Moderate hypofractionation for early laryngeal cancer improves local control: a systematic review and meta-analysis

Radiation therapy is considered the standard treatment for early glottic cancers; and recent trials have evaluated the role of hypofractionation with mixed results. We conducted this systematic review and meta-analysis to assess the impact of hypofractionation in early glottic cancers.

We performed a comprehensive search of the PubMed, Embase and Google scholar to look for studies which have evaluated the role of hypofractionation in early glottic cancers. Only prospective trials were included in the present analysis. RevMan software (Cochrane Collaboration's Information Management System) was used for the meta-analysis.

The analysis included a total of five studies and 1153 patients. Hypofractionation was found to significantly improve local control rates with an Odds ratio of 0.55 [95% CI 0.13-0.85]. The voice preservation rates with hypofractionation ranged from 86 to 94%. No significant improvement in overall survival was noted with the used of hypofractionation [hazard ratio 1.09, 95% CI 0.69-1.71]. There was an increased incidence of grade 2 or higher acute mucositis toxicity with use of hypofractionation [Odds ratio 1.54, 95% CI 1.12-2.11]. The incidence of acute skin toxicity was not increased with use of hypofractionation. Late toxicity was very low and not increased with use of hypofractionation.

Moderate hypofractionation as compared to conventional fractionation, in laryngeal cancer, is associated with significantly improved local control without impact on overall survival. The use of hypofractionation is associated with an increased incidence of acute mucositis though incidence of long-term toxicity was not significantly increased. Hence, moderate-dose hypo-fractionation should be considered as the new standard of care in early laryngeal cancer.