Main Session
Sep
29
PQA 07 - Head and Neck Cancer, Lung Cancer/Thoracic Malignancies, and Nursing and Supportive Care
3562 - Precise Radiation, Better Airway Preservation: Vocal Cord-only Image-guided Intensity-modulated Radiation Therapy for Early-stage Glottic Cancer
Presenter(s)
Issa Mohamad, MD - King Hussein Cancer Center, Amman, Amman
I. A. Mohamad1, I. Alotain2, A. Taqash3, M. Mukahal4, S. Abu Taha4, M. Berawi4, L. Wahbeh1, M. Y. Alsmairat1, A. Alzibdeh1, R. Alhabib5, F. J. Abuhijla1, R. Abuhijlih1, H. Ghatasheh6, and A. Hosni7; 1Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan, 2Radiation Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia, 3King Hussein Cancer Center, Amman, Jordan, 4King Hussien Cancer Center, Amman, Jordan, 5King Fahad Specialist Hospital, Dammam, Saudi Arabia, 6King Hussein Cancer Center, Amman, ON, Jordan, 7Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
Purpose/Objective(s):
Radiotherapy achieves excellent local control (LC) in early-stage glottic cancer, but treatment-related laryngeal edema or necrosis may necessitate tracheostomy and impair quality of life. We compared tracheostomy rates and oncologic outcomes between whole-larynx radiotherapy (WLRT) and vocal cord–only radiotherapy (VC-RT).Materials/Methods:
We retrospect reviewed 247 patients with Tis–T2 glottic cancer treated from 2007–2023 at two centers in the Middle east. Patients received WLRT (n=166) or VC-RT (n=81). The primary endpoint was tracheostomy rate =6 months after radiotherapy for treatment-related airway compromise without recurrence. Secondary endpoints included 3-year LC and overall survival (OS). Tracheostomy rate and LC were analyzed using cumulative incidence with death as a competing risk (Gray’s test). OS was estimated using Kaplan–Meier methodology and compared with the log-rank test.Results:
Median age was 59 years; 97.6% were male and 78.9% were smokers. Median follow-up was 45.3 months. VC-RT patients more frequently had cT2 disease (22.2% vs 5.4%, p<0.001) and received accelerated fractionation (19.8% vs 7.2%, p=0.0069). Overall, 38 patients (15.4%) required tracheostomy due to edema or recurrence: 21.7% after WLRT versus 2.5% after VC-RT (p<0.001). Edema-related tracheostomy occurred exclusively after WLRT, with a 3-year cumulative incidence of 14.9% versus 0% for VC-RT (p=0.001). Three-year LC was 87.9% (WLRT) versus 92.4% (VC-RT) (p=0.151), and OS was 89.5% versus 93.3% (p=0.161).Conclusion:
VC-RT significantly reduces tracheostomy risk without compromising oncologic outcomes in early-stage glottic cancer.