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Published on: April 17, 2012
SBRT for early-stage glottic larynx cancer-Initial clinical outcomes from a phase I clinical trial
David L Schwartz1, Alan Sosa1, Stephen G Chun1
1Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America.
Purpose:
To confirm safety and feasibility of hypofractionated SBRT for early-stage glottic laryngeal cancer.
Methods:
Twenty consecutive patients with cTis-T2N0M0 carcinoma of glottic larynx were enrolled. Patients entered dose-fractionation cohorts of incrementally shorter bio-equivalent schedules starting with 50 Gy in 15 fractions (fx), followed by 45 Gy/10 fx and, finally, 42.5 Gy/5 fx. Maximum combined CTV-PTV expansion was limited to 5 mm. Patients were treated on a Model G5 Cyberknife (Accuray, Sunnyvale, CA).
Results:
Median follow-up is 13.4 months (range: 5.6-24.6 months), with 12 patients followed for at least one year. Maximum acute toxicity consisted of grade 2 hoarseness and dysphagia. Maximum chronic toxicity was seen in one patient treated with 45 Gy/10 fx who continued to smoke >1 pack/day and ultimately required protective tracheostomy. At 1-year follow-up, estimated local disease free survival for the full cohort was 82%. Overall survival is 100% at last follow-up.
Conclusions:
We were able to reduce equipotent total fractions of SBRT from 15 to 5 without exceeding protocol-defined acute/subacute toxicity limits. With limited follow-up, disease control appears comparable to standard treatment. We continue to enroll to the 42.5 Gy/5 fx cohort and follow patients for late toxicity.
Trial Registration:
ClinicalTrials.gov NCT01984502.
