***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Treatment results in 223 patients with T1 and T2 glottic carcinoma were analysed . A multivariate analysis was performed to evaluate the prognostic significance of factors related to tumour , patient and treatment . Locoregional control after radiotherapy was 90 % for 129 patients with T1 tumours and 73 % for 94 with T2 tumours . Disease-specific survival was 96 % and 81 % for patients with T1 and T2 tumours , respectively . In the multivariate analysis of locoregional control , subglottic extension contributed prognostic information to T-stage . In the univariate analysis , number of involved tumour sites , cord mobility and treatment interruption had a significant influence , which was lost in the multivariate analysis . Age gave additional prognostic information in the multivariate analysis of disease-specific survival . Significant adverse effects of radiotherapy were found in 9 patients ( 4 % ) . Forty-nine patients ( 22 % ) had a second malignancy , 11 ( 5 % ) diagnosed before the glottic carcinoma SUMMARY Herein we assessed the impact of direct autofluorescence during intraoperative work-up on obtaining superficial free resection margins , identifying new areas of malignant transformation and altering disease-free survival and local control at 3 years in patients su bmi tted to transoral laser surgery ( TLS ) for early glottic cancer . Prospect i ve cohort evaluation was carried out on the diagnostic accuracy of the superficial extent and TNM staging in 73 patients with glottic carcinoma undergoing transoral CO2 laser surgery .  The use of direct autofluorescence was associated with superficial disease-free margins in 97.2 % of cases , and with superficial close margins in 2.8 % . The improvement in diagnostic accuracy was 16.4 % ; in 8.2 % of cases , there was upstaging of the TNM classification ( in one case , a second neoplastic area in a different laryngeal site was observed and considered to be a second endolaryngeal primary ) . The sensitivity of direct autofluorescence was 96.5 % with a specificity of 98.5 % . Overall , 3-year disease-specific survival and local control with laser alone were , respectively : T1a ( 97.5 % , 100 % ) , T1b ( 86.7 % , 86.7 % ) , T2 ( 88.9 % , 88.9 % ) . This study demonstrates that direct autofluorescence can help to identify positive superficial margins , and has a favourable impact on diseasespecific survival and local control at 3 years This study was carried out to evaluate the influence of fraction size 2.25 Gy on local control of T1 and T2 laryngeal and hypopharyngeal cancers . Between August 2002 and December 2010 , 80 patients with T1 and T2 laryngeal or hypopharyngeal cancers were treated with  definitive radiotherapy with a fraction size of 2.25 Gy . Primary sites were the larynx in 69 and the hypopharynx in 11 . Fifty-three patients were T1 and 27 were T2 . All patients ' pathology was squamous cell carcinoma except one carcinosarcoma .  Radiotherapy was delivered 5 days/week with a 4-MV photon beam up to a total dose of 63.0 Gy . Median treatment time was 41 days . Statistical analysis of survival was calculated using the Kaplan – Meier method . No acute toxicity greater than grade 2 ( CTCAE ver . 3.0 . ) including mucositis and dermatitis was observed . All but one patient had a complete response . The partial response patient received salvage surgery . The median follow-up period was 47 months ( ranging from 4 to 108 months ) . No late toxicity greater than 1 was observed . Nine patients developed recurrence , seven local and two neck lymph nodes . Three patients died , one from laryngeal cancer and two from intercurrent diseases . The 5-year local control rates ( LCRs ) in the entire group , larynx T1 , larynx T2 and hypopharynx T1 were 85.8 % , 97.6 % , 70.1 % and 85.7 % , respectively . The LCRs of T1 improved compared with our historical control , but not those of T2 . The 2.25-Gy fraction size is safe and may have the potential to achieve good LCR in T1 lesions OBJECTIVE Between 2002 and 2008 , over 100 patients with glottic carcinoma have undergone transoral laser microsurgical ( TLM ) resection at the QEII Health Sciences Centre in Halifax , Nova Scotia . The objective of this study was to assess the oncologic outcomes for all cases staged as T2 in this cohort . METHODS A prospect i ve data base was developed to monitor outcomes . All 36 cases of primary T2 glottic carcinoma were selected from the data base for analysis . Kaplan-Meier survival analyses evaluated the following end points at 36 months : overall survival , disease-specific survival , and local control and disease-free survival with one procedure . RESULTS The Kaplan-Meier estimates of 36-month outcomes were 89 % ( SE 6.0 % ) overall survival and disease-specific survival , 81 % ( SE 7.1 % ) local control with one procedure , and 70 % ( SE 8.0 % ) disease-free survival with one procedure . CONCLUSIONS The observed 36-month outcomes support the use of TLM as the primary treatment modality for T2 glottic cancers Abstract This prospect i ve study evaluates the oncological results of transoral laser surgery ( TLS ) for glottic carcinoma categorized Tis , T1 and T2 in a large , unselected group of 285 consecutive patients from a university-based referral center that uses transoral laser surgery as the st and ard approach to these tumors . Patients were treated between 1 January 1987 and 31 December 1996 . Thirty-three patients had Tis disease , 174 T1 tumors and 113 T2 . Main outcome measures were local control with initial therapy , ultimate local control , regional control , organ preservation , overall survival and cause-specific survival . The 5-year uncorrected actuarial survival for all 285 patients was 71.1 % , and cause-specific actuarial survival was 98.7 % . Local control with initial treatment was 85.9 % , ultimate local control with salvage for local treatment failures 98.5 % , and regional control 98.4 % . In all , 94.3 % had their larynges preserved after 5 years . Although favorable oncological results for early laryngeal carcinoma treated with laser surgery are supported this study , no definitive recommendations can be given for the best single treatment . Partial laryngectomies lead to the highest local control rates reported so far , radiotherapy is believed to preserve voice best and laser surgery is associated with time- and cost-effectiveness , low morbidity , fair local control rates and excellent re-treatment options in case of local failure . All specialists dealing with the treatment of early glottic carcinoma should be able to offer these different treatment modalities to their patients and to deal specifically with each patient ’s individual needs and preferences We aim ed to investigate the factors contributing to poor recruitment to the EaStER trial “ Early Stage glottic cancer :  Endoscopic excision or Radiotherapy ” feasibility study . We performed a prospect i ve qualitative assessment of the EaStER trial at three centres to investigate barriers to recruitment and implement changes . Methods used included semi-structured interviews , focus groups and audio-recordings of recruitment encounters . First , surgeons and recruiters did not all accept the primary outcome as the rationale for the trial . Surgeons did not always adhere to the trial eligibility criteria leading to variations between centres in the numbers of “ eligible ” patients . Second , as both treatments were considered equally successful , recruiters and patients focused on the pragmatics of the different trial arms , favouring surgery over radiotherapy . The lack of equipoise was reflected in the way recruiters presented trial information . Third , patient views , beliefs and preferences were not fully elicited or addressed by recruiters . Fourth , in some centres , logistical issues made trial participation difficult . This qualitative research identified several major issues that explained recruitment difficulties . While there was insufficient time to address these in the EaStER trial , several factors would need to be addressed to launch further RCTs in head and neck cancer . These include the need for clear ongoing agreement among recruiting clinicians regarding details in the study protocol ; an underst and ing of the logistical issues hindering recruitment at individual centres ; and training recruiters to enable them to explain the need for r and omisation and the rationale for the RCT to patients OBJECTIVES : To report the oncology and functional outcomes of transoral laser microsurgery ( TLM ) for untreated glottic carcinoma . STUDY DESIGN : A 2 center prospect i ve case series analysis . SETTING : Academic , tertiary referral centers . RESULTS : Seventy-six patients underwent TLM .  Pathologic T stages were : T1 , 45 ( 59 % ) ; T2 , 21 ( 28 % ) ; T3 , 5 ( 7 % ) ; and T4 , 5 ( 7 % ) . Five ( 7 % ) patients had neck dissections . Five ( 7 % ) patients received adjuvant radiotherapy . Mean follow-up was 42 months . Respective T1 and T2 5-year Kaplan-Meier estimates were : local control , 90 % and 93 % ; loco-regional control , 90 % and 93 % ; disease specific survival , 90 % and 93 % ; and overall survival , 94 % and 93 % . The average hospital stay was 2 days . Two ( 3 % ) patients experienced major complications . The overall laryngeal preservation rate was 95 % ( 72 of 76 ) . CONCLUSIONS : TLM is a safe and effective treatment in select carcinoma of the glottic larynx . Low morbidity and mortality and short periods of hospitalization make TLM an attractive therapeutic option . SIGNIFICANCE : TLM is an emerging strategy in the treatment of laryngeal cancer PURPOSE Radiotherapy ( RT ) is often the therapy of choice for patients with Stage T2 glottic carcinoma . This retrospective study up date d the results of RT for patients treated at our center . The primary focus of this study was whether a policy of using hyperfractionated RT for these patients result ed in a therapeutic gain . METHODS AND MATERIAL S A search of the data base of patients treated in the Department of Radiation Oncology at The University of Texas M. D. And erson Cancer Center was performed to identify patients with Stage T2 glottic carcinoma treated with RT alone between 1970 and 1998 . A total of 230 patients formed the study cohort . RESULTS The median follow-up for all patients was 82 months . Of the 230 patients , 180 were treated with parallel-opposed fields , and the median field size was 30 cm(2 ) . Eighty-one patients ( 36 % ) were treated with twice-daily fractionation to 74 - 80 Gy . Eighty-nine patients ( 38 % ) were treated with 32 - 75 Gy at 2-Gy per fraction once daily , and 57 patients ( 25 % ) were treated with 2.06 - 2.26 Gy , once daily , to 66 - 70 Gy . The 2- and 5-year actuarial local control rate was 75 % and 72 % , respectively . After salvage therapy , the ultimate 5-year local control and disease-specific survival rate was 91 % and 92 % , respectively . The presence of subglottic extension and treatment with a daily dose of < or = 2 Gy were associated with poorer local control ( p < 0.01 ) on both univariate and multivariate analyses . The 5-year local control rate for patients treated with twice-daily and once-daily RT was 79 % and 67 % , respectively ( p = 0.06 ) . CONCLUSION The 5-year local control rates with hyperfractionated RT for Stage T2 glottic carcinoma approach 80 % . Patients treated with twice-daily fractionation to a median dose of 77 Gy had an improvement in local control compared with patients treated with 70 Gy in 35 fractions . The Radiation Therapy Oncology Group is testing these two fractionation schedules in a r and omized study . High control rates were also seen in selected patients treated with hypofractionated schedules , leaving the question of the optimal schedule for patients with Stage T2 disease unanswered BACKGROUND Although intensity-modulated radiotherapy ( IMRT ) is a st and ard of care for many head and neck cancers , its use for carotid-sparing ( CS ) therapy in early-stage laryngeal carcinoma is controversial . METHODS 330 consecutive patients with early-stage laryngeal carcinoma were treated from 1/1989 to 5/2011 , including 282 conventional radiotherapy ( CRT ) and 48 CS-IMRT patients . The median follow-up was 43 ( CS-IMRT ) and 66 ( CRT ) months . RESULTS There was no difference in local failure rates comparing patients undergoing CS-IMRT with CRT , with 3-year local control rates of 88 % vs. 89 % , respectively ( p=0.938 ) . Using a 1 cm circumferential margin , the average dose to the left and right carotid arteries was 48.3 and 47.9 Gy , respectively 
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CONCLUSIONS The results of this review indicate no difference in 5-year local control between radiotherapy and transoral surgery for T2 glottic SCC .
The data demonstrated higher rates of local failure for T2b compared with T2a cases , although outcomes were similar between laser excision and radiotherapy for each substage .