Glottic Cancer: Surgical Salvage for Radiation Failure

Abstract

\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

Supracricoid Partial Laryngectomy After Failed Laryngeal Radiation Therapy

“…Kirchner 29 emphasized that if initial curative laryngeal RT for squamous cell carcinoma was unsuccessful, islands of tumor remained throughout the field, resulting in a wide area of recurrence. Various authors have also reported that vertical partial laryngectomy after RT failure for glottic carcinoma should not be attempted if 1. the true vocal cord was immobile, 2. the arytenoid cartilage or its mucosa were directly involved by tumor, 3. the tumor involved more than one third of the opposite true vocal cord, 4. there was either evidence of perichondritis or thyroid cartilage invasion, and 5. transglottic spread of disease was noted 1‐15 …”

“…The exact site involved by recurrent tumor is presented in Table I. According to the reported selection criteria, 1‐15 contraindications for salvage vertical partial laryngectomy (VPL) in the patients with glottic tumor included fixation of the true vocal cord (3 patients), transglottic extent of disease (1 patient), anterior infraglottic extent of disease (4 patients), invasion of more than one third of the contralateral true vocal cord (2 patients), invasion of the anterior aspect of the ipsilateral arytenoid cartilage (3 patients), and recurrent tumor exceeding its original limits (9 patients). Similarly, 13 horizontal partial laryngectomy was not indicated due to anterior commissure invasion, posterior vestibule invasion, and recurrent tumor exceeding its original limits in all 3 patients with supraglottic tumor.…”

“…Successful management of laryngeal recurrence after failed radiation therapy(RT) with vertical or horizontal partial laryngectomy requires strict selection criteria resulting in highly selected patients 1‐15 . Viani et al 16 also reported that many patients with laryngeal recurrence after failed RT had an advanced tumor by the time of the diagnosis, with almost half being transglottic T3 or T4 tumors.…”

“…Viani et al 16 also reported that many patients with laryngeal recurrence after failed RT had an advanced tumor by the time of the diagnosis, with almost half being transglottic T3 or T4 tumors. Therefore total laryngectomy remains the most frequently performed salvage procedure for RT failure 10,11,16‐18 …”

Partial laryngectomy for recurrent laryngeal carcinoma

“…In these patients the option of partial laryngectomy is generally overlooked and total laryngectomy is undertaken in as many as 70–80% patients. 10,11 In many of these patients, a functional, technically salvageable larynx is sacrificed with the aim of achieving disease‐free status. Several reports have demonstrated that salvage partial laryngectomy is oncologically effective and preserves acceptable laryngeal function in a reasonable proportion of patients.…”