The Evolution of Technology in the Management of Early Stage (T1) Cancer of the Glottic Larynx, an Institutional Review of Radiation Therapy Outcomes
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Bibliographic record
Abstract
Purpose: This single institution, retrospective cohort study was undertaken to evaluate the impact of evolving radiation therapy (RT) treatment technology on the long-term outcomes and patterns of failure for patients with early stage, T1, squamous cell cancer of the larynx. Materials and methods: All patients with T1N0 squamous cell cancer of the larynx that underwent radical RT from January 2008 to December 2018 were included. The planning and delivery of radiation, 2-dimensional RT vs IMRT or VMAT, as well as patient factors were reviewed in the context of local disease control. Results: A total of 171 Patients were eligible for inclusion in the analysis. The median age was 70 years (range of 38-91 years), and just over 90% (90.6%) of the cohort were male. While all patients were staged as having T1 disease, a smaller proportion had more detailed assignments of T1a (38 or 23.3%), or T1b (23 or 14.1%). The majority of patients were treated with 50-51 Gy in 20 daily fractions over four weeks. After a median follow up of over five years, there were only 11 patients (6.4%) that had demonstrated local regional failure, most occurring within the first two years of follow up, and in a multivariate model, only age was a prognostic factor for local control (p=0.013), whereas RT technique specifically was not. Conclusion: Single-modality RT provides an excellent and effective treatment for T1 glottic cancer. A shift to conformal 3-D planning and treatment delivery to minimize radiation dose to surrounding normal tissues, has not resulted in a significant change to rates of local failure. The majority of local failures have occurred within the first 2 years after RT. Prospective comparative measures of toxicity and functional preservation seem unlikely to be measured given the shift in the routine delivery of RT.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.005 |
| Science and technology studies | 0.000 | 0.007 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it