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

Zumsteg, Zachary S.; Riaz, Nadeem; Jaffery, S.; Hu, Man; Gelblum, Daphna Y.; Zhou, Ying; Mychalczak, Borys; Zeléfsky, Michael J.; Wolden, Suzanne L.; Rao, Shyam; Lee, Nancy Y.

doi:10.1016/j.oraloncology.2015.02.003

Cited by 55 publications

(56 citation statements)

References 33 publications

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“…This definitive radiotherapy to the larynx results in a very high cure rate with very low morbidity. Newer treatment approaches utilize intensity modulated radiotherapy to treat the larynx while sparing the adjacent carotid arteries and achieves 88% local control rate at three years for T1–2N0 glottic SCC . This highly accurate localized treatment has been taken one step further by a Dutch group who limited radiotherapy to the single involved vocal cord and reported a two‐year local control rate of 100% .…”

Section: Discussionmentioning

confidence: 99%

“…Newer treatment approaches utilize intensity modulated radiotherapy to treat the larynx while sparing the adjacent carotid arteries and achieves 88% local control rate at three years for T1-2N0 glottic SCC. 24 This highly accurate localized Data available for only 63 PCF (-) in active smoking; 64 PCF (-) in diabetic and COPD; 65 PCF (-) in preoperative albumin; 9 PCF (1) in cricopharyngeal myotomy; 58 PCF (-) and 9 PCF (1) in metronidazole and antiskin commensal antibiotic; 57 PCF (-) and 9 PCF (1) in PPI. PCF 5 pharyngocutaneous fistula; PTL 5 primary total laryngectomy; STL-LOR 5 Salvage total laryngectomy with radiation to the larynx only and no chemotherapy; STL-CRT 5salvage total laryngectomy with larynx and neck radiation PTL 5 primary total laryngectomy; STL-LOR 5 Salvage total laryngectomy with radiation to the larynx only and no chemotherapy; STL-CRT-Cis 5 salvage total laryngectomy with larynx and neck radiation plus cisplatin chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Defining the low‐risk salvage laryngectomy—A single‐center retrospective analysis of pharyngocutaneous fistula

Vasani

Youssef

Lin

et al. 2018

Laryngoscope Investig Oto

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ObjectivesSalvage total laryngectomies (STL) are not a homogeneous group. Most will fall into two groups: i) Patients with previous AJCC stage I/II larynx cancer who have had radiotherapy to the larynx only (STL‐LOR), or ii) Patients who have had previous AJCC stage III/IV larynx cancer and subsequent radiotherapy to the larynx and draining nodal basins with concurrent cisplatin chemotherapy (STL‐CRT). We aimed to compare PCF rates following STL in these two groups.MethodsA retrospective review of the department's cohort between January 2010 and August 2015 was conducted.ResultsSeventy‐seven patients underwent total laryngectomy for larynx cancer between January 2010 and August 2015. There were 10 post‐laryngectomy fistulas (13.0%). Three of these occurred in the 38 patients undergoing primary total laryngectomy (PTL), and seven in the 39 patients undergoing STL, rates of 7.9% and 17.9%, respectively. Twenty‐two patients had received radiation to the larynx alone without chemotherapy (STL‐LOR) for initial Stage I/II disease. Eleven patients had received laryngeal and neck irradiation plus cisplatin chemotherapy (STL‐CRT) for initial stage III/IV disease. Of the 22 STL‐LOR patients, two developed PCF (9.1%). Of the 11 STL‐CRT patients, five developed PCF. There was no difference in the rate of PCF between PTL and STL‐LOR. There was a statistically significant increase in PCF in STL‐CRT versus PTL (p = .009) and in PCF in STL‐CRT versus STL‐LOR (p = .027).ConclusionSalvage laryngectomies are often treated as a homogenous group. We demonstrate that PCF rates vary significantly depending on preoperative radiation fields and the use of chemotherapy.Level of Evidence2b.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Defining the low‐risk salvage laryngectomy—A single‐center retrospective analysis of pharyngocutaneous fistula

Vasani

Youssef

Lin

et al. 2018

Laryngoscope Investig Oto

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“…It was proposed that an increased conformality with IMRT and organ motion may increase the risk of marginal failures (19). However, a previous clinical study of IMRT for early-stage glottic cancer reported that the local control outcomes were comparable with those with conventional RT (20,21).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, concurrent systemic chemotherapy has been administered to several patients with T2 tumors. Zumsteg et al (20) reported conventional RT (n=282) and IMRT (n=48) outcomes for patients with T1-2N0M0 glottic cancer. The IMRT target volume was the entire larynx.…”

Section: Discussionmentioning

confidence: 99%

Volumetric modulated arc radiotherapy of the whole larynx, followed by a single affected vocal cord, for T1a glottic cancer: Dosimetric analysis of a case

Yeo

2016

Molecular and Clinical Oncology

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Abstract. Radiation therapy (RT) and endolaryngeal surgery are standard treatments for early-stage glottic cancer. They have closely matched oncological outcomes; however, it is debatable which method is superior in terms of functional outcomes. Several dosimetric studies have demonstrated that, compared with conventional RT, intensity-modulated RT (IMRT) reduces unnecessary radiation of the adjacent normal tissues, including the carotid artery and thyroid gland. However, RT targets the whole larynx, whereas endolaryngeal surgery is a highly focused treatment involving the en bloc resection of a tumor with safety margins. For T1a glottic cancer, in which the tumor is limited to one vocal cord, the technical feasibility of targeting IMRT on the single vocal cord affected has been investigated; however, the clinical feasibility and the possibility of inferior local control remain to be elucidated. In the present case study, IMRT was used to treat the whole larynx first, and then to treat a single vocal cord. The patient in the present study had T1a glottic cancer, and received volumetric modulated arc therapy with a total dose of 63 Gy/28 fractions. The first treatment phase (40.5 Gy/18 fractions) targeted the whole larynx to eliminate subclinical disease. The second treatment phase (22.5 Gy/10 fractions) targeted only the involved vocal cord. During this treatment phase, the exposure of the non-involved right vocal cord, the right carotid artery and the thyroid gland to the radiation was lower compared with the continuation of the initial treatment approach. These findings suggested that changing the target volume from the whole larynx to the affected vocal cord during the course of IMRT is feasible for T1a glottic cancer, and that it may reduce functional side effects while maintaining oncological outcomes.

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“…Nevertheless, in the specific context of LC patients, there is no study investigating the benefit of IMRT in comparison to conventional RT in terms of laryngeal functions. Some studies have, however, demonstrated a reduction of the average RT doses to the carotid arteries with IMRT in patients with early glottic cancer [8].…”

Section: Introductionmentioning

confidence: 99%

Current Role of Total Laryngectomy in the Era of Organ Preservation

Bozec

Culié

Poissonnet

et al. 2020

Cancers

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In this article, we aimed to discuss the role of total laryngectomy (TL) in the management of patients with larynx cancer (LC) in the era of organ preservation. Before the 1990s, TL followed by radiotherapy (RT) was the standard treatment for patients with locally advanced LC. Over the last 30 years, various types of larynx preservation (LP) programs associating induction or concurrent chemotherapy (CT) with RT have been developed, with the aim of treating locally advanced LC patients while preserving the larynx and its functions. Overall, more than two-thirds of patients included in a LP program will not require total laryngectomy (TL) and will preserve a functional larynx. However, despite these advances, the larynx is the only tumor site in the upper aero-digestive tract for which prognosis has not improved during recent decades. Indeed, none of these LP protocols have shown any survival advantage compared to primary radical surgery, and it appears that certain LC patients do not benefit from an LP program. This is the case for patients with T4a LC (extra-laryngeal tumor extension through the thyroid cartilage) or with poor pretreatment laryngeal function and for whom primary TL is still the preferred therapeutic option. Moreover, TL is the standard salvage therapy for patients with recurrent tumor after an LP protocol.

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

Cited by 55 publications

References 33 publications

Defining the low‐risk salvage laryngectomy—A single‐center retrospective analysis of pharyngocutaneous fistula

Defining the low‐risk salvage laryngectomy—A single‐center retrospective analysis of pharyngocutaneous fistula

Volumetric modulated arc radiotherapy of the whole larynx, followed by a single affected vocal cord, for T1a glottic cancer: Dosimetric analysis of a case

Current Role of Total Laryngectomy in the Era of Organ Preservation

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