Would you treat T1a glottic cancer with single vocal cord irradiation using IGRT?

Treating glottis larynx ca with IMRT/VMAT sparing the carotid artery has been reported by several institutions and is straightforward (for example, here). The benefits are supposed to be reduced cerebrovascular events, however, the utility of this approach is unknown, taking into account the relatively short length of the irradiated artery in glottis ca. For example, the Madison group found no differences in vascular events between elderly early glottic cancer patients who received standard RT or surgery. On the other hand, treating single cord in T1 glottic ca using IGRT has a potential to reduce edema and improve voice quality. The Erasmus cancer Ctr in Rotterdam conducted a careful study of laryngeal movement during respiration and desig...

Unilateral treatment with 3D planning has been done for a long time, for example see RTOG 9512. A recent PMH study suggests improved outcomes with IGRT.

I think it is reasonable to do unilateral 3D/IGRT for T1a and appropriate T2 glottic cancers. There are multiple studies with IMRT in these patients; selecting the appropriate technique is up to the comfort level of the radiation oncologist.