Hypo fractionated radiotherapy for early glottic carcinoma: Feasibility and toxicity

Abstract

Author(s): Rasha Abd El-Ghany Khedr and Lamiss Mohamed sad*

Introduction: for early stage glottic cancer, different schedules had been applied. The use of hypofractionation seems to be attractive for shorter overall treatment time and decreased cost of treatment. The aim of our trial is to study the local control and survival rates of hypo fractionated radiotherapy schedule of 55Gy/20 fractions with 2.75Gy/fraction. Methods: T1-2 N0 glottic squamous cell carcinoma was treated at Clinical Oncology department, Tanta university hospital between February 2015 and January 2018. All patients were treated with a schedule of 55Gy/20 fractions/4 weeks. Patients for whom surgery was done whether cordotomy or stripping using laser have been removed. Local control, regional control, and overall survival probabilities were determined. Results: This phase II prospective study, forty-one early stage glottic cancer patients who had fulfilled inclusion criteria were identified. The median follow-up time was 30 (range 5 - 64) months. T1 and T2 disease were reported in Twenty (48.8%) and 21 (51.2%) patients Complete response was reported in (40/41) 97.5 % patients. Five-year actuarial local control rates were 75.1%, 80.8%, 75% and 71.6% in overall, T1 a, T1b and T2 respectively (p=0.977). After the initial full clinical response, a total of 8/40 (20 percent) patients experienced disease recurrence with a median recurrence period of 19 (range 4-59) months after the initial complete clinical response. The 5-year OS were 83.7%. A total of 6 (14.6%) deaths occurred during follow up. Univariate covariate analysis did not show any important association (all p>0.05) with local control. Only one significant covariate associated with overall survival was trans glottic extension in T2 disease (p<0.019). Grade 3 skin toxicity was reported in 4 (11%) patients. Enteral nutrition using nasogastric tube was reported in 7 (17%) patients with grade 3 mucositis. Conclusions: This study had shown that a regimen of 55Gy /20 fractions/4 weeks achieve reasonable late toxicity with good local control for early glottis cancer.

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