Risk-adapted partial larynx and/or carotid artery sparing modulated radiation therapy of glottic cancer

Background: To evaluate outcome in patients with glottic cancer treated with intensity-modulated radiotherapy (IMRT) and to show effectiveness of partial laryngeal- and/or carotid artery sparing in low to intermediate risk tumors. Study design: Retrospective analysis. Material and methods: From 01/2004 to 03/2013 77 consecutive patients presenting with glottic cancer were treated in our department with IMRT as definitive treatment. T stages distributed as follows: T1: n = 17, T2: n = 24, T3: n = 15, T4: n = 13 and recurrences: 8 patients. Concomitant systemic therapy was applied in 39 patients consisting of either cisplatin or cetuximab. Results: Mean/median follow-up (FU) time was 32.2/28 months (range: 4-98.7). Three year local control (LC), ultimate LRC and laryngectomy free survival rate was 77%, 92% and 80%, respectively. Three year overall survival of the entire cohort was 81%. Three year local control for T1/T2, T3/T4, and recurred tumors was 95%, 65%, and 38%, respectively. Three year overall survival was 86% for T1 4 stages, 55% for recurred disease, respectively. Partial laryngeal/carotid artery sparing was performed in all T1 patients (n = 17) and 17/22 T2N0 patients. Rate of late sequels was low. Conclusion: IMRT for glottic cancer shows high control rates. In low to intermediate risk tumors an individualized treatment volume with partial larynx +/- carotid artery sparing is effective and holds the potential to reduce long term toxicity. The therapeutic outcome was not compromised.