Jennifer Kwan BS, Presenter: Nothing to Disclose

Wilma M Hopman MA, Abstract Co-Author: Nothing to Disclose

Steve Hall MD, MSc, Abstract Co-Author: Nothing to Disclose

Timothy E Owen MD,FRCPC, Abstract Co-Author: Nothing to Disclose

Khaled Osman Zaza MD, FRCPC, Abstract Co-Author: Nothing to Disclose

Purpose/Objective(s): Accurate staging is the most important factor guiding the management of patients with localized glottic cancers. To date, CT has served as the primary imaging modality used for staging of laryngeal cancers, but it is known that MRI has a higher sensitivity to detect cartilage invasion. It is hypothesized that use of MRI provides improved staging accuracy and better outcomes for early glottic cancers. This study reports our 15-year regional cancer center outcomes of treatment for T1-2N0 glottic cancers. Findings reflect our unique experience with early adoption of MRI for tumor staging, which began in the 1990s. In addition, based on the poorer outcomes of patients of low-socioeconomic status described in literature, it was hypothesized that these patients may have a different set of prognostic factors than the general population. Our cancer center serves a large proportion of rural and low-income residents; this allowed for the identification of relevant prognostic factors for this population.Materials/Methods: Medical records of 64 patients with T1-2N0 glottic cancers, treated from 1997-2012 at our institution, were retrospectively reviewed for patient, tumor, and treatment characteristics. Univariate analyses were performed and Kaplan-Meier curves were generated for 5-year disease-free (DFS), laryngectomy-free (LFS), disease-specific (DSS), cancer-specific (CSS), and overall (OS) survivals. National Cancer Institute definitions of survival outcomes were used.Results: 59 patients received radiation and 5 received surgery as definitive treatment for T1-2N0 glottic cancers. Of the 59 patients who received radiation, 13 (22.0%) had a local recurrence of cancer, which was retreated in 9 cases with total laryngectomy, 2 with hemilaryngectomy, 1 with hemicordectomy, and 1 case was not operated on. The median time to recurrence was 12.3 months. 5-year DFS, LFS, DSS, CSS, and OS were 79.7%, 84.7%, 94.9%, 84.7%, and 79.7% respectively for radiation-treated cancers. Patients treated with upfront surgery had comparable outcomes with 5-year DFS, DSS, CSS, and OS of 75.0%, 100.0%, 100.0%, and 75.0% respectively. On univariate analysis, top factors relating to poor overall survival from radiation included supraglottic extension (p=0.01), use of feeding tube (p=0.02), and higher T stage (p=0.05).Conclusion: This study describes optimal survival outcomes for patients with T1-2N0 glottic cancers that parallel or surpass CT-staged outcomes described in literature, despite the rural and low-income backgrounds of the study population. Results suggest that use of MR imaging to stage laryngeal cancers may be beneficial for achieving accurate staging and improved survival outcomes. Prognostic factors have also been identified for this unique patient population.

Kwan, J, Hopman, W, Hall, S, Owen, T, Zaza, K, Radiotherapy-Treated Early Glottic Cancers: 15-Year Regional Cancer Center Experience.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14041426.html