Moderate hypofractionation for early laryngeal cancer improves local control: a systematic review and meta-analysis
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HEAD AND NECK
Moderate hypofractionation for early laryngeal cancer improves local control: a systematic review and meta‑analysis Rony Benson1 · G. Prashanth1 · Supriya Mallick1 Received: 10 February 2020 / Accepted: 25 April 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction 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. Methods 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. Results 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. Conclusion 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. Keywords Larynx · Preservation · Hypo-fractionated · Radiotherapy · Conventional
Introduction Radiation therapy, considered the standard treatment for early glottic cancers, offers excellent cure rates with superior voice preservation [1]. Conventional fractionation has been used traditionally for early vocal cord tumors with a recent trend towards moderate hypofractionation. Smaller treatment volume and reduced overall treatment time makes larynx a very suitable subsite for moderate hypofractionation. Various prospective and retrospective trials have been conducted in this aspect with mixed results on local control and toxicity [2, 3]. No large phase III trials have shown superiority * Supriya Mallick [email protected] 1
Department of Radiation Oncology, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
in terms of overall survival with hypofractionation in early laryn
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