Definitive hypofractionated radiotherapy for early glottic carcinoma: experience of 55Gy in 20 fractions

Abstract

IntroductionA wide variety of fractionation schedules have been employed for the treatment of early glottic cancer. The aim is to report our 10-year experience of using hypofractionated radiotherapy with 55Gy in 20 fractions at 2.75Gy per fraction.MethodsPatients treated between 2004 and 2013 with definitive radiotherapy to a dose of 55Gy in 20 fractions over 4 weeks for T1/2 N0 squamous cell carcinoma of the glottis were retrospectively identified. Patients with prior therapeutic minor surgery (eg. laser stripping, cordotomy) were included. The probabilities of local control, ultimate local control (including salvage surgery), regional control, cause specific survival (CSS) and overall survival (OS) were calculated.ResultsOne hundred thirty-two patients were identified. Median age was 65 years (range 33–89). Median follow up was 72 months (range 7–124). 50 (38 %), 18 (14 %) and 64 (48 %) of patients had T1a, T1b and T2 disease respectively. Five year local control and ultimate local control rates were: overall - 85.6 % and 97.3 % respectively, T1a - 91.8 % and 100 %, T1b - 81.6 and 93.8 %, and T2 - 80.9 % and 95.8 %. Five year regional control, CSS and OS rates were 95.4 %, 95.7 % and 78.8 % respectively. There were no significant associations of covariates (e.g. T-stage, extent of laryngeal extension, histological grade) with local control on univariate analysis. Only increasing age and transglottic extension in T2 disease were significantly associated with overall survival (both p <0.01). Second primary cancers developed in 17 % of patients. 13 (9.8 %) of patients required enteral tube feeding support during radiotherapy; no patients required long term enteral nutrition. One patient required a tracheostomy due to a non-functioning larynx on long term follow up.ConclusionsHypofractionated radiation therapy with a dose of 55Gy in 20 fractions for early stage glottic cancer provides high rates of local control with acceptable toxicity.

Hypofractionated accelerated radiotherapy in T1–3 N0 cancer of the larynx: A prospective cohort study with historical controls

“…27 Ermis et al reviewed results of 10 published series of hypofractionated RT for T1 and T2 tumors and found 5-year local control of 61-89% in T2. 28 Our results do not demonstrate significant differences among standard, accelerated and hypofractionated groups. Importance of treatment duration is stressed in publications reporting RT for cancer of the glottis and other head and neck cancers.…”

“…Shorter RT with the same total and fraction doses as those used in conventional radiotherapy improves loco-regional control and DFS. 3,7,[26][27][28][29] This conclusion is also supported by results of meta-analysis of phase III trials that concentrated mainly on accelerated hyperfractionated protocols, published by Bourhis et al 5 Reduced total dose delivered over shorter time produced results similar to conventional RT. 15 Longer than standard treatment duration has a negative impact on outcomes of radiotherapy for head and neck cancer, with loco-regional control loss of 1.2% per day or 12-14% per week.…”

Outcomes of radiotherapy in early stage glottic laryngeal carcinoma: a single center experience

“…Numerous reports regarding the treatment of early stage glottic cancer have evaluated some prognostic factors, i.e., tumor volume, stage, tumor kinetics including p53 status, histological differentiation, intrinsic radiosensitivity, continued smoking during and after RT and hypoxia, low hemoglobin levels, poorly differentiated tumors, dose per fraction, total dose, overall treatment time, field size, beam energy, radiation technique, and anterior commissure involvement [3,[16][17][18][19][20][21][22][23][24][25]. These factors were not constantly presented to have a prognostic influence by all authors.…”

The voice quality after laser surgery versus radiotherapy of T1a glottic carcinoma: systematic review and meta-analysis

“…With the development of science and technology, modern RT technology tends to be more targeted accurately. Compared with conventional RT, modern RT technology can be accurately applied to the tumor location and reduce the damage to normal cells 22,23. Nowadays, RT has been the gold standard for T1a glottic carcinoma treatment, but gradually the use of LS has increased.…”