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Use this tool to discover new associated keyword & suggestions for the search term Aryepiglottic Fold. These are some of the images that we found for within the public domain for your "Aryepiglottic Fold" keyword. Hoarseness may be manifested as a voice that sounds breathy, strained, rough, raspy, or a voice that has higher or lower pitch. In this study we analyze locoregional control (LRC) and survival following hypofractionated radiotherapy in early stage glottic squamous cell carcinoma treated at Shaukat Khanum Memorial Cancer Hospital and Research Center. There are many causes of hoarseness, including viral laryngitis, vocal cord nodules, laryngeal papillomas, gastroesophageal reflux-related laryngitis, and environmental irritants (such as tobacco smoking). An accumulation of fluid in the vocal cords associated with hoarseness has been termed Reinke's edema. Reinke's edema may occur as a result of cigarette smoking or voice abuse (prolonged or extended talking or shouting). Patients with T1a and T1b disease had LRC rates of 95 and 88% (p = 0.32).
The LRC rates for patients with and without anterior commissure involvement at 5 years were 80 and 96% (p = 0.02) respectively. While most centers have adopted conventional 2 Gy fractionation for 6 to 7 weeks, others use hypofractionated regimens with shorter overall time.7-9 A theoretical benefit of hypofractionation is that treatment is completed before accelerated repopulation becomes a significant radiobiological factor. In addition, hypofractionated schedules with reduced number of fractions allow for a more efficient use of resources and are advantageous in countries with limited radiation facilities. The database identified 87 patients with T1 and T2 squamous cell carcinoma of the true vocal cord treated with radical hypofractionated radiation between October 2003 and June 2009.
Demographics, clinical, pathological and treatment variables were extracted from the database and electronic medical records. Each patient was seen in the joint head and neck clinic prior to treatment and primary disease was assessed by a comprehensive examination of the head and neck and fiberoptic nasoendoscopy. Tumors were staged according to the AJCC 6th edition (American Joint Commission on Cancer). The radiation field borders were superior border passing above the hyoid bone, inferior border at the bottom of the cricoid cartilage, posterior border passing through middle of vertebral bodies but keeping off-cord and falling off 1.5 cm anteriorly.


Field size ranged from 5 ? 5 cm to 6 ? 6 cm and these borders were kept constant for all patients, and treatment fields were neither reduced nor increased at any point during the treatment course.
The dose was prescribed at isocenter that just lie inside the tumor volume encompassing 95 to 105% isodose lines. Field verification films were obtained for each field at the start and during the course of treatment at weekly intervals.
LRC was our primary end point with secondary end points being overall survival (OS) and disease-specific survival (DSS).
LRC was defined as the time interval from the date of start of radiation until date of death date if patient died from laryngeal carcinoma, otherwise censored at the date of death due to noncancerous reasons or alive on last follow-up date. OS was calculated from starting date of radiotherapy till the death date for those who died or censored at the last follow-up date seen alive. Survival curves were obtained according to Kaplan-Meier method and 95% confidence intervals for survival estimates were calculated.
All patients received the planned dose of 55 Gy in 20 fractions except one patient who received 52.25 Gy in 19 fractions. Causes of death were local recurrence (n = 2), second primary cancer (n = 2) and intercurrent diseases (n = 4) (Table 2). The site of relapse was larynx in all cases and no patient failed either in the neck nodes or distant site. The remaining five patients following laryngectomy remain alive and free of disease at the time of last follow-up (Table 3). Patients with T1a and T1b disease had locoregional control rates of 95 and 88% (p = 0.32) (Fig. Of the 27 patients with anterior commissure (AC) involvement five had local relapse. In the remaining 60 patients without AC involvement, two patients had local recurrence.
The LRC rates for patients with and without AC involvement at 5 years were 80 and 96% (p = 0.02) respectively (Fig. Most of the radiation treatment delays were due to either machine breakdown or public holidays.


The locoregional control rates for patients completing radiotherapy in 28 days versus > 28 days were 90 and 92% respectively. LRC rates according to patient, tumor- and treatment-related factors are presented in Table 4.
Eighty-two percent of the patients were satisfied with their voice after treatment.
5: Locoregional control in patients with and without anterior commissure (AC) involvement The remaining 18% did not appreciate any improvement in the quality of speech after radiotherapy. The prognosis of females in head and neck cancer is believed to be similar or better than males and the reasons for this observation are unexplained. Smokers particularly those who continue to smoke after treatment are considered to have a worse LRC.10 However, no such difference was observed in our patients. According to the AJCC staging system T1 glottis carcinoma is divided into two subgroups, T1a tumor involving one vocal cord (may involve anterior or posterior commissure) and T1b tumor involving both the vocal cords. With tumors confined to the vocal cord the incidence of nodal metastasis ranges from 0 to 2%.
In more advanced lesions T2 and T3 the incidence increases from 10 to 15% respectively.11 Local control rates for T1 glottis cancer treated with radiation vary between 80 and 95% and with surgical salvage ultimate local control rates are between 90 to 100%.
In general T2 lesions have poor cure rates then T1 lesions. The local control rate for T2 squamous cell carcinoma of the glottis with conventional radiotherapy is approximately 71 to 85% and salvage rate for local radiation failure is 88 to 95%.7 Our series had only four patients with T2 tumors and this small number reflects the institutional practice of treating these patients with conventional fractionation encompassing the primary site and upper neck with radiation treatment portals.
Among the four patients with T2 tumors, two had local failure at 9 and 14 months following treatment that were salvaged with laryngectomy.
An audit by Royal College of Radiologists of radical radiotherapy for head and neck cancer showed 81% of treatment interruptions were due to machine breakdown or servicing.20 Fraction size may influence local control rates.
Dosimetry studies to calculate the degree of under dosage have yielded conflicting results.



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