Abstract：
Early-stage squamous cell carcinoma of the glottic larynx is commonly treated with 2-dimensional or 3-dimensional conventional radiation therapy (CRT). Despite its use in other head and neck cancers, intensity-modulated radiation therapy (IMRT) remains controversial in this patient population.
A systematic review was performed by querying 3 databases (Pubmed, Embase, Web of Science) for articles published between December 1, 2000 and September 2, 2022. Included studies reported outcomes in at least 10 patients treated with IMRT for early-stage glottic cancer. Data were extracted and reported following PRISMA standards. Pooled outcomes were estimated using random-effects models. Primary outcome was the rate of local failure (LF) following IMRT. Secondary outcomes included rates of regional failure (RF) following IMRT and rates of LF and RF following CRT.
A total of 15 studies (14 retrospective, 1 prospective) consisting of 2083 patients were identified. IMRT was used in 873 patients (64% T1, 28% T2). Multiple treatment (partial larynx, single vocal cord carotid sparing) and image-guided radiation therapy techniques were used. The pooled crude rate of LF was 7.6% (95% confidence inverval [CI], 3.6%-11.5%) and actuarial LF rates at 3 and 5 years were 6.3% (95% CI, 2.2%-10.3%) and 9.0% (95% CI, 4.4%-13.5%), respectively. The pooled crude rate of RF after IMRT was 1.5% (95% CI, 0.5%-2.5%). On metaregression analysis, increased rate of LF was significantly associated with T2 disease (P < .001) and grade 2 to 3 histology (P < .001). Treatment with CRT was reported in 738 patients (76% T1, 22% T2). Among the studies reporting outcomes of both modalities, there was no significant difference in LF (log odds ratio; P = .12) or RF (log odds ratio; P = .58) between IMRT or CRT.
In patients with early-stage glottic cancer, retrospective data suggests local and regional control are similar for patients treated with IMRT and CRT. Additional prospective studies with uniform methods of volume delineation and image guidance are needed to confirm the efficacy of IMRT.
A systematic review was performed by querying 3 databases (Pubmed, Embase, Web of Science) for articles published between December 1, 2000 and September 2, 2022. Included studies reported outcomes in at least 10 patients treated with IMRT for early-stage glottic cancer. Data were extracted and reported following PRISMA standards. Pooled outcomes were estimated using random-effects models. Primary outcome was the rate of local failure (LF) following IMRT. Secondary outcomes included rates of regional failure (RF) following IMRT and rates of LF and RF following CRT.
A total of 15 studies (14 retrospective, 1 prospective) consisting of 2083 patients were identified. IMRT was used in 873 patients (64% T1, 28% T2). Multiple treatment (partial larynx, single vocal cord carotid sparing) and image-guided radiation therapy techniques were used. The pooled crude rate of LF was 7.6% (95% confidence inverval [CI], 3.6%-11.5%) and actuarial LF rates at 3 and 5 years were 6.3% (95% CI, 2.2%-10.3%) and 9.0% (95% CI, 4.4%-13.5%), respectively. The pooled crude rate of RF after IMRT was 1.5% (95% CI, 0.5%-2.5%). On metaregression analysis, increased rate of LF was significantly associated with T2 disease (P < .001) and grade 2 to 3 histology (P < .001). Treatment with CRT was reported in 738 patients (76% T1, 22% T2). Among the studies reporting outcomes of both modalities, there was no significant difference in LF (log odds ratio; P = .12) or RF (log odds ratio; P = .58) between IMRT or CRT.
In patients with early-stage glottic cancer, retrospective data suggests local and regional control are similar for patients treated with IMRT and CRT. Additional prospective studies with uniform methods of volume delineation and image guidance are needed to confirm the efficacy of IMRT.
摘要：
目的：早期声门喉鳞状细胞癌通常采用常规的2D或3D放射治疗（CRT）治疗。尽管它用于其他头颈部癌症，调强放射治疗(IMRT)在该患者人群中仍存在争议.
方法：通过查询3个数据库（Pubmed，Embase,WebofScience）适用于2000年1月1日至2022年9月2日之间发表的文章。纳入的研究报告了至少10例接受IMRT治疗的早期声门癌患者的预后。按照PRISMA标准提取并报告数据。使用随机效应模型估计汇集的结果。主要结果是IMRT后的局部失败率（LF）。次要结果包括IMRT后的区域失败率（RF），以及CRT后的LF和RF速率。
结果：共15项研究（14项回顾性研究，1个前瞻性），由2,083名患者组成。873例患者采用IMRT(64%T1,28%T2)。多种治疗（部分喉，单声带颈动脉保留）和图像引导的RT技术。LF的合并粗比率为7.6％（95％CI：3.6％至11.5％），3年和5年的精算LF率分别为6.3％（95％CI：2.2％至10.3％）和9.0％（95％CI：4.4％至13.5％），分别。IMRT后RF的合并粗比率为1.5%(95%CI:0.5%至2.5%)。在荟萃回归分析中，LF的增加与T2疾病（P<0.001）和2-3级组织学（P<0.001）显着相关。据报道，738例患者接受CRT治疗（T1为76%，T2为22%）。在报告两种模式结果的研究中，IMRT或CRT之间的LF(对数比值比[OR];P=0.12)或RF(对数OR;P=0.58)无显著差异.
结论：在早期声门型喉癌患者中，回顾性数据显示,接受IMRT和CRT治疗的患者的局部和区域控制相似.需要采用统一的体积描绘和图像指导方法进行其他前瞻性研究，以确认IMRT的疗效。
方法：通过查询3个数据库（Pubmed，Embase,WebofScience）适用于2000年1月1日至2022年9月2日之间发表的文章。纳入的研究报告了至少10例接受IMRT治疗的早期声门癌患者的预后。按照PRISMA标准提取并报告数据。使用随机效应模型估计汇集的结果。主要结果是IMRT后的局部失败率（LF）。次要结果包括IMRT后的区域失败率（RF），以及CRT后的LF和RF速率。
结果：共15项研究（14项回顾性研究，1个前瞻性），由2,083名患者组成。873例患者采用IMRT(64%T1,28%T2)。多种治疗（部分喉，单声带颈动脉保留）和图像引导的RT技术。LF的合并粗比率为7.6％（95％CI：3.6％至11.5％），3年和5年的精算LF率分别为6.3％（95％CI：2.2％至10.3％）和9.0％（95％CI：4.4％至13.5％），分别。IMRT后RF的合并粗比率为1.5%(95%CI:0.5%至2.5%)。在荟萃回归分析中，LF的增加与T2疾病（P<0.001）和2-3级组织学（P<0.001）显着相关。据报道，738例患者接受CRT治疗（T1为76%，T2为22%）。在报告两种模式结果的研究中，IMRT或CRT之间的LF(对数比值比[OR];P=0.12)或RF(对数OR;P=0.58)无显著差异.
结论：在早期声门型喉癌患者中，回顾性数据显示,接受IMRT和CRT治疗的患者的局部和区域控制相似.需要采用统一的体积描绘和图像指导方法进行其他前瞻性研究，以确认IMRT的疗效。
