International Journal of Head and Neck Surgery

Register      Login

VOLUME 2 , ISSUE 3 ( September-December, 2011 ) > List of Articles


Hypofractionated Radiotherapy in the Treatment of Early Glottic Carcinoma

Raza Hussain, Sarah Jamshed, Uzma Majeed, Shahid Hameed, Arif Jamshed, Khaliq UR Rehman, Hassan Iqbal, Muhammad Ali, Natasha Hameed

Citation Information : Hussain R, Jamshed S, Majeed U, Hameed S, Jamshed A, Rehman KU, Iqbal H, Ali M, Hameed N. Hypofractionated Radiotherapy in the Treatment of Early Glottic Carcinoma. Int J Head Neck Surg 2011; 2 (3):138-143.

DOI: 10.5005/jp-journals-10001-1069

Published Online: 01-12-2012

Copyright Statement:  Copyright © 2011; The Author(s).



Given the high probability of cure, the aims of treatment are cure, laryngeal preservation and good voice quality while making effective use of available resources. In this study we analyze locoregional control (LRC) and survival following hypofractionated radiotherapy in early stage glottic squamous cell carcinoma treated at Shaukat Khanum Memorial Cancer Hospital and Research Center.

Materials and methods

Between October 2003 and June 2009, 87 patients with early glottic squamous cell carcinoma were treated with hypofractionated radiotherapy. All patients were included in the study (M: 94%; F:6%). Median age was 60 years (range: 21-81 years). Sixty-six percent of patients were smokers. AJCC stage was T1 in 95% and T2 in 5% of the patients. Radiotherapy dose was 55 Gy in 20 fractions over 4 weeks. All patients were treated on cobalt-60. Median radiotherapy treatment time was 28 days (range: 23-35 days).


The LRC rate after primary radiotherapy at 5 years was 91% (95% CI: 88-94%). The 5 years overall and disease-specific survival was 86% (95% CI: 81 and 91%) and 97% (CI 95%: 95 and 99%) respectively. Patients with T1a and T1b disease had LRC rates of 95 and 88% (p = 0.32). The LRC rates for patients with and without anterior commissure involvement at 5 years were 80 and 96% (p = 0.02) respectively.


Hypofractionated radiotherapy 55 Gy in 20 fractions is comparable to conventional fractionation schedules in terms of locoregional control and survival while offering potential for optimizing resources usage.

PDF Share
  1. Globocan 2000: Cancer incidence, mortality and prevalence worldwide. Version 1. Cancer base No. 5. Lyon: IARC Press 2001.
  2. Cancer of the head and neck (4th ed). Philadelphia, PA, Saunders 2003.
  3. Larynx. In: Million RR, Cassisi NJ (Eds). Management of head and neck cancer, a multidisciplinary approach (2nd ed). Philadelphia: JB Lippincott 1994;431-97.
  4. Tumors of the larynx and laryngopharynx. In: Ballanger JJ (Ed). Diseases of the nose, throat, ear, head and neck (14th ed). Philadelphia: Lea and Febiger; 1991;pp. 682-746.
  5. T1-T2N0 squamous cell carcinoma of the glottic larynx treated with radiation therapy. J Clin Oncol 2001;19:4029-36.
  6. American Society of Clinical Oncology: Clinical practice guidelines for the use of larynx preservation strategies in the treatment of laryngeal cancer. J Clin Oncol 2006;24(22):3693-704.
  7. T1-T2 squamous cell carcinoma of the glottis larynx treated with radiation therapy: Relationship of dose fractionation factors to local control and complications. Int J Radiat Oncol Biol Phys 1988;15:1267-73.
  8. Management of Tis, T1, T2 squamous cell carcinoma of the glottic larynx. Ann J Otolaryngol 1994;15:250-57.
  9. National survey of radiotherapy fractionation practice in 2003. Clinical Oncol 2006;18:3-14.
  10. The impact of treatment time and smoking on local control and complications in T1 glottic cancer. Int J Radiat Oncol Biol Phys 1998;42:247-55.
  11. Radiation therapy for head and neck neoplasms (2nd ed). Year Book Medical Publishers, Inc; 1990;pp. 228-29.
  12. T1/T2 glottic cancer managed by external beam radiotherapy: The influence of pretreatment hemoglobin on local control. Int J Radiat Oncol Biol Phys 1998;41:347-53.
  13. Stage T1 glottic carcinoma: Results of radiation therapy or laser excision. Radiology 1990;175:567-70.
  14. Causes of failure of curative radiation therapy in 205 early glottic cancers. Int J Radiat Oncol Biol Phys 1990;18:1307-13.
  15. Do overall treatment time, field size, and treatment energy influence local control of T1-T2 squamous cell carcinomas of glottic larynx. Int J Radiat Oncol Biol Phys 1996;34:823-31.
  16. The larynx…so to speak: Everything I want to know about laryngeal cancer I learned in the past 32 years. Int J Radiat Oncol Biol Phys 1992;23:691-704.
  17. The anterior commissure in glottic carcinoma. Laryngoscope 1975;85:1624-32.
  18. Importance of overall treatment time for the response to radiotherapy in patients with squamous cell carcinoma of the head and neck. Rays 2000;25(3):313-19.
  19. Prognostic factors for local control and survival in T1 squamous cell carcinoma of the glottis. Int J Radiat Oncol Biol Phys 1993;26:767-72.
  20. A national audit of radiotherapy fractionation in head and neck cancer. Clin Oncol 2003;15:41-46.
  21. T1N0/T2N0 glottic carcinoma: A comparison of two fractionation schedules. Australas Radiol 2006;50:152-57.
  22. Early stage glottic cancer: Importance of dose fractionation in radiation therapy. Radiology 1992;182:273-75.
  23. Effect of radiation fraction size on local control rates for early glottis carcinoma. A model analysis for in vivo tumor growth and radio-response parameters. Arch Otolaryngol Head Neck Surg 1994;120:737-42.
  24. Results of radiation therapy in early glottic carcinoma: Multivariate analysis of prognostic and radiation therapy variables. Radiology 1992;183:789-94.
  25. Final report on the second British Institute of Radiology fractionation study: Short versus long overall treatment times for radiotherapy of carcinoma of the laryngopharynx. Br J Radiol 1991;64:232.
  26. An evaluation of absorbed doses of high energy electromagnetic radiation in radiotherapy of laryngeal cancer. Nippon Jibiinkoka Gakkai Kaiho 1990;93:796-807.
  27. Radiotherapy of T1 glottic cancer with 6 MeV X-rays. Int J Radiat Oncol Biol Phys 1993;26:767-72.
  28. Radiation therapy for glottic cancer using 6-MV photons. Cancer 1996;77:381-86.
  29. Results of curative laser microsurgery of laryngeal carcinomas. Am J Otolaryngol 1993:14;116-21.
  30. Stage (T1 N0 M0) squamous cell carcinoma of the laryngeal glottis: Therapeutic results and voice preservation. Head Neck 1999;21:707-17.
  31. The role of laser microsurgery in the treatment of laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg 2007;15:82-88.
  32. Voice-related quality of life in T1 glottic cancer: Irradiation versus endoscopic excision. Ann Otol Rhinol Laryngol 2006;115:581-86.
  33. Multidisciplinary approach in the treatment of T1 glottic cancer. The role of patient preference in a homogenous patient population. Strahlenther Onkol 2010;186(11):607-13.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.