis is an important finding for prognostication. Level 3 Laryngoscope, 131:E1139-E1146, 2021.

Effects of Antiacid Therapy on Granuloma after Transoral Type IV-VI Cordectomy in Patients with Early-Stage Glottic Cancer.

Objective To investigate whether preventive administration of a proton pump inhibitor (PPI) can reduce the occurrence and development of traumatic granuloma (TG) following type IV-VI cordectomy. Methods We retrospectively analyzed the status of postoperative granulomas in 37 patients who underwent type IV-VI cordectomy due to glottic cancer and determined whether postoperative administration of a PPI had any impact on granuloma formation and development. Results The percentage and number of patients with granuloma in the PPI treatment group (experimental group) at the 1st, 2nd, 3rd, and 6th month following surgery were 81.25% (13/16), 25.00% (4/16), 18.75% (3/16), and 0.00% (0/16), respectively. The percentage and number of patients with granuloma in the no-PPI group (control group) were 95.24% (20/21), 71.43% (15/21), 52.38% (11/21), and 14.29% (3/21), respectively. The granuloma percentage of the PPI treatment group was lower than that of the control group at all postoperative time points assessed. The differences were not statistically significant at the 1st month (p = 0.175) but were statistically significant at the 2nd and 3rd months after surgery (p = 0.005, p = 0.037). Conclusion Preventive use of a PPI in patients after type IV-VI cordectomy can shorten the TG recovery duration and may reduce the severity of TG, but it cannot prevent TG from occurring. Our results should be confirmed by prospective randomized controlled trials with large sample sizes.

Predictors of Postoperative Radiation Following Laser Resection in Early-Stage Glottic Cancer.

Guideline recommendations for the treatment of early-stage glottic cancer are limited to single-modality therapy with surgery or radiation alone. We sought to investigate the clinicopathologic and treatment factors associated with the use of postoperative radiation therapy (PORT) following laser excision for patients with T1-T2N0 glottic squamous cell carcinoma (SCC). Retrospective observational study of the National Cancer Database. National Cancer Database review from 2004 to 2014. A total of 1338 patients with primary cT1-T2N0M0 glottic SCC undergoing primary laser excision were included. Hospitals were divided into quartiles based on yearly volume of laryngeal laser cases performed. Multivariate logistic regression was performed to identify independent predictors of PORT. The overall rate of PORT was 30.0%. Predictors of PORT included treatment at lower-volume hospitals (adjusted odds ratio [aOR] for quartiles 2-4, 1.32-4.84), positive margins (aOR, 3.83 [95% CI, 2.54-5.78]), and T2 tumors (aOR, 3.58 [95% CI, 2.24-5.74]). PORT utilization demonstrated a strong inverse correlation with hospital volume. Among top-quartile hospitals, the rate of PORT was 11.2%, while rates of PORT at second-, third-, and fourth-quartile institutions were 19.2%, 32.2%, and 37.4%, respectively. Predictors of PORT in multivariable analysis included treatment at lower-volume facilities, positive margins, and T2 disease. This study highlights the importance of treating early-stage glottic carcinoma at high-volume institutions. In addition, there is a need to reevaluate the use of PORT and reduce the rate of dual-modality therapy for patients with early-stage glottic SCC.

The role of CD133 expression of cancer stem cells on radiotherapy response in early stage glottic cancers.

To investigate the relationship between CD133 positivity and radiotherapy (RT) response in early stage glottic laryngeal cancers. Thirty seven patients with early-stage glottic laryngeal carcinoma who were treated with primary RT were evaluated. Patients with regular follow-up of at least 3years were included in the study. Patients who had previously received chemotherapy for laryngeal surgery or underwent surgery were excluded. The patients were divided into two groups as recurrent and non-recurrent. These two groups were compared in terms of CD133 expression by immunohistochemical method. There were 37 patients in the study. Ten patients had recurrence and seven (70%) had CD133 positive and three had CD133 negative. Of 27 patients who had no recurrence, 16 (59%) had CD133 positive and 11 (41%) had CD133 negative. 7 (70%) of ten patients with recurrence were found to be positive for CD133; There was no statistically significant difference between recurrent and non-recurrent patient groups in terms of CD133 positivity (p > 0.05). There was no correlation between the final CD133 score and recurrence status as well (p > 0.05). There was no relationship between radiotherapy response and CD133 staining in early-stage glottic laryngeal cancers. It is the largest study about CD133 and RT sensitivity in early stage glottic carcinomas.

Intensity-modulated radiation therapy in early stage squamous cell carcinoma of the larynx: treatment trends and outcomes.

PurposeDefinitive radiotherapy remains a primary treatment option for early stage glottic cancer. Intensity-modulated radiation therapy (IMRT) has emerged as the standard treatment technique for advanced head and neck cancers, whereas three-dimensional conformal radiotherapy (3D-CRT) has remained standard for early glottic cancers. We used the National Cancer Database (NCDB) to identify predictors of IMRT use and effect on outcome in these patients.Materials and MethodsWe queried the NCDB from 2004–2015 for squamous cell carcinoma of the glottic larynx staged Tis-T2N0 treated with radiation alone. Logistic regression was used to identify predictors of IMRT. Cox regression was used to identify factors predictive of overall survival. Propensity matching was conducted to account for indication bias. ResultsWe identified 15,627 patients, of which 11% received IMRT. IMRT use rose from 2% in 2004 to 16% in 2015. Predictors of IMRT include: increased comorbidity, T2 stage, urban location, chemotherapy, treatment at an academic center, and later treatment year. Predictors of improved survival were female gender, higher income, lower stage, no chemotherapy, academic facility, and more remote year. There was no difference in survival between 3D-CRT and IMRT across all stages. ConclusionsThe rate of IMRT use for early stage glottic laryngeal cancer has increased over time. There was no difference in outcome in patients receiving IMRT versus 3D-CRT across the cohort.

Trends in Intensity Modulated Radiation Therapy for Early Stage Glottic Larynx Cancer and Impact on Outcome

Definitive radiation remains a treatment option for early stage glottic larynx cancer. Intensity modulated radiation therapy (IMRT) has been the standard treatment for more advanced head and neck cancers, while 3D conformal radiotherapy (3D CRT) has remained standard for early glottic cancers. We used the National Cancer Database (NCDB) to identify predictors of IMRT use and effect on outcome in these patients.

Advantages of Transoral Endoscopic Diode Laser Microsurgery for the Treatment of Early-Stage Glottic Laryngeal Cancers

Background: Transoral laser microsurgery (TLM) has become the preferred and standardized method for the early treatment of many laryngeal carcinomas, due to the good treatment results, together with the scarcity of local complications. Objectives: The aim of this study is to investigate the advantages of TLM (diode laser) in the treatment of patients with early-stage (T1-2) glottic laryngeal cancer (GLC). Methods: In the present study, 228 patients, who were diagnosed with early-stage GLC between 2007 and 2013 and treated with diode TLM in our clinic, were analyzed retrospectively. Results: During the 5-year follow-up period of the patients, it was found that 5.2% of the patients had therapeutic neck dissection and 2.6% had a tracheostomy. The mean hospitalization period was 24 hours and their speech and swallowing functions were satisfactory. Eight percent of the patients developed local relapse. In addition, the 5-year disease survival 100%, disease-free survival was 92%, and laryngeal preservation was 98.7%. Conclusions: The TLM method is a minimally invasive treatment for early-stage GLCs and gives treatment results similar to radiotherapy and open surgery methods. However, it is more advantageous than other methods in terms of reducing hospitalization period, low complication rate, preserving speech-swallowing functions, and its re-application in cases of relapse. TLM is a safe and reliable surgical technique with less morbidity that can be repeated in selected tumor recurrence. Anterior commissure monitoring must be important in the treatment of TLM. Especially in anterior commissure, tumors with a tendency to spread in the vertical plane should be monitored for local recurrence. Diode (gallium-arsenide) 980-nm laser has advantages over the standard CO2 laser, and TLM treatment stands out in early-stage GLCs.

MACC1 expression is an indicator of recurrence in early-stage glottic cancer.

Metastasis-associated in colon cancer 1 (MACC1) has been reported to be an independent indicator of poor prognoses in some kinds of cancer due to disease metastasis or recurrence. We investigated the correlation between MACC1 expression and the prognosis of glottic cancer. Paraffin-embedded, early-stage (I or II) glottic cancer specimens (n=52) were immunohistochemically analyzed to explore MACC1 expression. The clinical records associated with each case were also examined. Recurrence-free survival (RFS) was estimated using the Kaplan-Meier method, and between-group RFS differences were assessed using the log-rank test. The multivariate analyses were evaluated using the Cox's proportional-hazard model. Patients were treated with only radiotherapy (RT) (n=37, including 18 with T1 disease and 19 with T2 disease), or with chemoradiotherapy (CRT) (n=15, including 1 with T1 disease and 14 with T2 disease). Eleven patients demonstrated local recurrence and two patients experienced cervical lymph node recurrence. Tumor specimens were MACC1-positive in 9 of the 13 (69.2%) patients with local or neck recurrence, and 7 of the 11 (63.6%) patients with local recurrence. The RFS rate of patients who were treated with only RT was significantly lower than that of patients who were treated with CRT (P=0.0243). The RFS rate was significantly lower in cases with MACC1 expression than in those without MACC1 expression (P=0.0003). Multivariate analysis revealed that MACC1 expression was an independent risk factor of local recurrence (P=0.0016). MACC1 is an independent indicator of recurrence related to RFS in early-stage glottic cancer.

Patterns of Care and Outcomes of Intensity-Modulated Radiotherapy and 3D Conformal Radiotherapy for Early Stage Glottic Cancer: A National Cancer Database Analysis.

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.

Prognostic significance of surgical margins after transoral laser microsurgery for early-stage glottic squamous cell carcinoma

ObjectivesThe impact of positive tumor margin status and other clinicopathological factors on prognosis in early stage glottic squamous cell carcinoma (SCC) treated with transoral laser microsurgery (TLM) remains unclear. This study examined overall survival (OS) rates of patients with positive tumor margin status compared to negative tumor margin status after TLM in clinical T1-2 glottic SCC. Materials and MethodsThe National Cancer Data Base (NCDB) was queried for patients who underwent resection of T1-2 glottic SCC by TLM. Patients were treated from 2004 to 2013. Overall survival was assessed with Kaplan-Meier curve analysis, and univariate and multivariate Cox proportional hazards analysis. Differences in clinicopathologic factors between positive and negative margin groups were compared using Pearson Chi-squared analysis. ResultsOf 747 patients meeting inclusion criteria, 598 (80.1%) had negative margins. Median follow-up time was 48.0 months. Unadjusted 5-year OS for positive margins (80.0%) was lower compared to that of negative tumor margins (82.9%), but this was not statistically significant (P = 0.265). This persisted after multivariate analysis (P = 0.960). When tumors were stratified by T stage (647 T1, 100 T2), unadjusted 5-year OS based on margin status remained statistically insignificant for both T1 (P = 0.933) and T2 tumors (P = 0.350). ConclusionPositive margins did not negatively impact overall survival among patients with TLM-treated early-stage glottic cancer. This finding might be useful clinically in deciding treatment modality for early stage glottic SCC.

Perceptual and Acoustic Outcomes of Early-Stage Glottic Cancer After Laser Surgery or Radiotherapy: A Meta-Analysis.

Laser surgery (LS) or radiotherapy (RT) is normally recommended in early glottic cancer. The objective of this study was to perform a comprehensive meta-analysis of acoustic and perceptual outcomes to compare voice quality of LS or RT in early-stage glottic cancer. Data sources were obtained after searching PubMed, Google Scholar, EBSCO, and RISS using the following search terms: glottic cancer, glottic carcinoma, endoscopic surgery, laser surgery, radiotherapy, radiation, voice, voice quality, and grade, roughness, breathiness, asthenia, and strain (GRBAS) scale. Articles that compared voice outcomes between LS and RT were identified. This meta-analysis included 15 articles with 744 patients, including 400 in the LS group and 344 in the RT group. Random effects models were selected. Forest plots included standardized mean differences, standard errors, variance, 95% confidence intervals (lower limit to upper limit), z-values, and P-values. In perceptual analysis, grade (G) and asthenia (A) of RT were significantly better than LS. There was no statistically significant difference in roughness (R), breath (B), or strain (S) between LS and RT groups. Jitter, shimmer, and noise to harmonic ratio measurements showed significant differences, resulting in enhanced posttreatment effect of RT compared to LS. Results of our meta-analysis suggested that RT might lead to superior voice quality than LS in early glottic cancer.

EP-1832 Dosimetric comparison of IMRT for early-stage glottic cancers with and without air cavity in the PTV

EP-1832 Dosimetric comparison of IMRT for early-stage glottic cancers with and without air cavity in the PTV

Early Closure of a Phase 1 Clinical Trial for SABR in Early-Stage Glottic Cancer

The early results of a phase 1 study of stereotactic ablative radiation therapy for early-stage glottis cancer were previously reported. However, additional late adverse events occurred in the second arm during the follow-up period. In this study, the dose-limiting toxicities and premature closure of the clinical trial are reported. Thirteen patients with cT1-2N0M0 squamous cell carcinoma of the glottis were enrolled between May 2015 and July 2018. Seven patients in the first arm received 59.5Gy to the gross tumor volume and 47.6Gy to the remaining larynx, delivered in 17 fractions. The second arm dose was 55Gy and 40.7Gy in 11 fractions to the gross tumor volume and the remaining larynx, respectively. Patients were treated according to the simultaneous integrated boost approach with volumetric modulated arc therapy. The median follow-up was 37months (range, 6-41.4) for the first arm and 14.5months (range, 4.8-21.5) for the second arm. Maximum acute toxicity was grade 2 laryngeal mucositis for each arm. Maximum chronic toxicity was grade 3 laryngeal inflammation, occurring in 2 patients (33.3%) in the second arm. One patient underwent a laryngomicrosurgical biopsy for a vocal cord ulcer, and another patient underwent supraglottic laryngectomy because of arytenoid cartilage necrosis. In the first arm, chronic toxicity was not observed, except for grade 1 laryngeal edema in 1 patient. The phase 1 dose escalation study was terminated early because of the unexpected dose-limiting toxicities occurring in patients in the second arm. It was concluded that stereotactic ablative radiation therapy is not feasible for early-stage glottic cancer owing to treatment-related toxicity.