Note: According to randomised control trials (Overgaard 2003 - DAHANCA, Yamazaki 2006), this protocol has been shown to have inferior outcomes.
Improved locoregional control rates have been reported with hypofractionated/ accelerated schedules and therefore the use of hypofractionated/accelerated protocols over conventional schedules is strongly recommended.
Link to Head and Neck, Early Glottic, Larynx, SCC, Definitive - Hypofractionation protocol
The ultimate goal in treating early glottic carcinoma is control of the tumour, preserving the best voice quality possible without serious side effects.r
There are currently no randomised studies comparing radiotherapy to conservative surgery with respect to local control or survival for early stage laryngeal cancer.r All patients with T1-T2 laryngeal cancer should be treated initially with the intent to preserve the larynx. Similar survival outcomes have been reported with radiation or larynx-preservation surgery as treatment modalities.r With radiotherapy recommended as the treatment of choice by the National Cancer Institute as "most early lesions can be cured by either radiation therapy or surgery, radiation therapy may be reasonable to preserve the voice, leaving surgery for salvage."
Functional outcome and treatment induced side effects should also be considered when deciding on the most appropriate treatment modality.r
Local control in early stage glottic carcinoma is related to total dose, dose per fraction and overall treatment time. Reported local control rates being higher for 2 - 2.25 Gy per faction than with 1.8 Gy for a similar total dose.r This is especially true for T2 lesions, although this trend is also noted for T1 lesions.r
- Tis - The initial local control rate for Tis in a study that included 79 patients with Tis and 7 with leukoplakia, all receiving RT was 85 %, rising to 99 % after surgical salvage of the failures.r In a series from Princess Margaret Hospital (PMH), Spayne et al 2001r reported a dose of 55 Gy/20 fractions had 5 year actuarial local control at 98 %, at 6.5 years follow-up.
- T1 - For T1 glottic carcinoma, the initial local control rates are in the order of 83 to 95 %, rising to 94 to 99 % after surgical salvage. Laryngeal preservation is high at 89 to 95 %.rrrrr
- T2 - Initial local control rates following primary radiotherapy are in the range of 67 to 88 %, rising to 85 to 96 % after surgical salvage. Larynx preservation is lower than in T1 at 71 to 88 %. Impaired vocal cord mobility,rr but not anterior commissure involvement,rr is associated with worse outcomes in some series.
© J Clin Oncol Mendenhall 2001r
© Cancer Mendenhall 2004r