Definitive radiation therapy for early glottic cancer: experience of two fractionation schedules

Objectives

The authors would report the results of definitive radiation therapy (RT) for early glottic cancer by two different radiation dose schedules.

Methods

From February of 1995 till June of 2008, 157 patients with T1-2N0 glottic cancer were treated with curative RT at Samsung Medical Center. All patients had squamous cell carcinoma, and there were 89 patients (56.7%) with T1a, 36 (22.9%) with T1b, and 32 (20.4%) with T2. Two different radiation dose schedules were used: 70 Gy in 35 fractions to 64 patients (40.8%, group A); and 67.5 Gy in 30 fractions to 93 patients (59.2%, group B). The median treatment durations were 50 days (range, 44 to 59 days) and 44 days (range, 40 to 67 days) in the groups A and B, respectively.

Results

The median follow-up durations were 85 and 45 months for the groups A and B. No severe late complication of RTOG grade 3 or higher was observed, and there was no difference in acute or chronic complication between the groups. Twenty-four patients experienced treatment failure: local recurrence only in 19 patients; regional recurrence only in one; combined local and regional recurrence in four; and systemic metastasis in none. The overall 5-year disease-free survival and disease-specific survival rates were 84.7% and 94.8%. The disease-free survival rate in the group B was better (78.3% vs. 90.8%, P=0.031). This difference was significant only in T1 stage (83.4% vs. 94.6%, P=0.025), but not in T2 (62.7% vs. 60.6%, P=0.965). Univariate analysis showed that the tumor extent, cord mobility, T-stage, and the dose schedule had significant influence on the disease-free survival, and multivariate analysis showed that only the tumor extent and the dose schedule were associated with the disease-free survival.

Conclusion

Superior disease-free survival could be achieved by 2.25 Gy per fraction without increased toxicity over shorter RT duration, when compared with 2.0 Gy per fraction.     

The Effect of Overall Treatment Time of Radiation Therapy on Local Control of T1-Stage Squamous Call Carcinoma of the Glottis

From 1975 to 1990, 72 patients with T1 glottic cancer, excluding a verrucous type of carcinoma, were treated with radiation therapy (RT). All treatments were given with a standard fractionation of 2 Gy per day. The total dose to the tumor ranged from 60 to 70 Gy. Six patients received a split-course RT. The overall local control rate was 87% at 5 years. Forty-one patients who completed RT in 45 days or less had a 5-year local control rate of 95%. Sixteen patients who completed a treatment course in 46 to 49 days had a local control rate of 81%. Fifteen patients with a treatment course of more than 50 days had a local control rate of 73%. There was a statistically significant difference in local control rates among the three groups (P<.05). The split-course RT group had a 5-year local control rate of 50%; that rate was statistically significantly inferior to that of the continuous course group (P<.001). Multivariate analysis also showed that an interruption of the treatment course was an important parameter in relation to the local control. The prolongation of standard RT schedules adversely affected local control of T1 glottic carcinoma and, therefore, should be avoided whenever possible.     

环状软骨上喉次全切除术后喉功能的临床分析

目的分析喉鳞状细胞癌患者接受环状软骨上喉次全切除(supracricoid partial laryngectomy,SCPL)术后喉功能的情况。方法回顾性分析2000~2006年采用SCPL治疗喉鳞状细胞癌患者38例,其中声门上型17例,声门型21例;术后辅助放射治疗8例,剂量累计为60~65 Gy。对切除(或)保留会厌、保留一侧(或)双侧杓状软骨患者术后呼吸、发音、吞咽功能分别进行评估。所得结果运用统计学方法进行检验。结果所有患者随访至今,无失访;3年生存率81.6%,5年生存率73.7%。其中声门上型喉癌3年生存率76.5%,5年生存率64.7%;声门型喉癌3年生存率85.7%,5年生存率81.0%。所有患者均拔除气管套管,拔管率为100%。切除会厌和一侧杓状软骨患者的误咽评分、平均气管套管拔除时间、平均鼻饲胃管拔除时间和平均住院天数均高于其他组,差异具有统计学意义;而呼吸、发音评估各组之间比较差异无统计学意义。结论 SCPL对喉癌治疗和喉功能保留有积极意义,临床分析表明会厌和一侧杓状软骨切除对于患者远期喉功能恢复无影响。     

Therapeutic outcomes of laryngeal cancer at Kyoto University Hospital for 10 years

CONCLUSION: It is important to prevent regional lymph node recurrence and distant metastasis to achieve better survival of laryngeal cancer. OBJECTIVE: Therapeutic outcomes of 130 cases with laryngeal cancer treated at Kyoto University Hospital between 1995 and 2004 were reviewed. PATIENTS AND METHODS: In all, 121 males and 9 females were involved. Their ages ranged from 40 years to 92 years (average 66 years). All tumors were squamous cell carcinoma - arising at the glottis in 111 cases, the supraglottis in 18, and the subglottis in 1 case. Most glottic cancers (77.5%) were classified as stage I or II, while most supraglottic cancers (77.8%) were at stage III or IV. Stage I/II cancers were basically treated by conventional radiotherapy (60-66 Gy) and twice-daily hyperfractionated radiotherapy (70-74 Gy), respectively, attempting to preserve the larynx. Total laryngectomy with neck dissection was performed in the treatment of stage III/IV cases. RESULTS: Five-year disease-specific survival rates were 100%, 96%, 100%, and 68% for stage I, II, III, and IV, respectively. Five-year laryngeal preservation rates were 98%, 100%, 86%, 0%, and 0% for T1a, T1b, T2, T3, and T4 of glottic cancer, respectively. Local recurrence occurred in five cases of stage I/II glottic cancer, which was successfully salvaged. Regional lymph node recurrence occurred in five cases including four patients with glottic cancer and one with supraglottic cancer. Two of them died of disease despite undergoing salvage therapy. Distant metastasis occurred in the lung in four cases including one glottic and three supraglottic cancer patients after initial treatment.     

Laryngeal long-term morbidity after supraglottic laryngectomy and postoperative radiation therapy

PURPOSE: This study was performed to investigate factors associated with laryngeal morbidity when postoperative radiation therapy (RT) is added to supraglottic laryngectomy. MATERIALS AND METHODS: From 1980 to 1994, 56 patients affected with T1 to 4 N0 to 2c supraglottic squamous cell carcinoma selected for standard (59%) or extended (41%) supraglottic laryngectomy at 2 different institutions were retrospectively analyzed. Most of the patients (91%) also underwent neck dissection. Approximately 80% of the patients had stage T4 primary lesions or N2 neck disease. Postoperative RT was added for presumed microscopic disease at the primary site (13 patients), regional nodes (23 patients), or both (20 patients). Median delivered doses to the larynx and to the neck were 50 Gy (range, 40 to 64 Gy) and 46 Gy (range, 40 to 64 Gy), respectively. Median follow-up for living patients is 11 years (range, 2.8 to 16.9 years). Laryngeal complication was defined as the appearance of grade 2 or higher toxicity according to the European Organization for Research and Treatment of Cancer (EORTC) and the Radiation Therapy Oncology Group (RTOG) scoring systems. RESULTS: Two- and 5-year actuarial locoregional control rates were 85+/-5% and 83+/-5%, respectively. Thirty patients (54%) developed laryngeal complications. However, just one patient experienced grade 4 laryngeal oedema requiring permanent tracheostomy. Estimated actuarial survival without laryngeal complications were 50+/-7%, 43+/-7%, and 39+/-7% at 2, 5, and 10 years, respectively. At univariate analysis, treated volumes (P = .03) and total dose to the larynx (P = .03) were significantly associated with local toxicity. A trend was observed also for the maximum dose to the neck (P = .06) and dose per fraction (P = .09). A multivariate Cox proportional hazards model showed total dose to the larynx to be the only independent predictor of toxicity (P = .03). The hazard ratio of laryngeal toxicity was 2.2 (95% confidence interval: 1.1/4.6), for a total dose to the larynx greater than 50 Gy. CONCLUSION: After supraglottic laryngectomy, postoperative RT to the neck does not affect local morbidity, but careful RT treatment planning is necessary to avoid delivering a total dose to the larynx greater than 50 Gy.     

Management of stage IV glottic carcinoma: therapeutic outcomes

OBJECTIVES/HYPOTHESIS: The best therapeutic approach for the treatment of stage IV glottic carcinoma is controversial. STUDY DESIGN: A retrospective study. METHODS: A retrospective study of Tumor Research Project data was performed using patients with stage IV glottic squamous cell carcinoma treated with curative intent by five different treatment modalities from 1955 to 1998 at Washington University School of Medicine and Barnes-Jewish Hospital (St. Louis, MO). RESULTS: Ninety-six patients with stage IV glottic carcinoma were treated by five modalities: total laryngectomy (TL) (n = 13), total laryngectomy with neck dissection (TL/ND) (n = 18), radiation therapy alone (RT) (n = 7) (median dose, 69.5 Gy), total laryngectomy combined with radiation therapy (TL/RT) (n = 10), and total laryngectomy and neck dissection combined with radiation therapy (TL/ND/RT) (n = 48). The overall 5-year observed survival (OS) rate was 39%, and the 5-year disease-specific survival (DSS) rate was 45%. The 5-year DSS rates for the individual treatment modalities included the following: TL, 58.3%; TL/ND, 42.9%; RT, 50.0%; TL/RT, 30.0%; and TL/ND/RT, 43.9%. There was no significant difference in DSS for any individual treatment modality (P =.759). The overall locoregional control rate was 69% (66 of 96). The overall recurrence rate was 39% with recurrence at the primary site and in the neck at 19% and 17%, respectively. Recurrence was not related to treatment modality. The 5-year DSS after treatment of locally recurrent cancer (salvage rate) was 30% (3 of 10) and for recurrent neck disease (28 of 67) was 42%. The incidence of delayed regional metastases was 28%; of distant metastasis, 12%; and of second primary cancers, 9%. There was no statistically significant difference in survival between node-negative (N0) necks initially treated (5-y DSS, 31%) versus N0 necks observed and later treated if necessary (5-y DSS, 44%) (P =.685). CONCLUSION: The five treatment modalities had statistically similar survival, recurrence, and complication rates. The overall 5-year DSS for patients with stage IV glottic carcinoma was 45%, and the OS was 39%. The cumulative disease-specific survival (CDSS) was 0.4770 with a mean survival of 10.1 years and a median survival of 3.9 years. Patients younger than age 55 years had better survival (DSS) than patients 56 years of age or older (P =.0002). Patients with early T stage had better survival than patients with more advanced T stage (P =.04). Tumor recurrence at the primary site (P =.0001) and in the neck (P =.014) and distant metastasis (P =.0001) had a deleterious effect on survival. Tumor recurrence was not related to treatment modality. Patients with clear margins of resection had a statistically significant improved survival (DSS and CDSS) compared with patients with close or involved margins (P =.0001). Post-treatment quality of life was not significantly related to treatment modality. Patients whose N0 neck was treated with observation and appropriate treatment for subsequent neck disease had statistically similar survival compared with patients whose N0 neck was treated prophylactically at the time of treatment of the primary. A minimum of 7 years of follow-up is recommended for early identification of recurrent disease, second primary tumors, and distant metastasis. None of the standard treatment modalities currently employed has a statistical advantage regarding survival, recurrence, complications, or quality of life.     

Conservation surgery for laryngeal and hypopharyngeal cancer

The charts of 173 patients treated by conservation laryngectomy and pharyngolaryngectomy were retrospectively reviewed. The patients treated by endoscopic laser resection were excluded of this study. Glottic carcinoma was diagnosed in 101 patients, supraglottic carcinoma in 44 patients, hypopharyngeal carcinoma in 24 patients and oropharyngeal carcinoma in 4 patients. The median follow-up period was 44 months, 84/101 glottic cancer, 34/44 supraglottic cancer, 23/24 hypopharyngeal cancer and 2/4 oropharyngeal cancer were staged as T1 and T2. A voice-sparing external approach was carried on in 20 patients with locally advanced tumor (T3-T4). At time of the last follow-up, 132 patients (77%) were alive when 41 patients (23%) died. Overall survival rates for patients treated for T1-T2 glottic cancer at 3, 5 and 10 years were 90, 90 and 78% respectively. Overall survival rates for patients treated for T1-T2 supralottic cancer at 3, 5 and 10 years were 73, 68 and 48% respectively. Overall survival rates for patients treated for T1-T2 hypopharyngeal cancer at 3 and 5 years were 74 and 37% respectively. The site of the primary tumor (glottic versus supraglottic or hypopharynx) showed significant impact on survival (P = 0.0025)). Regarding survival, T stage and N stage were not found statistically significant.     

Hyperfractionated radiotherapy for T2 glottic cancer for preservation of the larynx

To evaluate the effectiveness of hyperfractionation for T2 glottic cancer from a viewpoint of laryngeal preservation, we analyzed 21 patients (twice-a-day group) who were treated with hyperfractionation between 1992 and 1998 and compared the results with those of 27 patients (once-a-day group) treated with conventional once-a-day radiation between 1987 and 1992. In the twice-a-day group, radiation was performed with two fractions of 1.2 Gy/day up to a total dose of 72–74.4 Gy. In the once-a-day group, radiation was performed with a fraction of 2 Gy/day up to a total dose of 66 Gy. If radiation was ineffective at 40 Gy, it was stopped, and surgical treatment was carried out. Kaplan-Meier estimates were used for the analysis of the survival rate and laryngeal preservation rate, and the results were compared. In the once-a-day group, the 5-year survival rate was 92.3%. The 5-year laryngeal preservation rate was 51.8%, and it was 60.3% in 20 patients who had undergone full-dose radiation (once-a-day full-dose group). In the twice-a-day group, no major complication, such as laryngeal necrosis, was seen in any case, and the 5-year survival rate was 95.3%. The 5-year laryngeal preservation rate was 95.3%, and it was significantly better than that of both the once-a-day group and the once-a-day full-dose group. Hyperfractionation is considered to be useful for preserving the larynx for the treatment of T2 glottic cancer.     

Clinical study of early laryngeal cancer

We retrospectively analyzed 71 consecutive cases of early laryngeal cancer (stage I or II) that had undergone primary treatment in our department between 1999 and 2004. There were 68 males and 3 females, and their ages ranged from 40 to 85 years of age (average; 67.7 years). Eight patients had the supraglottic type, 61 had the glottic type, and 2 had the subglottic type. Chemoradiotherapy was performed as the primary treatment except in the patients with glottic T1a cancer, who received radiotherapy alone. The 5-year survival rates was 91.1% for glottic cancer (T1a: 100%, T1b: 92.3%, T2: 85.8%) and 75.0% for supraglottic cancer. The local control rate of glottic cancer was 79.6% (T1a: 80.0%, T1b: 74.0%, T2: 85.2%), and significantly higher than that of supraglottic cancer (56.2%, p < 0.05). The laryngeal preservation rate was 84.4% in glottic cancer (T1a: 100%, T1b: 76.9%, T2: 77.5%) and 58.3% in supraglottic cancer, and the difference between T1a and T2 glottic cancer was significant (p < 0.05). Local recurrence and cervical lymph node metastasis were seen in 9 patients and 6 patients, respectively. Distant metastasis occurred in 4 patients, all of whom had the glottic type. Four patients died of their disease, and distant metastasis was the major cause of death in 3 of them. These results indicate that additional treatment should be performed in cases in which radiotherapy/chemoradiotherapy is ineffective and that both in the early stages glottic and supraglottic cancers can be successfully treated by radiotherapy/chemoradiotherapy. The results also suggested that the survival of patients with early laryngeal cancer depends on whether they develop distant metastasis. Introduction of adjuvant chemotherapy to improve their prognosis remains to be assessed.     

Radiotherapy with 6-megavolt photons for early glottic carcinoma: potential impact of extension to the posterior vocal cord

PURPOSE: Radiation therapy has a high success rate in the treatment of early glottic carcinoma. Excellent outcomes have been reported from centers using cobalt-60 or relatively low-energy (< or = 4 MV) radiation therapy to achieve these results. Whether similar outcomes can be achieved with a 6 MV linear accelerator has been less rigorously evaluated. This study assesses the efficacy of 6 MV radiation therapy for early stage glottic cancer and identifies prognostic factors for local control and overall survival in this common disease. MATERIALS AND METHODS: One hundred twenty-eight consecutive cases of Tis, T1, and T2 squamous cell carcinomas of the glottis from 1982 to 1996 were retrospectively analyzed with regard to local control and survival. All patients were treated with definitive radiation therapy with a 6-MV linear accelerator. Potential prognostic factors for local control and survival were evaluated with univariate and multivariate models. Median follow-up of locally controlled patients was 65 months. RESULTS: The overall 3-year actuarial local control rates for T1 and T2 carcinomas were 86% and 68%, respectively. Patients with lesions involving the posterior third of the vocal cord had significantly worse 3-year local control (76% vs. 86%, P =.038). Radiation therapy technique and overall treatment time did not significantly affect local control. For patients with Tis and T1 lesions, factors associated with significantly worse local control included cordectomy-ineligible disease (P =.024), dose less than 6,600 cGy (P =.024), and lesions limited to the posterior third of the vocal cord (P =.004). Three-year local control was 76%, with doses less than 6,600 cGy and 90% with higher doses. High rates of second primary malignancies were observed and represented the major cause of death. Five-year overall survival was 84%. CONCLUSIONS: The use of 6-MV photons for treatment of early glottic cancer seems to achieve local control similar to that reported with lower-energy photons. However, patients with posterior third involvement had a poorer local control rate with standard radiation therapy, thereby suggesting that alternative approaches be considered.     

Radiotherapy of early-stage glottic cancer: analysis of factors affecting prognosis

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 < or = 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.     

喉癌术前放射治疗及单纯手术疗效比较

目的 探讨喉癌术前放射治疗加手术的治疗方式能否比单纯手术提高治愈率。方法 应用前瞻性的随机分组的方法进行临床试验。初治的喉癌病例（不包括声门型Ｔ１病变），年龄在７５岁以下，不伴有喉梗阻，经过临床检查确定解剖分型、ＴＮＭ分期（１９７８ＵＩＣＣ）及手术类型后，通过抽签的方法将患者分入单纯手术组（ＳＡ组）或综合治疗组（ＲＳ组）进行治疗。结果 共完成治疗３７０例，ＳＡ组２１５例，ＲＳ组１５５例，ＳＡ组３年     

A clinical study of 213 patients with laryngeal cancer

We retrospectively analyzed 213 patients--197 men and 14 women aged 40 to 87 years--with laryngeal cancer treated at our department from September 1986 to December 1997. The male to female ratio was about 12:1. Cases included 120 glottic (56.3%), 90 supraglottic (42.3%), and 3 subglottic (1.4%). Radiotherapy for early cases and surgery, mainly total laryngectomy for T3 and T4 were conducted first. The 5-year cause-specific survival by site was 97.6% glottic and 77.5% supraglottic. The five-year survival was 88.6% overall. Local control was 83.8% in glottic T1a and 84.6% in glottic T1b. The 3-year preservation of the larynx was 89.1% in glottic T1a and 92.3% in glottic T1b. Distant metastases were observed in 14 cases, mostly to the lung, bones, and liver. At high risk for distant metastasis were those with supraglottic T3-T4, N1, N2b, or pN2c.     

Five hundred cancers of the larynx and pyriform sinus: Results of treatment by radiation and surgery

Three hundred eighty cancers of the larynx and 120 of the pyriform sinus were treated in the 15 years from 1958-1973 at Yale-New Haven Hospital. They were studied for response to treatment by surgery, radiation or a combination of the two. Overall control rates in the entire group of 500 were 51% for radiotherapy, 51% for surgery. Further analysis showed significant differences in the results obtained by stage and by location for surgery and radiotherapy. The total number of cases treated by combined therapy was relatively small, except for pyriform sinus. Radiotherapy success showed a steep gradient from 82% in Tl lesions to 5% in T4. The gradient for surgery was less steep with 64% success for Tl and 40% for T4. Both radiotherapy and surgery were most successful in glottic cancer and least successful in the pyriform sinus. However, the success range varied more with radiation than with surgery (83% success in glottic cancer, 5% in pyriform sinus cancer for radiotherapy; 81% in glottic cancer and 24% in pyriform sinus for surgery). Late primary recurrences (3 years or more after radiation therapy) developed only in the glottic group. Recurrent cancer at the primary site in non-glottic lesions appeared within 2 years after radiotherapy in 65 of the 66 local recurrences. Similarly, 77 of the 82 local recurrences of non-glottic cancer after surgery appeared within 2 years. With only 1 exception in 34 cases, surgical salvage of radiation failures succeeded only in glottic cancer. Of the 136 T1 glottic lesions there were no discernible regional metas-tases. In the remaining 73 glottic T2 and T3 lesions, cervical node me-tastases developed in 8 lesions. Supraglottic cancer was the most likely to produce cervical node metastasis from an early primary lesion (5 Tl lesions among 10 supraglottic lesions with unrecognized positive nodes). Eight of the 65 patients with fixed cervical node metastasis were controlled with no evidence of disease after 3 years. Among the treatment failures, most of those in the radiotherapy group were due to uncontrolled primary disease (72%). The failures among the surgical group were due mainly to metastasis (72%). Final controls obtained by surgery, radiotherapy, combined treatment and secondary salvage of radiation or surgical failures were as follows: glottic 82%; supraglottic 58%; transglottic 58%; subglottic 60%; pyriform sinus 17%.     

Exclusive surgery versus postoperative radiotherapy for supraglottic cancer

AIM OF THE STUDY: To verify the effectiveness of prophylactic postoperative radiotherapy for supraglottic cancer. PATIENTS AND METHODS: 97 patients underwent supraglottic horizontal laryngectomy with bilateral neck dissection: 35 patients (group A) received postoperative radiotherapy (60-70 Gy, 2 Gy fractions daily); 62 patients (group B) received only surgery. RESULTS: Overall 5-year actuarial survival and corrected actuarial survival rates were 74 and 90% in group A and 61 and 80% in group B (p = 0.2 and 0.4, respectively). As for tumor extent, no significant differences were observed between the two groups. In N0 patients overall actuarial survival rate was significantly higher in group A as compared to group B (p = 0.01); most likely this difference was due to errors in clinical staging for the presence of reactive lymphadenitis and micrometastases. CONCLUSIONS: The present study did not document the effectiveness of postoperative radiotherapy. Radiation therapy should be avoided in those patients in whom surgery was proven to be curative while it could be considered in combination with surgery when the resection margins are dubious and/or inadequate.     

Hypofractionated radiotherapy and surgery compared to standard radiotherapy in early glottic cancer

PurposeEarly-stage glottic laryngeal cancer is treated with surgery or radiotherapy (RT), but limited randomized data exists to support one modality over the other. This study evaluates survival differences in early glottic cancer patients treated with either surgery or RT.Materials and methods14,498 patients with early glottic cancer diagnosed from 2004 to 2015 and treated with surgery or RT were identified in the National Cancer Database. Kaplan-Meier method was used to analyze differences in overall survival (OS) by treatment (surgery vs. RT) and radiation dose fractionation. Cox regression modeling and propensity score-matched (PSM) analysis were performed. Adjusted hazard ratios (aHR) with 95% confidence intervals (95% CI) were computed.ResultsMedian follow-up and median OS for all patients were 49.5 and 118 months, respectively. The estimated 5-year OS for surgery and RT was 77.5% and 72.6%, respectively (P < 0.0001). On multivariate analysis, aHR (95% CI) for surgery compared to RT was 0.87 (0.81–0.94, P = 0.0004). Compared to RT regimen 63–67.5 Gray (Gy) in 28–30 fractions, worse survival was noted for RT regimen 66–70 Gy in 33–35 fractions (aHR 1.15, 95% CI 1.07–1.23, P = 0.0003). When compared with hypofractionated RT (63–67.5 Gy in 28–30 fractions), patients undergoing surgery no longer showed improved OS (aHR 0.94, 95% CI 0.86–1.02, P = 0.154). The finding was confirmed on PSM analysis (surgery aHR 0.95, 95% CI 0.87–1.05, P = 0.322).ConclusionIn early glottic tumors, patients treated with surgery demonstrated improved survival compared to RT, but when hypofractionation was considered, there were no significant differences in OS between patients undergoing surgery or RT.     

Concurrent chemotherapy and radiotherapy as initial treatment for stage II supraglottic squamous cell carcinoma

Objective: To evaluate the efficacy and safety of concurrent carboplatin (CBDCA) and radiotherapy for laryngeal carcinoma, we investigated survival rates and laryngeal preservation rates in patients with this treatment modality and those with radiation therapy only. Methods: We underwent chemotherapy with CBDCA and conventional radiotherapy concurrently to 17 patients with untreated stage II (T2N0M0) supraglottic squamous cell carcinoma since November 1990. CBDCA (100 mg/m²) was administered intravenously once a week concurrently with radiotherapy (2.5 Gy/fr, 4 times a week). At the dose of 40 Gy, the results were evaluated, and some of the patients underwent planned surgery and others continued the radiotherapy up to 65 Gy. Results: Overall 5-year survival rate by Kaplan–Meier method was 81.1%. Actual laryngeal preservation rate was 76.0%. Toxicity over grade III was noticed in two patients. Compared with 14 cases of historical controls, which were treated by radiation therapy alone between 1988 and 1990, the cases with concurrent radiotherapy and chemotherapy had statistically significant advantage in overall successful laryngeal preservation rate (P<0.05), whereas the two groups were not significantly different in the overall 5-year survival rate.     

保留杓状软骨喉次全切除喉功能重建的体会

探讨应用保留杓状软骨的喉次全切除喉功能重建术治疗Ｔ３喉癌的拔管率和３、５年生存率。方法对２０例Ｔ３级喉癌,其中声门型３例,声门上型１７例,根据病变范围行保留单侧或双侧杓状软骨喉次全切除及功能重建术,并设计环咽吻合术式。     

T3 Supraglottic Cancer: Treatment Results and Prognostic Factors

Objective—A retrospective study was performed in order to analyze the treatment results and prognostic factors in patients with T3 supraglottic carcinoma and to differentiate between the treatment results obtained for T3 transglottic carcinoma and T3 pure supraglottic carcinoma. Material and Methods—Thirty-two patients who underwent surgery with or without postoperative radiation therapy between 1990 and 2000 were studied. Neck dissection was performed in 27 patients and 24 received postoperative radiation therapy. Results—The 3-year overall survival rate was 81.7%. The 3-year overall survival rates for T3 pure supraglottic carcinoma and T3 transglottic carcinoma were 91.7% and 73.2%, respectively (p<0.05). Univariate analysis revealed a prognostic significance for vocal cord fixation. T3 transglottic carcinoma was significantly correlated with vocal cord fixation. Conclusions—We suggest that surgery, either alone or in combination with postoperative radiation therapy, provides acceptable cancer control and survival rates for patients with T3 supraglottic carcinoma. Vocal cord fixation detected during preoperative fiberoptic laryngoscopy is a significant prognostic factor. T3 transglottic cancer needs more aggressive management.     

Prognostic significance of the DNA ploidy of the early glottic cancer

The stage classification is most frequently used at the present in predicting the outcome of laryngeal carcinoma. Recently, DNA ploidy pattern as detected by DNA flow cytometry and cytofluorometry has been also shown to be predictive. In this study, DNA cytofluorometry was performed on formalin-fixed paraffin-embedded tissues from 18 patients with T1 and T2 glottic squamous cell carcinoma for whom long-term follow-up data were available. The DNA ploidy pattern was classified into three types, diploid, diploid + tetraploid and aneuploid according to the DNA content of Go/G1 cells and mitotic cells. In these 18 cases, 8 cases (44%) had diploid pattern, 3 cases (17%) had the diploid + tetraploid pattern and 7 cases (39%) had the aneuploid pattern. The ploidy pattern was significantly associated with the relapse-free rate, but did not correlate with the stage of the carcinoma and differentiation of the cancer cells. Distribution of the patients by histology, stage and therapy was almost equal among the diploid, diploid + tetraploid and aneuploid groups. All the patients were treated with irradiation (60Gy). In the group as a whole, no patient died of glottic carcinoma. Relapse-free survival rates for diploid, diploid + tetraploid and aneupoid were 88%, 33% and 29% respectively. This retrospective study of glottic cancer treated with radiation therapy suggests the possibility that the DNA ploidy pattern would significantly predict patient outcome and would be useful for selecting patients whose poor prognosis demands more aggressive therapy.