Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지

Radiation Therapy for T2N0 Glottic Cancer

T2N0 병기 성문암의 방사선치료

  • Kim, Jae-Chul (Department of Radiation Oncology, Kyungpook National University School of Medicine)
  • 김재철 (경북대학교 의과대학 방사선종양학교실)
  • Published : 2006.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

$\underline{Purpose}$: This study evaluated the results of definitive radiation therapy and the prognostic factors that affect survival rates for T2N0 glottic cancer patients. $\underline{Materials\;and\;Methods}$: Thirty patients with T2N0 glottic cancer who were treated with definitive radiation therapy at our institution between September 1986 and June 2004 were retrospectively reviewed. All patients were pathologically confirmed as having squamous cell carcinoma and were staged as AJCC T2N0. The age of the patients ranged from 39 to 79 (median 62) years and all were male. A total dose of $66{\sim}70\;Gy$ (median 66 Gy) was delivered with a 6-MV linear accelerator in $6.5{\sim}7$ weeks. The median follow-up period was 63 months. $\underline{Results}$: The actuarial disease-free survival rate for the entire group of the patients was 79% at 5 years. The five-year disease-free survival rates for patients without and with subglottic extension were 90% and 56%, respectively (p=0.03). However, anterior commissure involvement, supraglottic extension, and impaired cord mobility were not statistically significant prognostic factors. The five-year disease-free survival rates for patients with and without concurrent chemotherapy were 86% and 69%, respectively (p=0.47). $\underline{Conclusion}$: Subglottic extension can be considered a poor prognostic factor for T2N0 glottic cancer.

목 적: T2N0 병기 성문암 환자에서 방사선치료의 결과 및 무병생존율에 영향을 미치는 예후인자를 알아보고자 하였다. 대상 및 방법: 1986년 9월부터 2004년 6월까지 본원에서 방사선치료를 받은 30예의 T2N0 병기 성문암 환자를 후향적으로 분석하였다. 대상 환자 모두 남자였으며 연령 범위는 39세에서 79세였다(중간값 62세). 조직학적 유형은 30예 모두 편평상피세포암이었다. 방사선치료는 6 MV 선형가속기를 이용하였고, 후두에 조사된 총방사선량은 $66{\sim}70\;Gy$의 범위였다(중간값 66 Gy). 추적기간의 중간값은 63개월이었다. 결 과: 대상 환자 전체의 5년 무병생존율은 79%였다. 성문하 침범이 있는 환자에서는 5년 무병생존율이 감소하는 양상을 보였다(p<0.05). 전연합 침범, 성문상 침범, 성문 운동성 감소 등은 5년 무병생존율의 감소와 무관하였다. 동시 화학요법 추가 또한 통계적 의의가 없었다. 원발병소 재발 3예 및 경부림프절 재발 2예는 근치적 수술로 구제되었으나, 원발병소 및 림프절 동시재발 2예는 근치적 수술로 구제되지 못하였다. 최종 국소제어율은 86%였고, 성대 보존율은 83%였다. 결 론: T2N0 성문암에서 근치적 방사선치료 시 성문하 침범이 무병생존율에 영향을 줄 수 있는 인자로 분석되었다.

Keywords

References

  1. Spector JG, Sessions DG, Chao KS, Hanson JM, Simpson JR, Perez CA. Management of stage II (T2N0M0) glottic carcinoma by radiotherapy and conservation surgery. Head Neck 1999;21:116-123 https://doi.org/10.1002/(SICI)1097-0347(199903)21:2<116::AID-HED4>3.0.CO;2-8
  2. Mendenhall WM, Parsons JT, Stringer SP, Cassisi NJ, Million RR. T1-T2 vocal cord carcinoma: a basis for comparing the results of radiotherapy and surgery. Head Neck Surg 1988; 10:373-377 https://doi.org/10.1002/hed.2890100603
  3. Lee HS, Moon SR, Ahn KJ, et al. The heterogeneity of T2N0 glottic carcinoma treated by irradiation. J Korean Soc Ther Radiol Oncol 1990;8:199-205
  4. Kim WT, Nam JH, Kyuon BH, Wang SG, Kim DW. Radiotherapy for early glottic carcinoma. J Korean Soc Ther Radiol Oncol 2002;20:295-302
  5. Akimoto T, Nonaka T, Kitamoto Y, et al. Radiation therapy for T2N0 laryngeal cancer: a retrospective analysis for the impact of concurrent chemotherapy on local control. Int J Radiat Oncol Biol Phys 2006;64:995-1001 https://doi.org/10.1016/j.ijrobp.2005.10.003
  6. Garden AS, Forster K, Wong PF, Morrison WH, Schechter NR, Ang KK. Results of radiotherapy for T2N0 glottic carcinoma: does the '2' stand for twice-daily treatment? Int J Radiat Oncol Biol Phys 2003;55:322-328 https://doi.org/10.1016/S0360-3016(02)03938-X
  7. Kumamoto Y, Masuda M, Kuratomi Y, et al. 'FAR' chemoradiotherapy improves laryngeal preservation rates in patients with T2N0 glottic carcinoma. Head Neck 2002;24:637-642 https://doi.org/10.1002/hed.10114
  8. Laccourreye O, Weinstein G, Brasnu D, et al. A clinical trial of continuous cisplatin-fluorouracil induction chemotherapy and supracricoid partial laryngectomy for glottic carcinoma classified as T2. Cancer 1994;74:2781-2790 https://doi.org/10.1002/1097-0142(19941115)74:10<2781::AID-CNCR2820741007>3.0.CO;2-U
  9. Chung WK, Ahn SJ, Nam TK, Nah BS, Cho JS, Lim SC. Prognostic factors for local control in early glottic cancer treated with radiation therapy. J Korean Soc Ther Radiol Oncol 2000; 18:226-232
  10. Mendenhall WM, Amdur RJ, Morris CG, Hinerman RW. T1-T2N0 squamous cell carcinoma of the glottic larynx treated with radiation therapy. J Clin Oncol 2001;19:4029-4036 https://doi.org/10.1200/JCO.2001.19.20.4029
  11. Million RR, Cassisi NJ, Mancuso AA. Larynx carcinoma. In: Million RR, Cassisi NJ, eds. Management of head and cancer. 2nd ed. Philadelphia: Lippincott. 1994:431-499
  12. Shvero J, Hadar T, Segal K, Yaniv E, Marshak G, Feinmesser R. T1 glottic carcinoma involving the anterior commissure. Eur J Surg Oncol 1994;20:557-560
  13. Fowler JF, Chappell R. Effect of overall time and dose on the response of glottic carcinoma of the larynx to radiotherapy. Eur J Cancer 1994;30A:719-721
  14. Zohar Y, Rahima M, Shvili Y, Talmi YP, Lurie H. The controversial treatment of anterior commissure carcinoma of the larynx. Laryngoscope 1992;102:69-72
  15. Hirota S, Soejima T, Obayashi K, et al. Radiotherapy of T1 and T2 glottic cancer: analysis of anterior commissure involvement. Radiat Med 1996;14:297-302
  16. Benninger MS, Gillen J, Thieme P, Jacobson B, Dragovich J. Factors associated with recurrence and voice quality following radiation therapy for T1 and T2 glottic carcinomas. Laryngoscope 1994;104:294-298
  17. Foote RL, Grado GL, Buskirk SJ, et al. Radiation therapy for glottic cancer using 6-MV photons. Cancer 1996;77:381-386 https://doi.org/10.1002/(SICI)1097-0142(19960115)77:2<381::AID-CNCR22>3.0.CO;2-X
  18. Akine Y, Tokita N, Ogino T, et al. Radiotherapy of T1 glottic cancer with 6 MeV X rays. Int J Radiat Oncol Biol Phys 1991; 20:1215-1218 https://doi.org/10.1016/0360-3016(91)90230-2
  19. Karim AB, Kralendonk JH, Yap LY, et al. Heterogeneity of stage II glottic carcinoma and its therapeutic implications. Int J Radiat Oncol Biol Phys 1987;13:313-317 https://doi.org/10.1016/0360-3016(87)90004-6
  20. Garden AS, Morrison WH, Ang KK, Peters LJ. Hyperfractionated radiation in the treatment of squamous cell carcinomas of the head and neck: a comparison of two fractionation schedules. Int J Radiat Oncol Biol Phys 1995;31:493-502 https://doi.org/10.1016/0360-3016(94)00334-H
  21. Le QT, Fu KK, Kroll S, et al. Influence of fraction size, total dose, and overall time on local control of T1-T2 glottic carcinoma. Int J Radiat Oncol Biol Phys 1997;39:115-126 https://doi.org/10.1016/S0360-3016(97)00284-8
  22. Mendenhall WM, Parsons JT, Brant TA, Stringer SP, Cassisi NJ, Million RR. Is elective neck treatment indicated for T2N0 squamous cell carcinoma of the glottic larynx? Radiother Oncol 1989;14:199-202 https://doi.org/10.1016/0167-8140(89)90167-9
  23. Frata P, Cellai E, Magrini SM, et al. Radical radiotherapy for early glottic cancer: results in a series of 1087 patients from two Italian radiation oncology centers. II. The case of T2N0 disease. Int J Radiat Oncol Biol Phys 2005;63:1387-1394 https://doi.org/10.1016/j.ijrobp.2005.05.013
  24. Mendenhall WM, Werning JW, Hinerman RW, Amdur RJ, Villaret DB. Management of T1-T2 glottic carcinomas. Cancer 2004;100:1786-1792 https://doi.org/10.1002/cncr.20181