IMRT for Image-Guided Single Vocal Cord Irradiation

Osman, Sarah; Astreinidou, E.; Boer, Hans C.J. de; Keskin-Cambay, Fatma; Breedveld, S.; Voet, P.; Al‐Mamgani, Abrahim; Heijmen, B.; Levendag, Peter C.

doi:10.1016/j.ijrobp.2010.12.022

Cited by 46 publications

(31 citation statements)

References 27 publications

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“…Intriguingly, preliminary reports from a prospective study examining the feasibility of IMRT-based single vocal cord irradiation for T1a glottic tumors has demonstrated promising 2-year local control rates and a modest, transient decline in voice quality by voice handicap index. These findings illustrate the potential to improve voice outcomes by minimizing irradiation of the contralateral VC (36–39). …”

Section: Discussionmentioning

confidence: 68%

Evaluating Post-Radiotherapy Laryngeal Function with Laryngeal Videostroboscopy in Early Stage Glottic Cancer

et al. 2017

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ObjectiveDysphonia is common among patients with early stage glottic cancer. Laryngeal videostroboscopy (LVS) has not been routinely used to assess post-radiotherapy (RT) voice changes. We hypothesized that LVS would demonstrate improvement in laryngeal function after definitive RT for early-stage glottic cancer.Study designBlinded retrospective review of perceptual voice and stroboscopic parameters for patients with early glottic cancer and controls.SettingHigh-volume, single-institution academic medical center.Subjects and methodsFifteen patients underwent RT for Tis-T2N0M0 glottic cancer and were evaluated with serial LVS exams pre- and post-RT. Stroboscopic assessment included six parameters: vocal fold (VF) vibration, VF mobility, erythema/edema, supraglottic compression, glottic closure, and secretions. Grade, roughness, breathiness, asthenia, strain (GRBAS) voice perceptual scale was graded in tandem with LVS score. Assessments were grouped by time interval from RT: pre-RT, 0–4, 4–12, and >12 months post-RT.Results60 LVS exams and corresponding GRBAS assessments were reviewed. There were significant improvements in ipsilateral VF motion (P = 0.03) and vibration (P = 0.001) and significant worsening in contralateral VF motion (P < 0.001) and vibration (P = 0.008) at >12 months post-RT. Glottic closure significantly worsened, most prominent >12 months post-RT (P = 0.01). Composite GRBAS scores were significantly improved across all post-RT intervals.ConclusionLVS proved to be a robust tool for assessing pre- and post-RT laryngeal function. We observed post-RT improvement in ipsilateral VF function, a decline in contralateral VF function, and decreased glottic closure. These results demonstrate that LVS can detect meaningful changes in VF and glottic function and support its use for post-RT evaluation of glottic cancer patients.

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Section: Discussionmentioning

confidence: 68%

Evaluating Post-Radiotherapy Laryngeal Function with Laryngeal Videostroboscopy in Early Stage Glottic Cancer

et al. 2017

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“…Anderson Cancer Center revealed significantly reduced radiation dose to the carotid arteries compared with conventional lateral fields while maintaining target volume coverage [20]. Other study groups showed similar results [21,33]. Chera and Feigenberg et al challenge the interpretation of a new standard because of the risk of complication from dose heterogeneity [15,34].…”

Section: Discussionmentioning

confidence: 99%

“…Intensity-modulated radiotherapy (IMRT) offers the potential to spare surrounding tissues, e.g. carotid arteries or parts of the larynx [15-21]. Latter series only include few patients or consist of dosimetric comparison of different treatment techniques only.…”

Section: Introductionmentioning

confidence: 99%

Risk-adapted partial larynx and/or carotid artery sparing modulated radiation therapy of glottic cancer

2014

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“…High local control rates should shift focus onto reducing dose to surrounding normal structures since conventional therapy exposes organs-at-risk (contralateral vocal cord, arytenoids, low pharyngeal constrictors) to full dose. In fact, IMRT-based single cord irradiation strategies are currently being investigated [19]. Our initial dosimetric review indicates that our SBRT approach using sophisticated near real-time image guidance improves upon selective IMRT larynx treatment (manuscript submitted).…”

Section: Discussionmentioning

confidence: 99%

SBRT for early-stage glottic larynx cancer—Initial clinical outcomes from a phase I clinical trial

et al. 2017

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PurposeTo confirm safety and feasibility of hypofractionated SBRT for early-stage glottic laryngeal cancer.MethodsTwenty consecutive patients with cTis-T2N0M0 carcinoma of glottic larynx were enrolled. Patients entered dose-fractionation cohorts of incrementally shorter bio-equivalent schedules starting with 50 Gy in 15 fractions (fx), followed by 45 Gy/10 fx and, finally, 42.5 Gy/5 fx. Maximum combined CTV-PTV expansion was limited to 5 mm. Patients were treated on a Model G5 Cyberknife (Accuray, Sunnyvale, CA).ResultsMedian follow-up is 13.4 months (range: 5.6–24.6 months), with 12 patients followed for at least one year. Maximum acute toxicity consisted of grade 2 hoarseness and dysphagia. Maximum chronic toxicity was seen in one patient treated with 45 Gy/10 fx who continued to smoke >1 pack/day and ultimately required protective tracheostomy. At 1-year follow-up, estimated local disease free survival for the full cohort was 82%. Overall survival is 100% at last follow-up.ConclusionsWe were able to reduce equipotent total fractions of SBRT from 15 to 5 without exceeding protocol-defined acute/subacute toxicity limits. With limited follow-up, disease control appears comparable to standard treatment. We continue to enroll to the 42.5 Gy/5 fx cohort and follow patients for late toxicity.Trial registrationClinicalTrials.gov NCT01984502

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IMRT for Image-Guided Single Vocal Cord Irradiation

Abstract: Single vocal cord irradiation with IMRT resulted in good target coverage and provided significant sparing of the critical structures. This has the potential to improve the quality-of-life outcomes after RT and maintain the same local control rates.

Cited by 46 publications

References 27 publications

Evaluating Post-Radiotherapy Laryngeal Function with Laryngeal Videostroboscopy in Early Stage Glottic Cancer

Evaluating Post-Radiotherapy Laryngeal Function with Laryngeal Videostroboscopy in Early Stage Glottic Cancer

Risk-adapted partial larynx and/or carotid artery sparing modulated radiation therapy of glottic cancer

SBRT for early-stage glottic larynx cancer—Initial clinical outcomes from a phase I clinical trial

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