Single vocal cord irradiation: A competitive treatment strategy in early glottic cancer

Levendag, Peter C.; Teguh, David N.; Keskin-Cambay, Fatma; Al‐Mamgani, Abrahim; Rooij, Peter van; Astreinidou, E.; Kwa, Stefan L.S.; Heijmen, B.; Monserez, Dominiek; Osman, Sarah

doi:10.1016/j.radonc.2011.05.026

Cited by 33 publications

(25 citation statements)

References 31 publications

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“…found a strong correlation between quality of speech and doses to the aryepiglottic folds, pre‐epiglottic space, false vocal cords and lateral pharyngeal walls. The use of IMRT for early glottic cancer has been investigated in several studies and has consistently shown a significant sparing of the carotids . In the era of IMRT and IGRT, it becomes increasingly difficult to argue in favour of whole larynx irradiation in glottic cancer because of fear of laryngeal motion, while the surgical approach proposes a focused resection of tumour bearing vocal cord.…”

Section: Discussionmentioning

confidence: 99%

“…Although swallowing was a rare event, the occurrence of an inadvertent swallowing episode during treatment with the proposed PL‐VMAT margin resulted in a median time of CTV excursion beyond the 95% IDL below 1 second. The group from Erasmus Medical Center Cancer Institute has previously assessed dosimetric feasibility of focal vocal cord irradiation for early‐stage local cancer T1aN0 using 4D‐CT; they showed sparing of contralateral vocal cord and various laryngeal structures compared to conventional radiotherapy . The same group recently published the first clinical outcomes from a retrospective analysis of 30 patients with T1aN0 glottic cancer treated with single vocal cord to a dose of 58 Gy in 16 fractions and showed excellent 2 year LC of 100% .…”

Section: Discussionmentioning

confidence: 99%

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Larynx motion considerations in partial larynx volumetric modulated arc therapy for early glottic cancer

et al. 2017

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Although swallowing motion is rare, rapid and easily suppressed by patients, there is a risk of systematic miss-targeting if planning CT is acquired during swallowing. Larynx position shift relative to vertebrae occurs in 1/3 of patients over the course of radiotherapy. With soft-tissue image guidance and margins accounting for respiratory motion, PL-VMAT allows safe reduction of dose to organs at risk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Larynx motion considerations in partial larynx volumetric modulated arc therapy for early glottic cancer

et al. 2017

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“…In contrast, other groups have proposed limiting the treatment volume only to the involved vocal cord to maximize carotid sparing. 20 For example, Janssen and colleagues recently reported excellent local control rates in 39 patients with T1-2N0 glottic carcinoma treated with IMRT, including 21 patients that underwent ipsilateral vocal cord irradiation with bilateral carotid sparing resulting in a mean contralateral carotid dose of 20.2 Gy. 21 Since the time period of this study, we have chosen to employ an intermediate approach, using daily image guidance and decreasing our circumferential margin to 0.5cm, with as little as 0.3cm margin allowable near the carotid arteries in order to achieve a more significant reduction in carotid dose.…”

Section: Discussionmentioning

confidence: 99%

Carotid sparing intensity-modulated radiation therapy achieves comparable locoregional control to conventional radiotherapy in T1-2N0 laryngeal carcinoma

et al. 2015

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Background Although intensity-modulated radiotherapy (IMRT) is a standard of care for many head and neck cancers, its use for carotid-sparing (CS) therapy in early-stage laryngeal carcinoma is controversial. Methods 330 consecutive patients with early-stage laryngeal carcinoma were treated from 1/1989 to 5/2011, including 282 CRT and 48 CS-IMRT patients. The median follow-up was 43 (CS-IMRT) and 66 (CRT) months. Results There was no difference in local failure rates comparing patients undergoing CS-IMRT with CRT, with 3-year local control rates of 88% vs. 89%, respectively (p=0.938). Using a 1cm circumferential margin, the average dose to the left and right carotid arteries was 48.3 and 47.9 Gy, respectively. 88% of locoregional recurrences involved the ipsilateral true vocal cord, including all local recurrences in the IMRT group. Conclusions These results warrant further prospective evaluation of CS-IMRT for early-stage glottic larynx cancer.

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“…Targeting only the involved vocal cord with RT could further improve voice quality, and reduce the radiation exposure of the surrounding OAR. Osman et al (9)(10)(11)(12), Levendag et al (13) and Kwa et al (14) explored the technical feasibility, and dosimetric advantages, of targeting only a single affected vocal cord with IMRT for T1a glottic cancer.…”

Section: Discussionmentioning

confidence: 99%

“…However, to date, few studies have investigated the possibility of changing the target volume. Only one institution in the Netherlands has investigated limiting the IMRT target volume to a single affected vocal cord for T1a glottic cancer (9)(10)(11)(12)(13)(14); their studies revealed that IMRT with a limited target volume was associated with a reduction in the irradiation of adjacent normal tissue. However, the oncological outcomes of limiting the target volume to a single vocal cord throughout the course of RT remain to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

Volumetric modulated arc radiotherapy of the whole larynx, followed by a single affected vocal cord, for T1a glottic cancer: Dosimetric analysis of a case

Yeo

2016

Molecular and Clinical Oncology

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Abstract. Radiation therapy (RT) and endolaryngeal surgery are standard treatments for early-stage glottic cancer. They have closely matched oncological outcomes; however, it is debatable which method is superior in terms of functional outcomes. Several dosimetric studies have demonstrated that, compared with conventional RT, intensity-modulated RT (IMRT) reduces unnecessary radiation of the adjacent normal tissues, including the carotid artery and thyroid gland. However, RT targets the whole larynx, whereas endolaryngeal surgery is a highly focused treatment involving the en bloc resection of a tumor with safety margins. For T1a glottic cancer, in which the tumor is limited to one vocal cord, the technical feasibility of targeting IMRT on the single vocal cord affected has been investigated; however, the clinical feasibility and the possibility of inferior local control remain to be elucidated. In the present case study, IMRT was used to treat the whole larynx first, and then to treat a single vocal cord. The patient in the present study had T1a glottic cancer, and received volumetric modulated arc therapy with a total dose of 63 Gy/28 fractions. The first treatment phase (40.5 Gy/18 fractions) targeted the whole larynx to eliminate subclinical disease. The second treatment phase (22.5 Gy/10 fractions) targeted only the involved vocal cord. During this treatment phase, the exposure of the non-involved right vocal cord, the right carotid artery and the thyroid gland to the radiation was lower compared with the continuation of the initial treatment approach. These findings suggested that changing the target volume from the whole larynx to the affected vocal cord during the course of IMRT is feasible for T1a glottic cancer, and that it may reduce functional side effects while maintaining oncological outcomes.

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Single vocal cord irradiation: A competitive treatment strategy in early glottic cancer

Cited by 33 publications

References 31 publications

Larynx motion considerations in partial larynx volumetric modulated arc therapy for early glottic cancer

Larynx motion considerations in partial larynx volumetric modulated arc therapy for early glottic cancer

Carotid sparing intensity-modulated radiation therapy achieves comparable locoregional control to conventional radiotherapy in T1-2N0 laryngeal carcinoma

Volumetric modulated arc radiotherapy of the whole larynx, followed by a single affected vocal cord, for T1a glottic cancer: Dosimetric analysis of a case

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