Single Vocal Cord Irradiation: Image Guided Intensity Modulated Hypofractionated Radiation Therapy for T1a Glottic Cancer: Early Clinical Results

Al‐Mamgani, Abrahim; Kwa, Stefan L.S.; Tans, Lisa; Moring, Michael; Fransen, D.; Mehilal, Robert; Verduijn, Gerda M.; Jong, Rob J. Baatenburg de; Heijmen, B.; Levendag, Peter C.

doi:10.1016/j.ijrobp.2015.06.016

Cited by 52 publications

(75 citation statements)

References 23 publications

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“…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% . In that study, CTV to PTV margin was defined as an isotropic margin of 3 mm for the first five patients, and was then increased to 5 mm based on observed intra‐fraction target motion for the remaining patients.…”

Section: Discussionmentioning

confidence: 99%

“…6,26,28 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%. 7 In that study, CTV to PTV margin was defined as an isotropic margin of 3 mm for the first five patients, and was then increased to 5 mm based on observed intra-fraction target motion for the remaining patients. Our prospective study is limited by the fact that no clinical outcomes using the proposed margins are reported.…”

Section: Discussionmentioning

confidence: 99%

“…The group from Erasmus Medical Center Cancer Institute has previously reported feasibility 6 and, more recently, excellent LC outcomes from a retrospective analysis of 30 patients with T1aN0 glottic cancer treated with single vocal cord IMRT. 7 A recent study by Princess Margaret Hospital reported clinical outcomes of partial larynx IMRT for T2 glottic cancer patients 8 and showed that use of daily image-guidance using vertebral match resulted in worse LC compared to laryngeal tissue match based on cone beam CT (CBCT) (69% vs. 91% at 3 years). These results stress the importance of a better understanding of laryngeal motion when considering margin reduction.…”

Section: Introductionmentioning

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%

Section: Introductionmentioning

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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“…Newer treatment approaches utilize intensity modulated radiotherapy to treat the larynx while sparing the adjacent carotid arteries and achieves 88% local control rate at three years for T1–2N0 glottic SCC . This highly accurate localized treatment has been taken one step further by a Dutch group who limited radiotherapy to the single involved vocal cord and reported a two‐year local control rate of 100% . Some of these T1/T2 patients will not be cured by radiotherapy and some will subsequently undergo salvage total laryngectomy (STL‐LOR).…”

Section: Discussionmentioning

confidence: 99%

“…treatment has been taken one step further by a Dutch group who limited radiotherapy to the single involved vocal cord and reported a two-year local control rate of 100%. 25 Some of these T1/T2 patients will not be cured by radiotherapy and some will subsequently undergo salvage total laryngectomy (STL-LOR).…”

Section: Discussionmentioning

confidence: 99%

Defining the low‐risk salvage laryngectomy—A single‐center retrospective analysis of pharyngocutaneous fistula

Vasani

Youssef

Lin

et al. 2018

Laryngoscope Investig Oto

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ObjectivesSalvage total laryngectomies (STL) are not a homogeneous group. Most will fall into two groups: i) Patients with previous AJCC stage I/II larynx cancer who have had radiotherapy to the larynx only (STL‐LOR), or ii) Patients who have had previous AJCC stage III/IV larynx cancer and subsequent radiotherapy to the larynx and draining nodal basins with concurrent cisplatin chemotherapy (STL‐CRT). We aimed to compare PCF rates following STL in these two groups.MethodsA retrospective review of the department's cohort between January 2010 and August 2015 was conducted.ResultsSeventy‐seven patients underwent total laryngectomy for larynx cancer between January 2010 and August 2015. There were 10 post‐laryngectomy fistulas (13.0%). Three of these occurred in the 38 patients undergoing primary total laryngectomy (PTL), and seven in the 39 patients undergoing STL, rates of 7.9% and 17.9%, respectively. Twenty‐two patients had received radiation to the larynx alone without chemotherapy (STL‐LOR) for initial Stage I/II disease. Eleven patients had received laryngeal and neck irradiation plus cisplatin chemotherapy (STL‐CRT) for initial stage III/IV disease. Of the 22 STL‐LOR patients, two developed PCF (9.1%). Of the 11 STL‐CRT patients, five developed PCF. There was no difference in the rate of PCF between PTL and STL‐LOR. There was a statistically significant increase in PCF in STL‐CRT versus PTL (p = .009) and in PCF in STL‐CRT versus STL‐LOR (p = .027).ConclusionSalvage laryngectomies are often treated as a homogenous group. We demonstrate that PCF rates vary significantly depending on preoperative radiation fields and the use of chemotherapy.Level of Evidence2b.

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Feasibility of single vocal cord irradiation as a treatment strategy for T1a glottic cancer

Chung

Lee

2019

Head & Neck

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Background: Generally, radiotherapy for patients with early glottic cancer includes treatment of the whole larynx. This study was conducted to evaluate the treatment outcomes and toxicity in patients who received single vocal cord irradiation (SVCI) for T1a classification glottic cancer. Methods: A total of 34 patients diagnosed with clinical T1aN0M0 classification squamous cell carcinoma of the glottis who received radiotherapy to the single vocal cord were included for analysis. Results: Median follow-up period was 41.3 months (range, 6.4-124.5 months).The 3-year and 5-year local control (LC) rates were both 96.8%. Grade 3 radiation dermatitis was observed as severe acute toxicity in two (6%) patients. No patients experienced any severe late toxicity events during follow-up. Conclusions: SVCI showed good LC, low acute and late toxicities, and reasonable voice recovery. SVCI may be considered a feasible treatment strategy for patients with T1a glottic cancer. K E Y W O R D Shead and neck cancer, laryngeal neoplasms, local neoplasm recurrence, radiotherapy, toxicity

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Single Vocal Cord Irradiation: Image Guided Intensity Modulated Hypofractionated Radiation Therapy for T1a Glottic Cancer: Early Clinical Results

Cited by 52 publications

References 23 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

Defining the low‐risk salvage laryngectomy—A single‐center retrospective analysis of pharyngocutaneous fistula

Feasibility of single vocal cord irradiation as a treatment strategy for T1a glottic cancer

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