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Title: T1N0 to T2N0 Squamous Cell Carcinoma of the Glottic Larynx Treated With Definitive Radiotherapy

Abstract

Purpose: To report the treatment outcomes of definitive radiotherapy (RT) for early-stage squamous cell carcinoma (SCCA) of the glottic larynx. Methods and Materials: We retrospectively reviewed the medical records of 585 patients with T1N0 to T2N0 invasive SCCA of the glottic larynx treated between 1964 and 2006 with RT alone. All patients had at least 2 years of follow-up, had histologic diagnosis of invasive SCCA, and received continuous-course RT. None of these patients received chemotherapy or had elective nodal RT. The probabilities of local control (LC), ultimate LC, ultimate LC with larynx preservation, neck control, cause-specific survival (CSS), and overall survival (OS) were calculated by the Kaplan-Meier product-limit method. Results: The median follow-up for survivors was 12 years. Five-year LC rates were as follows: T1A, 94%; T1B, 93%; T2A, 80%; and T2B, 70%. Multivariate analysis revealed that overall treatment time greater than 41 days (p = 0.001) and poorly differentiated histology (p = 0.016) adversely affected LC. Five-year rates of ultimate LC with laryngeal preservation were: T1A, 95%; T1B, 94%, T2A, 81%; and T2B, 74%. Twenty-four (4%) of 585 patients failed in the neck; only 7 neck failures (1%) were isolated. Five-year CSS and OS rates were as follows: T1A,more » 97% and 82%; T1B, 99% and 83%; T2A, 94% and 76%; and T2B, 90% and 78%, respectively. Ten (1.7%) patients had severe and/or fatal complications. One patient died of a radiation-induced carotid artery angiosarcoma. Conclusion: Based on our study results, RT cures a high proportion of patients with T1N0 to T2N0 glottic SCCAs and has a low rate of severe complications.« less

Authors:
; ; ;  [1];  [1]
  1. Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States)
Publication Date:
OSTI Identifier:
21436188
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 78; Journal Issue: 2; Other Information: DOI: 10.1016/j.ijrobp.2009.08.066; PII: S0360-3016(09)03022-3; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; LARYNX; RADIOTHERAPY; DISEASES; MEDICINE; NEOPLASMS; NUCLEAR MEDICINE; RADIOLOGY; RESPIRATORY SYSTEM; THERAPY

Citation Formats

Chera, Bhishamjit S., Amdur, Robert J., Morris, Christopher G., Kirwan, Jessica M., and Mendenhall, William M., E-mail: mendwm@shands.ufl.ed. T1N0 to T2N0 Squamous Cell Carcinoma of the Glottic Larynx Treated With Definitive Radiotherapy. United States: N. p., 2010. Web. doi:10.1016/j.ijrobp.2009.08.066.
Chera, Bhishamjit S., Amdur, Robert J., Morris, Christopher G., Kirwan, Jessica M., & Mendenhall, William M., E-mail: mendwm@shands.ufl.ed. T1N0 to T2N0 Squamous Cell Carcinoma of the Glottic Larynx Treated With Definitive Radiotherapy. United States. doi:10.1016/j.ijrobp.2009.08.066.
Chera, Bhishamjit S., Amdur, Robert J., Morris, Christopher G., Kirwan, Jessica M., and Mendenhall, William M., E-mail: mendwm@shands.ufl.ed. Fri . "T1N0 to T2N0 Squamous Cell Carcinoma of the Glottic Larynx Treated With Definitive Radiotherapy". United States. doi:10.1016/j.ijrobp.2009.08.066.
@article{osti_21436188,
title = {T1N0 to T2N0 Squamous Cell Carcinoma of the Glottic Larynx Treated With Definitive Radiotherapy},
author = {Chera, Bhishamjit S. and Amdur, Robert J. and Morris, Christopher G. and Kirwan, Jessica M. and Mendenhall, William M., E-mail: mendwm@shands.ufl.ed},
abstractNote = {Purpose: To report the treatment outcomes of definitive radiotherapy (RT) for early-stage squamous cell carcinoma (SCCA) of the glottic larynx. Methods and Materials: We retrospectively reviewed the medical records of 585 patients with T1N0 to T2N0 invasive SCCA of the glottic larynx treated between 1964 and 2006 with RT alone. All patients had at least 2 years of follow-up, had histologic diagnosis of invasive SCCA, and received continuous-course RT. None of these patients received chemotherapy or had elective nodal RT. The probabilities of local control (LC), ultimate LC, ultimate LC with larynx preservation, neck control, cause-specific survival (CSS), and overall survival (OS) were calculated by the Kaplan-Meier product-limit method. Results: The median follow-up for survivors was 12 years. Five-year LC rates were as follows: T1A, 94%; T1B, 93%; T2A, 80%; and T2B, 70%. Multivariate analysis revealed that overall treatment time greater than 41 days (p = 0.001) and poorly differentiated histology (p = 0.016) adversely affected LC. Five-year rates of ultimate LC with laryngeal preservation were: T1A, 95%; T1B, 94%, T2A, 81%; and T2B, 74%. Twenty-four (4%) of 585 patients failed in the neck; only 7 neck failures (1%) were isolated. Five-year CSS and OS rates were as follows: T1A, 97% and 82%; T1B, 99% and 83%; T2A, 94% and 76%; and T2B, 90% and 78%, respectively. Ten (1.7%) patients had severe and/or fatal complications. One patient died of a radiation-induced carotid artery angiosarcoma. Conclusion: Based on our study results, RT cures a high proportion of patients with T1N0 to T2N0 glottic SCCAs and has a low rate of severe complications.},
doi = {10.1016/j.ijrobp.2009.08.066},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 2,
volume = 78,
place = {United States},
year = {Fri Oct 01 00:00:00 EDT 2010},
month = {Fri Oct 01 00:00:00 EDT 2010}
}
  • Purpose: We recently reported on the identification of the Fas-associated death domain (FADD) as a possible driver of the chromosome 11q13 amplicon and the association between increased FADD expression and disease-specific survival in advanced-stage laryngeal carcinoma. The aim of this study was to examine whether expression of FADD and its Ser194-phosphorylated isoform (pFADD) predicts local control in patients with early-stage glottic carcinoma primarily treated with radiotherapy only. Methods and Materials: Immunohistochemical staining for FADD and pFADD was performed on pretreatment biopsy specimens of 92 patients with T1-T2 glottic squamous cell carcinoma primarily treated with radiotherapy between 1996 and 2005. Coxmore » regression analysis was used to correlate expression levels with local control. Results: High levels of pFADD were associated with significantly better local control (hazard ratio, 2.40; 95% confidence interval, 1.04-5.55; p = 0.040). FADD overexpression showed a trend toward better local control (hazard ratio, 3.656; 95% confidence interval, 0.853-15.663; p = 0.081). Multivariate Cox regression analysis showed that high pFADD expression was the best predictor of local control after radiotherapy. Conclusions: This study showed that expression of phosphorylated FADD is a new prognostic biomarker for better local control after radiotherapy in patients with early-stage glottic carcinomas.« less
  • This is a retrospective analysis of 68 patients with Stage T3 squamous cell carcinoma of the glottic larynx treated with surgery and/or irradiation from March 1965 to April 1981 at the University of Florida. Follow-up ranged from 2 to 17.5 years. Initial local-regional control of disease above the clavicles (i.e., prior to salvage attempts) by treatment technique for patients a risk for greater than or equal to 2 years was 11/19 (58%) with irradiation alone, 5/7 (71%) with preoperative irradiation and surgery, 8/9 (89%) with surgery and postoperative irradiation, and 18/23 (78%) with surgery alone. Initial control of disease atmore » the primary site was accomplished in 11/18 (61%) treated with radiation therapy alone, and ultimate control of the primary was obtained in 15/18 (83%) after surgical salvage. Analysis of complications and survival is included, and treatment recommendations are discussed.« less
  • Purpose: To describe and illustrate examples of early-stage larynx and hypopharynx cancer that can be successfully treated with radiotherapy alone. Methods and Materials: Review of the NCCN and ASCO practice guidelines. Representative examples are included. Results: Early-stage larynx and hypopharynx cancer is defined by tumor extent based on physical and imaging examination. Conclusions: Radiotherapy alone is appropriate treatment for properly selected early-stage squamous cell carcinoma of the larynx and hypopharynx. The NCCN and ASCO practice guidelines can be an aid to the clinician in identifying favorable cancers that can be successfully treated with radiotherapy alone with preservation of organ function.
  • Purpose: To report the long-term results after definitive radiotherapy (RT) for T1-T2 pyriform sinus squamous cell carcinoma. Patients and Methods: The data from 123 patients with T1-T2 pyriform sinus squamous cell carcinoma treated with RT with or without neck dissection between November 1964 and June 2003 were analyzed. The median follow-up for all patients was 3.2 years, and the median follow-up for living patients was 10.7 years. Results: The 5-year local control, locoregional control, freedom from distant metastasis, cause-specific survival, and overall survival rate was 85%, 70%, 75%, 61%, and 35%, respectively. The ultimate local control rate, including successful salvagemore » of RT failure, for T1 and T2 cancer patients was 96% and 94%, respectively. The overall local control rate with a functional larynx was 83%. Pretreatment computed tomography tumor volume data were available for 55 patients. The median computed tomography tumor volume was 4.2 cm{sup 3} (range, 0-22.4). Local control was worse for patients with a tumor volume >6.5 cm{sup 3} compared with those with a smaller tumor volume. Of the 123 patients, 16% developed moderate to severe acute (2%), late (9%), or postoperative (5%) complications. Conclusions: Local control with larynx preservation after definitive RT for T1-T2 pyriform sinus squamous cell carcinoma likely results in local control and survival similar to that after total laryngectomy or larynx-conserving surgery. Two-thirds of our living patients retained a functional larynx.« less
  • Purpose: To evaluate the pretreatment risk factors of para-aortic lymph node (PALN) recurrence after primary radiotherapy for cervical cancer. Methods and Materials: Between May 1992 and January 2006, the data from 758 patients with squamous cell carcinoma of the uterine cervix were retrospectively analyzed. No patient had undergone PALN radiotherapy as their initial treatment. PALN recurrence was diagnosed by computed tomography. PALN relapse-free status was determined clinically or radiographically. We analyzed the actuarial rates of PALN recurrence using Kaplan-Meier curves. Multivariate analyses were performed with Cox regression models. Results: Of the 758 patients, 38 (5%) and 42 (6%) had isolatedmore » and nonisolated PALN recurrences after a median follow-up of 50 months (range, 2-159 months), respectively. The 3-year and 5-year overall survival rate after PALN recurrence was 35% and 28%, respectively. A squamous cell carcinoma antigen (SCC-Ag) level >40 ng/mL (p <0.001), advanced parametrial involvement (score 4-6; p = 0.002), and the presence of pelvic lymphadenopathy (p = 0.007) were independent factors associated with PALN relapse on multivariate analysis. The 5-year PALN recurrence rate in patients with a SCC-Ag level >40 ng/mL, SCC-Ag level of 20-40 ng/mL, parametrial score of 4-6, pelvic lymphadenopathy, and no risk factors was 57%, 22%, 34%, 37%, and 9%, respectively. Conclusions: Patients with squamous cell carcinoma of the uterine cervix and a high SCC-Ag level, pelvic lymphadenopathy, or advanced PM involvement were predisposed to PALN recurrence after definitive radiotherapy. More intensive follow-up schedules are suggested for early detection and salvage in high-risk patients.« less