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- W4385757373 abstract "I would treat with three-dimensional conformal radiotherapy, opposed laterals, with wedges (heels orientated anteriorly), with a 1 cm (thickness) x 2 cm (width) x 6-cm (length) daily bolus placed over the anterior larynx. 1 De Leo AN Dagan R. Early glottic cancer with adverse features: Can larynx-only RT cut it without needing to eventually cut it out?. Int J Radiat Oncol Biol Phys. 2023; 117: 6 Abstract Full Text Full Text PDF Scopus (4) Google Scholar The field borders would be as follows: superiorly, top of thyroid notch; inferiorly, 5-mm inferior to cricoid cartilage; posteriorly, 1 cm into the vertebral body; and anteriorly, a 2- to 3-cm flash on the skin. I would try to limit the superior-inferior extent of the field to ≤ 6 cm. The radiation prescription would be 225 cGy per fraction, over 29 fractions, for a total dose of 6525 cGy. I would not recommend concurrent chemotherapy. Starting with the AJCC 7th edition, the presence of paraglottic fat space invasion (regardless of vocal cord mobility) became a criterion for T3 designation. I standardly would treat a T3 N0 glottic cancer with intensity-modulated radiotherapy (IMRT) to 7000 cGy with concurrent cisplatin and elective nodal radiation. However, in this case with impaired mobility and early paraglottic fat space involvement, I would not. Historically (prior to the 7th edition of the AJCC staging manual), patients with impaired mobility with and without paraglottic fat space invasion were treated with narrow-field larynx-only radiation. If the vocal cord was fixed, I would treat with IMRT, 7000 cGy with cisplatin, and elective nodal radiation. Although I am aware of the purported benefits of sparing the carotid arteries with IMRT, my interpretation of the SEER Medicare studies, regarding cerebrovascular risk, is that the potential excess risk is small and does not outweigh the real cost and complexities of IMRT." @default.
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- W4385757373 date "2023-09-01" @default.
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- W4385757373 title "Old School" @default.
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- W4385757373 doi "https://doi.org/10.1016/j.ijrobp.2023.07.012" @default.
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