Prognostic factors in patients with T1 glottic cancer treated with radiotherapy

Abstract

Purpose Presentation of long-term results of radiation treatment in patients with T1 glottic cancer and evaluation of prognostic factors. Methods We performed a retrospective analysis in a group of 569 patients with T1 squamous cell glottic carcinoma treated with radiotherapy at the Center of Oncology in Cracow between 1977 and 2007. In all, 503 (88%) patients presented with T1a stage disease and 66 (12%) with T1b. Anterior commissure infiltration was present in 179 (31%) patients. Average hemoglobin level prior to therapy was 13.9 g/dl. Using the body mass index (BMI), 114 (20%) patients were underweight, and 91 (16%) were overweight. Median time between collecting tumor specimen and beginning of radiotherapy was 56 days (range 14–145 days). Treatment regimen was normofractionated with single fraction ≤2 Gy in 102 (18%) and hypofractionated in 467 (82%) patients. Results The 5‑ and 10-year overall survival (OS), disease-specific survival (DSS) and local control (LC) rates were 85 and 68%, 88 and 86%, 89 and 87%, respectively. Multivariate analysis showed that tobacco smoking, low hemoglobin level (<13 g/dl), anterior commissure infiltration, fraction dose ≤2 Gy and time from collecting specimen to beginning of therapy longer than 30 days had negative impact on LC and DSS. Patients’ age over 60 years, worse performance status and malnutrition (BMI <18.5) had negative impacts on OS. Conclusions Radiotherapy is a highly effective treatment method in patients with T1N0M0 glottic cancer. LC and DSS may be improved following hypofractionation, smoking cessation, and shortening of waiting-time until start of treatment. OS was mainly influenced by nutritional and performance status.

The prognostic value of anterior commissure involvement in T1 glottic cancer: A systematic review and meta‐analysis

“…The database search resulted in 801 studies, and eventually only 16 studies were selected for the analysis . The process of selection is shown in Figure .…”

“…The study by Wolber et al (44 patients) is the one with the smallest sample size, whereas the study by Cellai et al (831 patients) is the one with the largest sample size. Eight studies (50%) were performed in Europe, three (19%) in United States, and five (31%) in Asia …”

“…PubMed, Embase, Scopus, and Cochrane libraries were first searched in September 2018 for the identification of all the studies related to the topic. The literature research was updated several times after September 2018 (last research updated in July 2019), and the last study included in the meta‐analysis was published in June 2019 …”

“…The impact of ACI on the oncologic outcomes of T1 glottic tumors remains controversial, insignificant for some authors or implying poorer results for others . This disagreement is the question behind our work, which through a systematic review and meta‐analysis of the literature aimed to verify whether ACI affects the prognosis of T1 glottic tumors treated either with RT or with transoral microsurgery.…”

Hypofractionated carbon‐ion radiotherapy for stage I peripheral nonsmall cell lung cancer (GUNMA0701): Prospective phase II study

“…They assumed that the harmful effects of smoking during radiation therapy may be explained by its hypoxic effect. In another report of prognostic factors in patients with glottis cancer treated with photon radiation therapy, local control was negatively affected by tobacco smoking (particularly more than 20 cigarettes per day over a period of time—more than 40 pack‐years) . The mechanisms underlying effects by smoking on C‐ion RT remain uncertain, and the results might be confirmed in further study.…”