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Optimized radiotherapy treatment strategy for early glottic carcinoma

Ono, Tamami Itoh, Yoshiyuki Ishihara, Shunichi Kawamura, Mariko Oie, Yumi Takase, Yuuki Okumura, Masayuki Oyoshi, Hidekazu Nagai, Naoya Naganawa, Shinji 名古屋大学

2023.05

概要

The goals of treatment for early glottic carcinoma (GC) are tumor eradication and preservation
of larynx functions, including speaking and swallowing. The recommended treatment strategy
for early GC is partial laryngectomy, including endoscopic and open resection, and definitive
radiation therapy (RT); generally, the efficacies of resection and RT are comparable.1,2 Previous
studies have shown that the local control (LC) rate of early stage GC varies widely, while that
of RT alone for T2 GC is unsatisfactory, ranging from 65% to 80%.3-5 Reddy et al6 reported that
tumor size is an important prognostic factor for the LC rate in T1 GC, and that the LC rate is
lower in T1 bulky tumors. Several studies have subclassified T2 GC into T2a and T2b, reporting
lower LC rates in T2b.7-9 In this study, we subclassified T1 and T2 GCs into T1 nonbulky, T1
bulky, T2 favorable, and T2 unfavorable, following previous reports.
We first designed a concurrent chemoradiotherapy (CCRT) protocol using S-1 (tegafur, gimeracil, and oteracil) for T1 bulky and T2 favorable GCs with the aim of improving the LC rate;
the efficacy and safety of this protocol was demonstrated in our previous phase I/II study.10,11
S-1 is an orally administered antineoplastic agent shown to be effective against a variety of solid
tumors including head and neck cancer. Due to the inadequate results observed in our previous
experiments regarding CCRT with low-dose cisplatin (CDDP)/5-fluorouracil for T2 GC,12,13 we
were concerned that CCRT with S-1 may be inadequate in patients with T2 unfavorable GC;
thus, CCRT with high-dose CDDP was selected. Furthermore, we changed the RT dose from
2.0 Gy/fraction to 2.25 Gy/fraction, thereby reducing the number of fractions from 35 to 28
for patients with T1 nonbulky GC. This was based on reports, from Japan as well as overseas,
that the LC rates for T1 tumors were higher than 90% when using 2.25 Gy/fraction.14,15 Our
research group also reported comparable efficacy and acceptable safety of the 2.25 Gy/fraction
method, compared with the conventional 2.0 Gy/fraction method, in a multicenter survey of the
Tokai Study Group for Therapeutic Radiology and Oncology conducted in Japan from 2011 to
2015.16 A recent meta-analysis by Benson et al,17 including several randomized controlled trials,
also reported that hypofractionation for early GC is effective for improving LC rates.
The overall results of our optimized treatment strategy were reported in 2017, demonstrating
that our protocol, which has been used in our institution since 2007,18 was both effective and
well tolerated.19 The purpose of this study was to evaluate the clinical efficacy of our optimized
treatment strategy in early GC in a larger cohort. ...

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参考文献

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References End

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