ABSTRACT
Objective To carry out a Meta-analysis on the published data to evaluate voice after laser surgery versus radiotherapy of T1a glottic carcinoma.Methods The major medical-related databases were used in this study including PubMed, Web of Science,Embase, Cochrane library, CNKI and Wanfang Date.The articles by two co-authors at the same time were screened to read the relevant literatures, extraction of data and research related to the purpose from the selected literature.Results According the necessary conditions,fourteen literatures was included finally, and statistical analysis results showed that owing to the meta-analysis of the maximum time of speech (MPT) [test for overall effect:Z=2.65,MD=-2.26,95%CI(-3.94,-0.59),P=0.008] and the fundamental frequency (F0) [test for overall effect:Z=7.49,MD=14.41,95%CI(10.14,18.19),P<0.000 01], radia-tion therapy was superior to laser surgery,but the Meta-analysis of voice handicap index (VHI) [test for overalleffect:Z=1.04,MD=5.86,95%CI(-5.22,16.94),P=0.30], jitter[test for overall effect:Z=1.43,MD=0.75,95%CI(-0.28,1.79),P=0.15], shimmer[test for overall effect:Z=1.26,MD=1.07,95%CI(-0.60,2.75,P=0.21] and Airflow rate(AFR) [test for overall effect:Z=0.42,MD=21.46,95%CI(-78.79,121.72),P=0.67] don''t show statistically significant difference between the two groups.Conclusion The radiation therapy is slightly superior to the laser surgery in protecting voice in the treatment of T1a glottic carcinoma.
ABSTRACT
Objective To investigate the curative effect of surgery,radiotherapy and photodynamic therapy combined with chemotherapy on early glottic carcinoma and prognostic factors.Methods Clinical data of 122 cases of early glottic carcinoma with Tis ~T2 N0 M0 were analyzed retrospectively.Small doses of chemotherapy applied to single drug cisplatin (according to the surface area of 50 mg/m2 ).83 patients underwent surgical treatments combined with chemotherapy,20 cases accepted radiotherapy combined with chemotherapy and 19 cases accepted photodynamic therapy combined with chemotherapy. Results The 3 and 5 years overall survival rates (overall survival,OS ) of surgery group,radiotherapy group and photodynamic group were 92.7%,93.8% and 89.5%,89.5% and 84.4% ,89.5%,respectively.The 2-year disease free survival rate (disease-freesurvival,DFS)were 87.6%,79.4%,78.6%,respectively.The 2-year local control rate(local control,LC)were 91.9%,84.4%,83.0%, respectively.27 cases suffered from tumor recurrence or metastasis,15 cases in the surgery group,3 cases in the radiotherapy group and 5 cases in the photodynamic group,among them 19 patients accepted salvage surgery.Multifactor retrospective analysis indicated anterior commissure invasion (P=0.047),clinical stage(P =0.018)and KPS score before treatment(P =0.001)were independent adverse prognostic factors for OS.Anterior commissure invasion(P=0.027)and differentiation degree(P=0.041)were adverse prognostic factors for DFS.Anterior commissure invasion was also poor prognostic features for LC(P=0.047).Conclusion Radiotherapy and photodynamic therapy combined with chemotherapy may be the first or very important treatment on early stage glottic squamous cell cancer(Tis ~T2N0M0 ).High preservation rate of laryngeal function with radiotherapy and photodynamic therapy combined with chemotherapy can significantly improved quality of life of patients.Curative effect of three groups was similar,and three kinds of curative methods achieved good effect.KPS score before treatment,glottis impair and differentiation degree were the main adverse prognostic factors for early stage glottic carcinoma.
ABSTRACT
PURPOSE: The purpose of this study was to establish general guidelines for the treatment of patients with early glottic carcinoma (T1-2N0M0), by assessing the role of primary radiotherapy and by analyzing the tumor-related and treatment-related factors that have an influence on the treatment results. MATERIALS AND METHODS: This retrospective study was composed of 80 patients who suffered from early glottic carcinoma and were treated by primary radiotherapy at Pusan National University Hospital, between August 1987 and December 1996. The distribution of patients according to T-stage was 66 for stage T1 and 14 for stage T2. All of the patients were treated with conventional radical radiotherapy using a 6MV photon beams, a total tumor dose of 60~75.6 Gy (median 68.4 Gy), administered in 5 weekly fractions of 1.8~2.0 Gy. The overall radiation treatment time was from 40 to 87 days, median 51 days. All patients were followed up for at least 3 years. Univariate and multivariate analysis was done to identify the prognostic factors affecting the treatment results. RESULTS: The five-years overall survival rate was 89.2% for all patients, 90.2% for T1 and 82.5% for T2. The local control rate was 81.3% for all patients, 83.3% for T1 and 71.4% for T2. However, when salvage operations were taken into account, the ultimate local control rate was 91.3%, T1 94.5%, T2 79.4%, representing an increase of 8~12% in the local control rate. The voice preservation rate was 89.2%, T1 94.7 %, T2 81.3%. Fifteen patients suffered a relapse after radiotherapy, among whom 12 patients underwent salvage surgery. We included T-stage, tumor location, total radiation dose, fraction size, field size and overall radiation treatment time as potential prognostic factors. T-stage and overall treatment time were found to be statistically significant in the univariate analysis, but in the multivariate analysis, only the overall treatment time was found to be significant. CONCLUSION: The high cure and voice preservation rates obtained when using a procedure, comprising a combination of radical radiotherapy and salvage surgery, may make this the treatment of choice for patients with early glottic carcinoma. However, the prognostic factors affecting the treatment results must be kept in mind, and more accurate treatment planning and further optimization of the radiation dose are necessary.
Subject(s)
Humans , Multivariate Analysis , Radiotherapy , Recurrence , Retrospective Studies , Survival Rate , VoiceABSTRACT
This study was performed to analyse the outcome of definitive radiation therapy (RT) for early stage (T1,T2) squamous cell carcinoma of the glottis and define the prognostic factors influencing the local control by this method of treatment. Sixty-two newly-diagnosed patients treated at Division of Radiation Oncology, Department of Radiology, Siriraj Faculty of Medicine from January 1987 to December 1995 were retrospectively reviewed with the median follow-up period 35 months. The complete response rate (CR) from this study was 91.9 percent (57/62) with 14 patients developing locoregional recurrence later. The two-year and five-year local control were 72.8 and 67.8 percent respectively. Among the factors analysed for local control (stage, anterior commissure involvement, initial field size and histologic grade), only grade showed statistically significant impact by univariate analysis. The overall survival at two-year and five-year were 91.6 and 86.2 percent, respectively. RT can be definitive treatment in this group of patients but salvage surgery should be provided in some cases.
ABSTRACT
PURPOSE: To assess the effectiveness and problems of the primary radiation therapy and salvage surgery in a series of patients affected by T1-T2 NO glottic cancers treated from 1985 to 1991 at the Pusan National University Hospital. MATERIALS AND METHODS: From 8.85 to 12/91, 34 patients affected by early glottic carcinoma histologically proven were treated with curative radiation therapy. Distribution of patients according to T stage was 30 for T1 and 4 T2. Male to female ratio was 33:1. Age of patients ranged from 31 to 73 with mean age of 58 years. All of the patients were treated with radical radiation with total tumor dose of 63-75. 3 Gy(median 68.2 Gy), of 5 weekly fractions of 1.8-2Gy and with 6MV photon beams through two laterally opposed fields. RESULTS: The overall 5-year local control rates were 74%(8/30) for T1, and 25%(3/4) for T2. The main cause of failure was progression or recurrence in T(10/11). One failures were observed in T and N at the same time. Of these 11 patients, 9(81%) were salvaged with surgery. After surgical salvage of radiation failures, the 5-year survival rates were 96% for T1 and 75% T2. Among the survivors, 73% of T1 and 33% of T2 were able to preserve the larynx. CONCLUSION: It can be concluded that radiotherapy is the first choice in the treatment of glottic T1 carcinoma.