Hypofractionated Radiotherapy of Early Glottic Cancer - A Single Institution Experience of 52.5 Gray in 15 Fractions among Patients Attending a Tertiary Care Center

Abstract

BACKGROUND The standard conventional radiation schedule for early laryngeal cancer is 64 - 70 Gy in 2 Gy per fraction over 6.5 - 7 weeks. Hypofractionated radiotherapy in early laryngeal cancer allows delivery of larger dose per fraction (fraction size) in decreased overall treatment time with improved local control and similar survival rates. Reduction in treatment time also optimizes the usage of radiotherapy resources. The purpose of this study was to estimate the local control rates, survival rates and toxicity profile of hypofractionated radiotherapy of 52.5 Gy in 15 fractions for early glottic cancer. METHODS Twenty-eight patients with early glottic squamous cell carcinoma (SCC) treated with hypofractionated definitive radiotherapy from June 2015 to December 2019 were analyzed. The median age was 61 years. Total dose of 52.5 Gy in 15 fractions was delivered over three-four weeks with a fraction size of 3.5 Gy. The median follow-up period was 23.8 months. RESULTS The 5-year local control rates were 96.4 % with one recurrence. The 5-year overall survival rate was 100 % and cause specific survival at 5 years was 100 %. There was no association of T1 sub staging, T2 (P - 0.40) and no significant association of anterior commissure involvement (P = 0.408, chi square value = 3.982) and pretreatment haemoglobin (P - 0.480) on local control. Late complications include laryngeal oedema (21.5 %), altered thyroid function (3.6 %), cardiac complication (3.6 %) and altered voice quality (14.3 %).There was no association of local control with field size (FS) (P = 0.812), beam energy (P = 0.098 ) overall treatment time of less than thirty days (P - 0.747). CONCLUSIONS Local control with hypofractionated radiotherapy for early laryngeal glottis squamous cell carcinoma is excellent with no severe complications. The short overall treatment time enables channelling of radiotherapy resources in low budget countries with long wait list for radiation. KEYWORDS Early Laryngeal Cancer, Glottic Cancer, Hypofractionated Radiotherapy, Overall Treatment Time.