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Mandal S, Chaudhuri T, Mukhopadhyay D. Prospective Observational Comparative Study of Response and Toxicities in Early Glottic Cancer Using Telecobalt Versus 3D-CRT. Indian J Otolaryngol Head Neck Surg 2022; 74:1725-1734. [PMID: 36452791 PMCID: PMC9701978 DOI: 10.1007/s12070-019-01729-4] [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: 07/09/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022] Open
Abstract
The study was performed with 50 patients, 24 patients in Arm A and 26 patients in Arm B. Arm A-Conventional Telecobalt RT 66 Gy/33 fraction in stage T1N0M0 and stage T2N0M0 and Arm B-3D-CRT 66 Gy/33 fraction in T1N0M0 and T2N0M0 used. At the end of RT, 6 weeks, 3 months acute and late toxicities were noted by RTOG/EORTC morbidity scoring criteria for skin reaction, dysphagia and laryngeal toxicity. Fiber optic Laryngoscopy clinical assessment criteria were used to assess response after 6 weeks, 3 months of treatment completion. At 6 weeks of follow-up-Both Arm A and B complete response rate were 83.3% and 88.5% respectively and at 3 months rate were 85.0% and 95.7% respectively. There was no superiority of results with 3D-CRT over 2DRT. At the end of RT dysphagia grade 3 toxicity seen 1 patient (4.2%) but in Arm B (total 26 patients) no grade 3 toxicity found. At the end of 6 week and 3 month, one patient (4.3%) had grade 3 toxicity on Arm B only at 3 month. All these results are comparable. At the end of RT, one patient (3.8%) had incidentally dermatitis grade 3 toxicity in Arm B only. But all the results are comparable. On follow up, 6 week and 3 months, no grade 3 toxicity noted. At the end of RT, grade 3 laryngeal toxicity noted in 3 (12.5%) in Arm A and 2 (7.7%) in Arm B, not statistically significant. At 6 week, grade 3 toxicity found in 3/24 (12.5%) in Arm A and 2/26 (7.7%) in Arm B, at 3 months, 1/26 (4.3%) patient had incidental grade 3 toxicity only in Arm B. As conformal radiotherapy is more time consuming, less available in India and more costly than 2DRT, we can consider Conventional 2D planning for patients in India where most of people belong to low economic profile. Due to limitation in sample size and long-term follow-up further randomized studies are needed to validate the results.
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Affiliation(s)
- Sanchayan Mandal
- Department of Radiotherapy, VMMC and Safdarjung Hospital, New Delhi, India
- Kalyani, Nadia, West Bengal India
| | - Tamohan Chaudhuri
- Department of Radiotherapy, Saroj Gupta Cancer Center and Research Institute (S.G.C.C.R.I), Kolkata, India
| | - Dhrubajyoti Mukhopadhyay
- Department of E.N.T, Saroj Gupta Cancer Center and Research Institute (S.G.C.C.R.I), Kolkata, India
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Kovarik J, Kelly C, Cunnell M, Jamil F, Iqbal MS. Hypofractionated (2.75 Gy per fraction) versus Conventionally Fractionated Primary Radiotherapy for T2N0M0 Carcinoma of the Glottis. Int Arch Otorhinolaryngol 2022; 27:e16-e23. [PMID: 36714891 PMCID: PMC9879650 DOI: 10.1055/s-0042-1745855] [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: 06/26/2020] [Accepted: 05/17/2021] [Indexed: 02/01/2023] Open
Abstract
Introduction Radiotherapy provides excellent outcome in early stage glottic cancer; however, the optimal radiotherapy dose fractionation remains unknown. Objective To investigate the outcome of patients with T2N0M0 treated with either hypofractionated (HypoFxn) or conventionally fractionated radical (ConFxn) radiotherapy. Methods According to our institutional protocol, patients with T2N0M0 glottic cancer can be treated either with ConfFxn or HypoFxn radiotherapy, as per clinician's and patient's choice, following shared decision making discussing the advantages and disadvantages of both modalities. A total of 77 patients with T2N0M0 squamous cell carcinoma of glottis treated with either HypoFxn 55Gy in 20 fractions ( n = 19) or ConFxn 63 to 65Gy in 30 fractions ( n = 58) were included. Results With median follow-up of 3.4 years, there was no significant difference in disease-free survival (median: HypoFxn = 65.2 months, and ConFxn = 75.3 months; p = 0.874), local recurrence free survival rates (median: HypoFxn = 78.8 months vs. ConFxn = 81.2 months; p = 0.274), and overall survival (median: HypoFxn = 65.9 months vs. ConFxn = 67.7 months; p = 0.532). Elective neck irradiation was given to 43 patients, all in the ConFxn group, and this was associated with poorer local control ( p = 0.027). The use of radiotherapy modality, three-dimensional conformal radiotherapy (3DRT) versus intensity modulated radiotherapy (IMRT), was not a prognostic factor ( p = 0.36). In the HypoFxn group, grade III acute dysphagia requiring nasogastric tube was 16%, compared with 25% in the ConFxn group ( p = 0.446). Conclusion HypoFxn radiotherapy provides a comparable treatment outcome with acceptable toxicity. The addition of prophylactic irradiation of the neck lymph nodes has no impact on regional control.
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Affiliation(s)
- Josef Kovarik
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom,Address for correspondence Josef Kovarik, PhD Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon Tyne, NE7 7DNUnited Kingdom
| | - Charles Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Michelle Cunnell
- Department of Medical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Fatima Jamil
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Muhammad Shahid Iqbal
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Kim D, Ki Y, Joo J, Jeon H, Park D, Nam J, Kim W. Prognostic value of the maximum standardized uptake value for the locoregional control in early glottic cancer. Radiat Oncol J 2022; 39:297-303. [PMID: 34986551 PMCID: PMC8743459 DOI: 10.3857/roj.2021.00507] [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: 05/11/2021] [Accepted: 09/29/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose To evaluate the prognostic value of the pretreatment maximum standardized uptake value (SUVmax) for locoregional control (LRC) of early glottic cancer treated with primary radiotherapy. Materials and Methods We retrospectively reviewed the medical records of 101 patients with T1-T2N0 glottic cancer treated with helical tomotherapy between 2013 and 2016. The clinical T-stages were T1 in 87 (86.1%) and T2 in 14 (13.9%) patients. The median total dose was 63 Gy (63–67.5 Gy) in 2.25 Gy per fraction. The survival outcomes were plotted using Kaplan-Meier curves. Receiver operating characteristic curves were used to assess the optimal SUVmax cut-off value for predicting locoregional recurrence. Results The median follow-up period was 58 months (range, 11 to 90 months). The 5-year overall survival (OS) and locoregional recurrence-free survival rates were 96.8% and 85.4%, respectively. The median pretreatment SUVmax of the primary tumor for all 101 patients was 2.3 (range, 1.1 to 9.1). The best cut-off value for SUVmax for predicting LRC was 3.3, with a sensitivity of 78.6% and specificity of 73.6%. Univariate analysis showed that T-stage, overall treatment time (≥43 days), and high SUVmax (≥3.3) were significant predictors of LRC. Multivariate analysis showed that LRC was independently affected by a high SUVmax (≥3.3) (hazard ratio = 5.505, p = 0.020). Conclusion High pretreatment SUVmax (≥3.3) is a negative prognostic factor for LRC in early glottic cancer patients treated with primary radiotherapy.
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Affiliation(s)
- Donghyun Kim
- Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Yongkan Ki
- Department of Radiation Oncology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Jihyeon Joo
- Department of Radiation Oncology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Hosang Jeon
- Department of Radiation Oncology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Dahl Park
- Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jiho Nam
- Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Wontaek Kim
- Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Oie Y, Itoh Y, Kawamura M, Takase Y, Murao T, Ishihara S, Nomoto Y, Hirasawa N, Asano A, Yamakawa K, Ito J, Kinoshita F, Naganawa S. Poor local control of ulcerative T1 glottic cancer treated with 2.25-Gy per fraction radiotherapy. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 83:811-825. [PMID: 34916724 PMCID: PMC8648532 DOI: 10.18999/nagjms.83.4.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022]
Abstract
The Tokai Study Group for Therapeutic Radiology and Oncology (TOSTRO) started managing T1 glottic cancer using 2.25 Gy/fraction radiotherapy in 2011. The aim was to evaluate the local control (LC) rate and toxicity with 2.25-Gy radiotherapy in clinical practice and identify prognostic factors.The eligibility criteria were T1 glottic squamous cell carcinoma patients with age ≥20 years, treated with 2.25 Gy/fraction without chemotherapy between 2011 and 2017. LC rates were evaluated based on age, performance status, sex, T-category, tumor type (ulcerative or non-ulcerative), presence of anterior commissure invasion, tumor size, X-ray beam energy, and overall treatment time. Acute and late adverse events were evaluated using CTCAE version 4.0. A total of 202 patients were enrolled. The median follow-up period was 34.2 months. The 2- and 4-year LC rates were 93.8% and 93.1%, respectively. There was a significant difference in the LC rate between non-ulcerative type and ulcerative type (95.2% vs. 74.1% at 2 years, 94.4% vs. 74.1% at 4 years; p = 0.01). On univariate analysis, only tumor type was significantly correlated with a poor LC rate (hazard ratio 4.3; 95% confidence interval 1.2-15.4; p = 0.03). Acute grade 3 adverse events occurred in 17 patients. However, no late adverse events of grade 3 or higher have occurred to date. T1 glottic cancer treatment outcomes using hypofractionated radiotherapy with 2.25 Gy/fraction in clinical practice were comparable to previously reported results. However, ulcerative type tumor was associated with a poor LC rate.
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Affiliation(s)
- Yumi Oie
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,Department of Radiology, Chubu Rosai Hospital, Nagoya, Japan
| | - Yoshiyuki Itoh
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,Department of Radiology, Nishio Municipal Hospital, Nishio, Japan
| | - Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuuki Takase
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,Department of Radiation Oncology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Takayuki Murao
- Department of Radiation Oncology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Shunichi Ishihara
- Department of Radiology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Yoshihito Nomoto
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Naoki Hirasawa
- Department of Radiology, Komaki City Hospital, Komaki, Japan
| | - Akiko Asano
- Department of Radiation Oncology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Kouji Yamakawa
- Department of Radiology, Tosei General Hospital, Seto, Japan
| | - Junji Ito
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,Department of Radiation Oncology, Nakatsugawa Municipal General Hospital, Nakatsugawa, Japan
| | - Fumie Kinoshita
- Statistical Analysis Section, Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Mucha-Małecka A, Małecki K, Amrogowicz N, Biesaga B, Modrzejewski M. Prognostic factors in elderly patients with T1 glottic cancer treated with radiotherapy. Sci Rep 2021; 11:17717. [PMID: 34489495 PMCID: PMC8421427 DOI: 10.1038/s41598-021-96146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/08/2021] [Indexed: 12/05/2022] Open
Abstract
The aim of the study was the evaluation of the effectiveness of radiotherapy in elderly T1 glottic cancer patients and prognostic factors with particular focus on comorbidities. Five-year overall survival, disease-specific survival, and local control rates were 63%, 92%, and 93%, respectively. Multivariate analysis showed that the following factors had statistically significant impact on local relapse risk and cancer death risk: diabetes, underweight, and fraction dose of 2 Gy. High number of comorbidities, high CCI, and underweight negatively influenced overall survival. A retrospective analysis was performed in a group of 131 T1N0M0 glottic cancer patients aged 70 and above treated with irradiation at the National Institute of Oncology in Cracow between 1977 and 2007. In the analyzed group men prevailed (92%) of mean age of 74 years. Each patient was diagnosed with at least one comorbidity with the following comorbid conditions being most frequent: hypertension, ischemic heart disease, and chronic obstructive pulmonary disease. In the studied group, the effect of comorbidities on overall survival was evaluated using Charlson Comorbidity Index (CCI). Twenty five (19%) patients showed underweight. All patients were irradiated once daily, 5 days a week, to a total dose of 60-70 Gy with a fraction dose of 2 or 2.5 Gy. Radiotherapy is an effective treatment modality in elderly T1 glottic cancer patients. Diabetes as comorbidity, underweight, and conventional dose fractionation decrease the probability of curative effect of radiotherapy in this group of patients, while high number of comorbidities diminishes the probability of long-term survival.
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Affiliation(s)
- Anna Mucha-Małecka
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland.
| | - Krzysztof Małecki
- Department of Radiotherapy for Children and Adults, University Children's Hospital of Cracow, Wielicka 265, 30-663, Cracow, Poland
- Faculty of Health Sciences, Jagiellonian University in Cracow, Michałowskiego 12, 31-126, Cracow, Poland
| | - Natalia Amrogowicz
- 1St Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Beata Biesaga
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland
- Department of Tumour Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
| | - Maciej Modrzejewski
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
- Department of Otolaryngology, Head and Neck Surgery, 5th Military Hospital with Polyclinic, Wroclawska 1-3, 30-901, Cracow, Poland
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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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Feghali KAA, Youssef BY, Mohamed AS, Hilal L, Smith BD, Abu-Gheida I, Farha G, Gunn GB, Phan J, Lewin J, Thekdi A, Morrison WH, Garden AS, Fuller CD, Rosenthal DI. Outcomes after radiation therapy for T2N0/stage II glottic squamous cell carcinoma. Head Neck 2020; 42:2791-2800. [PMID: 32484591 PMCID: PMC7686276 DOI: 10.1002/hed.26308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/27/2020] [Accepted: 05/15/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND We report outcomes for patients with T2N0M0 glottic squamous cell carcinoma (SCC) treated with radiation therapy (RT). METHODS Patients who received definitive RT for T2 glottic SCC from 2000 through 2013 were retrospectively reviewed. RESULTS One hundred and thirteen patients were analyzed (median follow-up time 91 months; 85 patients received three-dimensional conformal radiotherapy [3D-CRT] and 28 received intensity-modulated radiation therapy [IMRT]). Fractionation was conventional (58%) or altered (42%); 20 patients (18%) received concurrent chemotherapy. Five-year local control was 83% for the 3D-CRT vs 81% for the IMRT group (P = .76). The ultimate locoregional control at 5 years was 100% for IMRT vs 91% for 3D-CRT (P = .1). The 5-year overall survival (OS) was 78% for 3D-CRT vs 81% for IMRT (P = .83). On multivariate analysis, younger age was the only independent predictor of improved OS (P = .0002). CONCLUSIONS Oncologic and survival outcomes were excellent for patients with T2N0 glottic cancer. Patients treated with IMRT and 3D-CRT had no statistically significant differences in all investigated endpoints.
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Affiliation(s)
- Karine A. Al Feghali
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bassem Y. Youssef
- Department of Radiation Oncology, American University of Beirut, Beirut, Lebanon
| | - Abdallah S.R. Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lara Hilal
- Department of Radiation Oncology, American University of Beirut, Beirut, Lebanon
| | - Blaine D. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ibrahim Abu-Gheida
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Georges Farha
- Department of Radiation Oncology, St George Hospital University Medical Center, Beirut, Lebanon
| | - G. Brandon Gunn
- Department of Radiation Oncology, American University of Beirut, Beirut, Lebanon
| | - Jack Phan
- Department of Radiation Oncology, American University of Beirut, Beirut, Lebanon
| | - Jan Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Apurva Thekdi
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - William H Morrison
- Department of Radiation Oncology, American University of Beirut, Beirut, Lebanon
| | - Adam S. Garden
- Department of Radiation Oncology, American University of Beirut, Beirut, Lebanon
| | - C. David Fuller
- Department of Radiation Oncology, American University of Beirut, Beirut, Lebanon
| | - David I. Rosenthal
- Department of Radiation Oncology, American University of Beirut, Beirut, Lebanon
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Shen J, Hu K, Ma J, Zhen H, Guan H, Wang W, Zhang F. Clinical analysis of EBRT vs TLM in the treatment of early (T1-T2N0) glottic laryngeal cancer. J Cancer 2020; 11:6686-6694. [PMID: 33046989 PMCID: PMC7545664 DOI: 10.7150/jca.46487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022] Open
Abstract
Objective: To analyze the clinical efficacy of external beam radiation therapy (EBRT) vs transoral laser microsurgery (TLM) in patients with early glottic laryngeal carcinoma (T1-T2N0) and the effect of treatment choice on vocal function. Methods: A retrospective analysis of patients with T1-T2N0 glottic laryngeal carcinoma who underwent EBRT or TLM between January 2012 and December 2018 in PUMCH. The Kaplan-Meier method was used to analyze local control, progression-free survival and overall survival, and the VHI-30 scale was used to evaluate the effects of EBRT and TLM on vocal function. Results: A total of 185 patients, all with pathologically confirmed squamous cell carcinoma, were enrolled. The median age was 62 years (38-88). N0 disease was confirmed by imaging: 142/185 (76.76%) patients had T1N0 disease, and 43/185 patients (23.24%) had T2/N0 disease. A total of 91/195 (49.19%) patients received an EBRT dose of 66-70 Gy/30-35f, at 2.0-2.3 Gy/f. 94/185 (50.81%) patients received TLM. The median follow-up time was 42 months (12-92), and the 3-year LC, PFS, and OS rates for the EBRT and TLM groups were 96.9% vs 94.1%(p=0.750), 95.3% vs 93.1%(p=0.993) and 93.3% vs 95.4%(p=0.467), respectively. The VHI-30 scales were used at the baseline showed no significant difference between the two groups 19.20±3.324 vs 21.65±9.80 (p=0.250), but the EBRT group had a low voice handicap after treatment, 10.24±6.093 vs 19.45±5.112 (p=0.001) (6 months) and 9.45±5.112 vs 14.97±7.741 (12 months). No CTCAE grade 3 or above side effects were observed in the EBRT group, but 3 cases of vocal cord stenosis were observed in the TLM group. Conclusion: The application of EBRT for early glottic laryngeal carcinoma (T1-T2N0) had an obvious curative effect with high LC and OS rates, no serious side effects, and a low voice handicap rate.
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Affiliation(s)
- Jing Shen
- Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, People's Republic of China
| | - Ke Hu
- Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, People's Republic of China
| | - Jiabin Ma
- Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, People's Republic of China
| | - Hongnan Zhen
- Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, People's Republic of China
| | - Hui Guan
- Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, People's Republic of China
| | - Wenhui Wang
- Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, People's Republic of China
| | - Fuquan Zhang
- Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, People's Republic of China
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Kim KN, Dyer MA, Qureshi MM, Shah NK, Grillone GA, Faden DL, Jalisi SM, Truong MT. Hypofractionated radiotherapy and surgery compared to standard radiotherapy in early glottic cancer. Am J Otolaryngol 2020; 41:102544. [PMID: 32505989 DOI: 10.1016/j.amjoto.2020.102544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Early-stage glottic laryngeal cancer is treated with surgery or radiotherapy (RT), but limited randomized data exists to support one modality over the other. This study evaluates survival differences in early glottic cancer patients treated with either surgery or RT. MATERIALS AND METHODS 14,498 patients with early glottic cancer diagnosed from 2004 to 2015 and treated with surgery or RT were identified in the National Cancer Database. Kaplan-Meier method was used to analyze differences in overall survival (OS) by treatment (surgery vs. RT) and radiation dose fractionation. Cox regression modeling and propensity score-matched (PSM) analysis were performed. Adjusted hazard ratios (aHR) with 95% confidence intervals (95% CI) were computed. RESULTS Median follow-up and median OS for all patients were 49.5 and 118 months, respectively. The estimated 5-year OS for surgery and RT was 77.5% and 72.6%, respectively (P < 0.0001). On multivariate analysis, aHR (95% CI) for surgery compared to RT was 0.87 (0.81-0.94, P = 0.0004). Compared to RT regimen 63-67.5 Gray (Gy) in 28-30 fractions, worse survival was noted for RT regimen 66-70 Gy in 33-35 fractions (aHR 1.15, 95% CI 1.07-1.23, P = 0.0003). When compared with hypofractionated RT (63-67.5 Gy in 28-30 fractions), patients undergoing surgery no longer showed improved OS (aHR 0.94, 95% CI 0.86-1.02, P = 0.154). The finding was confirmed on PSM analysis (surgery aHR 0.95, 95% CI 0.87-1.05, P = 0.322). CONCLUSION In early glottic tumors, patients treated with surgery demonstrated improved survival compared to RT, but when hypofractionation was considered, there were no significant differences in OS between patients undergoing surgery or RT.
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10
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Mohamed ASR, Smith BD, Smith JB, Sevak P, Malek JS, Kanwar A, Browne T, Gunn GB, Garden AS, Frank SJ, Morrison WH, Phan J, Zafereo M, Skinner H, Lai SY, Hutcheson KA, Lewin JS, Hessel AE, Thekdi AA, Weber RS, Fuller CD, Rosenthal DI. Outcomes of carotid-sparing IMRT for T1 glottic cancer: Comparison with conventional radiation. Laryngoscope 2020; 130:146-153. [PMID: 30756394 PMCID: PMC6895404 DOI: 10.1002/lary.27873] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/19/2019] [Accepted: 01/28/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We aim to report oncologic outcomes after conventional radiotherapy (ConRT) using opposed lateral beams and intensity-modulated radiation therapy (IMRT) for tumor (T)1 nodal (N)0 T1 N0 glottic squamous cell carcinoma. STUDY DESIGN Retrospective case-control study. METHODS We retrospectively reviewed demographic, disease, and treatment characteristics for patients treated at our institution during 2000 to 2013. RESULTS One hundred fifty-three patients (71%) were treated using ConRT and 62 (29%) using IMRT. The median follow-up for all patients was 68 months. There was no statistically significant difference in 5-year local control between patients with T1a versus T1b disease (94% vs. 89%, respectively, P = 0.5). Three-year locoregional control for patients treated with ConRT was 94% compared to 97% with IMRT (P = 0.4). Three-year overall survival (OS) for patients treated with ConRT was 92.5% compared with 100% with IMRT (P = 0.1). Twelve of 14 patients with local recurrence underwent salvage surgery with 5-year ultimate locoregional control of 98.5% and 97.1% in the ConRT and IMRT cohorts, respectively (P = 0.7). Multivariate analysis showed age < 60 years (P < 0.0001) and pretreatment Eastern Cooperative Oncology Group performance status <2 (P = 0.0022) to be independent correlates of improved OS. Postradiation cerebrovascular events were in four patients in the ConRT cohort (3%), whereas no patients in the IMRT cohort suffered any events. CONCLUSION Because the oncologic outcomes for patients treated with IMRT were excellent and IMRT allows for carotid sparing, we have transitioned to IMRT as our standard for most patients with T1 glottic cancer. LEVEL OF EVIDENCE 3b Laryngoscope, 130:146-153, 2020.
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Affiliation(s)
- Abdallah S R Mohamed
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
- Department of Clinical Oncology, University of Alexandria, Alexandria, Egypt
| | - Blaine D Smith
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
- University of Texas McGovern Medical School, The University of Texas Graduate School of Biomedical Sciences, Houston, Texas, U.S.A
| | - Joshua B Smith
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
- University of Texas McGovern Medical School, The University of Texas Graduate School of Biomedical Sciences, Houston, Texas, U.S.A
| | | | | | | | | | - G Brandon Gunn
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Adam S Garden
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Steven J Frank
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - William H Morrison
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Jack Phan
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Heath Skinner
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Amy E Hessel
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Apurva A Thekdi
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Clifton D Fuller
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
- Medical Physics Program, The University of Texas Graduate School of Biomedical Sciences, Houston, Texas, U.S.A
| | - David I Rosenthal
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
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11
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Lee JW, Lee JE, Park J, Sohn JH, Ahn D. Hypofractionated radiotherapy for early glottic cancer: a retrospective interim analysis of a single institution. Radiat Oncol J 2019; 37:82-90. [PMID: 31266289 PMCID: PMC6610011 DOI: 10.3857/roj.2019.00143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/17/2019] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To evaluate the results of hypofractionated radiotherapy (HFX) for early glottic cancer. MATERIALS AND METHODS Eighty-five patients with cT1-2N0M0 squamous cell carcinoma of the glottis who had undergone HFX, performed using intensity-modulated radiotherapy (IMRT, n = 66) and three-dimensional conformal radiotherapy (3D CRT, n = 19) were analyzed. For all patients, radiotherapy was administered at 60.75 Gy in 27 fractions. Forty-three patients received a simultaneous integrated boost (SIB) of 2.3-2.5 Gy per tumor fraction. RESULTS The median follow-up duration was 29.9 months (range, 5.5 to 76.5 months). All patients achieved complete remission at a median of 50 days after the end of radiotherapy (range, 14 to 206 days). The 5-year rates for locoregional recurrence-free survival was 88.1%, and the 5-year overall survival rate was 86.2%. T2 stage was a prognostic factor for locoregional recurrencefree survival after radiotherapy (p = 0.002). SIB for the tumor did not affect disease control and survival (p = 0.191 and p = 0.387, respectively). No patients experienced acute or chronic toxicities of ≥grade 3. IMRT significantly decreased the dose administered to the carotid artery as opposed to 3D CRT (V35, p < 0.001; V50, p < 0.001). Conclusions Patients treated with HFX achieved acceptable locoregional disease control rates and overall survival rates compared with previous HFX studies. A fraction size of 2.25 Gy provided good disease control regardless of SIB administration.
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Affiliation(s)
- Jeong Won Lee
- Department of Radiation Oncology, Catholic University of Daegu, School of Medicine, Daegu, Korea
| | - Jeong Eun Lee
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Junhee Park
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Ho Sohn
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dongbin Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Outcomes of transoral laser microsurgical management of T1b stage glottic cancer. The Journal of Laryngology & Otology 2017; 131:433-441. [DOI: 10.1017/s0022215117000329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:This study aimed to evaluate the oncological and voice outcomes of transoral laser microsurgery for tumour stage T1b stage glottic cancer patients.Methods:A prospective cohort study in a tertiary care head and neck cancer centre included tumour–node–metastasis stage T1bN0M0 glottic cancer patients scheduled to undergo transoral laser microsurgery from January 2002 until June 2014. Kaplan–Meier five-year analyses of local control, overall survival, disease-specific survival and laryngeal preservation were performed. Voice Handicap Index-10 scores and maximum phonation times were also recorded.Results:Twenty-one participants with a mean age of 66.8 years were enrolled. The mean follow up was 56.5 months. Kaplan–Meier 5-year survival analysis illustrated a local control rate of 82 per cent, overall survival of 88 per cent, disease-specific survival of 100 per cent, and laryngeal preservation of 100 per cent. The pre-operative Voice Handicap Index-10 score was 19.1 ± 9.47 (mean ± standard deviation (SD)) and the post-operative scores were 13.5 ± 9.29 at three months, 10.44 ± 9.70 at one year and 5.83 ± 4.91 at two years. The pre-operative maximum phonation time was 16.23 ± 5.46 seconds (mean ± SD) and the post-operative values were 14.44 ± 6.73 seconds at three months, 15.27 ± 5.71 seconds at one year and 14.33 ± 6.44 seconds at two years.Conclusion:Transoral laser microsurgery yields relatively high rates of oncological control and acceptable voice outcomes, and thus shows utility as a primary treatment modality for T1b glottic cancer.
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13
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Szutkowski Z, Kawecki A, Jarząbski A, Laskus Z, Krajewski R, Michalski W, Kukołowicz P. Hypofractionated accelerated radiotherapy in T1-3 N0 cancer of the larynx: A prospective cohort study with historical controls. Rep Pract Oncol Radiother 2016; 21:537-543. [PMID: 27698593 DOI: 10.1016/j.rpor.2016.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 05/27/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022] Open
Abstract
AIM The goal of this prospective study was to assess the effectiveness of a hypofractionated accelerated regime in treatment of the larynx cancer. BACKGROUND Multiple radiotherapy delivery regimes are used for treatment of the larynx cancer. Hypofractionated regimes could provide similar results with reduced use of radiotherapy facilities. MATERIAL AND METHODS 223 patients with squamous cell carcinoma of the upper or middle larynx have been treated with 63 Gy delivered in 28 fractions of 2.25 Gy during 38 days, 5 fractions per week. The study endpoints were overall survival, progression-free survival, early and late treatment toxicity. Standard and accelerated radiotherapy groups from the study published by Hliniak et al.20 served as controls. RESULTS Five-year actuarial overall survival was 87.5% in the study group, 84.5% in the control group receiving accelerated radiotherapy (33 fractions of 2.0 Gy, 6 fractions per week) and 86.2% in the control group (33 fractions of 2.0 Gy, 5 fractions per week). Five-year progression-free survival was 73.6%, 77.2% and 66.2%, respectively. Overall, treatment toxicity and complication rates did not differ between the study group and the control groups. CONCLUSIONS The hypofractionated accelerated radiotherapy protocol using 5 fractions per week reduced the use of radiotherapy facilities. There was no significant difference in overall survival and progression-free survival between the study and control groups treated with accelerated or standard radiotherapy.
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Affiliation(s)
- Zbigniew Szutkowski
- Head and Neck Cancer Department, Cancer Center - M. Curie-Sklodowska Memorial Institute, ul. Roentgena 5, 02-781 Warsaw, Poland
| | - Andrzej Kawecki
- Head and Neck Cancer Department, Cancer Center - M. Curie-Sklodowska Memorial Institute, ul. Roentgena 5, 02-781 Warsaw, Poland
| | - Andrzej Jarząbski
- Head and Neck Cancer Department, Cancer Center - M. Curie-Sklodowska Memorial Institute, ul. Roentgena 5, 02-781 Warsaw, Poland
| | - Zofia Laskus
- Head and Neck Cancer Department, Cancer Center - M. Curie-Sklodowska Memorial Institute, ul. Roentgena 5, 02-781 Warsaw, Poland
| | - Romuald Krajewski
- Head and Neck Cancer Department, Cancer Center - M. Curie-Sklodowska Memorial Institute, ul. Roentgena 5, 02-781 Warsaw, Poland
| | - Wojciech Michalski
- Department of Biostatistics, Cancer Center - M. Curie-Sklodowska Memorial Institute, ul. Roentgena 5, 02-781 Warsaw, Poland
| | - Paweł Kukołowicz
- Medical Physics Department, Cancer Center - M. Curie-Sklodowska Memorial Institute, ul. Roentgena 5, 02-781 Warsaw, Poland
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14
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Tao Y, Ma C, Yin X, Fang X, Liu L. Therapeutic effects of sequential chemoradiotherapy with pemetrexed and cisplatin on locally advanced laryngeal cancer. Pak J Med Sci 2016; 32:1126-1130. [PMID: 27882007 PMCID: PMC5103119 DOI: 10.12669/pjms.325.10640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective: To explore the therapeutic effects of sequential chemoradiotherapy with pemetrexed and cisplatin on locally advanced laryngeal cancer (LALC). Methods: Fifty LALC patients who were treated in our hospital between January 2010 and January 2012 were selected and randomly divided into an observation group and a control group (n=25). The two groups were given conventional radiotherapy in the same manner, before which two cycles of chemotherapy were performed. The observation group intravenously infused with 500 mg/m2 pemetrexed on d1 and 25 mg/m2 cisplatin on d1-3, with 28 days as a cycle. The control group was intravenously infused with 25 mg/m2 cisplatin on d1-3 and 400 mg/m2 fluorouracil, with 28 days as a cycle. The short-term effects and adverse reactions of both groups were observed after treatment, and their survival was observed by follow-up for five years. Results: The response rate was 84% (21/25) in the observation group and 64% (16/25) in the control group, between which the difference was statistically significant (P<0.05). The differences in the incidence rates of short-term adverse reactions such as grade III-IV gastrointestinal reactions and bone marrow suppression were not statistically significant between PC regimen (pemetrexed combined with cisplatin) and PF regimen (cisplatin combined with fluorouracil) (P>0.05). The incidence of long-term adverse reactions such as grade III-IV laryngeal edemas, laryngeal cartilage inflammation and laryngeal cartilage necrosis showed no significant differences between the two groups (P>0.05). The median survival was 3.3 years after PC chemotherapy and 2.8 years after PF chemotherapy, between which the difference was not statistically significant (P>0.05). The levels of serum tumor markers significantly decreased after PC and PF treatments compared with those before (P<0.05). Conclusion: Combining PC chemotherapy with radiotherapy has satisfactory short-term therapeutic effects on LALC, and the resulting adverse effects can be tolerated. Therefore, this strategy is worthy of promotion and application in clinical practice.
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Affiliation(s)
- Youmao Tao
- Youmao Tao, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Chong Ma
- Chong Ma, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Xiangdang Yin
- Xiangdang Yin, Jilin Cancer Hospital, Changchun 130001, China
| | - Xuedong Fang
- Xuedong Fang, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Lixiu Liu
- Lixiu Liu, China-Japan Union Hospital, Jilin University, Changchun 130033, China
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15
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Tamaki Y, Hieda Y, Yoshida R, Yoshizako T, Fuchiwaki T, Aoi N, Sekihara K, Kitajima K, Kawauchi H, Kitagaki H, Sasaki R, Inomata T. Short treatment time and excellent treatment outcome in accelerated hyperfractionated radiotherapy for T1 glottic cancer. NAGOYA JOURNAL OF MEDICAL SCIENCE 2015; 77:585-94. [PMID: 26663937 PMCID: PMC4664590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/25/2015] [Indexed: 11/13/2022]
Abstract
Accelerated hyperfractionated radiotherapy was performed as treatment for patients with T1 glottic cancer, and its utility was evaluated based on treatment outcomes and adverse effects. Fifty-eight men who had undergone radiotherapy were retrospectively reviewed. Tumor classification was Tis in 4 patients, T1a in 38, and T1b in 16. Histological examination revealed squamous cell carcinoma in 55 patients. Travel time from home to hospital was 0-1 hour for 24 patients, 1-2 hours for 9, and >2 hours for 25. Laser vaporization was performed prior to radiotherapy in 38 patients, and 19 patients received concurrent chemotherapy with an agent such as S-1. Patients were irradiated twice daily using an irradiation container. Most patients received a dose of 1.5 Gy/fraction up to a total of 60 Gy. The median overall treatment time was 30 days, with a median observation period of 59.6 months. A complete response was observed in all patients. The 5-year overall survival, disease-free survival, and local control rates were 97.2%, 93.2%, and 97.8%, respectively. Although grade 3 pharyngeal mucositis was observed in 2 patients, there were no other grade 3 or higher acute adverse events. As late toxicity, grade 2 laryngeal edema and grade 1 laryngeal hemorrhage were observed in 1 patient each, but no serious events such as laryngeal necrosis or laryngeal stenosis were observed. In conclusion, this treatment method brings excellent outcome and will substantially reduce the treatment duration among patients who need to stay at nearby hotels while undergoing treatment at hospitals in rural areas.
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Affiliation(s)
- Yukihisa Tamaki
- Department of Radiation Oncology, Shimane University School of Medicine, Izumo, Japan
| | - Yoko Hieda
- Department of Radiation Oncology, Shimane University School of Medicine, Izumo, Japan
| | - Rika Yoshida
- Department of Radiology, Shimane University School of Medicine, Izumo, Japan
| | - Takeshi Yoshizako
- Department of Radiology, Shimane University School of Medicine, Izumo, Japan
| | - Takafumi Fuchiwaki
- Department of Otorhinolaryngology, Shimane University School of Medicine, Izumo, Japan
| | - Noriaki Aoi
- Department of Otorhinolaryngology, Shimane University School of Medicine, Izumo, Japan
| | - Kazumasa Sekihara
- Department of Genetics, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Kazuhiro Kitajima
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideyuki Kawauchi
- Department of Otorhinolaryngology, Shimane University School of Medicine, Izumo, Japan
| | - Hajime Kitagaki
- Department of Radiology, Shimane University School of Medicine, Izumo, Japan
| | - Ryohei Sasaki
- Department of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Taisuke Inomata
- Department of Radiation Oncology, Shimane University School of Medicine, Izumo, Japan
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Ermiş E, Teo M, Dyker KE, Fosker C, Sen M, Prestwich RJ. Definitive hypofractionated radiotherapy for early glottic carcinoma: experience of 55Gy in 20 fractions. Radiat Oncol 2015; 10:203. [PMID: 26395876 PMCID: PMC4580345 DOI: 10.1186/s13014-015-0505-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/10/2015] [Indexed: 12/05/2022] Open
Abstract
Introduction A wide variety of fractionation schedules have been employed for the treatment of early glottic cancer. The aim is to report our 10-year experience of using hypofractionated radiotherapy with 55Gy in 20 fractions at 2.75Gy per fraction. Methods Patients treated between 2004 and 2013 with definitive radiotherapy to a dose of 55Gy in 20 fractions over 4 weeks for T1/2 N0 squamous cell carcinoma of the glottis were retrospectively identified. Patients with prior therapeutic minor surgery (eg. laser stripping, cordotomy) were included. The probabilities of local control, ultimate local control (including salvage surgery), regional control, cause specific survival (CSS) and overall survival (OS) were calculated. Results One hundred thirty-two patients were identified. Median age was 65 years (range 33–89). Median follow up was 72 months (range 7–124). 50 (38 %), 18 (14 %) and 64 (48 %) of patients had T1a, T1b and T2 disease respectively. Five year local control and ultimate local control rates were: overall - 85.6 % and 97.3 % respectively, T1a - 91.8 % and 100 %, T1b - 81.6 and 93.8 %, and T2 - 80.9 % and 95.8 %. Five year regional control, CSS and OS rates were 95.4 %, 95.7 % and 78.8 % respectively. There were no significant associations of covariates (e.g. T-stage, extent of laryngeal extension, histological grade) with local control on univariate analysis. Only increasing age and transglottic extension in T2 disease were significantly associated with overall survival (both p <0.01). Second primary cancers developed in 17 % of patients. 13 (9.8 %) of patients required enteral tube feeding support during radiotherapy; no patients required long term enteral nutrition. One patient required a tracheostomy due to a non-functioning larynx on long term follow up. Conclusions Hypofractionated radiation therapy with a dose of 55Gy in 20 fractions for early stage glottic cancer provides high rates of local control with acceptable toxicity.
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Affiliation(s)
- Ekin Ermiş
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Mark Teo
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Karen E Dyker
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Chris Fosker
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Mehmet Sen
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Robin Jd Prestwich
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK.
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17
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Lim YJ, Wu HG, Kwon TK, Hah JH, Sung MW, Kim KH, Park CI. Long-Term Outcome of Definitive Radiotherapy for Early Glottic Cancer: Prognostic Factors and Patterns of Local Failure. Cancer Res Treat 2015; 47:862-70. [PMID: 25687859 PMCID: PMC4614182 DOI: 10.4143/crt.2014.203] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 08/21/2014] [Indexed: 11/24/2022] Open
Abstract
Purpose This study evaluates the long-term results of definitive radiotherapy (RT) for early glottic cancer. Clinical and treatment factors related to local control and patterns of failure are analyzed. Materials and Methods We retrospectively reviewed 222 patients with T1-2N0 squamous cell carcinoma of the glottic larynx treated with definitive RT from 1981 to 2010. None of the patients received elective nodal RT or combined chemotherapy. The median total RT dose was 66 Gy. The daily fraction size was < 2.5 Gy in 69% and 2.5 Gy in 31% of patients. The RT field extended from the hyoid bone to the cricoid cartilage. Results The median age was 60 years, and 155 patients (70%) had T1 disease. The 5-year rates of local recurrence-free survival (LRFS) and ultimate LRFS with voice preservation were 87.8% and 90.3%, respectively. T2 (hazard ratio [HR], 2.30; 95% confidence interval [CI], 1.08 to 4.94) and anterior commissural involvement (HR, 3.37; 95% CI, 1.62 to 7.02) were significant prognostic factors for LRFS. In 34 patients with local recurrence, tumors recurred in the ipsilateral vocal cord in 28 patients. There were no contralateral vocal cord recurrences. Most acute complications included grade 1-2 dysphagia and/or hoarseness. There was no grade 3 or greater chronic toxicity. Conclusion Definitive RT achieved a high cure rate, voice preservation, and tolerable toxicity in early glottic cancer. T2 stage and anterior commissural involvement were prognostic factors for local control. Further optimization of the RT method is needed to reduce the risk of ipsilateral tumor recurrence.
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Affiliation(s)
- Yu Jin Lim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institution, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - J Hun Hah
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Whun Sung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang Hyun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Charn Il Park
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
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18
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[Long-term results and cause of failure analysis in larynx cancer patients irradiated conventionally and with accelerated fractionation schedules in 1995-1998]. Otolaryngol Pol 2014; 68:320-7. [PMID: 25441938 DOI: 10.1016/j.otpol.2014.05.002] [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: 03/21/2014] [Revised: 04/29/2014] [Accepted: 05/21/2014] [Indexed: 11/22/2022]
Abstract
The clinical material consists of 217 patients with squamous cell carcinoma in supraglottic and glottic larynx in clinical stage T1-3N0M0 irradiated radically in Warsaw Oncology Centre in 1995-1998. All patients were treated with Co-60, according to two schedules of fractionation, with maintenance of the consistent therapeutic protocol. The same team of doctors worked on the treatment of patients and on the follow-up as well. The clinical material is a part of a three-phased clinical trial KBN 0295. In the course of observation, the progression of cancer was not observed in 157 patients, among whom, 66% were treated conventionally and 79% with accelerated fractionation method. 60 cases of loco-regional recurrences were noted, among which 55 were regional. The majority of failure cases was observed until the 30(th) of the month after the radiotherapy ended. In conventional fractionation treatment, recurrences in T1 were 8/31 (26%), in T2 22/59 (37%) and in T3 8/20 (40%). In patients treated with AF, recurrences were T1 5/39 (13%), T2 15/55 (27%) and T3 2/13 (15%) respectively. The percentage of primary site tumour recurrences for each localization and kind of treatment was analysed. In CF 28/78 (37%) of glottic tumour recurrences and 10/34 (29%) of supraglottic tumour, recurrences were observed. In AF, 12/71 (17%) and 10/36 (28%) were observed respectively. In 48 cases salvage surgery was used, and 12 patients were not qualified because of tumour massive progression or because they refused to have a surgery. Among 34 cases (16%) of the second primary tumour or distant methastases, 25 were observed with glottic cancer, among which 23 were observed in early stages, and 9 cases with supraglottic cancer, among which, 6 showed early stage of tumour. In only 3 cases out of all the patients, distant methastases were confirmed in histopatology examination. The main cause of failure in larynx cancer patients in stage T1 is that 3N0M0 are local recurrences. Second primary or distant methastases constitute 16% of the patients in this paper.
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