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      Clinical Outcomes of Curative Intent Radiotherapy by Helical Tomotherapy for Laryngeal Squamous Cell Carcinoma: A Retrospective Analysis in a Tertiary Referral Center

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          Abstract

          Background

          The management of laryngeal cancer involves balancing curative treatment with preserving essential functions. This study aimed to evaluate the clinical outcomes of helical tomotherapy, an advanced form of radiation therapy, as a primary treatment modality for laryngeal squamous cell carcinoma (LSCC).

          Methods

          A retrospective analysis of data obtained from a tertiary referral center was performed to assess treatment response rates, survival outcomes, disease control, and treatment-related adverse events.

          Results

          The study included 45 patients with LSCC treated with helical tomotherapy between May 2015 and September 2022. The 5-year overall survival (OS) rate and disease-free survival (DFS) rate were 89.2% and 71.1%, respectively. Local control and laryngeal preservation rates at 5 years were 79.7% and 84.7%, respectively. Subgroup analysis revealed higher DFS rates in early-stage patients (84.2%) compared to advanced-stage patients (58.9%).

          Conclusions

          The results indicate that helical tomotherapy offers effective tumor control and potential for laryngeal preservation in LSCC. Further prospective studies and longer follow-up are needed to validate these findings and optimize treatment strategies for LSCC patients.

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          Most cited references25

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          Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer.

          Arlene Forastiere, Qiang Zhang, Randal Weber … (2013)
          To report the long-term results of the Intergroup Radiation Therapy Oncology Group 91-11 study evaluating the contribution of chemotherapy added to radiation therapy (RT) for larynx preservation. Patients with stage III or IV glottic or supraglottic squamous cell cancer were randomly assigned to induction cisplatin/fluorouracil (PF) followed by RT (control arm), concomitant cisplatin/RT, or RT alone. The composite end point of laryngectomy-free survival (LFS) was the primary end point. Five hundred twenty patients were analyzed. Median follow-up for surviving patients is 10.8 years. Both chemotherapy regimens significantly improved LFS compared with RT alone (induction chemotherapy v RT alone: hazard ratio [HR], 0.75; 95% CI, 0.59 to 0.95; P = .02; concomitant chemotherapy v RT alone: HR, 0.78; 95% CI, 0.78 to 0.98; P = .03). Overall survival did not differ significantly, although there was a possibility of worse outcome with concomitant relative to induction chemotherapy (HR, 1.25; 95% CI, 0.98 to 1.61; P = .08). Concomitant cisplatin/RT significantly improved the larynx preservation rate over induction PF followed by RT (HR, 0.58; 95% CI, 0.37 to 0.89; P = .0050) and over RT alone (P < .001), whereas induction PF followed by RT was not better than treatment with RT alone (HR, 1.26; 95% CI, 0.88 to 1.82; P = .35). No difference in late effects was detected, but deaths not attributed to larynx cancer or treatment were higher with concomitant chemotherapy (30.8% v 20.8% with induction chemotherapy and 16.9% with RT alone). These 10-year results show that induction PF followed by RT and concomitant cisplatin/RT show similar efficacy for the composite end point of LFS. Locoregional control and larynx preservation were significantly improved with concomitant cisplatin/RT compared with the induction arm or RT alone. New strategies that improve organ preservation and function with less morbidity are needed.
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            Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

            V. Grégoire, J.-L. Lefebvre, L. Licitra … (2010)
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              Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines.

              Benoît G. Lengelé, Wilfried Budach, Chris Nutting … (2013)
              In 2003, a panel of experts published a set of consensus guidelines for the delineation of the neck node levels in node negative patients (Radiother Oncol, 69: 227-36, 2003). In 2006, these guidelines were extended to include the characteristics of the node positive and the post-operative neck (Radiother Oncol, 79: 15-20, 2006). These guidelines did not fully address all nodal regions and some of the anatomic descriptions were ambiguous, thereby limiting consistent use of the recommendations. In this framework, a task force comprising opinion leaders in the field of head and neck radiation oncology from European, Asian, Australia/New Zealand and North American clinical research organizations was formed to review and update the previously published guidelines on nodal level delineation. Based on the nomenclature proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery, and in alignment with the TNM atlas for lymph nodes in the neck, 10 node groups (some being divided into several levels) were defined with a concise description of their main anatomic boundaries, the normal structures juxtaposed to these nodes, and the main tumor sites at risk for harboring metastases in those levels. Emphasis was placed on those levels not adequately considered previously (or not addressed at all); these included the lower neck (e.g. supraclavicular nodes), the scalp (e.g. retroauricular and occipital nodes), and the face (e.g. buccal and parotid nodes). Lastly, peculiarities pertaining to the node-positive and the post-operative clinical scenarios were also discussed. In conclusion, implementation of these guidelines in the daily practice of radiation oncology should contribute to the reduction of treatment variations from clinician to clinician and facilitate the conduct of multi-institutional clinical trials. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
              Article 0 comments Cited 134 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): World J Oncol
                Journal ID (iso-abbrev): World J Oncol
                Journal ID (publisher-id): Elmer Press
                Title: World Journal of Oncology
                Publisher: Elmer Press
                ISSN (Print): 1920-4531
                ISSN (Electronic): 1920-454X
                Publication date (Print): February 2024
                Publication date (Electronic): 9 December 2023
                Volume: 15
                Issue: 1
                Pages: 136-142
                Affiliations
                [a ]Department of Radiology, the University of Tokyo Hospital, Tokyo, Japan
                Author notes
                [b ]Corresponding Author: Atsuto Katano, Department of Radiology, the University of Tokyo Hospital, Tokyo 113-8655, Japan. Email: katanoa-rad@ 123456h.u-tokyo.ac.jp
                Author information
                https://orcid.org/0000-0003-4393-1828
                Article
                DOI: 10.14740/wjon1638
                PMC ID: 10807912
                SO-VID: 2f92d20c-bf54-43d1-8928-66f30cc5066b
                Copyright © Copyright 2024, Katano et al.
                License:

                This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 October 2023
                Date accepted : 21 November 2023
                Funding
                None to declare.
                Categories
                Subject: Short Communication

                Keywords: laryngeal squamous cell carcinoma,helical tomotherapy,radiation therapy,survival rate
                Data availability:
                Keywords: laryngeal squamous cell carcinoma, helical tomotherapy, radiation therapy, survival rate

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