Outcome of Early-Stage Glottic Laryngeal Carcinoma Patients Treated with Radical Radiotherapy Using Different Techniques

Abstract

Purpose The aim was to evaluate the treatment outcomes and prognostic characteristics of patients with early-stage glottic laryngeal carcinoma who underwent radical radiotherapy (RT) with different techniques. Patients and Methods Radiotherapy was applied using the 2D conventional technique between 1991 and 2004 (130 patients), 3DCRT until 2014 (125 patients), and by VMAT until January 2017 (44 patients). Clinical T stages were 38 (12.7%) for Tis, 209 (69.9%) for T1, and 52 (17.4%) for T2. Radiotherapy technique and energy, anterior commissure involvement, and stage were analyzed as prognostic factors. Results The median total dose was 66 (50–70) Gy, and median follow-up time was 72 (3–288) months; 5-year disease-specific survival (DSS) rates were 95.8%, 95.5%, and 88.6%, respectively, in Tis, T1, and T2 stages. In multivariate analyses, anterior commissure involvement was found significant for all survival and local control rates. The patients treated with VMAT technique had better local control and DSS rates. However, these results were not statistically significant. Conclusion In early-stage laryngeal carcinomas, radical RT is a function sparing and effective treatment modality, regardless of treatment techniques.

A Dysfunctional Larynx Dilemma: Carcinoma Recurrence or Radiation-induced Damage?

“…Some studies have reported five-year laryngectomy-free survival rates at 80-86% for T2 stage cancers after RT. 11,12 Studies have reported various rates of dysfunctional larynges after radiation ranging from 0.3-21% although stratification of cancer stage was not specified in any of the studies. 9,11,12 Allen et al reviewed several studies which showed that 45%-75% of those with post-radiation changes were found to have recurrent or residual malignancy.…”

Early-Stage Glottic Squamous Cell Carcinoma in the Era of Image-Guided Radiotherapy

“…There was a trend for increased local recurrences in the T2 N0 population, which highlighted the potential consequences for not adequately appreciating the risk of local subclinical spread above or below the glottis. Although follow-up periods are short, the dosimetric advantages to OARs and comparable local control rates for IMRT and VMAT have been further demonstrated by numerous retrospective analyses (11,(103)(104)(105)(106)(107).…”

“…Spread beyond the vocal cord frequently occurs through invasion of the anterior commissure, as the attachment of Broyles’ ligament onto the thyroid cartilage serves as a weak point, where tumour may invade through the cricothyroid membrane into the laryngeal cartilage and supraglottic or subglottic spaces ( 10 ). Anterior commissure invasion appears to be the most important prognostic determinant for local control for ESGC ( 11 ).…”

The underlying molecular mechanism and identification of transcription factor markers for laryngeal squamous cell carcinoma

“…At present, clinical strategies for treating LC include surgery, radiotherapy, chemotherapy and systemic treatment (5)(6)(7)(8). Early treatment has achieved good results with the 5-year disease-specific survival > 75% (9)(10)(11). For patients with advanced LC, total laryngectomy may be the only option (5,12); however, problems caused by this surgery (such as loss of speech and swallowing dysfunction) greatly reduce patient quality of life.…”