Treatment of T1b glottic SCC: laser vs. radiation- a Canadian multicenter study

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Abstract

Objective

To assess the oncological and functional outcomes of T1b squamous cell carcinoma (SCC) of the glottic larynx treated with laser in comparison with radiation.

Design

A Canadian multicenter cohort study.

Setting

Three tertiary referral centers for head and neck cancer- Dalhousie University in Halifax, Nova Scotia, Western University in London, Ontario and the University of Manitoba, Winnipeg.

Methods

Patients with T1b glottic SCC who underwent transoral laser resection or radiation as the primary modality of treatment.

Outcome measures

Oncological outcomes were evaluated using local control, laryngeal preservation, disease free survival and disease specific survival. Voice outcomes were assessed using the Voice Handicap Index-10 (VHI-10).

Results

63 patients met study criteria. 21 were treated with laser and 42 with radiation. Oncologic outcomes at 2 years for laser and radiation demonstrated local control of 95% and 85.9%; laryngeal preservation of 100% and 85.9%; disease free survival of 88.7% and 85.9% and overall survival of 94.1% and 94.8% respectively. VHI-10 data was available for 23/63 patients. During the last follow up visit VHI-10 ranged from 0 to 11 (median 6) in the laser group and 0 to 34 (median 7) in the radiation group.

Conclusion

T1b SCC of the glottis can be effectively treated with transoral laser microsurgery with oncological outcomes that are at least equivalent to radiation. For patients with VHI scores, voice quality was similar between the two groups. To our knowledge this is the first study directly comparing the oncologic and voice outcomes with laser and radiation for the treatment of glottic cancer involving the anterior commissure.

Related collections

Most cited references 24

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Laser surgery in the larynx. Early clinical experience with continuous CO 2 laser.

John M Strong, G. Jako (1972)

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T1-T2N0 squamous cell carcinoma of the glottic larynx treated with radiation therapy.

W M Mendenhall, R J Amdur, C G Morris … (2001)

The end results after radiation therapy for T1-T2N0 glottic carcinoma vary considerably. We analyze patient-related and treatment-related parameters that may influence the likelihood of cure. Five hundred nineteen patients were treated with radiation therapy and had follow-up for >or= 2 years. Three patients who were disease-free were lost to follow-up at 7 months, 21 months, and 10.5 years. No other patients were lost to follow-up. Local control rates at 5 years after radiation therapy were as follows: T1A, 94%; T1B, 93%; T2A, 80%; and T2B, 72%. Multivariate analysis of local control revealed that the following parameters significantly influenced this end point: overall treatment time (P < .0001), T stage (P = .0003), and histologic differentiation (P = .013). Patients with poorly differentiated cancers fared less well than those with better differentiated lesions. Rates of local control with laryngeal preservation at 5 years were as follows: T1A and T1B, 95%; T2A, 82%; and T2B, 76%. Cause-specific survival rates at 5 years were as follows: T1A and T1B, 98%; T2A, 95%; and T2B, 90%. One patient with a T1N0 cancer and three patients with T2N0 lesions experienced severe late radiation complications. Radiation therapy cures a high percentage of patients with T1-T2N0 glottic carcinomas and has a low rate of severe complications. The major treatment-related parameter that influences the likelihood of cure is overall treatment time.

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Influence of fraction size, total dose, and overall time on local control of T1-T2 glottic carcinoma.

Max T Q Le, Jeanne Quivey, Fernanda Kroll … (1997)

To evaluate the influence of fraction size, overall time, total dose, and other prognostic factors on local control of T1 and T2 glottic carcinomas. Between 1956 and 1995, 398 consecutive patients with early glottic carcinoma (315 T1 and 83 T2) were treated with once-a-day definitive radiotherapy at the University of California, San Francisco, and associated institutions. Treatment was delivered 5 days per week. Minimum tumor dose ranged from 46.6 to 77.6 Gy (median: 63 Gy). The fraction size was or = 2.25 Gy in 62 patients. Overall time ranged from 34 to 75 days (median: 50 days). The majority of patients treated with a fraction size of 2.25 Gy completed therapy within 43 days. Median follow-up of all alive patients was 116 months (range 3-436 months). Five-year local control was 85% for T1 and 70% for T2 glottic carcinomas (p = 0.0004). For T1 lesions, within the dose and time range evaluated, there was no apparent relationship between fraction size, overall time, total dose, and local control on multivariate analysis. Treatment era was the only significant prognostic factor (p = 0.02), and anterior commissure (AC) involvement was of borderline significance (p = 0.056). Five-year local control was 77% for patients treated between 1956-1970, 89% for between 1971-1980, and 91% for between 1981-1995; 80% for patients with AC involvement and 88% for those without. For T2 lesions, prognostic factors for local control on multivariate analysis were: overall time (p = 0.003), fraction size (p = 0.003), total dose (p = 0.01), impaired vocal cord mobility (p = 0.02), and subglottic extension (p = 0.04). Five-year local control was 100% for T2 lesions treated with overall time 43 days; 100% for fraction size > or = 2.25 Gy vs. 44% for fraction size 65 Gy vs. 60% for total dose < or = 65 Gy; 79% for normal cord mobility vs. 45% for impaired cord mobility, and 58% for lesions with subglottic extension vs. 77% for those without. The severe complication rate for the entire group was low: 1.8%. Total dose, fraction size, and overall time were significant factors for local control of T2 but not T1 glottic carcinomas. Anterior commissure involvement was associated with decreased local control for T1 but not T2 lesions. For T1 lesions, local control improved over the treatment era. For T2 lesions, local control decreased with impaired cord mobility and subglottic extension.

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Author and article information

Contributors

S Mark Taylor

Paul Kerr

Kevin Fung

Mankavil K Aneeshkumar

Derek Wilke

Yida Jiang

John Scott

Judith Phillips

Robert D Hart

Jonathan RB Trites

Matthew H Rigby

Journal

Journal ID (nlm-ta): J Otolaryngol Head Neck Surg

Journal ID (iso-abbrev): J Otolaryngol Head Neck Surg

Title: Journal of Otolaryngology - Head & Neck Surgery

Publisher: BioMed Central

ISSN (Print): 1916-0208

ISSN (Electronic): 1916-0216

Publication date Collection: 2013

Publication date (Electronic): 19 March 2013

Volume: 42

Issue: 1

Page: 22

Affiliations

[1 ]Dalhousie University, Division of Otolaryngology – Head and Neck Surgery, Halifax, NS, Canada

[2 ]The University of Manitoba, Department of Otolaryngology – Head and Neck Surgery, Winnipeg, Canada

[3 ]Western University, Department of Otolaryngology – Head and Neck Surgery, London, ON, Canada

[4 ]Dalhousie University, Department of Radiation Oncology, Halifax, NS, Canada

[5 ]Otolaryngology - Head & Neck Surgery Facial Plastic & Reconstructive Surgery, Suite 3052, Dickson Bldg., 5820 University Avenue, Halifax, NS B3H 1V9, Canada

Article

Publisher ID: 1916-0216-42-22

DOI: 10.1186/1916-0216-42-22

PMC ID: 3651230

PubMed ID: 23672802

SO-VID: 4c2340b1-a254-4f9a-80b4-fbda3baa9c18

License:

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.

History

Date received : 24 January 2013

Date accepted : 11 March 2013

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Treatment of T1b glottic SCC: laser vs. radiation- a Canadian multicenter study

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Abstract

Objective

Design

Setting

Methods

Outcome measures

Results

Conclusion

Related collections

Chinese Journal of Radiological Health

Most cited references 24

Laser surgery in the larynx. Early clinical experience with continuous CO 2 laser.

T1-T2N0 squamous cell carcinoma of the glottic larynx treated with radiation therapy.

Influence of fraction size, total dose, and overall time on local control of T1-T2 glottic carcinoma.

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Cited by 20

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