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

2003 ◽  
Vol 112 (10) ◽  
pp. 904-911 ◽  
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.

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

2004 ◽  
Vol 180 (2) ◽  
pp. 84-90 ◽  
Author(s):  
Abderrahim Zouhair ◽  
David Azria ◽  
Philippe Coucke ◽  
Oscar Matzinger ◽  
Luc Bron ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Control ◽  
Early Stage ◽  
Anterior Commissure ◽  
Glottic Carcinoma

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

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Oguz Cetinayak ◽  
Ersoy Dogan ◽  
Ahmet Kuru ◽  
Nesrin Akturk ◽  
Barbaros Aydin ◽  
...  
Keyword(s):  
Local Control ◽  
Laryngeal Carcinoma ◽  
Early Stage ◽  
Anterior Commissure ◽  
Conventional Technique ◽  
Radical Radiotherapy ◽  
Treatment Techniques ◽  
Median Total Dose ◽  
Effective Treatment Modality ◽  
Laryngeal Carcinomas

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.

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

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.

Carcinoma of the Anterior Commissure of the Larynx: II. Proposal of a New Staging System

1996 ◽  
Vol 105 (5) ◽  
pp. 391-396 ◽  
Author(s):  
Lucio Rucci ◽  
Lucio Gammarota ◽  
Oreste Gallo
Keyword(s):  
Retrospective Analysis ◽  
Clinical Experience ◽  
Local Control ◽  
Anterior Commissure ◽  
Tnm Classification ◽  
Staging System ◽  
Conservative Surgery ◽  
Glottic Cancer ◽  
Human Larynx

On the basis of embryology and clinical experience, we have defined here an anterior commissure (AC) subsite of the human larynx and have addressed the issue as to whether the degree of involvement of this subsite is related to the outcome of glottic cancer, in terms of local control within 5 years of therapy. Retrospective analysis of 534 patients included 1) classification of patients according to the TNM, 2) actuarial evaluation of the outcome, 3) reclassification of patients according to the involvement of the AC subsite, and 4) ree valuation of the outcome according to this latter classification. The results showed that the outcome was not well correlated with TNM classification, whereas patients with progressively heavier involvement of the AC subsite had a progressively worse outcome. On the basis of these data, we suggest that TNM classification of cancer involving the AC be implemented by an AC classification, in order to better forecast the prognosis and design specific conservative surgery.

scholarly journals Early Glottic Cancer: Role of MRI in the Preoperative Staging

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Eugenia Allegra ◽  
Pierpaolo Ferrise ◽  
Serena Trapasso ◽  
Orazio Trapuzzano ◽  
Antonio Barca ◽  
...  
Keyword(s):  
Prospective Study ◽  
Early Stage ◽  
Anterior Commissure ◽  
Preoperative Staging ◽  
High Specificity ◽  
Clinical Staging ◽  
Glottic Cancer ◽  
Pathology Report ◽  
Supracricoid Laryngectomy ◽  
Early Glottic Cancer

Introduction.Clinical staging is the most important time in management of glottic cancer in early stage (I-II). We have conducted a prospective study to evaluate if magnetic resonance imaging (MRI) is more accurate than computed tomography (CT) about tumoral extension, to exactly choose the most appropriate surgical approach, from organ preservation surgery to demolitive surgery.Materials and Methods.This prospective study was conducted on 26 male patients, with suspected laryngeal neoplasia of glottic region. The images of MRI and CT were analyzed to define the expansion of glottic lesion to anterior commissure, laryngeal cartilages, subglottic and/or supraglottic site, and paraglottic space. The results of MRI and CT were compared with each other and with the pathology report.Results.CT accuracy was 70% with low sensitivity but with high specific value. MRI showed a diagnostic accuracy in 80% of cases, with a sensitivity of 100% and high specificity. Statistical analysis showed that MRI has higher correlation than CT with the pathology report.Conclusion.Our study showed that MRI is more sensitive than CT in the preoperative staging of early glottic cancer, to select exactly the eligible patients in conservative surgery of the larynx, as supracricoid laryngectomy and cordectomy by CO2laser.

Surgical Treatment for Early Stage Glottic Carcinoma with Involvement of the Anterior Commissure

2017 ◽  
Vol 158 (2) ◽  
pp. 295-302 ◽  
Author(s):  
Philipp Wolber ◽  
David Schwarz ◽  
Thoralf Stange ◽  
Magdalene Ortmann ◽  
Matthias Balk ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Local Recurrence ◽  
Cell Carcinoma ◽  
Recurrence Rate ◽  
Squamous Cell ◽  
Early Stage ◽  
Anterior Commissure ◽  
Glottic Cancer ◽  
Recurrence Rates ◽  
Significant Difference

Objective Assessment of the value of transoral laser microsurgery (TLM) compared with open surgery (OS) for early stage squamous cell carcinoma of the glottic larynx with special regard to involvement of the anterior commissure (AC). Study Design Case series with chart review. Setting Tertiary care otolaryngology clinic. Subjects and Methods Review of clinicopathological data of all patients with previously untreated T1a, T1b, and T2 glottic squamous cell carcinoma of the larynx who were consecutively enrolled over a 10-year period (January 1, 1992, to December 31, 2002). Results Local recurrence rate was 20.4% (10 of 49) for TLM and 10.7% (3 of 28) for OS. Comparison of the TLM and OS groups regarding local recurrence rates revealed a significant difference only for tumors invading the AC ( P = .046). Within the TLM group, tumors with involvement of the AC showed a significantly higher recurrence rate (38.1%; 8 of 21) compared with tumors without involvement of the AC (7.1%; 2 of 28; P = .008). In the OS group, involvement of the AC revealed no significant difference ( P = .45). The overall survival in both groups was comparable in both groups (TLM, 93.9%; OS, 89.3%; P = .47). Conclusion TLM and OS are equally effective surgical treatments for early stage glottic cancer without involvement of the AC, with selection of treatment based on pretreatment endoscopy. However, TLM is associated with less morbidity. In case of invasion of the AC, OS yields lower recurrence rates.

Risk Factors and Prognosis of Anterior Commissure versus Posterior Commissure T1-T2 Glottic Cancer

2003 ◽  
Vol 112 (3) ◽  
pp. 223-229 ◽  
Author(s):  
Lucio Rucci ◽  
Paolo Romagnoli ◽  
Corso Bocciolini ◽  
Jan Olofsson
Keyword(s):  
Risk Factors ◽  
Alcohol Consumption ◽  
Anterior Commissure ◽  
Survival Rates ◽  
Glottic Cancer ◽  
Posterior Commissure ◽  
Disease Free Interval ◽  
Larynx Preservation ◽  
Laryngeal Tumors ◽  
And Behavior

For better understanding of the causation and behavior of T1–T2 commissural glottic laryngeal tumors, we retrospectively analyzed risk factors and outcome related to T class and type of therapy for tumors involving the anterior (184 cases) or the posterior (60 cases) commissure. The patients' smoking habits and alcohol consumption were similar, regardless of involved subsite. The disease-free interval was longer after surgery than after radiotherapy. The survival rates after recovery upon relapse were similar among subsites, T classes, and types of therapy. In anterior commissure tumors, the larynx remained preserved more frequently after partial laryngeal resection than after radiotherapy, and was more frequently preserved the lower the T class. In posterior commissure tumors, larynx preservation was less frequent and apparently independent of type of therapy or T class. In conclusion, smoking and alcohol consumption play similar pathogenetic roles in either subsite; partial laryngeal resection gave a higher rate of laryngeal preservation than did radiotherapy; and anatomic peculiarities of the subsites influence tumor behavior.

Accuracy of flexible versus rigid laryngoscopic photo-documentation in the diagnosis of early glottic cancer

2013 ◽  
Vol 127 (9) ◽  
pp. 890-896 ◽  
Author(s):  
F M Makki ◽  
A Hilal ◽  
E Fung ◽  
R Hart ◽  
S M Taylor ◽  
...  
Keyword(s):  
Image Quality ◽  
Early Stage ◽  
Anterior Commissure ◽  
Glottic Cancer ◽  
Accuracy Rate ◽  
Early Glottic Cancer ◽  
Clinical Accuracy ◽  
Clinical Description ◽  
Accuracy Rates ◽  
Single Blind

AbstractObjective:To compare the image quality provided by rigid laryngoscopes versus flexible distal-chip laryngoscopes when documenting the same laryngeal pathology.Methods:This paper reports a prospective single-blind study. Ten early stage glottic cancer cases were selected. Photographs of the pathologies were taken using both rigid and flexible distal-chip laryngoscopes (a total of 20 photographs). Nineteen clinicians were asked to review the laryngoscopic photographs; the clinicians were provided with a worksheet, which included questions regarding the clinical description, photograph quality and overall satisfaction with the images obtained. Clinicians' responses to the worksheet questions were then analysed.Results:The overall accuracy rate for lesion sidedness, anatomical sub-site involvement, anterior commissure involvement and tumour staging were 94.7 per cent, 46.6 per cent, 53.7 per cent and 47.1 per cent respectively. There were no statistically significant differences in terms of the accuracy rates, photograph quality or overall satisfaction with the photographs obtained by either modality.Conclusion:There were no statistically significant differences demonstrated in overall clinical accuracy or perceived image quality between the use of the rigid or flexible endoscopes when interpreting images of early glottic cancer.

Sign in / Sign up

Export Citation Format

Share Document