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Mohamed AE, Hassouna AH, Mosalum HS, Alnagmy AK, Ashour MG. The outcome of early-stage glottic carcinoma patients treated with radiotherapy: Egyptian National Cancer Institute (NCI-Egypt) experience. Rep Pract Oncol Radiother 2023; 28:496-505. [PMID: 37795222 PMCID: PMC10547425 DOI: 10.5603/rpor.a2023.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/19/2023] [Indexed: 10/06/2023] Open
Abstract
Background Radiotherapy (RT) is an appropriate treatment option for early-stage glottic cancer (ESGC) that achieves high local control and preserves voice quality. However, the optimal radiation treatment schedule remains unknown. We present our institution's 14-year experience in treating ESGC with definitive radiotherapy between 2005 and 2019 inclusively. Materials and methods We reviewed the medical records of 104 patients; 63 (60.5%) were treated with conventional fractionation (CF), and 41 (39.5%) were treated with hypofractionated radiotherapy (HF). The clinical T-stage was T1a in 50 patients (48%), T1b in 27 (26%), and T2 in 27 (26%). Age, gender, anterior commissure involvement, stage, radiotherapy technique, radiation fraction size, and overall treatment time (OTT) were analyzed as prognostic factors. The survival outcomes, local regional control (LRC), and laryngeal preservation rate were evaluated. Results The 5-year overall survival (OS) and LCR were 83.3% and 78%, respectively. On univariate analysis, treatment with CF (p = 0.02), prolonged OTT > 49 days in CF and > 40 days in HF (p = 0.04), and RT total dose < 66 Gy (p = 0.03) were associated with poor LRC. Multivariate analysis showed a non-significant association with LRC (all p > 0.05). The 5-year OS rate in the CF and HF-treated patients was 84.9% and 72.1%, respectively (p = 0.99), and in patients who had T1a, T1b, and T2 disease, were 78.2%, 96.0%, and 82.1%, respectively (p = 0.43). All patients and tumor variables showed no statistically significant association with OS. Only low-grade acute toxicity was observed. Conclusion Non-inferiority results supported the HF schedule to ESGC, including high local disease control and decreased overall treatment time. Our study supports its efficacy in the primary care of ESGC with manageable side effects.
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Affiliation(s)
- Aisha Elsayed Mohamed
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ashraf Hamed Hassouna
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Ahmed Khaled Alnagmy
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - May Gamal Ashour
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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Reinhardt P, Giger R, Seifert E, Shelan M, Riggenbach E, Terribilini D, Joosten A, Schanne DH, Aebersold DM, Manser P, Dettmer MS, Simon C, Ozsahin EM, Moeckli R, Limacher A, Caparrotti F, Nair D, Bourhis J, Broglie MA, Al-Mamgani A, Elicin O. VoiceS: voice quality after transoral CO 2 laser surgery versus single vocal cord irradiation for unilateral stage 0 and I glottic larynx cancer-a randomized phase III trial. Trials 2022; 23:906. [PMID: 36303192 PMCID: PMC9615245 DOI: 10.1186/s13063-022-06841-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Surgery and radiotherapy are well-established standards of care for unilateral stage 0 and I early-stage glottic cancer (ESGC). Based on comparative studies and meta-analyses, functional and oncological outcomes after both treatment modalities are similar. Historically, radiotherapy (RT) has been performed by irradiation of the whole larynx. However, only the involved vocal cord is being treated with recently introduced hypofractionated concepts that result in 8 to 10-fold smaller target volumes. Retrospective data argues for an improvement in voice quality with non-inferior local control. Based on these findings, single vocal cord irradiation (SVCI) has been implemented as a routine approach in some institutions for ESGC in recent years. However, prospective data directly comparing SVCI with surgery is lacking. The aim of VoiceS is to fill this gap. Methods In this prospective randomized multi-center open-label phase III study with a superiority design, 34 patients with histopathologically confirmed, untreated, unilateral stage 0-I ESGC (unilateral cTis or cT1a) will be randomized to SVCI or transoral CO2-laser microsurgical cordectomy (TLM). Average difference in voice quality, measured by using the voice handicap index (VHI) will be modeled over four time points (6, 12, 18, and 24 months). Primary endpoint of this study will be the patient-reported subjective voice quality between 6 to 24 months after randomization. Secondary endpoints will include perceptual impression of the voice via roughness – breathiness – hoarseness (RBH) assessment at the above-mentioned time points. Additionally, quantitative characteristics of voice, loco-regional tumor control at 2 and 5 years, and treatment toxicity at 2 and 5 years based on CTCAE v.5.0 will be reported. Discussion To our knowledge, VoiceS is the first randomized phase III trial comparing SVCI with TLM. Results of this study may lead to improved decision-making in the treatment of ESGC. Trial registration ClinicalTrials.gov NCT04057209. Registered on 15 August 2019. Cantonal Ethics Committee KEK-BE 2019-01506 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06841-5.
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Affiliation(s)
- Philipp Reinhardt
- Department of Radiation Oncology, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Roland Giger
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Eberhard Seifert
- Division of Phoniatrics, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Elena Riggenbach
- Department of Radiation Oncology, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Dario Terribilini
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Andreas Joosten
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Daniel H Schanne
- Department of Radiation Oncology, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Peter Manser
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Matthias S Dettmer
- Department of Pathology, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.,Department of Pathology, University of Bern, Murtenstrasse 31, 3010, Bern, Switzerland
| | - Christian Simon
- Department of Otolaryngology - Head and Neck Surgery, CHUV University of Lausanne, Rue du Bugnon, 2, 1011, Lausanne, Switzerland
| | - Esat M Ozsahin
- Department of Radiation Oncology, Lausanne University Hospital and Lausanne University, Rue du Bugnon, 21, 1011, Lausanne, Switzerland
| | - Raphaël Moeckli
- Institut of Radiation Physics, Lausanne University Hospital and Lausanne University, Rue du Grand-Pré 1, 1007, Lausanne, Switzerland
| | - Andreas Limacher
- Clinical Trials Unit Bern, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Francesca Caparrotti
- Department of Radiation Oncology, Genève University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Deepa Nair
- Department of Head Neck Surgical Oncology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Jean Bourhis
- Department of Radiation Oncology, Lausanne University Hospital and Lausanne University, Rue du Bugnon, 21, 1011, Lausanne, Switzerland
| | - Martina A Broglie
- Department of Head and Neck Surgery, University Hospital of Zurich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, 1066, Amsterdam, CX, Netherlands
| | - Olgun Elicin
- Department of Radiation Oncology, Bern University Hospital and University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland.
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Lee TH, Lee JH, Kwon SK, Chung EJ, Wu HG. Hypofractionated radiotherapy for early stage glottic cancer: efficacy of 3.5 Gy per fraction. Radiat Oncol J 2022; 40:120-126. [PMID: 35796115 PMCID: PMC9262701 DOI: 10.3857/roj.2021.01025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/11/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the treatment outcomes and toxicity profile of patients with early glottic cancer who underwent hypofractionated radiation therapy (RT) with 3.5 Gy per fraction. Materials and Methods A retrospective review was performed of the medical records of 35 patients with early stage (T1-2N0M0) glottic cancer who underwent definitive RT. The dose fractionation scheme was 59.5 Gy in 17 fractions. Posterior commissure was excluded from the clinical target volume (CTV) for 26 patients (74.3%) without glottic lesions close to this region. Results With a median follow-up of 16.23 months (range, 6.82 to 67.15 months), no local, regional, or distant recurrence was reported. Acute hoarseness (65.7%), mucositis (68.6%), radiation dermatitis (60.0%) was frequent. One patient (2.9%) reported grade 3 acute toxicity (mucositis) and there was no grade 4–5 acute toxicity. There was no grade ≥3 late toxicities; however, grade 1 late intermittent hoarseness was frequent (45.7%). The receiver operative characteristic analysis revealed that mean hypopharyngeal dose was predictive for acute grade ≥2 mucositis (area under the curve=0.9314; 95% confidence interval, 0.8524–1). The optimal threshold of mean hypopharyngeal dose for occurrence of acute grade ≥2 mucositis was 26.31 Gy, with a specificity and sensitivity of 83.3% and 88.2%, respectively. Conclusion Hypofractionated RT with fraction size of 3.5 Gy for early glottic cancer is effective. The hypopharyngeal mean dose could predict the occurrence of grade ≥2 acute mucositis. The posterior commissure can be safely excluded from the CTV.
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Affiliation(s)
- Tae Hoon Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
- Correspondence: Hong-Gyun Wu Department of Radiation Oncology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-2072-3177 E-mail:
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Tonneau M, Matta R, Lals S, Mirabel X, Crop F, Lacornerie T, Pasquier D, Escande A, Liem X. [Radiotherapy for patients with early-stage glottic squamous cell carcinoma of the larynx: Interest of hypofractionation?]. Cancer Radiother 2021; 25:801-810. [PMID: 33931299 DOI: 10.1016/j.canrad.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/15/2022]
Abstract
Hypofractionated radiotherapy of early-stage squamous cell carcinoma of the glottic larynx is a promising treatment option. This can be divided into radiotherapy with moderate hypofractionation (up to 2.5Gy per fraction), more intense hypofractionation (between 2.5 and 4.5Gy per fraction) and stereotactic radiotherapy (above 4.5Gy per fraction). Most studies evaluating moderate hypofractionation show a local control rate between 85 and 95%. Acute laryngeal toxicity is superior to conventional treatment, but only for grades 1 and 2, with no significant difference reported for severe toxicity. Stereotactic radiotherapy in this pathology is also an emerging entity, but some authors have reported significant toxicity. There are currently no standardized guidelines for treatment and management regimen. We conducted a systemic review of published prospective and retrospective trials to evaluate efficacy, toxicity, and discuss future directions.
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Affiliation(s)
- M Tonneau
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France; Centre de recherche du centre hospitalier universitaire de Montréal (CRCHUM), QC, Canada
| | - R Matta
- Université de Lille, université Henri-Warembourg, 59000 Lille, France
| | - S Lals
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - X Mirabel
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - F Crop
- Service de physique médicale, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - T Lacornerie
- Service de physique médicale, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - D Pasquier
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France; Université de Lille, université Henri-Warembourg, 59000 Lille, France; Centre de recherche en informatique, signal et automatique de Lille (Cristal), UMR 9189, 59000 Lille, France
| | - A Escande
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - X Liem
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France.
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