Outcome of T2 Glottic Cancer Treated with Radiotherapy Alone or Concurrent Chemo-Radiotherapy

Background: Radiotherapy is the standard treatment for early-stage glottic cancer. This study retrospectively evaluates oncological outcomes in T2N0M0 glottic cancer to identify the most effective treatments. Methods: Data from 121 patients with T2N0M0 glottic cancer treated between 2001 and 2022 were analyzed. Treatments included radiotherapy (60-76 Gy, median 70 Gy, fraction sizes 1.8-2.25 Gy, median 2.12 Gy) with or without cisplatin-based concurrent chemotherapy. Additionally, 44 patients (36.4%) underwent transoral laser microsurgery before radiotherapy or chemoradiation for debulking or diagnostic purposes. Results: Locoregional control rates were 82.1% at 5 years and 77.8% at 10 years. Recurrence-free survival rates were 72.9% at 5 years and 58.3% at 10 years, while overall survival rates were 80.2% and 66.8% at 5 and 10 years, respectively. Multivariable analysis identified concurrent chemoradiotherapy (CCRT) as a significant predictor of tumor control, recurrence-free survival, and overall survival. The 5-year and 10-year locoregional control rates for patients receiving CCRT were 88.5% and 83.2%, respectively, compared to 72.8% and 69.6% for those receiving definitive radiotherapy alone (adjusted hazard ratio: 0.30, 95% confidence interval 0.12-0.76, p = 0.011). Radiation doses > 70 Gy equivalent dose in 2 Gy fractions (EQD2) were not associated with improved tumor control. Acute toxicities were more frequent with CCRT but did not increase late toxicities. Conclusions: CCRT with cisplatin improves local control, recurrence-free survival, and overall survival in T2N0M0 glottic cancer, albeit with high toxicity. Prospective studies are needed to optimize treatment protocols, balancing efficacy with toxicity.