Clinical Research Papers:
Radiotherapy for T3N0 glottic carcinoma without cord fixation: elective nodal irradiation or not?
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Ryo Toya1, Ryuji Murakami2, Daizo Murakami3, Tetsuo Saito1, Tomohiko Matsuyama1, Yutaka Toya3, Yasuyuki Yamashita4 and Natsuo Oya1
1Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
2Department of Medical Imaging, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
3Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Hospital, Kumamoto, Japan
4Department of Diagnostic Radiology, Kumamoto University Hospital, Kumamoto, Japan
Ryo Toya, email: [email protected]
Keywords: glottic carcinoma, radiotherapy, lymph node metastasis, elective nodal irradiation, clinical target volume
Received: March 10, 2017 Accepted: June 30, 2017 Published: July 18, 2017
Background: Although the T3 category has been changed in the sixth edition of the TNM staging system proposed by the Union for International Cancer Control (UICC), the appropriate clinical target volume (CTV) of elective nodal irradiation (ENI) for T3N0 glottic carcinoma without cord fixation, which was formerly treated as a T1-2N0 disease, is not fully discussed.
Materials and Methods: We retrospectively analyzed 64 patients staged or restaged as T3N0 disease without cord fixation. All patients received irradiation to the primary lesion alone using opposed lateral fields. Surgery was performed in 10 patients without tumor regression after the delivery of 40 Gy. The other 54 patients received a median total dose of 66 Gy. Concurrent chemoradiotherapy (CRT) with low-dose cisplatin and UFT (low-dose CRT) and docetaxel, cisplatin, and 5-fluorouracil (TPF-CRT) were performed in 23 and 19 patients, respectively.
Results: Eighteen (28.1%) patients suffered treatment failure; all were recorded as local failure alone. The 5-year local control rates for RT alone, low-dose CRT, and TPF-CRT groups were 51.7%, 61.6%, and 93.8%, respectively (p = 0.027). The 5-year laryngeal preservation rates for RT alone, low-dose CRT, and TPF-CRT groups were 57.4%, 81.6%, and 89.5%, respectively (p = 0.048).
Conclusions: The rate of regional failure was zero when irradiating the primary lesion alone using opposed lateral fields. This treatment technique covers the most level III regions; hence, CTV for ENI should include level III alone.
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