Long-Term Outcome of Definitive Radiotherapy for Early Glottic Cancer: Prognostic Factors and Patterns of Local Failure
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Purpose This study evaluates the long-term results of definitive radiotherapy (RT) for early glotticcancer. Clinical and treatment factors related to local control and patterns of failure areanalyzed. Materials and MethodsWe retrospectively reviewed 222 patients with T1-2N0 squamous cell carcinoma of the glotticlarynx treated with definitive RT from 1981 to 2010. None of the patients received electivenodal RT or combined chemotherapy. The median total RT dose was 66 Gy. The dailyfraction size was < 2.5 Gy in 69% and 2.5 Gy in 31% of patients. The RT field extended fromthe hyoid bone to the cricoid cartilage. ResultsThe median age was 60 years, and 155 patients (70%) had T1 disease. The 5-year rates oflocal 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 to4.94) and anterior commissural involvement (HR, 3.37; 95% CI, 1.62 to 7.02) were significantprognostic factors for LRFS. In 34 patients with local recurrence, tumors recurred inthe 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 nograde 3 or greater chronic toxicity. ConclusionDefinitive RT achieved a high cure rate, voice preservation, and tolerable toxicity in earlyglottic cancer. T2 stage and anterior commissural involvement were prognostic factors forlocal control. Further optimization of the RT method is needed to reduce the risk of ipsilateraltumor recurrence.
Abstract
Purpose This study evaluates the long-term results of definitive radiotherapy (RT) for early glotticcancer. Clinical and treatment factors related to local control and patterns of failure areanalyzed. Materials and MethodsWe retrospectively reviewed 222 patients with T1-2N0 squamous cell carcinoma of the glotticlarynx treated with definitive RT from 1981 to 2010. None of the patients received electivenodal RT or combined chemotherapy. The median total RT dose was 66 Gy. The dailyfraction size was < 2.5 Gy in 69% and 2.5 Gy in 31% of patients. The RT field extended fromthe hyoid bone to the cricoid cartilage. ResultsThe median age was 60 years, and 155 patients (70%) had T1 disease. The 5-year rates oflocal 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 to4.94) and anterior commissural involvement (HR, 3.37; 95% CI, 1.62 to 7.02) were significantprognostic factors for LRFS. In 34 patients with local recurrence, tumors recurred inthe 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 nograde 3 or greater chronic toxicity. ConclusionDefinitive RT achieved a high cure rate, voice preservation, and tolerable toxicity in earlyglottic cancer. T2 stage and anterior commissural involvement were prognostic factors forlocal control. Further optimization of the RT method is needed to reduce the risk of ipsilateraltumor recurrence.
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