Do you omit adjuvant radiotherapy in T4a laryngeal SCC with favorable prognostic factors?

According to the NCCN guidelines, there is a highly selected group of T4a glottic larynx patients that can undergo observation instead of postoperative RT. These pathologic features include but are not limited to pN0, favorable histopathology, low volume disease, wide margins, and subglottic extension <1cm. Is this recommendation for observation based on any specific study and is this recommendation frequently utilized in practice?

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Would you consider omitting postoperative RT for T4a glottic larynx patients with otherwise favorable features?

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4 Answers

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Radiation Oncology · Medical University of South Carolina (Charleston)

Answered on

I guess one could omit PORT for such a situation. I have never encountered this situation and I don't know what data NCCN is using to support this recommendation. Historically, pT4 is the indication for PORT.

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Radiation Oncology · University of Florida

Answered on

It would be very unlikely that it would be so favorable that RT could be omitted. If that were the case, larynx preservation should have been employed. There would likely be subglottic extension that would increase the risk of positive level 6 nodes and a stomal recurrence.

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Radiation Oncology · University of Missouri at Columbia, Ellis Fischel Cancer Cener

Answered on

I agree with Dr. @Dr. First Last, there is little data to support observation, and T4 alone without any other risk factor is a high/high intermediate risk factor (Peters et al., PMID 8482629). It still should remain a classic indication for PORT.

A recent NCDB analysis we did at our institution noted...

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Radiation Oncology · University of Arizona Cancer Center

Answered on

It depends upon the histology. For example, a low-grade chondrosarcoma of the larynx can do very well with surgery alone, even if T4a. See Chin et al., PMID 27291822 for more details.

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