Conventional fractionation should not be the standard of care for T2 glottic cancer

Abstract

BackgroundThe aim of this study was to report outcomes and late toxicity following hypofractionated accelerated radiotherapy for T2 glottic cancers. We highlight the importance of hypofractionated treatments with shorter overall treatment times, in improving outcomes for T2 glottic cancers. We also compare the biologically effective dose of hypofractionated regimes, with conventional fractionation.MethodsOne hundred twelve patients with T2 glottic cancer were treated between January 1999 and December 2005. All patients were prescribed a hypofractionated accelerated radiotherapy dose of 52.5 Gray in 3.28 Gray per fraction, delivered over 22 days. Radiobiological calculations were used to assess the relationship of fraction size and overall treatment time on local control outcomes and late toxicity.ResultsThe 5-year overall survival was 67%, the 5-year local control was 82%, and the 5-year disease-specific survival was 90%. The respective 5-year local control for T2a and T2b disease was 88.8 and 70.8% (p = 0.032). Severe late toxicity occurred in two patients (1.8%). Radiobiological calculations showed an increase in local control of nearly 12%, with a 10 Gray increase in biologically effective dose.ConclusionThis study has demonstrated that accelerated hypofractionated regimes have improved local control and similar late toxicity compared with conventional fractionation schedules. This supports the use of hypofractionated regimes as the standard of care for early glottic laryngeal cancers.

Clinical relevance of metal artefact reduction in computed tomography (iMAR) in the pelvic and head and neck region: Multi‐institutional contouring study of gross tumour volumes and organs at risk on clinical cases

“…Recent research has shown that there is a trend towards hypofractionated radiotherapy (e.g. in prostate carcinomas [25][26][27][28] and in some H & N tumours 29,30 ). The phase III prostate advances in comparative evidence (PACE) trial even investigates extreme hypofractionation in prostate cases, using doses of > 7 Gy per fraction.…”

A Review of Controversial Issues in the Management of Head and Neck Cancer: A Swiss Multidisciplinary and Multi-Institutional Patterns of Care Study—Part 2 (Radiation Oncology)

“…Reports on large series from cancer registries (42, 43), prospective clinical databases (44), meta-analyses (41), and prospective randomized trials (45–47) demonstrated favorable results with altered fractionation either by means of hypofractionation and/or acceleration. The possible effect of hypofractionation is probably based on its treatment-accelerating effect, rather than the exploitation of the β value (44, 45, 48, 49). As reported so far, long-term toxicity is not a major point of concern with accelerated or moderately-hypofractionated irradiation (46, 47, 50), which is in line with the biological rationale regarding the time factor (49).…”

“…The possible effect of hypofractionation is probably based on its treatment-accelerating effect, rather than the exploitation of the β value (44, 45, 48, 49). As reported so far, long-term toxicity is not a major point of concern with accelerated or moderately-hypofractionated irradiation (46, 47, 50), which is in line with the biological rationale regarding the time factor (49). It can be safely applied and may be preferred due to its benefits in terms of costs, logistics, and patient comfort.…”

Hypofractionated radiotherapy for early stage glottic cancer: efficacy of 3.5 Gy per fraction

“…Many studies have evaluated hypofractionated RT for early glottic cancer with fraction sizes up to 2.5 Gy, and resulted in better local control or survival rates [4,6,15]. Furthermore, there was an effort to apply 52.5 Gy in 3.28 Gy per fraction to early glottic cancer, with a 5-year LC rate of 3.5 Gy per fraction for glottic cancer 93% and 82% for T1 and T2 tumors, respectively, which is comparable to other fractionation regimens [8,16]. It should be noted that the fractionation scheme of the current study has relatively high biologically effective dose (BED).…”