Definitive Radiation Therapy for Early Glottic Carcinoma

Background: Definitive radiation therapy (RT) for early laryngeal glottic carcinoma offers an excellent probability of cure and it is associated with persistent disease or tumor recurrence in a minority of patients. The objective of treatment controlling the malignant tumor and preserving a functionally useful voice is best optimized by the use of radiotherapy in early stages. Although surgery can offer equal good results, it is best reserved in the event of radiation failure. Aim of the work: The aim of the present retrospective study is to identify the treatment outcomes and different prognostic variables affecting early (T1N0M0 and T2N0M0) laryngeal glottic squamous cell carcinoma (SCC) treated with definitive radiation therapy. Methods: The medical records of 81 patients with T1N0M0 and T2N0M0 glottic invasive SCC treated with definitive radiation therapy throughout the period from January, 2002 to September, 2010, at Clinical Oncology Department, Tanta University Hospital, were reviewed. All patients had at least 12 months of follow-up. These patients were evaluated for response to RT, local control, disease specific survival (DSS) rates and treatment toxicity. The different prognostic factors affected the local control and DSS rates were also statistically analyzed. Results: The median follow-up period was 45.9 months. Eleven patients (13.58%) received < 65 Gy as a total irradiation dose and 86.42% received > 65 Gy. Complete disappearance of the laryngeal glottic lesion (CR) was achieved in 91.36% of patients. Five-year local control rates were 89.1% in T1 and 64.96% in T2 tumor stage. Multivariate analysis revealed that anterior commissure involvement (P=0.048) and overall treatment time (P=0.002) are adversely affected local control rates with statistical significance. Seven (9.46%) patients failed locally and 2 (2.7%) had developed distant failure. Five-year DSS rates were as follows: T1, 89.81% and T2, 70.76%. Sever early radiation reaction involving skin, larynx & pharynx were rare (1.2%, 3.7% and 6.2%, respectively), and severe late reactions was recorded in 1.2% of patients. Conclusion: Definitive RT cures a high proportion of patients with T1N0M0 and T2N0M0 glottic SCC and has a low rate of severe complications. The anterior commissure involvement and overall treatment time were adversely affected local control rate. [Alaa Maria; Mohamed El-Shebiney and Omnia Abd El-Fattah. Definitive Radiation Therapy for Early Glottic Carcinoma. Life Science Journal 2012; 9(2):146-153]. (ISSN: 1097-8135). http://www.lifesciencesite.com. 25