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1 Carlo Fallai S.C. Radioterapia 2 Fondazione IRCCS Istituto Nazionale Tumori Milano
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3 Easy task difficult life
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5 T1N0 GLOTTIC CANCER
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8 T1N0 Glottic cancer Initial& ultimate local control in historical series
9 Author Pts Initial LC Surg. Salvage Ult LC Lar Pres % (%) % %
10 T1N0 Glottic cancer Treatment factors: overall treatment time
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13 T1N0 Glottic cancer Treatment factors: fraction size
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17 RADIOTHERAPY FOR EARLY GLOTTIC CARCINOMA (T1N0M0): RESULTS OF PROSPECTIVE RANDOMIZED STUDY OF RADIATION FRACTION SIZE AND OVERALL TREATMENT TIME HIDEYA YAMAZAKI, M.D.,* KINJI NISHIYAMA, M.D.,* EIICHI TANAKA, M.D.,* Local control 5-year OS: 87 vs 88% Int. J. Radiation Oncology Biol. Phys., Vol. 64, No. 1, pp , 2006
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22 T1N0 Glottic cancer Tumor factors: anterior commissure involvement
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26 T2N0 GLOTTIC CANCER
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28 T2N0 Glottic cancer Initial& ultimate local control in historical series
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30 T2N0 Glottic cancer Treatment factors: overall treatment time
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32 T2N0 Glottic cancer Treatment factors: fraction size
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34 Hypofx
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39 Mod. AJCC Impaired vc mobility
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42 RTOG conclusions RTOG 9512 tested an HFX schedule in T2 glottictumors similar to schedules tested in more locally advanced disease in RTOG 9003 and EORTC Although the difference between treatment arms did notreach statistical significance, the trial outcome is consistent with gains observed for hyperfractionationin more locally advanced disease, enhancing local control by 8 points. This was achieved with low acute and late toxicity. Other effective and more convenient fractionation schedules in the management of early glotticcancer include hypofractionationat 225 cgyper fraction. Outcomes in patients with T2btumors remain suboptimaland may benefit from concurrent chemotherapy.
43 T2N0 Glottic cancer Tumor factors: subglottic extension
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45 T2N0 Glottic cancer Tumor factors: cord mobility
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49 T2N0 Glottic cancer Tumor factors: tumor volume
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53 A tugof war? Radiotherapy vs Surgery
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55 Cochrane Database Syst Rev Dec 12; Update There is only one randomised controlled trial comparing open surgery and radiotherapy but its interpretation is limited because of concerns about the adequacy of treatment regimens and deficiencies in the reporting of the study design and analysis.
56 HartlDM, Ferlito A, BrasnuDF, LangendijkJA, Rinaldo A, Silver CE, Wolf GT. S vs RT
57 HartlDM, Ferlito A, BrasnuDF, LangendijkJA, Rinaldo A, Silver CE, Wolf GT. S vs RT
58 HartlDM, Ferlito A, BrasnuDF, LangendijkJA, Rinaldo A, Silver CE, Wolf GT. S vs RT
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60 OtolaryngolHead NeckSurg.2015 May; 152(5): Voice outcomesfollowingradiationversus laser microsurgeryfort1 glotticcarcinoma: systematic review and meta-analysis. Greulich et al. Voice Handicap Index (VHI) scores were comparable following transoral Voice Handicap Index (VHI) scores were comparable following transoral laser microsurgery and radiation therapy for T1 glottic carcinoma in the current literature, suggesting no clinically significant difference in functional voice outcomes between treatment types.
61 CONCLUSIONS Min Yao- University Case medical Center
62 CONCLUSIONS
63 CONCLUSIONS
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65 Appendix Dedicated to radiation oncologists Early laryngeal cancer RADIATION THERAPY Technical notes
66 T1N0 Glottic cancer
67 T2N0 Larynx cancer Radiotherapy for Head and Neck Cancers Ang KA, Garden AS Eds.
68 T2N0 Glottic cancer Intensity Modulated Radiation Therapy for Head and Neck Cancer Chao KSC, Ozyigit G Eds
69 CONTOURING
70 CONTOURING
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72 Treatment accuracy
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74 IMRT and carotid sparing Conclusions: Elderly patients with early-stage laryngeal cancer have a high burden of cerebrovascularevents after surgical management or RT. RT and surgery are associated with comparable risk for subsequent CVD development after treatment in elderly patients. Conclusion: IMRT provided the finest planning target volume coverage with minimal RT CA doses.
75 OralOncol.2015 Jul;51(7): Carotid sparing intensity- modulated radiation therapy achieves comparable locoregional control to conventional radiotherapy in T1-2N0 laryngeal carcinoma. Zumsteg et al
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81 Thanks for your attention
T1/T2 LARYNX CANCER. Click to edit Master Presentation Date. Thomas J Gernon, MD Otolaryngology-Head and Neck Surgery
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