Radiotherapy for T1 Carcinoma of the Glottis

Aims and background The management of patients with T1 carcinoma of the glottic larynx is controversial, because surgery and radiation therapy are reported to be effective treatments. Several studies have shown radiotherapy to be safe and effective, with a high percentage of voice preservation and minimal complications, but most Italian physicians prefer to surgically treat such patients. Methods From 1980 to 1990, 36 patients with stage I squamous cell glottic carcinoma were treated with radiotherapy alone at the Institute of Radiology of University of Rome “La Sapienza”. In all patients the irradiation fields were limited to the larynx, with field size ranging from 4 × 4 cm to 7 × 7 cm. Total tumor doses ranged between 51 and 70 Gy (median 60 Gy) with a mean number of 30 fractions of 2 to 3 Gy per fraction (3 or 5 fractions per week). Results After a median follow-up of 98 months, we observed an overall survival rate at 5 years of 91.4% and actuarial 10-year survival of 85.7%. Local control was achieved in 97.1% of cases, with an event-free survival of 94.2% at 5 and 10 years. No major complications like necrosis or persistent edema of the larynx were observed. Minor complications like dysphonia (8%) and dysphagia (5.5%) were temporary; laryngeal function was completely preserved at the end of therapy. Final voice quality ranged from good to excellent. Conclusions Our series confirms that radiation therapy has a major role in the management of early glottic cancer, with results comparable to surgical approaches and with better voice preservation.

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S179 – Voice Self-evaluation after Treatment for T1 Glottic Cancer

Otolaryngology ◽

10.1016/j.otohns.2008.05.353 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P136-P136

Author(s):

Faustino Nunez ◽

Maria Jesus Caminero ◽

Jose-Luis Llorente-Pendas ◽

Carlos Suarez-Nieto

Keyword(s):

Laser Surgery ◽

Voice Quality ◽

Well Being ◽

Voice Handicap Index ◽

Glottic Cancer ◽

Glottic Carcinoma ◽

Subjective Analysis ◽

Maximum Phonation Time ◽

Self Evaluation ◽

The Voice

Objectives 1) To present the objective and subjective analysis of voice quality following treatment of an early epidermoid glottic carcinoma. 2) Results from the objective evaluation of the voice, along with the self-evaluation of voice quality quantified using the Voice Handicap Index of a group of patients treated with endoscopic laser surgery, are compared with patients treated with radiotherapy. Methods We performed an objective voice evaluation, as well as a physical, emotional, and functional well-being assessment of 19 patients treated with laser surgery and 18 patients treated with radiotherapy. The data obtained was gathered in the statistical database SPSS 12.0. The statistical analysis used was the “Student t test” in order to compare averages and the Chi-squared test for comparing proportions. The statistical differences were considered significant when p was lower than 0.05. Results Voice quality is affected both by surgery and radiotherapy. Voice parameters only show differences in the maximum phonation time between both treatments (p < 0,005). Patients Self-Perception Analysis (Voice Handicap Index) Upon completing the comparison between the two groups, the statistical difference is significant, in favor of the radiotherapy patients in functional and emotional ratings, as well as the global scores (p < 0,005). No significant differences were found in the physical scales. Conclusions There is a reduced impact in patient's perception of voice quality after radiotherapy, despite no significant differences in vocal quality between radiotherapy and laser cordectomy.

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Evaluation of acute/late toxicity and local recurrence in Τ1-Τ2 glottic carcinoma treated with accelerated hypofractionated 3D-conformal external beam radiotherapy (3D-CRT)

Radiology and Oncology ◽

10.2478/raon-2013-0020 ◽

2013 ◽

Vol 47 (2) ◽

pp. 185-191 ◽

Cited By ~ 2

Author(s):

Vassilis E. Kouloulias ◽

Anna Zygogianni ◽

Eftychia Mosa ◽

Kalliopi Platoni ◽

John Georgakopoulos ◽

...

Keyword(s):

Local Recurrence ◽

External Beam Radiotherapy ◽

Late Toxicity ◽

Glottic Cancer ◽

Primary Study ◽

Radiation Toxicity ◽

Glottic Carcinoma ◽

Conventional Fractionation ◽

Effects Of Radiation ◽

Voice Preservation

Background.The aim of the study was to evaluate the efficacy, as well as the acute and late toxicity of an accelerated hypofractionated 3DCRT schedule as radical treatment in patients with organ confined glottic cancer cT1-2N0. Patients and methods. Between June of 2004 and September 2010, 47 retrospectively selected patients (29 males, 18 females) diagnosed with organ confined T1 or T2 glottic cancer, were treated with external 3DCRT in an accelerated hypofractionation schedule. The median age was 70 years. A dose of 64.4 Gy in 28 daily fractions was prescribed. The primary study endpoints were to assess the acute and late effects of radiation toxicity, according to the EORTC/ RTOG scale, as well as the therapeutic impact of this schedule in terms of local recurrence. Results. The median follow up was 36 months. At the end of radiotherapy, grade I, II and III acute toxicity was observed in 34, 9 and4 patients, respectively. Late grade I and II toxicity was observed in 25 and in 8 patients respectively. Only two local recurrences were observed, 15 and 24 months post 3DCRT respectively. Conclusions. Our radiotherapy schedule achieves a high locoregional control rate with the advantage of voice preservation. The proposed hypofractionated schedule can be recommended as a standard radiotherapy treatment, since these results are comparable with those of conventional fractionation schedules.

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Voice Quality After Radiation Therapy for Early Glottic Cancer

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archotol.126.9.1097 ◽

2000 ◽

Vol 126 (9) ◽

pp. 1097 ◽

Cited By ~ 38

Author(s):

Irena Honocodeevar-Boltežar ◽

Miha Žargi

Keyword(s):

Radiation Therapy ◽

Voice Quality ◽

Glottic Cancer ◽

Early Glottic Cancer

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Factors affecting voice quality in early glottic cancer before and after radiotherapy

Radiology and Oncology ◽

10.2478/raon-2019-0050 ◽

2019 ◽

Vol 53 (4) ◽

pp. 459-464 ◽

Cited By ~ 2

Author(s):

Jana Mekis ◽

Primoz Strojan ◽

Irena Hocevar Boltezar

Keyword(s):

Anterior Commissure ◽

Voice Quality ◽

Vocal Folds ◽

Medical Documentation ◽

Glottic Cancer ◽

Glottic Carcinoma ◽

Early Glottic Cancer ◽

Factors Affecting ◽

Maximum Phonation Time ◽

Multimodal Methods

Abstract Background Radiotherapy (RT) is a successful mode of treatment for early glottic cancer. The aim of the study was to assess voice quality both before and 3 months after successful RT using multimodal methods while also identifying the factors affecting it. Patients and methods In 50 patients with T1 glottic carcinoma, the subjective (patients’ assessment of voice quality [VAS], Voice Handicap Index [VHI] questionnaire, phoniatricians’ assessment using the grade/roughness/ breathiness [GRB] scale), and objective assessments (fundamental laryngeal frequency [F0], jitter, shimmer, maximum phonation time [MPT]) of voice quality were performed before RT and 3 months post-RT. The data on gender, age, extent of the tumors, biopsy types, smoking, local findings, and RT were obtained from the medical documentation. Results Three months after the treatment, VAS, VHI, G and R scores, F0, and MPT significantly improved in comparison with their assessment prior to treatment. Before the treatment, the involvement of the anterior commissure significantly deteriorated jitter (p = 0.044) and the involvement of both vocal folds deteriorated jitter (p = 0.003) and shimmer (p = 0.007). After the RT, F0 was significantly higher in the patients with repeated biopsy than in the others (p = 0.047). In patients with post-RT changes, the B score was significantly higher than in those without post-RT changes (p = 0.029). Conclusions Voice quality already significantly improved three months after the treatment of glottic cancer. The main reason for the decreased voice quality prior to treatment is the tumor’s extent. Post-RT laryngeal changes and repeated biopsies caused more scarring on vocal folds adversely influencing voice quality after the treatment.

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Imbrication Reconstruction following Partial Laryngectomy

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948609500605 ◽

1986 ◽

Vol 95 (6) ◽

pp. 567-571 ◽

Cited By ~ 22

Author(s):

Chen Liu ◽

Paul H. Ward ◽

Lawrence Pleet

Keyword(s):

Young People ◽

Normal Tissue ◽

Voice Quality ◽

Glottic Cancer ◽

Partial Laryngectomy ◽

Glottic Carcinoma ◽

Salvage Procedure ◽

Adjacent Normal Tissue ◽

Full Thickness ◽

Early Glottic Carcinoma

Experience over a 16-year period with 38 patients who underwent partial laryngectomy with imbrication reconstruction is reviewed. We have found this technique to be an expeditious and highly successful means of eradicating T1 or T2 glottic cancer. The use of the patient's own full-thickness, adjacent normal tissue with imbrication of cartilage produces an adequate airway, an almost normal-appearing larynx, and a remarkable posttreatment voice quality, better results than from most cordectomies or vertical hemilaryngectomies. It is valuable as a salvage procedure after full-course radiation. Imbrication laryngoplasty is an alternative and a preferred modality for treatment of young people with early glottic carcinoma for whom the possible carcinogenic properties of radiation must be considered. The survival results are comparable with the more extensive vertical laryngectomies.

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Radiotherapy in Early Glottic Carcinoma

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949610501001 ◽

1996 ◽

Vol 105 (10) ◽

pp. 759-763 ◽

Cited By ~ 24

Author(s):

Georg Kanonier ◽

Esther Fritsch ◽

Thomas Rainer ◽

Walter Franz Thumfart

Keyword(s):

Statistical Significance ◽

Primary Treatment ◽

Glottic Cancer ◽

Glottic Carcinoma ◽

Control Analysis ◽

Larynx Preservation ◽

T2 Lesions ◽

Radiotherapy Alone ◽

T1 Stage ◽

T1 And T2

Radiotherapy is widely accepted as primary treatment in the T1 stage of glottic cancer, but controversy surrounds the proper approach to T2 lesions of the glottis. A retrospective review of 90 patients addresses treatment results for T1 and T2 lesions of glottic carcinoma managed by primary radiotherapy with 60 to 64 Gy from 1977 to 1989. Seventy-nine patients met the criteria for local control analysis with a minimum follow-up of 5 years. Radiotherapy alone controlled disease in 93% (43 of 46) of patients with T1 lesions and 18% (6 of 33) of those with T2 tumors (including 10 patients in whom radiotherapy was terminated at 40 Gy because of persistent tumor). Ultimate control of disease for T1 and T2 lesions, including surgical salvage, was 100% and 82%, respectively. Larynx preservation was achieved in 100% of Tl and in 45% of T2 lesions. Extension of tumor and impaired vocal cord mobility showed statistical significance for adverse prognosis (p < .001). This paper discusses how these results affect treatment of glottic carcinoma, particularly in the T2 stage.

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Outcome of Open Surgical Therapy for Glottic Carcinoma

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949310201003 ◽

1993 ◽

Vol 102 (10) ◽

pp. 752-755 ◽

Cited By ~ 43

Author(s):

Jonas T. Johnson ◽

Sheng-Po Hao ◽

Eugene N. Myers ◽

Robin L. Wagner

Keyword(s):

Neck Dissection ◽

Distant Metastasis ◽

Medical Records ◽

Glottic Cancer ◽

Partial Laryngectomy ◽

Glottic Carcinoma ◽

Early Glottic Cancer ◽

Regional Control ◽

Open Surgical Therapy ◽

Voice Preservation

A retrospective review was undertaken of the medical records of 270 patients with carcinoma of the glottic larynx. Patients were staged pathologically, and clinical pathologic correlates were made with outcome. In 92 patients with early glottic cancer, the 2-year rate of no evidence of disease for T1 was 98%, and for T2, 84%. Vertical partial laryngectomy resulted in voice preservation in 89%. Patients treated for advanced (T3 or T4) glottic carcinoma underwent total laryngectomy with or without neck dissection. Cervical nodes were involved in 22% of T3 and 41% of T4 patients at the time of treatment. Survival with no evidence of disease was chiefly determined by the development of regional recurrence, distant metastasis, and new primary cancer. Distant metastasis was associated with extracapsular spread (p = .003). Patients treated for T4 glottic carcinoma with neck dissection had improved survival compared with patients treated with laryngectomy alone (p = .006). Improved survival must be aimed at regional control, prevention, and management of distant metastasis and new primary carcinoma.

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Oncological and Functional Outcome after Surgical Treatment of Early Glottic Carcinoma without Anterior Commissure Involvement

BioMed Research International ◽

10.1155/2014/464781 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Jovica Milovanovic ◽

Ana Jotic ◽

Vojko Djukic ◽

Bojan Pavlovic ◽

Aleksandar Trivic ◽

...

Keyword(s):

Anterior Commissure ◽

Medical Center ◽

Voice Quality ◽

Surgical Techniques ◽

Functional Results ◽

Glottic Cancer ◽

Glottic Carcinoma ◽

Open Approach ◽

Endoscopic Laser ◽

Early Glottic Carcinoma

Introduction. Glottic carcinoma can be successfully diagnosed in its early stages and treated with high percentage of success. Organ preservation and optimal functional outcomes could be achieved with wide array of surgical techniques for early glottic cancer, including endoscopic approaches or open laryngeal preserving procedures, making surgery the preferred method of treatment of early glottic carcinoma in the last few years.Material and Methods. Prospective study was done on 59 patients treated for Tis and T1a glottic carcinoma over a one-year time period in a tertiary medical center. Patients were treated with endoscopic laser cordectomy (types II–IV cordectomies according to European Laryngological Society classification of endoscopic cordectomies) and open cordectomy through laryngofissure. Follow-up period was 60 months. Clinical and oncological results were followed postoperatively. Voice quality after the treatment was assessed using multidimensional voice analysis 12 months after the treatment.Results. There were no significant differences between oncological and functional results among two groups of patients, though complications were more frequent in patients treated with open cordectomy.Conclusion. Endoscopic laser surgery should be the first treatment of choice in treatment of early glottic carcinomas, though open approach through laryngofissure should be available for selected cases where anatomical factors present limiting adequate tumor removal.

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Evolution of voice after transoral laser cordectomy for precancerous lesions and early glottic cancer

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06751-3 ◽

2021 ◽

Author(s):

Lucia Staníková ◽

Karol Zeleník ◽

Martin Formánek ◽

Jana Seko ◽

Radana Walderová ◽

...

Keyword(s):

Precancerous Lesions ◽

Voice Quality ◽

Quality Parameters ◽

Substantial Improvement ◽

Glottic Cancer ◽

Early Glottic Cancer ◽

Post Surgery ◽

Group I ◽

Group Ii ◽

Laser Cordectomy

Abstract Purpose To evaluate voice quality evolution after a transoral laser cordectomy (TLC) for precancerous lesions and early glottic cancer. Methods This prospective study enrolled 18 patients scheduled for TLC for high-grade dysplasia, Tis, T1, and T2 glottic squamous cell cancers, from May 2017 to March 2020. Patients were grouped according to the extent of TLC: Group I (n = 11, 61.1%): unilateral subepithelial or subligamental cordectomy; Group II (n = 7, 38.9%): unilateral transmuscular, total, or extended cordectomy. Voice quality parameters, including dysphonia grade (G), roughness (R), breathiness (B), maximal phonation time (MPT), jitter, and shimmer, were evaluated before, and at 6 weeks and 6 months after the TLC. Results In Group I, the degree of G and R items remained without substantial improvement 6 weeks after surgery; however, improved above the pre-surgery level up to 6 months after surgery. The MPT, jitter, and shimmer did not change significantly at 6 weeks or 6 months post-TLC. In Group II, G, R, and B remained significantly impaired even 6 months post-surgery. Jitter, and shimmer worsened at 6 weeks, but reached preoperative levels at 6 months post-surgery. MPT was significantly worse at 6 weeks and remained deteriorated at 6 months post-surgery. All measured parameters were significantly worse in Group II than in Group I at 6 weeks and 6 months post-surgery. No patient required a phonosurgical procedure. Conclusion After a TLC, voice quality evolution depended on the extent of surgery. It did not improve at 6 weeks post-surgery. Improvements in less extent cordectomies occurred between 6 weeks and 6 months post-surgery. Understanding voice development over time is important for counseling patients when considering phonosurgical procedures.

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