Volumetric Adaptive SBRT Versus Conventional Accelerated Radiation Therapy for Early-Stage Glottic Cancer

This non-inferiority trial will compare conventional long-course accelerated fractionation radiation therapy (AF-RT) with volumetric adaptive stereotactic body radiation therapy (SBRT) in patients with early-stage (cT1-2N0M0) glottic squamous cell carcinoma. Participants will be randomized in a 1:2 ratio to receive either AF-RT (Arm A) or adaptive SBRT (Arm B). The primary objective is to determine whether adaptive SBRT provides non-inferior local control compared with AF-RT in patients with early-stage glottic squamous cell carcinoma. Secondary analyses will evaluate treatment-related toxicity and other clinical outcomes. The study hypothesizes that adaptive SBRT will achieve local control rates that are non-inferior to those of AF-RT while offering a substantially shorter treatment course. Imaging biomarkers, transcriptome/methylome profiles, plasma biomarkers, and cfDNA will be analyzed to identify novel biomarkers that predict oncologic outcomes and treatment-related toxicity.