Outcome of Early-Stage Glottic Laryngeal Carcinoma Patients Treated with Radical Radiotherapy Using Different Techniques

Purpose. The aim was to evaluate the treatment outcomes and prognostic characteristics of patients with early-stage glottic laryngeal carcinoma who underwent radical radiotherapy (RT) with different techniques. Patients and Methods. Radiotherapy was applied using the 2D conventional technique between 1991 and 2004 (130 patients), 3DCRT until 2014 (125 patients), and by VMAT until January 2017 (44 patients). Clinical T stages were 38 (12.7%) for Tis, 209 (69.9%) for T1, and 52 (17.4%) for T2. Radiotherapy technique and energy, anterior commissure involvement, and stage were analyzed as prognostic factors. Results. The median total dose was 66 (50–70) Gy, and median follow-up time was 72 (3–288) months; 5-year disease-specific survival (DSS) rates were 95.8%, 95.5%, and 88.6%, respectively, in Tis, T1, and T2 stages. In multivariate analyses, anterior commissure involvement was found significant for all survival and local control rates. The patients treated with VMAT technique had better local control and DSS rates. However, these results were not statistically significant. Conclusion. In early-stage laryngeal carcinomas, radical RT is a function sparing and effective treatment modality, regardless of treatment techniques.

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Decreased Local Control Following Radiation Therapy Alone in Early-Stage Glottic Carcinoma with Anterior Commissure Extension*

Strahlentherapie und Onkologie ◽

10.1007/s00066-004-1164-y ◽

2004 ◽

Vol 180 (2) ◽

pp. 84-90 ◽

Cited By ~ 32

Author(s):

Abderrahim Zouhair ◽

David Azria ◽

Philippe Coucke ◽

Oscar Matzinger ◽

Luc Bron ◽

...

Keyword(s):

Radiation Therapy ◽

Local Control ◽

Early Stage ◽

Anterior Commissure ◽

Glottic Carcinoma

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T1b Glottic Tumor and Anterior Commissure Involvement: Is the Transoral CO2 Laser Microsurgery a Safe Option?

Ear Nose & Throat Journal ◽

10.1177/0145561320937238 ◽

2020 ◽

Vol 100 (1_suppl) ◽

pp. 68S-72S

Author(s):

Juan Antonio Cabrera-Sarmiento ◽

Juan Carlos Vázquez-Barro ◽

Jesús Herranz González-Botas ◽

Carlos Chiesa-Estomba ◽

Miguel Mayo-Yáñez

Keyword(s):

Laser Therapy ◽

Local Control ◽

Organ Preservation ◽

Randomized Trials ◽

Early Stage ◽

Anterior Commissure ◽

Local Recurrences ◽

Laryngeal Tumors

Objectives: Transoral CO2 laser therapy represents the treatment of choice for early-stage laryngeal tumors. The anterior commissure involvement (ACI) is related to a worse local control and a lower rates of organ preservation. The objective of this study is to analyze the differences in survival, local control, and organ preservation in T1b glottic patients according to the presence of ACI. Methods: Observational prospective study in pT1b treated with transoral CO2 laser between 2009 and 2014. Results: Forty patients (37 male and 3 female) with a mean age of 66.43 ± 8.16 years were recruited. Anterior commissure involvement was present in 70% of the patients. The 5-year specific cause survival was 91.66%, with 32.50% of local recurrences. Laryngeal preservation was 80%, being lower in the group with local recurrence ( P < .000). The involvement of the anterior commissure does not influence the organ preservation ( P = .548), the appearance of local recurrences ( P = .391), or the survival ( P = .33). Conclusions: Transoral CO2 laser therapy is an effective and reproducible treatment for early-stage laryngeal tumors. The results obtained are similar to previous studies, although they present discrepancies in relation to the role of the ACI. Prospective randomized trials are required focusing also on the patients’ quality of life and functional outcome in order to clarify the role of the ACI and the need to implement changes in its evaluation, staging, and evolution.

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Ứng dụng nội soi dải ánh sáng hẹp kết hợp nội soi vi phẫu bằng laser CO2 trong chẩn đoán và điều trị ung thư hạ họng, thanh quản giai đoạn sớm

Journal of Clinical Medicine- Hue Central Hospital ◽

10.38103/jcmhch.2021.74.17 ◽

2021 ◽

Author(s):

Phuong Nam Tran

Keyword(s):

Co2 Laser ◽

Laryngeal Carcinoma ◽

Narrow Band ◽

Narrow Band Imaging ◽

Early Stage ◽

Anterior Commissure ◽

Tumor Control ◽

Post Surgery ◽

Endoscopic Microsurgery ◽

Type V

TÓM TẮT Mục tiêu: Đánh giá kết quả ứng dụng nội soi dải ánh sáng hẹp kết hợp nội soi vi phẫu bằng Laser CO2 trong chẩn đoán và điều trị ung thư hạ họng và ung thư thanh quản giai đoạn sớm. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, có can thiệp lâm sàng trên 18 bệnh nhân ung thư hạ họng, ung thư thanh quản ở giai đoạn sớm, được phát hiện tổn thương ác tính bằng nội soi dải ánh sáng hẹp, điều trị phẫu thuật nội soi vi phẫu bằng Laser CO2. Kết quả: Tuổi trung bình mắc bệnh là 63,8 ± 12,6; bệnh nhân có hút thuốc lá chiếm 61,1%; triệu chứng khàn tiếng chiếm 72%, ung thư giai đoạn T1a có tỷ lệ 72,2%; IPCL type V-1 là 72,2%; khả năng kiểm soát bờ rìa là 83,3%, không có tai biến trong phẫu thuật 17/18 trường hợp và di chứng sau phẫu thuật tháng thứ 1 là tăng sinh mô hạt (77,8%), tháng thứ 3 là dính mép trước dây thanh (27,8%). Kết luận: Nội soi dải ánh sáng hẹp có giá trị phát hiện sớm ung thư hạ họng, ung thư thanh quản. Phẫu thuật nội soi vi phẫu bằng Laser CO2 ung thư hạ họng, ung thư thanh quản ở giai đoạn sớm mang lại kết quả tốt, tỷ lệ tai biến và biến chứng sau phẫu thuật thấp, bảo tồn được tối đa chức năng phát âm, hô hấp và nuốt. ABSTRACT UTILITY OF NARROW - BAND IMAGING ENDOSCOPY COMBINED WITH CO2 LASER ENDOSCOPIC MICROSURGERY IN DIAGNOSIS AND TREATMENT OF EARLYSTAGE HYPOPHARYNGEAL AND LARYNGEAL CARCINOMA Objective: To evaluate the results of applying narrow band imaging endoscopy combined with CO2 laser endoscopic microsurgery to diagnose and treat early stage hypopharyngeal and laryngeal carcinoma. Methods: A prospective study was conducted on 18 patients with early stage hypopharyngeal and laryngeal carcinoma. Results: The mean age was 63.8 ± 12.6; smoker was 61.1%, the rate of hoarseness was 72%, T1a tumor stage was 72.2%, IPCL type V-1 was 72,2%, marginal tumor control was 83.3%. There were of 17/18 case with no complication during operation. The rate of extensive granuloma was 77.8% in the first month, and of anterior commissure adhesion was 27.8% in the third month post - surgery. Conclusion: Narrow band imaging endoscopy was a valuable tool in screening for early stage hypopharyngeal and laryngeal carcinoma. CO2 laser endoscopic microsurgery was an effective method. The rate of complication during and after surgery was low. This method restores the maximum function of speech, breathing and swallowing. Keywords: Early - stage pharyngeal cancer, early - stage laryngeal cancer, narrow - band imaging endoscopy, CO2 laser endoscopic microsurgery.

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Radiotherapy of Early-Stage Glottic Cancer: Analysis of Factors Affecting Prognosis

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940311201014 ◽

2003 ◽

Vol 112 (10) ◽

pp. 904-911 ◽

Cited By ~ 29

Author(s):

Miao-Fen Chen ◽

Joseph Tung-Chieh Chang ◽

Chun-Ta Liao ◽

Ngan-Ming Tsang ◽

Wen-Cheng Chen

Keyword(s):

Local Control ◽

Negative Impact ◽

Early Stage ◽

Anterior Commissure ◽

Treatment Strategies ◽

Glottic Cancer ◽

Larynx Preservation ◽

Poor Outcome ◽

Fraction Size ◽

Subglottic Extension

This study is a retrospective analysis of 134 patients treated with radiotherapy at our hospital. The sample included 88 stage T1 and 46 stage T2 patients. Sixty-two patients had anterior commissure involvement, 37 patients had impaired vocal cord mobility, and 24 patients had supraglottic or subglottic extension. Irradiation was given, with the dose ranging from 60 to 72 Gy. Laryngectomy was the main salvage treatment for local recurrence. The 5-year initial and final local control rates were 71% and 83%, and the 10-year initial and final local control rates were 69% and 80%, comparable to the results of other series. The 5-year rate of overall survival with final larynx preservation was 77%. Multivariate analysis revealed that anterior commissure involvement is prognostic of a poor outcome in patients with T1 glottic cancer. Further subgroup analysis revealed that a fraction size of >200 cGy could overcome the negative impact of anterior commissure involvement and significantly improve the 5-year local control rate in T1 patients (100% at >200 cGy versus 45% at ≤200 cGy; p = .04). Subglottic extension of the glottic cancer predicted poor outcome in T2 patients. The 5-year local control rates of patients with and without subglottic extension were 9% and 77%, respectively (p < .001). According to our results, radiotherapy with a fraction size of >200 cGy is recommended for T1 disease with anterior commissure involvement. For patients with T2 disease and subglottic extension, radiotherapy alone produces poor results. Further improvement of outcomes by other treatment strategies needs to be investigated.

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Re: Importance of Local Control in Early-Stage Prostate Cancer: Outcomes of Patients with Positive Post-Radiation Therapy Biopsy Results Treated in RTOG 9408

The Journal of Urology ◽

10.1016/j.juro.2015.10.167 ◽

2016 ◽

Vol 195 (2) ◽

pp. 351-352

Author(s):

Samir S. Taneja

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Local Control ◽

Early Stage ◽

Cancer Outcomes ◽

Post Radiation

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Local control in young women with early-stage breast cancer treated with hypofractionated whole breast irradiation

The Breast ◽

10.1016/j.breast.2018.07.002 ◽

2018 ◽

Vol 41 ◽

pp. 89-92 ◽

Cited By ~ 3

Author(s):

Kathy Rock ◽

Sylvia Ng ◽

Louise Murray ◽

Jie Su ◽

Anthony Fyles ◽

...

Keyword(s):

Breast Cancer ◽

Local Control ◽

Young Women ◽

Early Stage ◽

Early Stage Breast Cancer ◽

Whole Breast Irradiation ◽

Breast Irradiation ◽

Hypofractionated Whole Breast Irradiation

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Excessive Toxicity When Treating Central Tumors in a Phase II Study of Stereotactic Body Radiation Therapy for Medically Inoperable Early-Stage Lung Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.07.5937 ◽

2006 ◽

Vol 24 (30) ◽

pp. 4833-4839 ◽

Cited By ~ 940

Author(s):

Robert Timmerman ◽

Ronald McGarry ◽

Constantin Yiannoutsos ◽

Lech Papiez ◽

Kathy Tudor ◽

...

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Radiation Therapy ◽

Phase Ii ◽

Local Control ◽

Stereotactic Body Radiation Therapy ◽

Early Stage ◽

Stage I ◽

Severe Toxicity ◽

Stereotactic Body Radiation

PurposeSurgical resection is standard therapy in stage I non–small-cell lung cancer (NSCLC); however, many patients are inoperable due to comorbid diseases. Building on a previously reported phase I trial, we carried out a prospective phase II trial using stereotactic body radiation therapy (SBRT) in this population.Patients and MethodsEligible patients included clinically staged T1 or T2 (≤ 7 cm), N0, M0, biopsy-confirmed NSCLC. All patients had comorbid medical problems that precluded lobectomy. SBRT treatment dose was 60 to 66 Gy total in three fractions during 1 to 2 weeks.ResultsAll 70 patients enrolled completed therapy as planned and median follow-up was 17.5 months. The 3-month major response rate was 60%. Kaplan-Meier local control at 2 years was 95%. Altogether, 28 patients have died as a result of cancer (n = 5), treatment (n = 6), or comorbid illnesses (n = 17). Median overall survival was 32.6 months and 2-year overall survival was 54.7%. Grade 3 to 5 toxicity occurred in a total of 14 patients. Among patients experiencing toxicity, the median time to observation was 10.5 months. Patients treated for tumors in the peripheral lung had 2-year freedom from severe toxicity of 83% compared with only 54% for patients with central tumors.ConclusionHigh rates of local control are achieved with this SBRT regimen in medically inoperable patients with stage I NSCLC. Both local recurrence and toxicity occur late after this treatment. This regimen should not be used for patients with tumors near the central airways due to excessive toxicity.

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Oncological and Surgical Outcomes of Patients Treated by Transoral CO2 Laser Cordectomy for Early-Stage Glottic Squamous Cell Carcinoma: A Retrospective Chart Review

Ear Nose & Throat Journal ◽

10.1177/0145561320911486 ◽

2020 ◽

Vol 100 (1_suppl) ◽

pp. 33S-37S ◽

Cited By ~ 1

Author(s):

Stéphane Hans ◽

Lise Crevier-Buchman ◽

Marta Circiu ◽

Younes Chekkoury Idrissi ◽

Léa Distinguin ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Surgical Procedures ◽

Vocal Fold ◽

Chart Review ◽

Early Stage ◽

Anterior Commissure ◽

Retrospective Chart Review ◽

Margin Status ◽

Counter Pressure ◽

Preservation Rate

Objective: To investigate the feasibility and the outcomes of transoral laser CO2 microsurgery (TLM) for resection of early-stage squamous cell carcinoma (SCC) of the vocal folds through several additional surgical procedures and tips improving the glottic exposure. Methods: Retrospective chart review of patients treated by TLM cordectomy in a single European University Hospital for early-stage vocal fold SCCs (Tis, T1a, T1b, and T2). The following TLM outcomes were studied regarding the tumor size (Tis and T1a vs T1b and T2) and the margin status (negative vs positive/suspicious): patient position; type of laryngoscope; requirement to external counter pressure; resection of supraglottic structures (eg, ventricular band, epiglottic petiole, and suprahyoid epiglottis); pre- and postoperative complications; overall survival; disease-specific survival (DSS); and disease-free survival (DFS). Results: A total of 148 patients were included. The TLM was realized in 95.3% of cases. External counter pressure, partial, or total vestibulectomy were necessary in 65.9%, 57.4%, and 4.2% of cases, respectively. A resection of the epiglottic petiole was required in 24.8% of cases. The realization of both epiglottis petiole resection and vestibulectomies were significantly higher in patients with T2 and T1b SCCs compared to those with T1a and Tis SCCs ( P = .01). Different procedure tips were described for improving the laryngeal exposition. The 5-year laryngeal preservation rate, DSS, and DFS were significantly better in patients without SCC involvement of the anterior commissure, and did not vary according to the margin status. The laryngeal exposure difficulties did not impact the margin status. Conclusion: The exposure of glottis is possible in 95% of cases of early-stage vocal cord SCC but requires the use of several additional surgical procedures, especially for anterior commissure SCCs. The SCC involvement of the vocal fold anterior commissure is associated with lower DSS, DFS, and laryngeal preservation rate.

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