ArticleFrontiers in oncology2026
Precise radiation, better airway preservation: vocal cord-only image-guided intensity-modulated radiation therapy for early-stage glottic cancer.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: Radiotherapy (RT) achieves excellent local control (LC) in early-stage glottic cancer (ESGC); however, treatment-related edema or necrosis may necessitate tracheostomy and adversely affect quality of life. We compared tracheostomy rates and oncologic outcomes between whole-larynx radiotherapy (WLRT) and vocal cord-only radiotherapy (VC-RT) in patients with ESGC. Methods: We retrospectively analyzed 247 patients with Tis-T2 glottic cancer treated with definitive RT (2007-2023) at two Middle Eastern centers. Patients received WLRT (n = 166) or VC-RT (n = 81). The primary endpoint was a tracheostomy rate (TR) ≥6 months after RT for non-recurrent airway compromise. Secondary endpoints included 3-year local failure (LF) and overall survival (OS). TR and LF rates were analyzed using cumulative incidence with death as a competing risk, whereas OS was estimated using the Kaplan-Meier method. Results: The median age was 59 years; 97.6% of patients were men and 78.9% were smokers. The median follow-up among surviving patients was 38.2 months (range 1.6-194 months). The median potential follow-up for the entire cohort, estimated by the reverse Kaplan-Meier method, was 45.3 months. VC-RT patients more frequently had cT2 disease (22.2% vs. 5.4%, p < 0.001) and received accelerated fractionation (19.8% vs. 7.2%, p = 0.0069). Overall, 20 of 247 patients (8%) required tracheostomy without recurrence. Edema-related tracheostomy occurred exclusively in WLRT patients (14.2% vs. 0% with VC-RT; p < 0.001). Tracheostomy was reversed in 8/20 patients (40%) after a median of 13.4 months. The 3-year LF rates were 7.6% with VC-RT and 11.6% with WLRT (p = 0.18), and OS was 93.3% and 89.5% (p = 0.16), respectively. Conclusions: VC-RT reduces the risk of tracheostomy without compromising oncologic outcomes.
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