In situ carcinoma of the vocal cords

Abstract

Eighty-one patients with preinvasive carcinoma of the vocal cord, seen over a thirteen year period, were reviewed histologically and analyzed for response to treatment. Sixty-seven cases were clinically T1 and fourteen cases T2 (by virtue of extension of disease beyond the vocal cord). All patients had mobile cords. Histological criteria for in situ carcinoma and the spectrum of microscopic patterns are presented. Sixty-nine patients were treated by external beam radiotherapy--the remainder by a variety of surgical procedures. Five and ten year actuarial, recurrence-free rates 83% and 75%, respectively for the group treated by irradiation. No difference in local control was observed when analyzed for: 1) dose response, 2) initial extent of disease, 3) treatment plan, or 4) histologic diagnosis. Analysis of failures reveals that 15/17 patients with local failure were salvaged, eleven of these patients requiring laryngectomy. Time to appearance of recurrence ranged from seven to one hundred and seven months.

Carcinoma in situ of the larynx

“…In most reported series of carcinoma in situ there was a predominant male influence, with a male-to-female ratio of 8: l. 16,17 However, the sex ratio in our series was 3 : 1 in favor of males for carcinoma in situ compared to a ratio of 7.6: 1 for invasive glottic squamous cell carcinoma. We do not know the retison for this.…”

Laryngeal Dysplasia: Epidemiology and Treatment Outcome

“…In this light, it is difficult to explain why patients with severe dysplasia developed invasive carcinoma more frequently than those with carcinoma in situ. Making similar observations, Hellquist et a1 3 found that invasive carcinoma developed more frequently in patients showing a welldifferentiated form of severe dysplasia than those showing poorly differentiated severe dysplasia or classic carcinoma in situ, and Elman et al 16 found that invasive carcinoma developed more frequently in patients undergoing radiotherapy for severe dysplasia than in those undergoing it for classic carcinoma in situ. In the current series, this difference in clinical behavior may be explained in part by the fact that patients in the carcinoma in situ group were treated more aggressively (with partial laryngectomy, total laryngectomy, or radiotherapy) prior to developing invasive carcinoma than were those patients in the severe dysplasia group.…”

A 'Watchful Waiting' Policy for In Situ Carcinoma of the Vocal Cords

“…Much of the disparity in results probably stems from VC carci¬ noma in situ encompassing a hetero¬ geneous group of lesions. The hetero¬ geneity includes the following: (1) misdiagnosed, truly invasive neo¬ plasms, (2) lesions so small that they are cured by the biopsy or stripping performed before irradiation, (3) le¬ sions so indolent that they are des¬ tined never to become highly prolifer¬ ative or invasive regardless of treat¬ ment rendered, (4) lesions that are biologically aggressive, (5) "field" lesions in which recurrence may, in fact, be a new neoplasm, and (6) lesions existing in different types of hosts (smokers vs ex-smokers), which may have a bearing on the clinical course. The majority of articles sug¬ gest that irradiation can cure VC car¬ cinoma in situ.…”