Definitive radiotherapy for early (T1-T2) Glottic Squamous cell carcinoma: a 20 year Cleveland clinic experience

Reddy, Khan, Koyfman, Hunter, Saxton

Description

Purpose To report our 20 yr experience of definitive radiotherapy for early glottic squamous cell carcinoma (SCC). Methods and materials Radiation records of 141 patients were retrospectively evaluated for patient, tumor, and treatment characteristics. Cox proportional hazard models were used to perform univariate (UVA) and multivariate analyses (MVA). Cause specific survival (CSS) and overall survival (OS) were plotted using cumulative incidence and Kaplan-Meir curves, respectively. Results Of the 91% patients that presented with impaired voice, 73% noted significant improvement. Chronic laryngeal edema and dysphagia were noted in 18% and 7%, respectively. The five year LC was 94% (T1a), 83% (T1b), 87% (T2a), 65% (T2b); the ten year LC was 89% (T1a), 83% (T1b), 87% (T2a), and 53% (T2b). The cumulative incidence of death due to larynx cancer at 10 yrs was 5.5%, respectively. On MVA, T-stage, heavy alcohol consumption during treatment, and used of weighted fields were predictive for poor outcome (p < 0.05). The five year CSS and OS was 95.9% and 76.8%, respectively. Conclusions Definitive radiotherapy provides excellent LC and CSS for early glottis carcinoma, with excellent voice preservation and minimal long term toxicity. Alternative management strategies should be pursued for T2b glottis carcinomas.

Sujets

• Larynx
• Outcome
• Radiation therapy
• Squamous epithelium
• Carcinoma

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 10
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Khanet al. Radiation Oncology2012,7:193 http://www.rojournal.com/content/7/1/193

R E S E A R C H

Open Access

Definitive radiotherapy for early (T1T2) Glottic Squamous cell carcinoma: a 20 year Cleveland clinic experience 1* 2 2 2 2 Mohammad K Khan , Shlomo A Koyfman , Grant K Hunter , Chandana A Reddy and Jerrold P Saxton

Abstract Purpose:To report our 20 yr experience of definitive radiotherapy for early glottic squamous cell carcinoma (SCC). Methods and materials:Radiation records of 141 patients were retrospectively evaluated for patient, tumor, and treatment characteristics. Cox proportional hazard models were used to perform univariate (UVA) and multivariate analyses (MVA). Cause specific survival (CSS) and overall survival (OS) were plotted using cumulative incidence and KaplanMeir curves, respectively. Results:Of the 91% patients that presented with impaired voice, 73% noted significant improvement. Chronic laryngeal edema and dysphagia were noted in 18% and 7%, respectively. The five year LC was 94% (T1a), 83% (T1b), 87% (T2a), 65% (T2b); the ten year LC was 89% (T1a), 83% (T1b), 87% (T2a), and 53% (T2b). The cumulative incidence of death due to larynx cancer at 10 yrs was 5.5%, respectively. On MVA, Tstage, heavy alcohol consumption during treatment, and used of weighted fields were predictive for poor outcome (p < 0.05). The five year CSS and OS was 95.9% and 76.8%, respectively. Conclusions:Definitive radiotherapy provides excellent LC and CSS for early glottis carcinoma, with excellent voice preservation and minimal long term toxicity. Alternative management strategies should be pursued for T2b glottis carcinomas. Keywords:Glottic carcinoma, Larynx, Outcome, Radiotherapy, Squamous cell, Carcinoma

Introduction Several institutions have reported long term outcomes of patients with T12N0 SCC of the glottis treated with de finitive radiotherapy[110]. The fiveyear local control (LC) rates have ranged from 8294% for T1a, 8093% for T1b, 6294% for T2a, and 2373% for T2b. We report our first 20 year institutional outcome, and identify pa tient, tumor, and treatment related factors associated with inferior outcomes.

Methods and materials We obtained institutional review board (IRB) approval to retrospectively review the charts of all patients treated with definitive radiotherapy at the Cleveland Clinic be tween 1986–2006. All patients had biopsyproven

* Correspondence: [e-mail] 1 Winship Cancer Center, Emory University, Atlanta, GA, USA Full list of author information is available at the end of the article

invasive SCC of the glottis, staged T1 or T2 with nega tive lymph node disease, and had received an uninter rupted course of radiotherapy. Patients were excluded if they previously had major surgery of the neck or the glottis, had a synchronous primary, or had received chemotherapy. Minor surgery (stripping for squamous cell carcinoma insitu (SCIS) or minor cordotomy) was th allowed. The AJCC 6 edition [11] was used to stage all patients, but with further subclassification of T2 patients. Patients were staged as follows: T1 included tumor confined to a single vocal cord (T1a) or both vocal cords (T1b) with normal vocal cord mobility; T2 included tumor with supra or subglottic extension and further subdivided into T2a (without) or T2b (with) impaired vocal cord mobility. All patients were treated with radiotherapy alone using either a unilateral field or a weighted opposed lateral field technique (Figure 1A). Standard field borders were

© 2012 Khan et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.