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01-09-2014 | Original Research

Outcome following IMRT for T2 glottic cancer: the potential impact of image-guidance protocols on local control

Authors: Albert Tiong, Shao Hui Huang, Brian O’Sullivan, Indranil Mallick, John Kim, Laura A. Dawson, John Cho, Jolie Ringash, Andrew Bayley, Andrew Hope, Eugene Yu, Stephen Breen, Andrea McNiven, Ralph Gilbert, Wei Xu, John Waldron

Published in: Journal of Radiation Oncology | Issue 3/2014

Abstract

Objective

This study aims to report on the outcome of intensity-modulated radiation therapy (IMRT) for T2 glottic cancer and the impact of changes in image-guidance protocol on local control. The result is compared to a historical cohort treated to the same dose with parallel-opposed pairs radiotherapy (POP).

Methods

Patients with T2N0M0 glottic cancers who received primary radiotherapy (60 Gy/25 fractions/5 weeks) between July 1, 2003 and March 30, 2010 were included. The gross tumor volume (GTV) was delineated according to endoscopy/radiology. The clinical target volume (CTV) for POP encompassed the whole larynx with 60 Gy. IMRT generally treated partial laryngeal volumes comprising two CTVs: CTV1 (GTV+ 0.3∼0.5 cm, receiving 60 Gy) and CTV2 (GTV+ ≥1.0 cm, receiving 50 Gy). Planning target volumes (PTVs) were CTVs+ 0.5 cm. Local control (LC) in the IMRT cohort were stratified by image-guidance protocols: matching to bone vertebrae (IMRT-bone, treated prior to 2008) or to laryngeal tissue (IMRT-laryngeal_tissue, treated after 2008), and compared to the POP cohort.

Results

Seventy IMRT (44 IMRT-bone and 26 IMRT-laryngeal_tissue) and 48 POP patients were identified. The 3-year LC was 81 % (95 % CI 65–90) for the POP and 77 % (95 % CI 64–85) for the IMRT cohorts (p = 0.52). The IMRT-bone cohort had decreased LC compared with IMRT-laryngeal_tissue (69 vs. 91 %, p = 0.03). A trend towards increasing local failure for IMRT-bone vs. IMRT-laryngeal_tissue remained after adjusting for various tumor factors.

Conclusions

This modest cohort study demonstrates a comparable LC with IMRT for T2 glottic cancers compared to our historical POP cohort. It adds clinical evidence to previous technical observations that have hypothesized a potential impact of laryngeal_tissue movement independent of bone_vertebrae, when partial laryngeal irradiation is contemplated.

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Title: Outcome following IMRT for T2 glottic cancer: the potential impact of image-guidance protocols on local control
Authors: Albert Tiong
Shao Hui Huang
Brian O’Sullivan
Indranil Mallick
John Kim
Laura A. Dawson
John Cho
Jolie Ringash
Andrew Bayley
Andrew Hope
Eugene Yu
Stephen Breen
Andrea McNiven
Ralph Gilbert
Wei Xu
John Waldron
Publication date: 01-09-2014
Publisher: Springer Berlin Heidelberg
Published in: Journal of Radiation Oncology / Issue 3/2014
Print ISSN: 1948-7894
Electronic ISSN: 1948-7908
DOI: https://doi.org/10.1007/s13566-013-0131-6

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