Single vocal cord irradiation:a competitive treatment strategy in early glottic cancer

INTRODUCTION: The treatment of choice for early glottic cancer is still being debated; ultimately it relies on the functional outcome. This paper reports on a novel sparing 4D conformal technique for single vocal cord irradiation (SVCI).

MATERIAL AND METHODS: The records of 164 T1a patients with SCC of the vocal cord, irradiated in the Erasmus MC between 2000 and 2008, were analyzed for local control and overall survival. The quality of life was determined by EORTC H&N35 questionnaires. Also the VHI (voice handicap index), and the TSH (thyroid stimulating hormone) blood levels, were established. On-line image guided SVCI, using cone beam CT or stereotactic radiation therapy (SRT) techniques, were developed.

RESULTS: A LC rate at five-years of 93% and a VHI of 12.7 (0-63) was determined. It appeared feasible to irradiate one vocal cord within 1-2mm accuracy. This way sparing of the contralateral (CL) vocal cord and CL normal tissues, could be achieved.

CONCLUSIONS: Given the accuracy (1-2mm) and small volume disease (CTV limited to one vocal cord), for the use of stereotactic RT techniques SVCI with large fraction sizes is currently being investigated in clinic. It is argued that hypofractionated SVCI can be a competitive alternative to laser surgery.

Non-competitive phenotypic differences can have a strong effect on ideal free distributions

1. We present a model of the ideal free distribution (IFD) where differences between phenotypes other than those involved in direct competition for resources are considered. We show that these post-acquisitional differences can have a dramatic impact on the predicted distributions of individuals.

2. Specifically, we predict that, when the relative abilities of phenotypes are independent of location, there will be a continuum of mixed evolutionarily stable strategy (ESS) distributions (where all phenotypes are present in all patches).

3, When the relative strengths of the post-acquisitional trait in the two phenotypes differ between patches, however, we predict only a single ESS at equilibrium. Further, this distribution may be fully or partially segregated (with the distribution of at least one phenotype being spatially restricted) but it will never be mixed.

4, Our results for post-acquisitional traits mirror those of Parker (1982) for direct competitive traits. This comparison illustrates that it does not matter whether individual differences are expressed before or after competition for resources, they will still exert considerable influence on the distribution of the individuals concerned.