T1 Glottic Cancer Research Articles

Carotid dosimetry for T1 glottic cancer radiotherapy.

Radiotherapy for T1 glottic cancer is commonly delivered using a lateral parallel opposed pair of megavoltage photon fields. There is increasing reported evidence of cerebrovascular events due to radiation-induced carotid stenosis. An alternative field arrangement is to use an anterior oblique technique. This study compares the carotid dosimetry between the two techniques and reviews the evidence for the risk of radiation-induced vascular events. The radiotherapy plans of 10 patients with T1 glottic cancer treated with an anterior oblique technique were examined for carotid dose. Alternative plans were then created using a parallel opposed pair of fields and the dose to the carotids compared. All patients received 50 Gy in 16 fractions treating once daily, for 5 days in a week. The average of the mean dose to the carotids with the anterior oblique technique was 21 Gy compared with 37 Gy using the lateral parallel opposed pair arrangement (p < 0.0001). An anterior oblique field arrangement for the treatment of T1 glottic cancer results in a significantly lower radiation dose to the carotid arteries, which may be clinically important in terms of reducing the risk of cerebrovascular events in long-term survivors. Although the anterior oblique technique for treating early glottic cancers is well described, and it is predictable that the dose received by the carotid arteries should be lower with this technique, to our knowledge this is the first study to quantify that reduction in dose with a series of patients.

Outcome following IMRT for T2 glottic cancer: the potential impact of image-guidance protocols on local control

This study aims to report on the outcome of intensity-modulated radiation therapy (IMRT) for T2 glottic cancer and the impact of changes in image-guidance protocol on local control. The result is compared to a historical cohort treated to the same dose with parallel-opposed pairs radiotherapy (POP). Patients with T2N0M0 glottic cancers who received primary radiotherapy (60 Gy/25 fractions/5 weeks) between July 1, 2003 and March 30, 2010 were included. The gross tumor volume (GTV) was delineated according to endoscopy/radiology. The clinical target volume (CTV) for POP encompassed the whole larynx with 60 Gy. IMRT generally treated partial laryngeal volumes comprising two CTVs: CTV1 (GTV+ 0.3∼0.5 cm, receiving 60 Gy) and CTV2 (GTV+ ≥1.0 cm, receiving 50 Gy). Planning target volumes (PTVs) were CTVs+ 0.5 cm. Local control (LC) in the IMRT cohort were stratified by image-guidance protocols: matching to bone vertebrae (IMRT-bone, treated prior to 2008) or to laryngeal tissue (IMRT-laryngeal_tissue, treated after 2008), and compared to the POP cohort. Seventy IMRT (44 IMRT-bone and 26 IMRT-laryngeal_tissue) and 48 POP patients were identified. The 3-year LC was 81 % (95 % CI 65–90) for the POP and 77 % (95 % CI 64–85) for the IMRT cohorts (p = 0.52). The IMRT-bone cohort had decreased LC compared with IMRT-laryngeal_tissue (69 vs. 91 %, p = 0.03). A trend towards increasing local failure for IMRT-bone vs. IMRT-laryngeal_tissue remained after adjusting for various tumor factors. This modest cohort study demonstrates a comparable LC with IMRT for T2 glottic cancers compared to our historical POP cohort. It adds clinical evidence to previous technical observations that have hypothesized a potential impact of laryngeal_tissue movement independent of bone_vertebrae, when partial laryngeal irradiation is contemplated.

Intensity Modulated Radiation Therapy for T1 Glottic Cancer: Initial Clinical Outcomes

T1 glottic cancer is highly curable with definitive RT. Traditional radiation techniques result in high radiation doses to the carotid arteries that accelerates atherosclerosis, and increases the risk for ischemic stroke in a dose-dependent fashion. We review our clinical outcomes for T1 larynx cancer patients treated with IMRT. Dosimetric in silico comparisons were performed between virtual conventional opposed lateral and delivered IMRT plans in terms of dosimetric correlates for RT sequelae.

American college of radiology appropriateness criteria® treatment of stage I T1 glottic cancer

Controversy surrounds the appropriate therapy for T1 glottic cancer. Both transoral endolaryngeal resection and radiation offer excellent local control and voice quality; some lesions are best addressed with resection and others with radiation. The American College of Radiology (ACR) Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed by a multidisciplinary expert panel. The guideline development includes an analysis of current literature from peer reviewed journals and the well-established "modified Delphi" consensus methodology to rate the appropriateness of treatment. Where evidence is not definitive, expert opinion informed recommendations. The ACR Expert Panel on Radiation Oncology - Head and Neck Cancer developed consensus recommendations for treatment of T1 glottic cancer. Treatment planning is complex and decisions nuanced. Best treatment for a particular cancer cannot be defined without consideration of the lesion's location, extent, depth of invasion, and quality of surgical exposure during direct laryngoscopy.

Comparative Assessment on Laryngeal Function after Radiotherapy and Laser Surgery against Early Glottic Cancer

Objectives: Comparatively assess the laryngeal function and quality of life (QOL) of the patients after laser surgery and radiotherapy against early glottic cancer. Methods: Sixty-seven patients with T1 glottic cancer treated in our institution with radiotherapy (RT, n=30) or CO2 laser surgery (LS, n=37) were incorporated in this retrospective cohort study. LSs were performed following the type II subligamental cordectomy concept. Patients in LS group were categorized into subgroups for further analyses. Twenty-seven patients had vaporization of the lesion with defocused mode, and a residual 10 patients had cancer excision with focused mode using relatively lower power (LS-EX group). GRBAS subjective voice assessment scale, maximum phonation time, and acoustic parameters were measured as vocal parameters. Voice-Related Quality of Life Measure and Voice Handicap Index were used to evaluate post-therapeutic QOL. Laryngeal videostroboscopic images were further examined to assess post-therapeutic laryngeal pliability. The mean follow-up period was 46 months. Results: Compared with their pre-therapeutic scores, worse GRBAS scores were observed at the end of the treatments in 20% and 60% of RT group and LS group respectively. Although these scores recovered 1 year after treatment, abnormal stroboscopic findings remained in 40% and 95% of RT group and LS group respectively. Interestingly, further subgroup analysis proved no significant difference of post-therapeutic vocal parameters and QOL between RT group and LS-EX group. Conclusions: Early glottic cancer could be treated with equivalent post-therapeutic laryngeal function and QOL with either radiotherapy or focused low power CO2 laser surgery.

Supracricoid Partial Laryngectomy in the Management of T3 Laryngeal Cancer

To evaluate the oncologic results only in T3 glottic and supraglottic cancers regarding supracricoid partial laryngectomy (SCPL) not requiring total laryngectomy and to assess functional results by self-evaluation by the patient. Study Design Case series with medical record review. Single tertiary care center. Thirty-two patients with laryngeal squamous cell carcinoma, previously untreated, who underwent SCPL with cricohyoidopexy or cricohyoidoepiglottopexy were reviewed. At 1, 3, and 5 years, the disease-free survival rates were 96.9%, 89.4%, and 78.2%; overall survival rates were 96.9%, 93.2%, and 87.3%; local control and locoregional control rates were 100%, 96.2%, and 96.2%; and distant metastasis-free survival rates were 100%, 100%, and 88.2%, respectively. Aspiration pneumonia was the most common complication observed. The 3 laryngeal functions (speech, swallowing, and breathing) were spared in 83.9% of patients. Supracricoid partial laryngectomy for selected glottic and supraglottic T3 tumors has excellent oncologic and functional results.

Evaluation of acute/late toxicity and local recurrence in Τ1-Τ2 glottic carcinoma treated with accelerated hypofractionated 3D-conformal external beam radiotherapy (3D-CRT)

BackgroundThe aim of the study was to evaluate the efficacy, as well as the acute and late toxicity of an accelerated hypofractionated 3DCRT schedule as radical treatment in patients with organ confined glottic cancer cT1-2N0.Patients and methods.Between June of 2004 and September 2010, 47 retrospectively selected patients (29 males, 18 females) diagnosed with organ confined T1 or T2 glottic cancer, were treated with external 3DCRT in an accelerated hypofractionation schedule. The median age was 70 years. A dose of 64.4 Gy in 28 daily fractions was prescribed. The primary study endpoints were to assess the acute and late effects of radiation toxicity, according to the EORTC/ RTOG scale, as well as the therapeutic impact of this schedule in terms of local recurrence.ResultsThe median follow up was 36 months. At the end of radiotherapy, grade I, II and III acute toxicity was observed in 34, 9 and4 patients, respectively. Late grade I and II toxicity was observed in 25 and in 8 patients respectively. Only two local recurrences were observed, 15 and 24 months post 3DCRT respectively.ConclusionsOur radiotherapy schedule achieves a high locoregional control rate with the advantage of voice preservation. The proposed hypofractionated schedule can be recommended as a standard radiotherapy treatment, since these results are comparable with those of conventional fractionation schedules.

Function preservation using transoral laser surgery for T2–T3 glottic cancer: oncologic, vocal, and swallowing outcomes

Aim of this study was to retrospectively analyze oncologic and functional results of a cohort of T2 and selected T3 glottic tumors treated by transoral laser surgery (TLS). Eighty-nine patients affected by T2 and T3 glottic tumors were treated by TLS from 2005 to 2010 at an academic institution by Type V cordectomies using an "en bloc" or, more frequently, a "piece-meal" technique depending on a number of variables. Kaplan-Meier curves were used to evaluate 5-year overall, disease-specific survivals, local control with laser, and organ preservation rates. Univariate analysis of the impact of different variables was performed. At least 1 year after surgery, we examined: subjective voice evaluation by voice handicap index (VHI), perceptive analysis by GRBAS scale, objective measurements with multidimensional voice program (MDVP), swallowing assessment with the M.D. Anderson Dysphagia Inventory (MDADI), videonasal endoscopic evaluation of swallowing (VEES), and videofluoroscopy (VFS). Fifty-nine patients were pT2 and 30 pT3. The 5-year overall, disease-specific survivals, local control with laser, and organ preservation rates were 92.4, 98.7, 68.5, and 82.1 %, respectively. VHI mean score was 20 (mild dysphonia). Mild and moderate dysphonias were detected by GRBAS in 82 and 18% of patients, respectively. Mean values of Jitter, Shimmer, and noise-to-harmonic ratio by MDVP resulted 7.87%, 24.8%, and 0.37, respectively. Mean value of MDADI was 95.75. Only 2% of patients at VEES and 4% at VFS showed tracheal aspiration. Our results highlight that T2 and selected T3 glottic tumors treated by TLS have favorable oncologic and functional outcomes.

Salvage Endoscopic Angiolytic KTP Laser Treatment of Early Glottic Cancer after Failed Radiotherapy

Management of early glottic cancer subsequent to failed radiotherapy is challenging, especially in balancing oncological control and function preservation. Patients frequently have been incentivized against surgical management and thus have undergone radiotherapy as initial treatment. This history compounds the difficulty of discussions about surgical management after recurrence. Typically, endoscopic salvage has less morbidity than transcervical partial laryngectomy and is clearly desirable over total laryngectomy. However, there are appropriate concerns about the efficacy of endoscopic salvage and the overarching impact on larynx preservation and survival. Given our success with endoscopic angiolytic KTP laser treatment of previously nonirradiated T1 and T2 glottic cancers, we examined our results from treating similar-sized lesions after failed radiotherapy. We performed a retrospective chart review of 20 patients from our cancer database who had undergone failed radiation therapy elsewhere for early glottic cancer and then underwent endoscopic angiolytic KTP laser treatment. Analysis of the geographic tumor recurrence of the 20 patients revealed T1a N0 M0 cancer in 4 patients, T1b N0 M0 cancer in 1 patient, T2a N0 M0 cancer in 1 patient, and T2b N0 M0 cancer in 14 patients. After KTP laser salvage treatment, 4 patients (20%) had local recurrence (all T2b) and required subsequent total laryngectomy, and 3 of these patients (15%) ultimately died of disease. The remaining 16 patients (80%) were free of disease at least 2 years after endoscopic salvage (average follow-up, 39 months). Our investigation provides preliminary evidence that angiolytic KTP laser salvage treatment of early glottic cancer is an effective treatment after failed irradiation. Studies with larger cohorts and longer follow-up will be necessary to establish incontrovertible evidence of its efficacy.

Supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) in the management of laryngeal carcinoma: oncologic results. A 35-year experience

To evaluate the long-term oncologic results of supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) for laryngeal cancer. A 35-year retrospective study concerning 291 patients treated by supracricoid laryngectomy with CHEP for laryngeal cancer was performed. The following postoperative data were studied: recurrence rates (lymph node and laryngeal), distant metastases and second cancer. The mortality rate and overall survival were estimated by the Kaplan-Meier method. The postoperative mortality was 1.03 %. 23 patients were lost to follow-up. The 3-year survival rate was 84 % and the 5-year survival rate was 80 %. 12 patients developed distant metastasis. 31 patients developed a second cancer. The local (laryngeal) control rate was 93.94 % and the regional (cervical lymph node) control rate was 92.05 %. In multivariate analysis, the occurrence of a second non-ENT cancer and metastasis as well as margins involvement were reliable to mortality. Supracricoid laryngectomy with CHEP appears to be associated with very good long-term oncologic results and still has a place in the management of T1, T2 and selected T3 glottic cancers.

Comparision of Transoral Laser and Open Partial Laryngectomy for T1 and T2 Glottic Cancer: A Review of literature.

T1–T2 glottic carcinomas may be treated with conservative surgery or radiotherapy. The goals of treatment are cure and laryngeal voice preservation. The aim of the current study was to review the literature and discuss the optimal management of T1 and T2 glottic carcinoma. Literature review indicated that the local control, laryngeal preservation, and survival rates of patients were similar after transoral laser resection and open partial laryngectomy. Voice quality depended on the extent of resection for patients undergoing surgery; results for patients undergoing laser resection for limited lesions showed better Voice Handicap Index scores, whereas open partial laryngectomy yielded poorer results. The cost of treatment was more for open partial laryngectomy. Patients with well defined lesions suitable for transoral laser excision with a good functional outcome were treated with laser. Open partial laryngectomy was reserved for patients with locally recurrent tumors. This review has been conducted by analyzing the Data which has been displayed in Pubmed literature in the last 25 years on the topics of Transoral Laser and Open partial Laryngectomy in the management of T1 and T2 glottic cancer. The various original articles and review articles were analyzed and compared and a conclusion derived.

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.

The impact of prelaryngeal node metastases on early glottic cancer treatment results

The aim of the study was to examine the impact of positive prelaryngeal node on the outcome of early glottic cancer and to compare the rate of local and regional recurrences and overall survival rates in patients with positive and negative Delphian node (DN). In the years 1989-2008, a consecutive cohort of 212 patients with T1b and T2 glottic cancer with anterior commisure involvement were treated by means of supracricoid partial reconstructive laryngectomies. No adjuvant radiotherapy was administered. Out of 212 patients, in 75 suspected prelaryngeal tissue was found, harvested and separately sent for histological investigation (16-thyroid, 11-fat, 14-connective tissue, 34-lymph nodes). In 137 remaining cases, there were only muscles and fascia without even a small amount of tissue to be taken. In 16 cases out of the whole group, metastases were found. 33 patients with positive ultrasound findings on the lateral neck underwent selective neck dissection; in 4 cases metastases were confirmed. Local and regional recurrence developed in 37 out of 212 patients (17.5%). There was significant correlation between local relapse and prelaryngeal node metastases; out of 20 cases with local recurrence, 13 had positive DN (P < 0.005). There was also significant correlation between nodal relapses and DN metastases; out of 22 cases with nodal relapse, 12 had positive DN and 10 were DN negative (P < 0.005). The organ preservation rates for DN positive and DN negative patients were 62.5 and 93.88%, respectively. There was noted a significant difference in the mean survival between the groups with positive and negative DN (P = 0.004; 38.7 vs. 49.3 months, respectively). In conclusion, positive DN seems to be a strong isolated factor influencing prognosis in patients with early glottic cancer. DN metastases are responsible for the increased rates of local and nodal relapses, decreased chances of organ preservation and poor overall survival rates.

Reply to HD‐10‐0738: Organ Preservation for T3 glottic cancer with vocal fold fixation: Response to the paper by Vilaseca et al.

Head & NeckVolume 33, Issue 5 p. 760-761 Letter to the Editor Reply to HD-10-0738: Organ Preservation for T3 glottic cancer with vocal fold fixation: Response to the paper by Vilaseca et al. Isabel Vilaseca MD, Corresponding Author Isabel Vilaseca MD Department of Otorhinolaryngology, Hospital Clinic, Barcelona, SpainDepartment of Otorhinolaryngology, Hospital Clinic, Barcelona, SpainSearch for more papers by this author Isabel Vilaseca MD, Corresponding Author Isabel Vilaseca MD Department of Otorhinolaryngology, Hospital Clinic, Barcelona, SpainDepartment of Otorhinolaryngology, Hospital Clinic, Barcelona, SpainSearch for more papers by this author First published: 29 March 2011 https://doi.org/10.1002/hed.21694Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume33, Issue5May 2011Pages 760-761 RelatedInformation

Organ preservation for T3 glottic cancer with vocal fold fixation

Organ preservation for T3 glottic cancer with vocal fold fixation

Comparison of different surgical approaches in T2 glottic cancer

The purpose of this study was to evaluate retrospectively the oncologic results of endoscopic and open surgical techniques in treating T2 glottic carcinomas. The medical chart of 354 patients with T2 glottic cancer managed with primary surgery were reviewed. Laser microsurgery and frontolateral partial laryngectomy were compared for disease-specific survival and local control rates, incidence of major complications, and related tracheostomies. Additionally, the influence of the anterior commissure invasion on these oncologic parameters was evaluated. No statistically significant differences were found between the surgical procedures regarding our oncologic parameters. A lower incidence of tracheotomies and complications were comparatively found for laser surgery. Tumor invasion of the anterior commissure did not seem to influence the oncologic results. Transoral surgery seems to be the treatment of choice for T2 glottic cancer. In our view, open partial laryngectomy should be reserved for those cases in which the lesion cannot be adequately exposed by direct microlaryngoscopy.

声門癌Ｔ１に対するレーザー切除術と術後経過

声門癌Ｔ１に対するレーザー切除術と術後経過

Radiation Therapy for Management of T1–T2 Glottic Cancer at a Private Practice

The purpose of this study was to retrospectively analyze patients with T1-T2N0 squamous cell carcinomas of the glottic larynx treated at a private institution, to review the pertinent literature, and to compare our outcomes to those of academic institutions. A total of 118 patients were treated with radiation therapy between May 1987 and August 2006 at a private institution and followed up for ≥2 years. Three patients were lost to follow-up between 18 and 19 months. The 5-year local control rates were: T1a, 91%; T1b, 95%; T2a, 96%; and T2b, 100%. The 5-year ultimate local control rates after irradiation and including patients who were successfully salvaged with surgery after a local recurrence were: T1a, 94%; T1b, 100%; T2a, 96%; and T2b, 100%. Eight (7%) of the 118 patients developed a local recurrence. There were no isolated regional or distant recurrences. The 5-year overall survival rates were: T1a, 73%; T1b, 78%; T2a, 62%; and T2b, 69%. The 5-year cause-specific survival rates were: T1a, 96%; T1b, 100%; T2a, 100%; and T2b, 100%. Two patients experienced severe complications. Patients with limited T1aN0 cancers may be treated with either transoral laser excision or RT. Those with more advanced T1-T2N0 cancers are treated with definitive RT. We do not advocate elective nodal irradiation, even for those with bulky T2B malignancies. The addition of concomitant weekly cisplatin 30 mg/M² is considered for patients with T2B cancers. Open parotid laryngectomy is reserved for salvage of suitable patients with a local recurrence.

Multidisciplinary Approach in the Treatment of T1 Glottic Cancer

To compare oncological outcome and voice quality among a uniform and well-defined subset of patients with T1 glottic carcinoma. Patients, affected by laryngeal glottic carcinoma, treated by laser CO2 surgery or radiotherapy, have been analyzed. Overall survival and disease-free survival were calculated. In order to verify differences in functional outcomes and voice quality, all patients were interviewed during their last follow-up visit during 2009 using the VHI (Voice Handicap Index) questionnaire. The data were analyzed using the MedCalc software. A total of 143 patients were analyzed: 73 underwent surgery and 70 underwent radiotherapy. No statistically significant differences were found between the two groups in terms of overall survival and disease-free survival; dividing patients into stages T1a and T1b also made no difference. In order to evaluate the differences in outcomes for surgery and radiotherapy, patients were interviewed using the VHI questionnaire. Better scores for each category in the VHI were found for patients receiving radiotherapy compared to surgery (physical: p = 0.0023; functional: p < 0.0001; environmental: p < 0.001). The median VHI score for radiotherapy patients was 4, while for surgical patients it was 18 (p < 0.0001). This study confirms the well-known knowledge that results from radiotherapy and surgery in early glottic cancer treatment are equivalent. Furthermore, the role of patient preference in the treatment modality choice and the value of a multidisciplinary approach for a detailed and multi-oriented discussion with the patient are outlined.

Radiotherapy with or without chemotherapy for patients with T1-T2 glottic carcinoma: retrospective analysis

BackgroundTo assess the results for local control (LC) and survival in patients with early-stage glottic cancer (GC) who were treated by radiotherapy (RT) with or without chemotherapy.MethodsFifty-eight patients with T1-T2 squamous cell carcinoma of the glottis who were treated between 2001 and 2006 were analyzed retrospectively. Potential prognostic factors for LC were evaluated by univariate analysis.ResultsThe 5-year LC rate in all patients was 84.3%. The overall 5-year LC rates for patients with T1a, Tb, and T2 GC were 85.9%, 83%, and 85%, respectively. Of the 58 patients, eight developed recurrent disease at the primary site, and one had lymph node recurrences on the neck. In the final analysis, the total laryngectomy-free survival rate was 93% at five years, and the ultimate LC rates for T1a, Tb, and T2 were 100%, 90.9%, and 95.2%, respectively. In a univariate analysis of 55 patients, there was no statistical significance between the LC rate for RT alone and that for chemoradiation. Only two patients died of laryngeal carcinoma, and one died of intercurrent disease. Fifty-five patients were living disease-free at the end of the study period. The 5-year overall survival (OS) rate for all patients was 88.1%, and the 5-year OS rates for T1a, Tb, and T2 were 91.6%, 77.8%, and 89.9%, respectively.ConclusionsThe retrospective analysis showed a high rate of LC and larynx preservation in patients with T1-T2 GC by means of RT with or without chemotherapy. There was, however, no statistical difference in LC rates for the two types of therapy.