Role of CCRT In T3n0 Squamous Cell Carcinoma Larynx, Pros Vs Cons
DOI:
https://doi.org/10.51253/pafmj.v74iSUPPL-2.10939Keywords:
Adjunctive chemotherapy, Concurrent, Laryngeal, Radiotherapy, Squamous cell carcinoma, T3NOAbstract
Objective: To assess the use and efficacy of Concurrent Chemoradiotherapy for a T3N0 Laryngeal Cancer as a Laryngeal
Function Preservation modality.
Study Design: Prospective Study design
Place and Duration of Study: CMH Rawalpindi, Pakistan from January 2022-January 2023.
Methodology: The sample size was n=24, having TPF-CCRT from January 2022 to January 2023 was chosen by using a
purposive sampling technique. Individuals were having abnormalities of T3 glottis without vocal cord fixation. Along with
MRI, the pretreatment evaluation also comprised clinical, endoscopy, and ultrasound examinations with or without fine
needle pick cytology samples. Moreover, F-fluoro-2-deoxy-D-glucose positron emitting tomography was used for whole-body
CT scanning. The UICC TNM grading method was used to grade the tumors as grade 15.
Results: Twelve out of 24 patients had grade 1 tumor (50%), eight had grade 2 tumors (25%), and four had grade 3 tumors
(25%). There had been complete resolution among 17 (70%) of patients, while the disease remains persistent disease in 7 (30%)
patients. 95% of patients found with good speech and breathing. 95% of patient organs remain preserved. All 24 patients
received CCRT. Four individuals (20%) without tumor regression received surgery following 40 Gy of RT. Others received RT
with a 66 Gy median total dose.
Conclusion: The study found that effective cancer control is possible with CCRT, and its effects are manageable in 70% of
patients with tolerable toxicity. However, in 30% of cases, it fails, requiring salvage laryngectomy. However, the search for a
viable strategy with tolerabl
Downloads
References
Braakhuis BJ, Leemans CR, Visser O. Incidence and survival
trends of head and neck squamous cell carcinoma in the
Netherlands between 1989 and 2011. Oral oncology. 2014 Jul 1;
(7): 670-5. https://doi.org/10.1016/j.oraloncology.2014.03.008
Murakami R, Nishimura R, Baba Y, Furusawa M, Ogata N,
Yumoto E, Yamashita Y. Prognostic factors of glottic carcinomas
treated with radiation therapy: value of the adjacent sign on
radiological examinations in the retroth edition of the UICC
TNM staging system. International Journal of Radiation
Oncology* Biology* Physics. 2005 Feb 1; 61(2): 471-5.
https://doi.org/10.1016/j.ijrobp.2004.05.024
Yang JC, Brose MS, Castro G, Kim ES, Lassen UN, Leyvraz S,
Pappo A, López-Ríos F, Reeves JA, Fellous M, Penault-Llorca F.
Rationale and design of ON-TRK: a novel prospective noninterventional study in patients with TRK fusion cancer treated
with larotrectinib. BMC cancer. 2022 Dec; 22(1): 1-1.
https://doi.org/10.1186/s12885-022-09687-x
Liang YJ, Liu LT, Li Y, Wang P, Luo MJ, Wen DX, Chen QY, Mai
HQ. Association of Treatment Advances With Survival Rates in
Pediatric Patients With Nasopharyngeal Carcinoma in China,
-2020. JAMA Network Open. 2022 Mar 1; 5(3): e220173-.
https://doi:10.1001/jamanetworkopen.2022.0173
Mojdami ZD, Barbour A, Oveisi M, Sun C, Fine N, Saha S,
Marks C, Elebyary O, Watson E, Tenenbaum H, Azarpazhooh A.
The Effect of Intensity-Modulated Radiotherapy to the Head and
Neck Region on the Oral Innate Immune Response and Oral
Microbiome: A Prospective Cohort Study of Head and Neck
Tumour Patients. International Journal of Molecular Sciences.
Aug 24; 23(17): 9594.
https://doi.org/10.3390/ijms23179594
Sun Y, Li WF, Chen NY, Zhang N, Hu GQ, Xie FY, Sun Y, Chen
XZ, Li JG, Zhu XD, Hu CS. Induction chemotherapy plus
concurrent chemoradiotherapy versus concurrent
chemoradiotherapy alone in locoregionally advanced
nasopharyngeal carcinoma: a phase 3, multicentre, randomised
controlled trial. The lancet oncology. 2016 Nov 1; 17(11): 1509-20.
https://doi.org/10.1016/S1470-2045(16)30410-7
Okumura M, Motegi A, Zenda S, Nakamura N, Hojo H,
Nakamura M, Hirano Y, Kageyama SI, Arahira S, Parshuram
RV, Kuno H. Efficacy and safety of accelerated fractionated
radiotherapy without elective nodal irradiation for T3N0 glottic
cancer without vocal cord fixation. Head & Neck. 2020 Aug;
(8): 1775-82. https://doi.org/10.1002/hed.26092
Biau J, Lapeyre M, Troussier I, Budach W, Giralt J, Grau C,
Kazmierska J, Langendijk JA, Ozsahin M, O'Sullivan B, Bourhis
J. Selection of lymph node target volumes for definitive head
and neck radiation therapy: a 2019 Update. Radiotherapy and
Oncology. 2019 May 1; 134: 1-9.
https://doi.org/10.1016/j.radonc.2019.01.018
Suzuki G, Yamazaki H, Aibe N, Masui K, Shimizu D, Kimoto T,
Nishimura T, Kawabata K, Nagasawa S, Machida K, Yoshino Y.
Comparison of three fractionation schedules in radiotherapy for
Role of CCRT in T3 n0 Squamous Cell Carcinoma
Pak Armed Forces Med J 2024; 74(Suppl-2): S273
early glottic squamous cell carcinoma. in vivo. 2020 Sep 1; 34(5):
-74. https://doi.org/10.21873/invivo.12101
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A.
Global cancer statistics 2018: GLOBOCAN estimates of incidence
and mortality worldwide for 36 cancers in 185 countries. CA: a
cancer journal for clinicians. 2018 Nov; 68(6): 394-424.
https://doi.org/10.3322/caac.21492
Dietz A, Wichmann G, Kuhnt T, Pfreundner L, Hagen R, Scheich
M, Kölbl O, Hautmann MG, Strutz J, Schreiber F, Bockmühl U.
Induction chemotherapy (IC) followed by radiotherapy (RT)
versus cetuximab plus IC and RT in advanced
laryngeal/hypopharyngealcancerresectable only by total
laryngectomy—final results of the larynx organ preservation
trial DeLOS-II. Annals of Oncology. 2018 Oct 1; 29(10): 2105-14.
https://doi.org/10.1093/annonc/mdy332
Forastiere AA, Zhang Q, Weber RS, Maor MH, Goepfert H,
Pajak TF, Morrison W, Glisson B, Trotti A, Ridge JA, Thorstad
W. Long-term results of RTOG 91-11: a comparison of three
nonsurgical treatment strategies to preserve the larynx in
patients with locally advanced larynx cancer. Journal of clinical
oncology. 2013 Mar 1; 31(7): 845-52.
https://doi:10.1200/JCO.2012.43.6097
. Weber RS, Berkey BA, Forastiere A, Cooper J, Maor M,
Goepfert H, Morrison W, Glisson B, Trotti A, Ridge JA, Chao
KC. Outcome of salvage total laryngectomy following organ
preservation therapy: the Radiation Therapy Oncology Group
trial 91-11. Archives of Otolaryngology–Head & Neck Surgery.
Jan 1; 129(1): 44-9.
doi:10.1001/archotol.129.1.44
Haddad R. Larynx preservation: a debate worth preserving.
Journal of Clinical Oncology. 2013 Sep 1; 31(25): 3170-.
https://doi.org/10.1200/JCO.2013.49.1332
Dietz A, Wiegand S, Kuhnt T, Wichmann G. Laryngeal
preservation approaches: Considerations for new selection
criteria based on the DeLOS-II trial. Frontiers in Oncology. 2019
Jul 10; 9: 625. https://doi.org/10.3389/fonc.2019.00625
Hartl DM, Ferlito A, Brasnu DF, Langendijk JA, Rinaldo A,
Silver CE, Wolf GT. Evidence‐based review of treatment options
for patients with glottic cancer. Head & neck. 2011 Nov; 33(11):
-48. https://doi.org/10.1002/hed.21528
Conibear J, AstraZeneca UK Limited. Rationale for concurrent
chemoradiotherapy for patients with stage III non-small-cell
lung cancer. British Journal of Cancer. 2020 Dec 1; 123(Suppl 1):
-7. https://doi.org/10.1038/s41416-020-01070-6
Campbell G, Glazer TA, Kimple RJ, Bruce JY. Advances in organ
preservation for laryngeal cancer. Current Treatment Options in
Oncology. 2022 Apr; 23(4): 594-608.
https://doi.org/10.1007/s11864-022-00945-5
Piazza C, Paderno A. Conservative Surgical and Non-surgical
Options in Management of T3 Laryngeal Cancer. Current
Otorhinolaryngology Reports. 2017 Jun; 5: 125-31.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Ayesha Khan, Naeem Riaz, Faisal Manzoor, Kamran Zamurrad Malik, Shakeel Ahmed, Muhammad Ali
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
