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

被引:9
作者
Kim, Kristine N. [1 ,5 ]
Dyer, Michael A. [1 ]
Qureshi, Muhammad M. [1 ]
Shah, Nishant K. [1 ]
Grillone, Gregory A. [2 ]
Faden, Daniel L. [3 ]
Jalisi, Scharukh M. [4 ]
Minh Tam Truong [1 ]
机构
[1] Boston Univ, Radiat Oncol, Sch Med, 830 Harrison Ave,Moakley Bldg LL 237, Boston, MA 02118 USA
[2] Boston Univ, Otolaryngol Head & Neck Surg, Sch Med, 830 Harrison Ave 1st Floor,Suite 1400, Boston, MA 02118 USA
[3] Harvard Med Sch, Otolaryngol Head & Neck Surg, Main Campus 243 Charles St, Boston, MA 02114 USA
[4] Harvard Med Sch, BIDMC Otolaryngol, Otolaryngol Head & Neck Surg, 110 Francis St,Suite 6E, Boston, MA 02215 USA
[5] Univ Penn, Radiat Oncol, Perelman Sch Med, 3400 Civ Ctr Blvd, Philadelphia, PA 19104 USA
关键词
Glottic cancer; Head and neck; Larynx-preservation; Laryngectomy; Radiotherapy; DEFINITIVE RADIATION-THERAPY; SQUAMOUS-CELL CARCINOMA; FRACTION SIZE; LARYNGEAL-CANCER; LASER-SURGERY; LOCAL-CONTROL; MANAGEMENT; SURVIVAL; METAANALYSIS; PATTERNS;
D O I
10.1016/j.amjoto.2020.102544
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
Purpose: Early-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 methods: 14,498 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. Results: Median 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). Conclusion: In 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.
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页数:10
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