Outcomes of Radiotherapy for Early-Stage Laryngeal Cancer: A 12-Year Retrospective Review.

Abstract

Simple Summary: This single-institution retrospective study from King Faisal Specialist Hospital and Research Center in Riyadh examined radiotherapy outcomes in 62 patients with early-stage laryngeal cancer (Tis, T1-T2 N0M0) treated between 2009-2021. The investigation compared three fractionation schedules: 60 Gy/25 fractions, 63 Gy/28 fractions, and 66 Gy/33 fractions, with hypofractionated regimens predominating (>90% of patients). Tomotherapy emerged as the preferred treatment technique (66.1% of cases). At 5-year follow-up, the study demonstrated promising outcomes with overall survival of 80.2%, local control of 80.5%, regional control of 96.77%, and cancer-specific survival of 84.6%. Despite the cohort's high smoking prevalence, these results align with international reports, supporting external beam radiotherapy as an effective and safe approach for early-stage laryngeal malignancies.

Background: Laryngeal cancer commonly originates in the glottic region and frequently presents at early stage (cT1-T2 N0M0, AJCC 8th edition). Both external beam radiation therapy (EBRT) and surgery demonstrate excellent efficacy as single-modality treatments for these early-stage malignancies.

Methods: We conducted a retrospective analysis of patients with early laryngeal carcinoma (Tis, T1-T2 N0M0) treated exclusively with External beam radiation therapy EBRT at King Faisal Specialist Hospital and Research Center in Riyadh from 2009-2021. Treatment consisted of one of three fractionation schedules (60Gy/25, 63Gy/28, or 66Gy/33) delivered via Tomotherapy, 3DCRT, or IMRT/VMAT. We evaluated demographic characteristics, risk factors, and multiple survival endpoints including local control, regional control, overall survival, and cancer-specific survival.

Results: The study comprised 62 patients (mean age: 60.4 years), predominantly male (90.3%) with high smoking prevalence (74.2%). All patients presented with voice hoarseness. Hypofractionated regimens were administered to over 90% of patients, with Tomotherapy being the most utilized technique (66.1%), followed by IMRT/VMAT (25.8%) and 3DCRT (8.1%). Treatment was well-tolerated with no grade 3-4 toxicities and manageable early side effects. The 5-year outcomes demonstrated favorable results: local control (80.5%), regional control (96.77%), overall survival (80.2%), and cancer-specific survival (84.6%).

Conclusion: Definitive radiotherapy has demonstrated efficacy and safety as a primary treatment modality for early-stage laryngeal cancer, consistent with prior studies. The outcomes from our cohort, despite the notably high prevalence of smokers, are comparable to international benchmarks, further confirming external beam radiotherapy's role as an effective therapeutic option for early-stage laryngeal carcinoma. Nonetheless, the significant smoking rates observed in our patient population highlight the critical need to incorporate smoking cessation strategies into comprehensive management plans to further enhance treatment outcomes and reduce risks.