title: Clinical and dosimetric implications of intensity-modulated radiotherapy for early-stage glottic carcinoma.
abstract: Conventional parallel-opposed radiotherapy (PORT) is the established standard technique for early-stage glottic carcinoma. However, case reports have reported the utility of intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) with or without image guidance (image-guided radiotherapy, IGRT) in select patients. The proposed advantages of IMRT/VMAT include sparing of the carotid artery, thyroid gland, and the remaining functional larynx, although these benefits remain unclear. The following case study presents a patient with multiple vascular comorbidities treated with VMAT for early-stage glottic carcinoma. A detailed explanation of the corresponding treatment details, dose-volume histogram (DVH) analysis, and a review of the relevant literature are provided. Conventional PORT remains the standard of care for early-stage glottic carcinoma. IMRT or VMAT may be beneficial for select patients, although great care is necessary to avoid a geographical miss. Clinical data supporting the benefit of CRT are lacking. Therefore, these techniques should be used with caution and only in selected patients.
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH. Electronic address: wardm3@ccf.org.
authors.forename: Matthew Christopher
authors.initials: MC
authors.lastname: Ward
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH.
authors.forename: Yvonne D
authors.initials: YD
authors.lastname: Pham
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH.
authors.forename: Rupesh
authors.initials: R
authors.lastname: Kotecha
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Zakem
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH.
authors.forename: Eric
authors.initials: E
authors.lastname: Murray
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH.
authors.forename: John F
authors.initials: JF
authors.lastname: Greskovich
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D008297:Male; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated
keywords: Carotid sparing; Early-stage glottis cancer; IMRT; VMAT