Teeradon Treechairusame, Edward Christopher Dee, Caineng Cao, Yingzhi Wu, Yao Yu, Daphna Gelblum, Nadeem Riaz, Sean M McBride, Linda Chen, Achraf Shamseddine, Kaveh Zakeri, Chiaojung Jillian Tsai, Jung Julie Kang, Ian Ganly, Jennifer R Cracchiolo, Snehal Patel, Marc A Cohen, Richard J Wong, Nancy Y Lee
{"title":"临床分期T1-2N0M0/喉癌的部分与全喉放疗。","authors":"Teeradon Treechairusame, Edward Christopher Dee, Caineng Cao, Yingzhi Wu, Yao Yu, Daphna Gelblum, Nadeem Riaz, Sean M McBride, Linda Chen, Achraf Shamseddine, Kaveh Zakeri, Chiaojung Jillian Tsai, Jung Julie Kang, Ian Ganly, Jennifer R Cracchiolo, Snehal Patel, Marc A Cohen, Richard J Wong, Nancy Y Lee","doi":"10.1001/jamaoto.2025.3214","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>The current standard treatment for clinical tumor stage 1 to 2 or in situ laryngeal carcinoma without node involvement or metastases (T1-2N0M0/Tis) is whole laryngeal radiotherapy (WLRT), whereas microsurgery typically resects only the tumor-involving vocal cord with a narrow margin. Clinical outcomes of partial laryngeal radiotherapy (PLRT) have not been quantified.</p><p><strong>Objective: </strong>To compare the effectiveness and toxic effects of PLRT vs WLRT in patients with clinical stage T1-2N0/Tis laryngeal carcinoma.</p><p><strong>Design, setting, and participants: </strong>This was a single-institution retrospective cohort study of patients with clinical stage T1-2N0M0/Tis squamous cell carcinoma of the larynx who underwent intensity-modulated RT from January 2013 to December 2024. Data were analyzed from January to February 2025.</p><p><strong>Main outcomes and measures: </strong>Long-term locoregional control, laryngectomy-free survival, distant metastasis, and overall toxic effects. Acute and late radiation toxic effects were graded using Common Terminology Criteria for Adverse Events, version 4.0. Patient-reported swallowing-related quality of life (MD Anderson Dysphagia Inventory) was collected at each visit when feasible.</p><p><strong>Results: </strong>The analyses included 233 consecutive patients with T1-2N0M0/Tis squamous cell carcinoma of the larynx who were treated with intensity modulated radiotherapy (176 with WLRT vs 57 with PLRT). The median (IQR) follow-up in the WLRT group was 60 (28-87) months, and in the PLRT group, 31 (16-64) months. The largest tumor stage-related difference in WLRT was observed in T1b (100%) and Tis (50%) disease, with an absolute difference of 50% (95% CI, 25.4% to 73.2%). There were no important clinical differences between PLRT and WLRT in 3-year locoregional control rates (85.4% vs 90.8%; rate difference, -5.4%; 95% CI, -13.5% to 6.9%), laryngectomy-free survival (93.2% vs 94%; rate difference, -0.8%; 95% CI, -9.1% to 7.5%), distant metastasis-free survival (100% vs 97.6%; rate difference, 2.4%; 95% CI, -0.3% to 4.9%), and overall survival (91.4% vs 88.9%; rate difference, 2.5%; 95% CI, -6.8% to 12.8%). There was no contralateral vocal-fold failure in the PLRT group. There was a large difference in the 3-year locoregional control in T2 tumors between the WLRT (85.1%) and PLRT groups (66.7%), with a difference of 18.4% (95% CI, -5.8% to 21.3%). The incidence of acute dysphagia was lower in the PLRT than in the WLRT group (73.7% vs 92.6%; difference, 18.9%; 95% CI, 6.9% to 30.9%). Median composite scores on the MD Anderson Dysphagia Inventory at 3 and 6 months postradiotherapy were higher in the PLRT group (86 vs 77; difference, 8; 95% CI, 2 to 14; and 96 vs 81; difference, 4; 95% CI, -2 to 8; respectively), although the observed differences may not be clinically important.</p><p><strong>Conclusions and relevance: </strong>This cohort study found that there were no clinically important differences observed in locoregional control between PLRT and WLRT; however, PLRT may be associated with lower rates of acute toxic effects compared to WLRT. Wide confidence intervals across all end points indicated substantial uncertainty regarding comparative effectiveness. The shorter median follow-up time in the PLRT group limited evaluation of late toxic effects and long-term tumor control outcomes; together with the lack of adjustment for confounding factors, this study underscores the need for further evaluation of PLRT.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6000,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Partial vs Whole Laryngeal Radiotherapy for Clinical Stage T1-2N0M0/Tis Laryngeal Carcinoma.\",\"authors\":\"Teeradon Treechairusame, Edward Christopher Dee, Caineng Cao, Yingzhi Wu, Yao Yu, Daphna Gelblum, Nadeem Riaz, Sean M McBride, Linda Chen, Achraf Shamseddine, Kaveh Zakeri, Chiaojung Jillian Tsai, Jung Julie Kang, Ian Ganly, Jennifer R Cracchiolo, Snehal Patel, Marc A Cohen, Richard J Wong, Nancy Y Lee\",\"doi\":\"10.1001/jamaoto.2025.3214\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>The current standard treatment for clinical tumor stage 1 to 2 or in situ laryngeal carcinoma without node involvement or metastases (T1-2N0M0/Tis) is whole laryngeal radiotherapy (WLRT), whereas microsurgery typically resects only the tumor-involving vocal cord with a narrow margin. Clinical outcomes of partial laryngeal radiotherapy (PLRT) have not been quantified.</p><p><strong>Objective: </strong>To compare the effectiveness and toxic effects of PLRT vs WLRT in patients with clinical stage T1-2N0/Tis laryngeal carcinoma.</p><p><strong>Design, setting, and participants: </strong>This was a single-institution retrospective cohort study of patients with clinical stage T1-2N0M0/Tis squamous cell carcinoma of the larynx who underwent intensity-modulated RT from January 2013 to December 2024. Data were analyzed from January to February 2025.</p><p><strong>Main outcomes and measures: </strong>Long-term locoregional control, laryngectomy-free survival, distant metastasis, and overall toxic effects. Acute and late radiation toxic effects were graded using Common Terminology Criteria for Adverse Events, version 4.0. Patient-reported swallowing-related quality of life (MD Anderson Dysphagia Inventory) was collected at each visit when feasible.</p><p><strong>Results: </strong>The analyses included 233 consecutive patients with T1-2N0M0/Tis squamous cell carcinoma of the larynx who were treated with intensity modulated radiotherapy (176 with WLRT vs 57 with PLRT). The median (IQR) follow-up in the WLRT group was 60 (28-87) months, and in the PLRT group, 31 (16-64) months. The largest tumor stage-related difference in WLRT was observed in T1b (100%) and Tis (50%) disease, with an absolute difference of 50% (95% CI, 25.4% to 73.2%). There were no important clinical differences between PLRT and WLRT in 3-year locoregional control rates (85.4% vs 90.8%; rate difference, -5.4%; 95% CI, -13.5% to 6.9%), laryngectomy-free survival (93.2% vs 94%; rate difference, -0.8%; 95% CI, -9.1% to 7.5%), distant metastasis-free survival (100% vs 97.6%; rate difference, 2.4%; 95% CI, -0.3% to 4.9%), and overall survival (91.4% vs 88.9%; rate difference, 2.5%; 95% CI, -6.8% to 12.8%). There was no contralateral vocal-fold failure in the PLRT group. There was a large difference in the 3-year locoregional control in T2 tumors between the WLRT (85.1%) and PLRT groups (66.7%), with a difference of 18.4% (95% CI, -5.8% to 21.3%). The incidence of acute dysphagia was lower in the PLRT than in the WLRT group (73.7% vs 92.6%; difference, 18.9%; 95% CI, 6.9% to 30.9%). Median composite scores on the MD Anderson Dysphagia Inventory at 3 and 6 months postradiotherapy were higher in the PLRT group (86 vs 77; difference, 8; 95% CI, 2 to 14; and 96 vs 81; difference, 4; 95% CI, -2 to 8; respectively), although the observed differences may not be clinically important.</p><p><strong>Conclusions and relevance: </strong>This cohort study found that there were no clinically important differences observed in locoregional control between PLRT and WLRT; however, PLRT may be associated with lower rates of acute toxic effects compared to WLRT. Wide confidence intervals across all end points indicated substantial uncertainty regarding comparative effectiveness. The shorter median follow-up time in the PLRT group limited evaluation of late toxic effects and long-term tumor control outcomes; together with the lack of adjustment for confounding factors, this study underscores the need for further evaluation of PLRT.</p>\",\"PeriodicalId\":14632,\"journal\":{\"name\":\"JAMA otolaryngology-- head & neck surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.6000,\"publicationDate\":\"2025-10-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JAMA otolaryngology-- head & neck surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1001/jamaoto.2025.3214\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OTORHINOLARYNGOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA otolaryngology-- head & neck surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1001/jamaoto.2025.3214","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
重要性:目前临床肿瘤1-2期或原位喉癌无淋巴结累及或转移(T1-2N0M0/Tis)的标准治疗是全喉放疗(WLRT),而显微手术通常只切除肿瘤累及的声带。部分喉放射治疗(PLRT)的临床效果尚未量化。目的:比较PLRT与WLRT治疗临床分期T1-2N0/Tis喉癌的疗效及毒副作用。设计、环境和参与者:这是一项单机构回顾性队列研究,研究对象是2013年1月至2024年12月期间接受调强放疗的临床分期为T1-2N0M0/Tis喉部鳞状细胞癌患者。数据分析时间为2025年1月至2月。主要结果和措施:长期局部控制,无喉切除生存,远处转移和总体毒性作用。使用不良事件通用术语标准4.0版对急性和晚期辐射毒性效应进行分级。在可行的情况下,每次就诊时收集患者报告的吞咽相关生活质量(MD安德森吞咽困难量表)。结果:分析包括233例连续接受调强放疗的T1-2N0M0/Tis喉部鳞状细胞癌患者(176例接受WLRT, 57例接受PLRT)。WLRT组的中位(IQR)随访为60(28-87)个月,PLRT组的中位(IQR)随访为31(16-64)个月。WLRT的肿瘤分期相关差异最大的是T1b(100%)和Tis(50%),绝对差异为50% (95% CI, 25.4%至73.2%)。PLRT和WLRT在3年局部区域控制率(85.4% vs 90.8%;率差,-5.4%;95% CI, -13.5%至6.9%)、无喉切除术生存率(93.2% vs 94%;率差,-0.8%;95% CI, -9.1%至7.5%)、无远处转移生存率(100% vs 97.6%;率差,2.4%;95% CI, -0.3%至4.9%)和总生存率(91.4% vs 88.9%;率差,2.5%;95% CI, -6.8%至12.8%)方面没有重要的临床差异。PLRT组无对侧声带衰竭。WLRT组(85.1%)和PLRT组(66.7%)在T2肿瘤的3年局部区域控制率方面存在较大差异,差异为18.4% (95% CI, -5.8%至21.3%)。PLRT组的急性吞咽困难发生率低于WLRT组(73.7% vs 92.6%;差异为18.9%;95% CI, 6.9% ~ 30.9%)。PLRT组在放疗后3个月和6个月MD Anderson吞咽困难量表的中位综合评分较高(分别为86比77,差异为8;95% CI, 2至14;96比81,差异为4;95% CI, -2至8),尽管观察到的差异可能在临床上并不重要。结论及相关性:本队列研究发现,PLRT和WLRT在局部控制方面没有观察到临床上重要的差异;然而,与WLRT相比,PLRT可能与较低的急性毒性作用发生率相关。所有终点的宽置信区间表明相对有效性存在很大的不确定性。PLRT组较短的中位随访时间限制了对晚期毒性效应和长期肿瘤控制结果的评估;再加上缺乏对混杂因素的调整,该研究强调了进一步评估PLRT的必要性。
Partial vs Whole Laryngeal Radiotherapy for Clinical Stage T1-2N0M0/Tis Laryngeal Carcinoma.
Importance: The current standard treatment for clinical tumor stage 1 to 2 or in situ laryngeal carcinoma without node involvement or metastases (T1-2N0M0/Tis) is whole laryngeal radiotherapy (WLRT), whereas microsurgery typically resects only the tumor-involving vocal cord with a narrow margin. Clinical outcomes of partial laryngeal radiotherapy (PLRT) have not been quantified.
Objective: To compare the effectiveness and toxic effects of PLRT vs WLRT in patients with clinical stage T1-2N0/Tis laryngeal carcinoma.
Design, setting, and participants: This was a single-institution retrospective cohort study of patients with clinical stage T1-2N0M0/Tis squamous cell carcinoma of the larynx who underwent intensity-modulated RT from January 2013 to December 2024. Data were analyzed from January to February 2025.
Main outcomes and measures: Long-term locoregional control, laryngectomy-free survival, distant metastasis, and overall toxic effects. Acute and late radiation toxic effects were graded using Common Terminology Criteria for Adverse Events, version 4.0. Patient-reported swallowing-related quality of life (MD Anderson Dysphagia Inventory) was collected at each visit when feasible.
Results: The analyses included 233 consecutive patients with T1-2N0M0/Tis squamous cell carcinoma of the larynx who were treated with intensity modulated radiotherapy (176 with WLRT vs 57 with PLRT). The median (IQR) follow-up in the WLRT group was 60 (28-87) months, and in the PLRT group, 31 (16-64) months. The largest tumor stage-related difference in WLRT was observed in T1b (100%) and Tis (50%) disease, with an absolute difference of 50% (95% CI, 25.4% to 73.2%). There were no important clinical differences between PLRT and WLRT in 3-year locoregional control rates (85.4% vs 90.8%; rate difference, -5.4%; 95% CI, -13.5% to 6.9%), laryngectomy-free survival (93.2% vs 94%; rate difference, -0.8%; 95% CI, -9.1% to 7.5%), distant metastasis-free survival (100% vs 97.6%; rate difference, 2.4%; 95% CI, -0.3% to 4.9%), and overall survival (91.4% vs 88.9%; rate difference, 2.5%; 95% CI, -6.8% to 12.8%). There was no contralateral vocal-fold failure in the PLRT group. There was a large difference in the 3-year locoregional control in T2 tumors between the WLRT (85.1%) and PLRT groups (66.7%), with a difference of 18.4% (95% CI, -5.8% to 21.3%). The incidence of acute dysphagia was lower in the PLRT than in the WLRT group (73.7% vs 92.6%; difference, 18.9%; 95% CI, 6.9% to 30.9%). Median composite scores on the MD Anderson Dysphagia Inventory at 3 and 6 months postradiotherapy were higher in the PLRT group (86 vs 77; difference, 8; 95% CI, 2 to 14; and 96 vs 81; difference, 4; 95% CI, -2 to 8; respectively), although the observed differences may not be clinically important.
Conclusions and relevance: This cohort study found that there were no clinically important differences observed in locoregional control between PLRT and WLRT; however, PLRT may be associated with lower rates of acute toxic effects compared to WLRT. Wide confidence intervals across all end points indicated substantial uncertainty regarding comparative effectiveness. The shorter median follow-up time in the PLRT group limited evaluation of late toxic effects and long-term tumor control outcomes; together with the lack of adjustment for confounding factors, this study underscores the need for further evaluation of PLRT.
期刊介绍:
JAMA Otolaryngology–Head & Neck Surgery is a globally recognized and peer-reviewed medical journal dedicated to providing up-to-date information on diseases affecting the head and neck. It originated in 1925 as Archives of Otolaryngology and currently serves as the official publication for the American Head and Neck Society. As part of the prestigious JAMA Network, a collection of reputable general medical and specialty publications, it ensures the highest standards of research and expertise. Physicians and scientists worldwide rely on JAMA Otolaryngology–Head & Neck Surgery for invaluable insights in this specialized field.