Early-stage Glottic Laryngeal Cancer Research Articles

Stereotactic Ablative Radiotherapy for T1 to T2 Glottic Larynx Cancer: Mature Results From the Phase 2 GLoTtic Larynx-SABR Trial

PurposeTraditional radiotherapy for early-stage larynx cancer irradiates the whole larynx over 5.5-6 weeks. Phase I data suggest that stereotactic ablative radiotherapy (SAbR) is a viable strategy to reduce the irradiated volume and compress treatment time. This phase II study evaluated the efficacy of gLoTtic larynx SAbR (LT-SABR) in 5 or 16 fractions. MethodsEligibility required stage 0-II squamous cell carcinoma of the glottic larynx. The arytenoid cartilage could not be involved beyond the vocal process, and patients smoking more than one pack-per-day were excluded. The treatment volume consisted of the gross tumor volume, with a 3 mm margin (5 mm craniocaudal) to create the planning target volume (PTV). Patients without active smoking and PTV volume < 10 cc receive 4250 cGy in 5 fractions, twice per week; other patients received 58.08 Gy in 16 daily fractions. The primary endpoint was 2-year incidence of local failure. ResultsTwenty-five patients were accrued to this study, with 21 and 4 treated with 5 and 16 fractions, respectively. The stage distribution was in situ (n=1, 4%), T1a/b (n=16/5, 64%/20%), and T2 (n=3, 12%). The median age was 72 years, with a prior smoking history in 16 (64%) and active smoking in one (4%). At a median follow-up for surviving patients of 3.7 years (IQR 3.1-4.4 years), there have been two in-field recurrences (one in each dose cohort). The cumulative incidences of local failure were 4% (90% CI 0.8% - 20%) and 8% (90% CI 3%-24%) at 1 and 2 years, respectively. There have been no acute or late grade 3+ toxicities in disease-free patients. The median baseline, 6, 12 and 24 month Voice Handicap Index scores were 57 (IQR, 32-69), 28.5 (8-48), 4 (0-12), 7.5 (0-12), and 5 (0-24). ConclusionsHighly conformal stereotactic radiotherapy appears safe and efficacious for early-stage glottic larynx cancer, with encouraging patient-reported. These results need to be interpreted with caution given the small sample size and large non-inferiority margin. Additional follow-up and ultimately comparative studies are necessary to validate this paradigm.

Does Anterior Commissure Involvement Change the Selection of Treatment Modality in Early-Stage Glottic Larynx Cancer?

Does Anterior Commissure Involvement Change the Selection of Treatment Modality in Early-Stage Glottic Larynx Cancer?

Prognostic Importance of Ki-67 Expression in Early-Stage Glottic Larynx Cancer Treated with Radiotherapy

Prognostic Importance of Ki-67 Expression in Early-Stage Glottic Larynx Cancer Treated with Radiotherapy

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.

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.

Stereotactic Ablative Radiotherapy for Early-Stage Glottic Larynx Carcinoma: Results From the Phase II LT-SABR Study

<h3>Purpose/Objective(s)</h3> Traditional radiotherapy for early-stage larynx cancer irradiates the whole larynx over 5.5-6 weeks. Phase I data suggest that stereotactic ablative radiotherapy (SAbR) is a viable strategy in this population to reduce the irradiated volume and compress the treatment time. This phase II study evaluated the efficacy of gLoTtic larynx SAbR (LT-SABR), utilizing a 5 or 16 fraction regimen depending on treatment volume and smoking status. <h3>Materials/Methods</h3> Eligibility required stage 0-II biopsy-proven carcinoma of the true glottic larynx, including squamous cell variants. The arytenoid cartilage could not be involved beyond the vocal process, and patients smoking more than one pack-per-day were excluded. The planning target volume (PTV) consisted of the gross tumor volume, including respiratory motion assessed on a 4D-CT, with a 3 mm AP/LR margin and 5 mm SI margin. Patients without active smoking and PTV volume < 10 cc receive 42.5 Gy in 5 fractions, two fractions per week; all other patients received 58.08 Gy in 16 daily fractions. The routine beam arrangement included 2 coplanar VMAT arcs and 2 non-coplanar arcs. Patients were treated with swallow-gating using surface imaging. The study required 25 patients to show that the local control probability is non-inferior to 75% at 2 years. <h3>Results</h3> A total of 25 patients were accrued to this study, with 21 and 4 treated with 5 and 16 factions, respectively. The stage distribution was CIS (n=1), T1a (n=16), T1b (n=5), and T2 (n=3). The median age was 72 years, with a prior smoking history in 16 and active smoking in one. Dosimetry metrics (mean values) are summarized in the Table. At a median follow-up of 21.1 months (IQR 14-31.8) in surviving patients, there have been two in-field recurrences (one in each dose cohort). One was salvaged with partial laryngectomy and the other died from local and regional disease. The cumulative risks of local failure were 4.2% and 9.3% at 1 and 2 years, respectively. There have been no acute or late grade 3+ toxicities. The baseline, 6 and 12 month total Voice Handicap Index (VHI) scores were: 53.0 (n=25), 9.8 (n=18), and 18.4 (n=15). The improvements in VHI between 6/12 months and baseline were both statistically significant (p<0.001). <h3>Conclusion</h3> Highly conformal stereotactic radiotherapy is safe and efficacious for early-stage glottic larynx cancer, with encouraging patient-reported outcomes. Additional follow-up and ultimately comparative studies are necessary to validate this paradigm.

Dual-energy CT may predict post-operative recurrence in early-stage glottic laryngeal cancer: a novel nomogram and risk stratification system.

To establish and validate a predictive model integrating with clinical and dual-energy CT (DECT) variables for individual recurrence-free survival (RFS) prediction in early-stage glottic laryngeal cancer (EGLC) after larynx-preserving surgery. This retrospective study included 212 consecutive patients with EGLC who underwent DECT before larynx-preserving surgery between January 2015 and December 2018. Using Cox proportional hazard regression model to determine independent predictors for RFS and presented on a nomogram. The model's performance was assessed using Harrell's concordance index (C-index), time-dependent area under curve (TD-AUC) plot, and calibration curve. A risk stratification system was established using the nomogram with median scores of all cases to divide all patients into two prognostic groups. Recurrence occurred in 39/212 (18.4%) cases. Normalized iodine concentration in arterial (NICAP) and venous phases (NICVP) were verified as significant predictors of RFS in multivariate Cox regression (hazard ratio [HR], 4.2; 95% confidence interval [CI]: 2.3, 7.7, p < .001 and HR, 3.0; 95% CI: 1.5, 5.9, p = .002, respectively). Nomogram based on clinical and DECT variables was better than did only clinical variables. The prediction model proved well-calibrated and had good discriminative ability in the training and validation samples. A risk stratification system was built that could effectively classify EGLC patients into two risk groups. DECT could provide independent RFS indicators in patients with EGLC, and the nomogram based on DECT and clinical variables was useful in predicting RFS at several time points. • Dual-energy CT(DECT) variables can predict recurrence-free survival (RFS) after larynx-preserving surgery in patients with early-stage glottic laryngeal cancer (EGLC). • The model that integrates clinical and DECT variables predicted RFS better than did only clinical variables. • A risk stratification system based on the nomogram could effectively classify EGLC patients into two risk groups.

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.

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.

Phantom-to-clinic development of hypofractionated stereotactic body radiotherapy for early-stage glottic laryngeal cancer

The purpose of this study was to commission and clinically test a robotic stereotactic delivery system (CyberKnife, Sunnyvale, CA) to treat early-stage glottic laryngeal cancer. We enrolled 15 patients with cTis-T2N0M0 carcinoma of the glottic larynx onto an institutional review board (IRB)-approved clinical trial. Stereotactic body radiotherapy (SBRT) plans prescribed 45 Gy/10 fractions to the involved hemilarynx. SBRT dosimetry was compared with (1) standard carotid-sparing laryngeal intensity-modulated radiation therapy (IMRT) and (2) selective hemilaryngeal IMRT. Our results demonstrate that SBRT plans improved sparing of the contralateral arytenoid (mean 20.0 Gy reduction, p < 0.001), ipsilateral carotid Dmax (mean 20.6 Gy reduction, p < 0.001), contralateral carotid Dmax (mean 28.1 Gy reduction, p < 0.001), and thyroid Dmean (mean 15.0 Gy reduction, p < 0.001) relative to carotid-sparing IMRT. SBRT also modestly improved dose sparing to the contralateral arytenoid (mean 4.8 Gy reduction, p = 0.13) and spinal cord Dmax (mean 4.9 Gy reduction, p = 0.015) relative to selective hemilaryngeal IMRT plans. This “phantom-to-clinic” feasibility study confirmed that hypofractionated SBRT treatment for early-stage laryngeal cancer can potentially spare dose to adjacent normal tissues relative to current IMRT standards. Clinical efficacy and toxicity correlates continue to be collected through an ongoing prospective trial.

Initial Clinical Outcomes From a Prospective Phase 1 Trial of Hypofractionated Stereotactic Body Radiation Therapy for Early-Stage Glottic Larynx Cancer

Initial Clinical Outcomes From a Prospective Phase 1 Trial of Hypofractionated Stereotactic Body Radiation Therapy for Early-Stage Glottic Larynx Cancer

Carotid sparing intensity-modulated radiation therapy achieves comparable locoregional control to conventional radiotherapy in T1-2N0 laryngeal carcinoma

Although intensity-modulated radiotherapy (IMRT) is a standard of care for many head and neck cancers, its use for carotid-sparing (CS) therapy in early-stage laryngeal carcinoma is controversial. 330 consecutive patients with early-stage laryngeal carcinoma were treated from 1/1989 to 5/2011, including 282 conventional radiotherapy (CRT) and 48 CS-IMRT patients. The median follow-up was 43 (CS-IMRT) and 66 (CRT) months. There was no difference in local failure rates comparing patients undergoing CS-IMRT with CRT, with 3-year local control rates of 88% vs. 89%, respectively (p=0.938). Using a 1cm circumferential margin, the average dose to the left and right carotid arteries was 48.3 and 47.9 Gy, respectively. 88% of locoregional recurrences involved the ipsilateral true vocal cord, including all local recurrences in the IMRT group. These results warrant further prospective evaluation of CS-IMRT for early-stage glottic larynx cancer.

Risk of Cerebrovascular Events in Elderly Patients After Radiation Therapy Versus Surgery for Early-Stage Glottic Cancer

Comprehensive neck radiation therapy (RT) has been shown to increase cerebrovascular disease (CVD) risk in advanced-stage head-and-neck cancer. We assessed whether more limited neck RT used for early-stage (T1-T2 N0) glottic cancer is associated with increased CVD risk, using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. We identified patients ≥66 years of age with early-stage glottic laryngeal cancer from SEER diagnosed from 1992 to 2007. Patients treated with combined surgery and RT were excluded. Medicare CPT codes for carotid interventions, Medicare ICD-9 codes for cerebrovascular events, and SEER data for stroke as the cause of death were collected. Similarly, Medicare CPT and ICD-9 codes for peripheral vascular disease (PVD) were assessed to serve as an internal control between treatment groups. A total of 1413 assessable patients (RT, n=1055; surgery, n=358) were analyzed. The actuarial 10-year risk of CVD was 56.5% (95% confidence interval 51.5%-61.5%) for the RT cohort versus 48.7% (41.1%-56.3%) in the surgery cohort (P=.27). The actuarial 10-year risk of PVD did not differ between the RT (52.7% [48.1%-57.3%]) and surgery cohorts (52.6% [45.2%-60.0%]) (P=.89). Univariate analysis showed an increased association of CVD with more recent diagnosis (P=.001) and increasing age (P=.001). On multivariate Cox analysis, increasing age (P<.001) and recent diagnosis (P=.002) remained significantly associated with a higher CVD risk, whereas the association of RT and CVD remained not statistically significant (HR=1.11 [0.91-1.37,] P=.31). Elderly patients with early-stage laryngeal cancer have a high burden of cerebrovascular events after surgical management or RT. RT and surgery are associated with comparable risk for subsequent CVD development after treatment in elderly patients.

Risk of Fatal Cerebrovascular Accidents (CVA) in Patients Treated with Radiation Therapy (RT) or Surgery for Early Stage Glottic Larynx Cancer

Risk of Fatal Cerebrovascular Accidents (CVA) in Patients Treated with Radiation Therapy (RT) or Surgery for Early Stage Glottic Larynx Cancer

Can carotid-sparing radiotherapy approaches replace with conventional techniques for the patients with T1 glottic laryngeal cancer?

This study aims to compare the carotid artery doses applied with various radiotherapy techniques for the treatment of T1N0 glottic larynx cancer. Five patients were simulated with using computed tomography (CT). Clinical (CTV) and planning target volumes (PTV) were created for T1N0 glottic larynx cancer. Planning risk volumes (PRV) were constructed for carotid arteries and spinal cord. Three irradiation planning, opposed lateral box field (OLBF), three dimension conformal radiation therapy (3DCRT), intensity modulated radiation therapy (IMRT) were done for each patient. Over 95% of planned target volumes were loaded with predetermined dose (a total of 62.25 Gy of 2.25 Gy daily dose). The comparison of the treatment planning of five T1 glottic larynx cancer, three involving the right vocal cord and two involving the left vocal cord, the technique of IMRT planning was provided the best carotid-sparing doses. Mean carotid V35, V50, and V63 values including OLBF, 3DCRT, and IMRT were 70%, 47%, 35%; 55%, 15%, 5% and 28%, 6%, 0%, respectively. The statistical comparison of V35, V50 and V63 revealed significant values for OLBF and IMRT. Dose of spinal cord did not exceed 45 Gy for any of radiation treatment planning. Between the three techniques, there was no significant difference in terms of conformity index and dose distribution was homogenous with all techniques. It is obvious that IMRT planning technique can decrease the carotid artery radiation doses in early stage glottic larynx cancer.

Erken evre glottik larenks kanserinde radyoterapi sonuçları: Tek merkez deneyimi

Erken evre glottik larenks kanseri tanisi ile kuratif radyoterapi uygulanmis olgularda geriye donuk olarak tedavi sonuclarinin ve prognostik faktorlerin degerlendirilmesi amaclandi. 1993-2010 yillari arasinda klinigimizde radyoterapi uygulanan, biyopsi ile histopatolojik olarak kanser tanisi dogrulanmis ve RT oncesi herhangi bir tedavi uygulanmamis erken evre (T1-2N0) glottik larenks kanserli 73 olgu geriye donuk olarak incelendi. Tum olgularin verileri guncellenerek hasta, tumor ve tedaviye ait parametrelerin lokal-bolgesel kontrol ve sagkalim uzerine olan etkileri arastirildi. Hastalarin medyan yasi 60 (37-83) olup 69’u erkek, 4’u kadindir. Evrelere gore dagilim; 41’i (% 56,2) T1a, 8’i (% 10,9) T1b, 24’u (% 32,9) T2 seklindedir. Hastalara medyan 66 Gy (58,5-72) eksternal radyoterapi uygulanmistir. Radyoterapiye bagli olarak, 1 olguda (% 1,4) grade 3-4 erken ve gec larengeal odem gelismis, bu olgu disinda diger olgularin hicbirinde grade 3-4 erken ve gec toksisite ile karsilasilmamistir. Medyan 73 (5-209) aylik takipte toplam 10 (% 13,7) hastada lokal-bolgesel nuks saptanmis, hicbir olguda uzak metastaz saptanmamistir. Hastalarin 5 yillik lokal-bolgesel kontrol, hastaliga ozgu sagkalim ve genel sagkalim orani sirasi ile % 85, % 92 ve % 78’dir. Incelenen faktorlerden “tedaviye 5 gun ve daha fazla ara verilmesi” lokal-bolgesel kontrol ve hastaliga ozgu sagkalimi anlamli olarak azaltirken (sirasi ile p=0,008, p=0,036), “tedavi oncesi ses kisikligi suresinin 5 aydan az olmasinin” sadece lokal-bolgesel kontrolu anlamli olarak azalttigi (p=0,036) saptanmistir. Sonuc olarak, erken evre glottik larenks kanserinde primer tedavi olarak radyoterapi yuksek lokal kontrol oranlarina sahip etkin bir tedavi seklidir. Radyoterapiye cesitli nedenlerden dolayi verilen aralar lokal-bolgesel kontrolu ve hastaliga ozgu sagkalimi olumsuz etkileyen prognostik bir faktordur. Bu nedenle tedavi aralarindan mumkun oldugunca kacinilmalidir. Results of radiotherapy in early stage glottic laryngeal carcinoma: A single center experience Patients with early stage glottic laryngeal cancer treated with curative radiotherapy were aimed to evaluate retrospectively for their treatment results and prognostic factors. In between 1993-2010, early stage (T1-2N0) 73 glottic laryngeal cancer cases which were treated with radiotherapy in our department that histopathological diagnosis of cancer was confirmed by biopsy and without any treatment prior to RT, were retrospectively analyzed. Patient, tumor and treatment parameters of all cases were updated and their effects on the local-regional control and survival were investigated. The median age of patients was 60 (37-83) and 69 patients were male and 4 were female. The distributions of patients according to stages were as follows: 41 (56.2% ) T1a, 8 (10.9% ) T1b and 24 (32.9% ) T2. Median of 66 Gy (58.5-72) of external beam radiotherapy was delivered to patients. In a patient (1.4% ), grade 3-4 early and late laryngeal edema depending on radiotherapy was developed. In other patients except from this patient, early and late grade 3-4 toxicity was not observed. During a median 73 months (5-209) follow-up, local recurrence was detected in 10 (13.7% ) cases and no distant metastasis was observed. Five year local-regional control, disease-specific and overall survival rates were 85% , 92% and 78% , respectively. From the investigated factors, while 5 or more days treatment interruption was found to decrease significantly local-regional control and disease-specific survival (p=0.008, p=0.036, respectively), less than 5 months duration of hoarseness was found to decrease significantly only local-regional control (p=0.036). In conclusion, radiotherapy as primary treatment modality in the early stage laryngeal cancer is an effective form of treatment with high rates of local control. Radiotherapy interruption due to various reasons is a prognostic factor which adversely effects loco-regional control and disease-specific survival. Therefore, interruptions during the radiotherapy should be avoided as much as possible. J. Exp. Clin. Med., 2012; 29:141-147

早期喉頭癌根治的放射線治療における分割照射法による入院期間の検討

早期喉頭癌根治的放射線治療における分割照射法による入院期間の検討