Radiotherapy For Early Glottic Cancer Research Articles

Transoral Laser Microsurgery and Radiotherapy for Early Glottic Cancer: An Old Story with a New Ending

Transoral laser microsurgery (TLM) and radiotherapy (RT) were stated equal in oncological outcome for early glottic cancer (EGC). But treatment rationale and cordectomy type might vary in TLM. We aimed to provide the clinical experience comparing TLM and RT in EGC. We retrospectively collected data of EGC from a medical center. Primary endpoint was local control (LC), defined as no in situ or invasive carcinoma found in the larynx after definitive treatment. Secondary outcome was total laryngectomy-free rate (TLF). Factors were evaluated with cox regression model. From 2013 to 2020, 58 Tis-T1a and 27 T1b-T2 EGC were included, with 43 underwent TLM and 42 received RT. After medial follow up of 55 months, the 4-year LC was 41.4% vs 78.6% for TLM vs RT, respectively. In multivariate analysis, RT (HR: 0.243, p<0.001) and T1b-T2 (HR: 2.326, p = 0.021) were significantly associated with LC. In subgroup analysis, the difference between treatment modalities was more profound in Tis-T1a subgroup (RT, HR: 0.10, p = 0.002; T1b-T2, RT, HR: 0.488, p = 0.199) and the prognostic value of T classification was less noticed in TLM subgroup (HR: 1.569, p = 0.341; RT, HR: 6.594, p = 0.019), indicating a possible selection bias regarding cordectomy type in Tis-T1a patients receiving TLM. 79.4% of the recurrent events were rEGC. The 4-year TLF rate were 94.9% in TLM and 94.4% in RT. In clinical practice, the LC of TLM might decrease in exchange for a better functional outcome in EGC. Nevertheless, the salvage rate was high that TLM and RT could still yield similar TLF rate.

Change in Voice Quality after Radiotherapy for Early Glottic Cancer.

Simple SummaryThe voice of a patient is expected to improve after successful radiotherapy for early glottic cancer. The aim of this study was to follow the changes in the voice for two years after a completed treatment. Subjective patient and physician assessments of the voice quality and objective acoustic analyses of the voice of each patient were used to follow up on the voice changes at regular intervals in 50 patients with T1 glottic cancer. A stroboscopy showed the progression of radiotherapy-induced fibrosis of the vocal folds, which influenced their vibration during phonation. A subjective assessment of the voice quality showed a gradual improvement, but an objective measurement showed a deterioration in a few voice parameters. Two years after the treatment, only 16% of patients had normal voices. The main cause of the impaired voice quality was post-radiotherapy scarring of the vocal folds.Our aim was to track the changes in voice quality for two years after radiotherapy (RT) for early glottic cancer. A videoendostroboscopy, subjective patient and phoniatrician voice assessments, a Voice Handicap Index questionnaire, and objective acoustic measurements (F0, jitter, shimmer, maximal phonation time) were performed on 50 patients with T1 glottic carcinomas at 3, 12, and 24 months post-RT. The results were compared between the subsequent assessments, and between the assessments at 3 months and 24 months post-RT. The stroboscopy showed a gradual progression of fibrosis of the vocal folds with a significant difference apparent when the assessments at 3 months and 24 months were compared (p < 0.001). Almost all of the subjective assessments of voice quality showed an improvement during the first 2 years, but significant differences were noted at 24 months. Jitter and shimmer deteriorated in the first year after RT with a significant deterioration noticed between the sixth and twelfth months (p = 0.048 and p = 0.002, respectively). Two years after RT, only 8/50 (16%) patients had normal voices. The main reasons for a decreased voice quality after RT for early glottic cancer were post-RT changes in the larynx. Despite a significant improvement in the voice after RT shown in a few of the evaluation methods, only a minority of the patients had a normal voice two years post-RT.

Revisiting the Concept of Non- and Minimally Invasive Interventions in Early Glottic Cancer - Part II: Single Therapy Should be Favored over the Combination of Transoral Laser Microsurgery and Radiotherapy, Regarding the Postinterventional Voice Quality.

Introduction Early glottic cancer (EGC) is associated with a high cure rate. Hence, patients and physicians also focus on the impact of the proposed treatment on the speaking function of the preserved larynx. Objectives The present study assessed the impact of single-modality treatment (transoral laser microsurgery [TLM], or radiotherapy) or combination therapy for EGC on postinterventional voicing and explored factors which might explain the related perceptions. Methods A total of 108 patients filled in the voice handicap index 10 questionnaire, 1 and 2 years postinterventionally. Non-parametric tests were used for the respective statistical analyses. Results Sixty-four patients were treated with TLM, 15 with radiotherapy, and 29 with both modalities. Transoral microsurgery and radiotherapy were associated with postinterventional dysphonia, which attenuated between the first and second postintervention year ( p = 0.000). No association between sociodemographic parameters and the attenuation of postinterventional dysphonia was identified for either treatment modality. Transoral microsurgery and radiotherapy resulted in comparable postinterventional voicing, in the first ( p = 0.940) and second ( p = 0.196) postintervention years. The addition of TLM to radiotherapy resulted in worse voice quality in the second, compared with the first postintervention year ( p = 0.000), demonstrating a detrimental effect on speech intelligibility in noise ( p = 0.000). Conclusion Single therapy should be favored over the combination of TLM and radiotherapy for EGC in terms of retaining better postinterventional voice quality. Postinterventional dysphonia should be taken into account, during preinterventional counseling, as it may exert leverage on the quality of patients' lives. Patients and physicians should acknowledge the optimal time of voice function return, which seems to be extending up to two years posttreatment.

OC-0514 Long-term follow up of a RCT of Accelerated Radiotherapy for early Glottic Cancer (JCOG 0701A3)

OC-0514 Long-term follow up of a RCT of Accelerated Radiotherapy for early Glottic Cancer (JCOG 0701A3)

Evaluation of Voice After Definitive Radiotherapy in Patients of Early Stage Squamous Cell Carcinoma of Larynx (Glottis): A Prospective Observational Study.

Post treatment voice quality is an important consideration in choosing the management option for laryngeal cancer. We assessed voice quality after radiotherapy in patients of early squamous cell carcinoma of glottis comprehensively using Videolaryngostroboscopy (VLS), Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scores and Voice Handicap Index (VHI)-10. Fifty four consenting patients of early squamous cell carcinoma of glottis (Tis, T1 and T2) awaiting definitive radiotherapy were recruited consecutively. Voice was evaluated by VLS, GRBAS scores and VHI-10 before radiotherapy as well as 3months and 12months after radiotherapy. There were 52 males and 2 females in the study. Hoarseness of voice was the commonest presenting symptom. Mean duration of symptoms was 2.45months (± 0.80), ranging from 1 to 4months. 35 (64.82%) were T1 while 19 (35.18%) were T2 lesions. They received 60-70Gy of radiotherapy in 28-35 fractions. There was only one recurrence on follow up for 12months. On VLS at 12months post-RT the periodicity, phase symmetry, mucosal waves and amplitude were normal in 74.07%, 70.37%, 56.67% and 78.7% cases respectively. Complete glottic closure was obtained in 72.22%. The voice was 'acceptable' (Grade 1 or 2 on VLS parameters) in more than 90% cases. Mean total GRBAS score was 3.39 (± 2.67). Mean total VHI-10 was 6.7 (± 1.75). All indices were significantly better than pre RT levels. Good quality of voice can be expected after radiotherapy for early glottic cancer in majority of patients.

Hypofractionated radiotherapy for early glottic cancer: a retrospective interim analysis of a single institution.

PurposeTo evaluate the results of hypofractionated radiotherapy (HFX) for early glottic cancer.Materials and MethodsEighty-five patients with cT1-2N0M0 squamous cell carcinoma of the glottis who had undergone HFX, performed using intensity-modulated radiotherapy (IMRT, n = 66) and three-dimensional conformal radiotherapy (3D CRT, n = 19) were analyzed. For all patients, radiotherapy was administered at 60.75 Gy in 27 fractions. Forty-three patients received a simultaneous integrated boost (SIB) of 2.3–2.5 Gy per tumor fraction.ResultsThe median follow-up duration was 29.9 months (range, 5.5 to 76.5 months). All patients achieved complete remission at a median of 50 days after the end of radiotherapy (range, 14 to 206 days). The 5-year rates for locoregional recurrence-free survival was 88.1%, and the 5-year overall survival rate was 86.2%. T2 stage was a prognostic factor for locoregional recurrence-free survival after radiotherapy (p = 0.002). SIB for the tumor did not affect disease control and survival (p = 0.191 and p = 0.387, respectively). No patients experienced acute or chronic toxicities of ≥grade 3. IMRT significantly decreased the dose administered to the carotid artery as opposed to 3D CRT (V35, p < 0.001; V50, p < 0.001).conclusionsPatients treated with HFX achieved acceptable locoregional disease control rates and overall survival rates compared with previous HFX studies. A fraction size of 2.25 Gy provided good disease control regardless of SIB administration.

EP-1140: Hypofractionated radiotherapy for early glottic cancer: retrospective analysis of single institution

EP-1140: Hypofractionated radiotherapy for early glottic cancer: retrospective analysis of single institution

EP-1052: Hypofractionated vs. conventional radiotherapy for early glottic cancer: a propensity score analysis

EP-1052: Hypofractionated vs. conventional radiotherapy for early glottic cancer: a propensity score analysis

Prediction of local control in early glottic carcinoma using the maximum standardised uptake value

PurposeThis retrospective study aimed to determine whether the maximum standardised uptake value (SUVmax) can predict local tumour control in early glottic cancer (Tis, T1, and T2). Patients and methodsFifty-nine patients treated with definitive radiotherapy for early glottic cancer between 2003 and 2011 were enrolled. We evaluated the SUVmax in the region of interest around the original tumour site. Local tumour control and survival were estimated using Kaplan-Meier curves. Receiver operating characteristic curves were used to assess the optimal SUVmax cut-off for predicting local control. ResultsAs determined by laryngoscopy, all patients achieved a complete response. Eleven patients experienced local recurrence, while no distant metastasis occurred. One patient died due to local recurrence, while five lost their larynxes. The median follow-up was 61.5 (range: 6.2–123.4) months. The five-year local progression-free survival was 84.7%, and larynx preservation was possible in 89.6% of cases. The median SUVmax was 2.2. The optimal SUVmax for predicting local tumour control was identified as 3.4. Patients with glottic cancers with an SUVmax>3.4 showed a significantly lower local progression-free survival rate than those with tumours with an SUVmax<3.4 (five-year local progression-free survival rate: 53.4% vs. 95.4%, P<0.01). Multivariate analysis confirmed that a high SUVmax was an independent predictive factor for local progression-free survival (P=0.006). ConclusionThe use of (18F)-fluorodeoxyglucose-positron emission tomography for evaluation of the SUVmax is useful to predict local progression-free survival in patients with early glottic cancer treated by radiation. Early glottic cancer with a high SUVmax may require aggressive local treatment and careful surveillance.

Transoral Laser Microsurgery vs Radiotherapy for Early Glottic Cancer: Study at Tertiary Care Center in India

ABSTRACT Aim To compare laryngeal preservation rates, survival rates, and voice outcomes after treatment of early glottic cancer between transoral laser microsurgery (TLM) and radiotherapy (RT). Materials and methods A review of oncologic results was performed on a consecutive series of individuals with early-stage glottic carcinoma (T1 and T2) who were treated between 2011 and 2014 at Kidwai Memorial Institute of Oncology and had received either RT or TLM. Data were collected with a view to assess overall survival, disease-specific survival, laryngectomyfree survival, and laryngeal preservation rates. The Voice Handicap Index-30 (VHI-30) was used as the measure of voice quality after treatment. Results Two-year overall survival for TLM group was 93.8% and for RT group was 90.5%, p = 0.643. Disease-free survival (TLM = 90.6% vs RT = 76.2%) was not found to be significant (p-value = 0.104). Laryngeal preservation rate was 79.5% in TLM and 71.4% in RT group (p-value = 0.003). Laryngectomy- free survival was better in TLM (TLM = 96.9% vs RT = 76.2%, p = 0.003). Substage analysis showed equivalent voice for TLM (VHI = 6–12) and RT (VHI = 6–14) in T1a patients (p = 0.94), whereas voice outcome was better for RT in T1b (VHI = 10–16 for TLM vs VHI = 11–18 for RT, p = 0.044) and T2 (VHI = 21–29 for TLM vs VHI = 16–23 for RT, p = 0.002) stages. Conclusion Transoral laser microsurgery can be considered the treatment of choice for early glottic cancer in view of better laryngeal preservation rate and laryngectomy-free survival with added advantage of low treatment cost and shorter hospital stay compared with RT. Clinical significance Laryngeal cancers represent the most common malignancy of head and neck, with estimated worldwide incidence of 120,000 cases annually. Optimal treatment modality has generated significant controversy in literature. External beam RT, open partial laryngectomy, and TLM are various treatment options available. This study depicts TLM as a preferred modality for early glottic cancer. How to cite this article Shenoy AM, Sharma V, Chavan P, Halkud R, Ranganath N, Pasha T, Shenoy P, Ravikumar B, Narayana SM, Sharif MI, Vijay CR. Transoral Laser Microsurgery vs Radiotherapy for Early Glottic Cancer: Study at Tertiary Care Center in India. Int J Head Neck Surg 2017;8(1):15-20.

Intensity-modulated radiotherapy for early glottic cancer: transition to a new standard of care?

For decades, the standard of care for radiation treatment of early larynx cancers has been conventional treatment using opposed lateral fields encompassing the larynx and overlying neck structures, including the adjacent carotid arteries. While intensity-modulated radiotherapy (IMRT) has replaced conventional radiotherapy for all other head/neck cancer situations, the use of IMRT to treat early glottic cancers remains controversial. The article reviews the published experience with IMRT for this clinical situation and provides a detailed review of the literature on radiation-induced carotid toxicity and how it might apply to the controversy. Finally, we discuss whether the radiation oncology community should transition to IMRT as a new standard of care for the treatment of early glottic cancers.

Radiotherapy for early glottic cancer and salvage surgery after recurrence

Early glottic cancer can be effectively treated with radiation or surgery, but recurrence is a possibility when using any of the treatment modalities. AimTo assess the outcome of radiotherapy as initial treatment in the control of squamous cell carcinoma of vocal cord (T1) and the effectiveness of salvage surgery (endoscopic or open) after treatment failure. Materials and MethodsA retrospective study was based on the analysis of medical records from 43 patients with T1 squamous cell carcinoma of the glottis, radiotherapy as initial treatment and follow-up period of five years. ResultsThe rate of recurrence after radiotherapy was 30.2% of the cases, mean diagnosis interval was 29.5 months. As an option for salvage treatment, patients underwent open partial laryngectomy or endoscopic surgery with control rates of 77.7% and 25% respectively. ConclusionOur cases showed high rates of recurrence after radiotherapy and open partial laryngectomy was more effective for the salvage surgery.

Long-Term Outcome of Definitive Radiotherapy for Early Glottic Cancer: Prognostic Factors and Patterns of Local Failure.

PurposeThis study evaluates the long-term results of definitive radiotherapy (RT) for early glottic cancer. Clinical and treatment factors related to local control and patterns of failure are analyzed.Materials and MethodsWe retrospectively reviewed 222 patients with T1-2N0 squamous cell carcinoma of the glottic larynx treated with definitive RT from 1981 to 2010. None of the patients received elective nodal RT or combined chemotherapy. The median total RT dose was 66 Gy. The daily fraction size was < 2.5 Gy in 69% and 2.5 Gy in 31% of patients. The RT field extended from the hyoid bone to the cricoid cartilage.ResultsThe median age was 60 years, and 155 patients (70%) had T1 disease. The 5-year rates of local recurrence-free survival (LRFS) and ultimate LRFS with voice preservation were 87.8% and 90.3%, respectively. T2 (hazard ratio [HR], 2.30; 95% confidence interval [CI], 1.08 to 4.94) and anterior commissural involvement (HR, 3.37; 95% CI, 1.62 to 7.02) were significant prognostic factors for LRFS. In 34 patients with local recurrence, tumors recurred in the ipsilateral vocal cord in 28 patients. There were no contralateral vocal cord recurrences. Most acute complications included grade 1-2 dysphagia and/or hoarseness. There was no grade 3 or greater chronic toxicity.ConclusionDefinitive RT achieved a high cure rate, voice preservation, and tolerable toxicity in early glottic cancer. T2 stage and anterior commissural involvement were prognostic factors for local control. Further optimization of the RT method is needed to reduce the risk of ipsilateral tumor recurrence.

Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

To assess the clinical utility of elective neck dissection in node-negative recurrent laryngeal carcinoma after curative radiotherapy for initial early glottic cancer. A retrospective review was undertaken of 110 consecutive early glottic cancer patients who developed laryngeal recurrence after radiotherapy (34 recurrent T1, 36 recurrent T2, 29 recurrent T3 and 11 recurrent T4a) and received salvage laryngeal surgery between 1995 and 2005. Six patients presented with laryngeal and neck recurrence and underwent salvage laryngectomy with therapeutic neck dissection, 97 patients with recurrent node-negative tumours underwent salvage laryngeal surgery without neck dissection and only 7 underwent elective neck dissection. No occult positive lymph nodes were documented in neck dissection specimens. During follow up, only three patients with neck failure were recorded, all in the group without neck dissection. There was no significant association between the irradiation field (larynx plus neck vs larynx) and the development of regional failure. A higher rate of post-operative pharyngocutaneous fistula development occurred in the neck dissection group than in the group without neck dissection (57.2 per cent vs. 13.4 per cent, p = 0.01). Multivariate logistic regression analysis showed that early (recurrent tumour-positive, node-positive) or delayed (recurrent tumour-positive, node-negative) neck relapse was not significantly related to the stage of the initial tumour or the recurrent tumour. An age of less than 60 years was significantly associated with early neck failure (recurrent tumour-positive, node-positive). Owing to the low occult neck disease rate and high post-operative fistula rate, elective neck dissection is not recommended for recurrent node-negative laryngeal tumours after radiation therapy if the initial tumour was an early glottic cancer.

Accelerated radiotherapy for T1 to T2 glottic cancer

Accelerated fractionation radiotherapy (RT) was administered in an attempt to improve the local control rates in patients with T1/T2 N0 glottic cancer. Medical charts of 148 consecutive patients who had undergone RT using 2.4 Gray (Gy) once-daily fractionation between July 1999 and April 2007 were reviewed. Of 104 patients with T1 disease treated by RT, 82 received 60 Gy/25 fractions, and the remaining 22 with large tumor volumes and/or slow response to RT received 64.8 Gy/27 fractions. All 44 patients with T2 disease received 64.8 Gy/27 fractions. The 5-year local control and overall survival (OS) rates were 93% and 96%, respectively, in patients with T1 disease, and 77% and 91%, respectively, in patients with T2 disease. No severe acute toxicities were observed, although 2 patients (1%) developed severe late toxicity. Accelerated RT for early glottic cancer is feasible, with encouraging local control rates.

8534 POSTER Voice Quality in Patients Treated With Surgery or Radiotherapy for Early Glottic Cancer – a Comparative Study

8534 POSTER Voice Quality in Patients Treated With Surgery or Radiotherapy for Early Glottic Cancer – a Comparative Study

Treatment Planning for Minimizing Carotid Artery Dose in the Radiotherapy of Early Glottic Cancer

Treatment Planning for Minimizing Carotid Artery Dose in the Radiotherapy of Early Glottic Cancer

Transoral laser microsurgery for recurrence after primary radiotherapy of early glottic cancer

Objective To analyze oncological results of transoral laser microsurgery (TLM) on recurrent early glottic cancer after primary radiotherapy. Methods The records of 53 patients treated by TLM for early (rTis–rT2) and advanced (rT3, rT4) recurrence after curative radiotherapy were retrospectively analyzed. Data on loco-regional control, overall survival, and disease specific survival were calculated by the Kaplan–Meier method. The larynx preservation rates were given absolutely. Results Mean post-therapeutic follow-up time after TLM for patients alive was 87.9 months. Twenty-two patients (42%) were cured by the first TLM procedure, but one of them underwent total laryngectomy after TLM due to chondronecrosis without evidence of residual tumor. Thirty-one patients (58%) developed another recurrence after TLM. Ten of them were cured by further laser procedures alone. Therefore, in 31 patients (58%), local recurrences were successfully treated by TLM alone. In 20 patients, recurrences could not be controlled by TLM: 14 patients underwent salvage laryngectomy and six palliative treatment. Three- and five-year loco-regional control rates for all patients were 46.1 and 38.8%. Three- and five-year overall survival rates were 67.5 and 53.3%. The corresponding 3- and 5-year disease specific survival rates were 68.6%, each. There was no statistically significant difference in loco-regional control or survival between patients presenting initially with early and advanced recurrence. Further recurrence after the first TLM procedure was associated with a statistically significant decrease in 3- and 5-year overall (56.6% vs. 81.8% and 40.2% vs. 70.5%; p = 0.03) and disease specific (48.9% vs. 100%, each; p = 0.001) survival. Ultimate local control rate including repeated TLM and salvage laryngectomy was 77.4%. Conclusions Many patients with recurrent glottic carcinoma after primary radiotherapy can be cured by single or repeated TLM as an organ-preserving procedure. However, in case of failure after TLM for the first recurrence, salvage laryngectomy should be considered early as local control by further laser surgery is unfavorable.

Risk factors for voice quality after radiotherapy for early glottic cancer

Background and purpose In the majority of patients irradiated for early glottic cancer an abnormal voice was reported. The purpose of the study was to determine the factors influencing voice quality after radiotherapy for T1 glottic cancer. Methods The voices of 75 male patients irradiated for T1 glottic carcinoma were assessed subjectively and objectively by acoustic analyses and aerodynamic measurements. The laryngeal function and morphology were evaluated by videolaryngostroboscopy. The data on smoking habits, the associated diseases influencing voice quality, the extent of the tumor, the type of biopsy, and the irradiation technique were collected from the medical records. The data on the factors influencing voice quality were compared for patients with a normal/near-normal voice and those with a hoarse voice. Results Voice quality was at least slightly abnormal in 94.7% and 81.3% of patients, when assessed perceptively and objectively, respectively. Smoking after the completed treatment, more severe morphologic alterations of the vocal folds, dryness of the throat, incomplete closure of the vocal folds and functional voice disorders expressed as supraglottic activity adversely influenced the voice quality. A good correlation between the perceptive voice assessment and the acoustic analyses was established. Conclusions After the successful irradiation for T1 glottic carcinoma, the great majority of the patients have at least a slightly hoarse voice. A better voice outcome could be achieved if radiotherapy was followed by the patient’s cessation of smoking and the appropriate voice therapy.

O21. Radical radiotherapy for early glottic cancer: 26 years experience from a single institution

O21. Radical radiotherapy for early glottic cancer: 26 years experience from a single institution