\s=b\Radiation therapy is a well-established treatment for early squamous cell carcinoma of the glottic larynx. However, the management of patients suspected to have persistent or recurrent disease may present both diagnostic and therapeutic dilemmas, particularly when laryngeal edema persists months after conclusion of radiation therapy. We reviewed the outcome of 212 patients with T1s, T1, and T2NOMO carcinoma of the glottic larynx who had been treated for cure with radiation therapy, with surgical salvage reserved for radiation failures. Twenty\x=req-\ four patients (11%) had recurrences after radiation therapy, 13 (59%) of whom had successful salvage by surgery. The fi ve\x=req-\year, recurrence-free survival in this series was 92% for T1s and T1 and 69% for T2. We conclude that T1s, T1, T2NOMO carcinoma of the glottic larynx is effectively managed by radiation therapy and surgical salvage for radiation failure. Total laryngectomy usually was necessary for surgical salvage. (Arch Otolaryngol Head Neck Surg 1986;112:519-521) Primary treatment with full-course radiation therapy (6,250 to 6,700 rad) is well established for early squa¬ mous cell carcinoma of the glottic larynx. This report describes the results of surgical salvage for radia¬ tion therapy failures of Tls, Tl, or T2 squamous cell carcinoma of the glottic larynx at Rush-Presbyterian-St Luke's Medical Center, Chicago. In a previous study from this institution, cumulative five-year recurrence-free rates for patients with Tls and T2N0M0 glottic carcinoma were 88% and 75%, respectively. The patients in this study, treated since 1970, were shown to have five-year disease-free survivals of 94%, 92%, and 69%, respectively, for the Tls, Tl, and T2
The use of definitive irradiation in T1‐T4N0 larynx cancer was reviewed in 236 patients at Rush‐Presbysterian‐St. Luke's Medical Center in Chicago. Recurrence‐free survival for all stages was 86% at five years. Ultimate recurrence‐free survival, including successful surgical salvage, was 91% at five years. The data described herein and the literature reviewed support the recommendation for definitive radiation therapy for T1 and T2N0 larynx cancer of any site. T3 lesions may also be reasonably treated with radiation therapy initially, reserving surgery for salvage. However, more data are needed to accurately identify the T3 larynx cancer patients most suited for radiation therapy.
Radiation injury develops in a small proportion of patients after therapeutic radiation. The key factors that influence the likelihood and character of these radiation sequelae are discussed in this article. Proper consideration of these points will lead to more accurate diagnosis and, hence, more effective patient management.
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