LARYNGOLOGY Radiotherapy for T1a glottic cancer: the influence of smoking cessation and fractionation schedule of radiotherapy Abrahim Al-Mamgani • Peter H. van Rooij • Robert Mehilal • Gerda M. Verduijn • Lisa Tans • Stefan L. S. Kwa Received: 20 March 2013 / Accepted: 13 June 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract The objective of the presented study is to report on retrospectively collected data on long-term outcome and toxicity and prospective assessment of quality of life (QoL) and Voice-Handicap Index (VHI) of patients with T1a glottic cancer treated with radiotherapy. Between 1985 and 2011, 549 patients were treated. Endpoints were local control (LC), toxicity, QoL and VHI. After a median fol- low-up of 93 months, the actuarial rates of LC were 91, and 90 % at 5- and 10-years, respectively. Continuing smoking (p \ 0.001) and anaemia (p = 0.02) were sig- nificantly correlated with poor LC on univariate analysis and fractionation schedule did not show significant corre- lation (p = 0.08). On multivariate analysis, only contin- uing smoking retained significance (p = 0.001). These patients had also significantly increased incidence of sec- ond primary tumour and lower overall survival rates. The incidence of grade C2 late xerostomia and dysphagia were 10 and 6 %, respectively. Slight and temporary deteriora- tion of QoL-scores was reported. The scores on the EROTC-QOL-H&N35 dysphagia and xerostomia at 24 months were -2 and -3, compared to baseline, respec- tively. VHI improved significantly from 34 at baseline to 21 at 24 months. Patients who continued smoking had significantly worse VHI. In conclusion, excellent outcome with good QoL and VHI were reported. Patients who continued smoking after radiotherapy had significantly poor LC and worse VHI. The current study emphasizes the importance of smoking cessation and the non-inferiority of hypofractionated schemes in terms of outcome and VHI. At our institution, phase II study is going to evaluate the role of single vocal cord irradiation with high fraction dose. Keywords Glottic cancer Á T1a Á Radiotherapy Á Voice handicap index Á Quality of life Introduction Laryngeal cancer is the most common site for head and neck cancer (HNC) with an estimated annual incidence of 700 new cases in the Netherlands. Two-thirds of laryngeal cancers arise in the glottic region and 85 % of those patients are presented at early stage (T1–T2) [1]. Between 1985 and 2011, 1,050 patients with early-stage larynx carcinoma were treated at our institution, 52 % of them had T1a disease. The most commonly used laryngeal-preser- vation options for the treatment of T1a glottic cancer are radiotherapy, CO2-laser surgery, and open partial laryn- gectomy. According to the recently published review written by the members of the International Head and Neck Group, the reported local control (LC) rate after trans-oral laser resection or open partial laryngectomy ranges from 85 to 100 %, while LC rate after radiotherapy alone ranges from 84 to 95 % [2]. The purpose of the current study is to report the long- term outcome of 549 patients with T1a glottic cancer treated by radiotherapy from 1985 onwards and the results of prospective assessment of quality of life (QoL) and Voice-Handicap Index (VHI) of all patients treated from 2006 onwards. Putative predictive factors for LC were analysed using logistic regression modelling. A. Al-Mamgani (&) Á P. H. van Rooij Á R. Mehilal Á G. M. Verduijn Á L. Tans Á S. L. S. Kwa Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands e-mail: a.al-mamgani@erasmusmc.nl 123 Eur Arch Otorhinolaryngol DOI 10.1007/s00405-013-2608-8