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Background: Radiotherapy (RT) is an appropriate treatment option for early-stage glottic cancer (ESGC) that achieves high local control and preserves voice quality. However, the optimal radiation treatment schedule remains unknown. We present our institution’s 14-year experience in treating ESGC with definitive radiotherapy between 2005 and 2019 inclusively. Materials and methods: We reviewed the medical records of 104 patients; 63 (60.5%) were treated with conventional fractionation (CF), and 41 (39.5%) were treated with hypofractionated radiotherapy (HF). The clinical T-stage was T1a in 50 patients (48%), T1b in 27 (26%), and T2 in 27 (26%). Age, gender, anterior commissure involvement, stage, radiotherapy technique, radiation fraction size, and overall treatment time (OTT) were analyzed as prognostic factors. The survival outcomes, local regional control (LRC), and laryngeal preservation rate were evaluated. Results: The 5-year overall survival (OS) and LCR were 83.3% and 78%, respectively. On univariate analysis, treatment with CF (p = 0.02), prolonged OTT > 49 days in CF and > 40 days in HF (p = 0.04), and RT total dose < 66 Gy (p = 0.03) were associated with poor LRC. Multivariate analysis showed a non-significant association with LRC (all p > 0.05). The 5-year OS rate in the CF and HF-treated patients was 84.9% and 72.1%, respectively (p = 0.99), and in patients who had T1a, T1b, and T2 disease, were 78.2%, 96.0%, and 82.1%, respectively (p = 0.43). All patients and tumor variables showed no statistically significant association with OS. Only low-grade acute toxicity was observed. Conclusion: Non-inferiority results supported the HF schedule to ESGC, including high local disease control and decreased overall treatment time. Our study supports its efficacy in the primary care of ESGC with manageable side effects. [ABSTRACT FROM AUTHOR]

We aimed to investigate possible causes of leukoplakia and squamous cell carcinoma. We particularly sought to characterize the effect of smoking history because leukoplakia has been observed in nonsmokers. We retrospectively identified patients with a diagnosis of leukoplakia who were treated at Mayo Clinic (Jacksonville, Florida), in the Department of Otorhinolaryngology, from 1/1/2006 through 8/31/2019. Each patient was age- and sex-matched (1:2 ratio) to control patients without leukoplakia. Information about possible risk factors, chief symptoms, and social history with smoking and alcohol use was obtained from health records. Nine risk factors were analyzed independently with multivariate analysis. Continuous risk factors were compared between cases and controls with the Wilcoxon rank sum test; categorical variables were compared with the χ2 test. The final cohort consisted of 72 patients with leukoplakia (mean [SD] age, 66 [11] years; 61 men [85%]) and 144 age- and sex-matched controls. Compared with the control group, significantly more cases were current smokers (26% vs. 5%) and fewer were never-smokers. (17% vs. 51%) (P < 0.001). Cases also had a significantly longer duration of smoking history compared with controls (median, 30 vs. 0 years; P < 0.001). Alcohol consumption was not significantly different between cases and controls (53% vs. 54%; P > 0.99). When assessing never-smokers and those who had not smoked for more than 25 years, a history of smoking (P = 0.002) and the number of years smoked (P = 0.002) were significantly different for cases and controls. Most vocal fold leukoplakia lesions have a low risk of malignancy. It is important to evaluate the characteristics of the lesion and assess the patient's risk factors. Follow-up is a key factor in patient management, but for patients with recurrent leukoplakia, the duration and frequency of surveillance is still controversial and varies among medical centers. Future prospective studies with advanced analyses are warranted because they may strengthen the ability to identify clinical factors that influence the development of squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the outcomes, patterns of failure and laryngeal preservation rates in patients with T1N0 glottic cancer treated with surgery or radiotherapy. Retrospective study of T1N0 glottic cancer patients treated in our institution between January 2007 and December 2017. Histologically proven squamous cell carcinoma patients, treated with upfront cordectomy/partial laryngectomy (S group) or radiotherapy (RT group) were included. Elective treatment of the neck was not permitted. Local failure (LF), disease-free survival (DFS), ultimate disease-free survival (UDFS), laryngectomy-free survival (LFS), disease-specific mortality (DSM) and overall survival (OS) were evaluated. Two hundred and one patients were eligible (172 S group, 29 RT group), with a median follow-up of 38.8 months. Overall, 33 (16%) patients had a recurrence, 30 (17%) in the S group and 3 (10%) in the RT group. Local failure was the predominant site of failure (28 S, 2 RT). Overall, of all those that were salvaged, 17 (8%) underwent total laryngectomy (15 S, 2 RT). There was no significant difference in the 5-year cumulative incidence of LF (20.8% S, 8.1% RT, p = 0.138), 5-y LFS (85.0% vs. 91.7%, p = 0.809), 5-y DFS (67.5% vs. 82.1%, p = 0.343), 5-y UDFS (82.5% vs. 90.3%, p = 0.647) and 5-y OS (84.5% vs. 90.3%, p = 0.892). Multivariate analysis showed no correlation between initial treatment and the analyzed outcomes. Primary surgery or radiotherapy were similar first line options, since they do not differ in all outcomes. Patients' and physician's preferences must be considered when choosing first treatment. [ABSTRACT FROM AUTHOR]

Summary Objectives The aim of this study was to investigate long-term voice outcomes and voice-related quality of life (QOL) for early glottic cancer treated with radiotherapy. Study Design Long-term exploratory follow-up study of a prospective patient cohort comparing outcomes at a mean of 11 years postradiotherapy with the original 1-year posttreatment results. Method Eight patients completed voice tasks for auditory perception and acoustic and aerodynamic measures. Patient-reported voice-related QOL (VR-QOL) and voice quality were measured. Changes in outcomes over time were analysed using repeated-measures linear mixed models. Results Acoustic and aerodynamic outcomes remained stable from 1 year postradiotherapy to long-term follow-up, with only jitter mildly increasing from 1.9% at 1 year posttreatment to 2.8% (difference = 1.0%, 95% confidence interval [CI] = 0.1–1.9). Perceptually, voice remained relatively stable with only phonation breaks slightly increasing within the normal range, from 1.1 to 1.7 (difference = 0.6, 95% CI = 0.3–0.9) and breathy quality increasing from normal to slight impairment, with scores increasing from 1.8 to 2.4 (difference = 0.6, 95% CI = 0.3–1.1). QOL scores indicate a good level of VR-QOL that were unchanged at long-term follow-up when compared with 1 year posttreatment. Conclusions Improvement in voice outcomes found at 1 year postradiotherapy were largely maintained long term, with only minor changes observed. QOL scores indicate that a high level of VR-QOL was maintained many years after curative radiotherapy. [ABSTRACT FROM AUTHOR]

Summary: Objective: Study of patients with stage T1N0M0 or T2N0M0 glottic cancer treated by exclusive radiotherapy and comparison of the survival and functional results of this series with those of the literature. Method: Retrospective study of stage T1N0M0 or T2N0M0 glottic cancers diagnosed between 1st January 2000 and 31st December 2010 and treated by exclusive radiotherapy. Evaluation of survival, recurrence and larynx preservation rates. Study centres: CLCC François-Baclesse and CHU de Caen. Patients: Fifty-nine patients (53 men and sixwomen) treated for glottic cancer (57 squamous cell carcinomas, two verrucous carcinomas) comprising 51 T1N0M0 and eight T2N0M0 tumours. Treatment with exclusive radiotherapy (mean dose of 70Grays limited to the thyroid cartilage for 57 patients, with lymph node irradiation for two patients). Results: In this series, five (9.8%) patients with stage T1N0M0 glottic cancer and three patients (37.5%) with stage T2N0M0 glottic cancer relapsed, corresponding to a global recurrence rate of 13.6%. Three of the eight recurrences involved lymph nodes exclusively (N), two patients relapsed exclusively at the primary tumour site (T) and three patients presented local and lymph node recurrence (T and N). Treatment consisted of salvage total laryngectomy with bilateral cervical lymph node dissection in three cases, bilateral cervical lymph node dissection and sensitized radiotherapy in two cases, exclusive chemotherapy in one case, cervical lymph node dissection and cervical radiotherapy in one case. The last patient with recurrence died prior to salvage therapy. The larynx preservation rate was 94.9%. Conclusion: In comparison with the literature, treatment of stage T1-T2N0M0 glottic cancer by exclusive radiotherapy gives very good results, with a larynx preservation rate of 95%. [Copyright &y& Elsevier]

Summary: Objective: To evaluate the long-term voice characteristics and quality of life of early glottic cancer patients after definitive treatment. Study Design: Case series with chart review in a tertiary care medical center in Taiwan. Methods: Forty-two consecutive patients who received radiation therapy (RT) or transoral laser microsurgery (TLM) for early glottic cancer over 12 months were evaluated for voice laboratory data and quality-of-life measurements. Results: Twenty-four patients received RT, and 18 underwent TLM. There was no difference between the two groups on acoustic and aerodynamic voice measures except for modal fundamental frequency in males. In the Functional Assessment of Cancer Therapy-Head and Neck survey, the TLM group had better communication than the RT group, but there were no differences in voice quality and strength. There was also no significant difference in the Voice Handicap Index 10 evaluation. Conclusions: Male patients who received TLM have higher modal fundamental frequency than male patients who received RT and norms. Voice-related life quality is similar in patients regardless of RT or TLM treatment for early glottic cancer, but those who receive TLM have better communication abilities than those who receive RT. [Copyright &y& Elsevier]

Abstract: Introduction: Various surgical techniques have been adopted for management of glottic cancer with the aim of eradicating the disease and preserving the voice character. Aim: The aim of the study was to determine the voice quality for patient after various surgical interventions for treatment of cancer larynx, and to evaluate the effect of postoperative voice therapy. Subjects: 20 patients were subjected to surgical intervention for management of glottic cancer (seven had unilateral laser cordectomy-group A, and five had bilateral laser cordectomy-group B and eight had vertical hemilaryngectomy-group C). Thirteen age matched males were randomly selected for obtaining normal computer voice function parameters as the control group-group D. Methodology: The four groups were subjected to protocol of voice evaluation postoperatively. Patients were re-evaluated two months later and a comparison of voice outcome for patients receiving voice therapy and those who did not was conducted. Conclusion: Most acoustic and aerodynamic parameters are significant different between patients from control. Subharmonics parameters (NSH and DSH) and degree of voice breaks (DVB) in addition to phonatory resistance specifically differentiate the voice of laser cordectomized from that of vertical hemilaryngectomized patient, this may reflect occurrence of vocal fry related to supraglottic phonation. Improvement was recorded by all patients receiving voice therapy. Unilateral laser cordectomy gave better phonatory outcome due to less extension of surgical resection and development of glottic phonation. Bilateral laser cordectomy gave relatively worse prognosis highlighting the advantage of the experience of surgeon in creation of pseudoglottis in improving phonatory outcome in vertical hemilaryngectomy over extensive resection of bilaterally cordectomized patients. [Copyright &y& Elsevier]

Summary: Objectives: Human papillomavirus (HPV) infection is controversial as a causative factor of head and neck cancers despite the relatively high frequency of HPV infection in extragenital organ cancers. We aimed to clarify whether HPV directly affects the oncogenesis and biologic behavior of glottis cancer (GC). Methods: Paraffin block was obtained from 95 patients who were diagnosed as GC and 15 normal controls. HPV genotyping chip, real-time polymerase chain reaction (PCR) was used for identification of prevalence, phenotype, and physical status of HPV. We compared results with the clinicopathological parameters of GC patients. Results: HPV was detected in 7.4% (7 of 95) of GC patients, whereas 0% (0 of 15) of controls. Of the HPV-positive tumors in GCs, HPV-16 was the single most common type and HPV-16 prevalence rate was 57.1% (4 of 7). Among the HPV-16 infected GCs, integration of HPV-16 was found only in one case (1 of 4). There was no significant difference in HPV prevalence between GC and controls and HPV had no significant relation with any clinicopathologic parameters of GC patients. Conclusion: HPV infection may not be a causative factor in the oncogenesis and biologic behavior of GC. [Copyright &y& Elsevier]

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PURPOSE Evaluate outcome in patients with T1 and T2 laryngeal cancer treated with radiation therapy. PATIENTS AND METHODS Retrospective review of 190 patients with SCC of the larynx, stage T1 (63%) or T2(37%), treated with primary radiation therapy from 1/75 through 12/93. Median age was 61 years and median follow-up was 16.6 years. Median field size was 6.0 cm × 6.0 cm with a median fraction size of 2 Gy delivered in 33 daily fractions over 48 days. Energy used was 2 MV (19%), 4 MV (46%), 6 MV (26%), or other (9%). Univariate Cox proportional hazards regression analysis was performed using the following variables: gender, age, T stage, anterior commissure involvement, treatment energy, treatment interruption, alcohol use, smoking history, and tobacco use during treatment. RESULTS Overall actuarial 5-year survival was 76%, and 10-year survival was 56%. Actuarial local recurrence free survival (LRFS) at 5 years was 81%, and 10 years LRFS was 79%. Local relapse correlated with T stage (9% T1 versus 28% T2, p = 0.0009) and smoking history (14% for less than 100 pack-year versus 29% for greater than 100 pack-year, P = 0.02). Gender, age, anterior commissure involvement, treatment energy, treatment interruption, alcohol history, alcohol use during treatment, and tobacco use during treatment had no influence on outcomes. Actuarial second malignancies rate at 5 years was 18%. CONCLUSION Heavy tobacco use and T stage appears to correlate with an increase in local relapse rates. Gender, age, anterior commissure involvement, treatment energy, treatment interruption, and alcohol use did not significantly correlate with local relapse rates. The risk of second malignancies is comparable to that of local relapse. [ABSTRACT FROM AUTHOR]