Results of Surgical Salvage After Failure of Definitive Radiation Therapy for Early-Stage Squamous Cell Carcinoma of the Glottic Larynx

Ganly, Ian; Patel, Snehal G.; Matsuo, Jeannette Marie S.; Singh, Bhuvanesh; Kraus, Dennis H.; Boyle, Jay O.; Wong, Richard J.; Shaha, Ashok R.; Lee, Nancy; Shah, Jatin P.

doi:10.1001/archotol.132.1.59

Cited by 137 publications

(71 citation statements)

References 20 publications

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“…In our series we recorded an overall rate of postoperative complications of 40 % and an incidence of postoperative mortality of 2.7 %, while a similar report in literature reveals a postoperative complication rate of 20 % and no postoperative mortality [5]. SPL showed a lower rate of postoperative complications than STL (15 vs 45 %, p = 0.005).…”

Section: Complications and Functional Resultssupporting

confidence: 73%

“…When we compare DFS and OS of patients who underwent STL and those who underwent total laryngectomy as primary surgery, DFS and OS of first group are 71 and 47.5 % in contrast with 0 and 62 % for the second group [5]. A worse prognosis is also reported for SPL as a salvage procedure rather than primary surgery, with a DFS of 100 % and OS of 94 % for the first-treatment group and both 83 and 100 %, respectively, for the salvage group.…”

Section: Survivalmentioning

confidence: 96%

“…According to Ganly [5] the decision must be based on a correct r-staging [24] to evidence extension of recurrence in higher risk areas such as supraglottic or hypoglottic larynx, or in case of extralaryngeal tissues' involvement (which corresponds to rT3 and rT4), parameters which are predictive factors of N? risk.…”

Section: Survivalmentioning

confidence: 99%

“…According to the new TNM classification for head and neck cancer updated in 2010 by the American Joint Committee for Cancer (AJCC) and the Union Internationale Contre le Cancer (UICC), this category includes neoplasms classified as T1aN0M0, T1bN0M0 (stage I), and T2N0M0 (stage II) [2][3][4]. As promoted by guidelines and medical evidence [5,6], early glottic cancer can be treated either with curative radiotherapy (RT) or with surgery, guaranteeing a comparable overall survival. RT is often preferred as primary treatment because it grants a better anatomical preservation and, thus, functional integrity of the larynx [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…Since second mid-nineties, several authors [5,10,11] have proposed in selected cases salvage partial laryngectomies (SPLs), that include supracricoid partial laryngectomy (SCPL, such as cricohyoidopexy, cricohyoidoepiglottopexy, tracheohyoidopexy, tracheohyoidoepiglottopexy) and endoscopic CO2 laser cordectomy, as an alternative to STL in the treatment of laryngeal recurrence after RT, allowing to preserve laryngeal functions [10]. Even if the common indications for salvage laryngeal surgery after radiotherapy treatment are the same of those recommended for primary laryngeal cancer treatment, the correct staging of the recurrent tumour is the real challenge to select the most suitable surgical indication.…”

Section: Introductionmentioning

confidence: 99%

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Surgical options in radiotherapy-failed early glottic cancer

Santoro

Meccariello

Mannelli

et al. 2013

Eur Arch Otorhinolaryngol

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After failure of curative radiotherapy (RT), surgery is the main therapeutic option to control recurrent laryngeal cancer. Recurrences after RT for T1-T2 tumours of the glottic larynx are often diagnosed at a more severe stage than the original disease and, thus, usually treated by radical approaches. Our aim is to investigate the feasibility of more conservative strategies for proper treatment of post-RT recurred glottic cancer. We collected and reviewed our files from 1990 to 2006, selecting 75 patients which matched the following inclusion criteria: (1) patient was originally diagnosed with early stage squamous cell carcinoma of the glottic larynx (stage I-II according to 2010 TNM), (2) patient was treated by RT with curative intent, (3) patient presented a recurrence of disease after RT which was surgically treated at our Institution. T stage at first diagnosis was T1a in 41 cases (55 %), T1b in 12 (16 %) and T2 in 22 (29 %). At clinical examination of RT-recurred lesions, we documented advanced lesions (rT3-rT4) in 29 out of 75 patients (39 %). Overall, an upstage was reported for 56 % RT-recurred cancers, while 37.3 % remained at the same stage than the original tumour and 6.7 % were downstaged. Twelve patients (16 %) underwent salvage partial laryngectomy (SPL), while 63 (84 %) received a salvage total laryngectomy (STL). Multivariate analysis showed that rTNM according to the AJCC-UICC of 2010 was the only prognostic factor for both disease-free survival (p = 0.042) and overall survival (p = 0.004). Considering the prognostic impact of rT and rN we documented a statistical significance only in terms of overall survival for both factors (p = 0.004 and p = 0.04, respectively). Although STL remains the most frequent treatment choice for failures after RT in laryngeal carcinomas, SPL represents a valid option for selected patients with limited recurrence and can deliver good oncologic and functional results if performed according to careful indications.

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Section: Complications and Functional Resultssupporting

confidence: 73%

Section: Survivalmentioning

confidence: 96%

Section: Survivalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Surgical options in radiotherapy-failed early glottic cancer

Santoro

Meccariello

Mannelli

et al. 2013

Eur Arch Otorhinolaryngol

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Endoscopic Carbon Dioxide Laser Surgery for Glottic Cancer Recurrence After Radiotherapy

Ansarin

Planicka

Rotundo

et al. 2007

Arch Otolaryngol Head Neck Surg

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Patients:The study, which was conducted between May 1999 and September 2005, included 37 consecutive patients (33 men and 4 women) with recurrent glottic cancer after radiotherapy. Selection criteria were as follows: rcTis, rcT1, or rcT2 with subglottic or supraglottic involvement of less than 5 mm and no arytenoid invasion; adequate laryngeal exposure; no previous open surgery; no contraindications to general anesthesia; and signed consent.Interventions: Endoscopic laser surgery with curative intent using types III to V cordectomies according to the European Laryngological Association.Main Outcome Measures: Five-year actuarial recurrence-free and overall survival, complications, and rate of laryngeal preservation. Results:The clinical classifications of the recurrences were rcTis (n=4), rcT1a (n=10), rcT1b (n=11), and rcT2 (n = 12). The pathologic classifications of the recurrences were rpT0 (n=2), rpTis (n=5), rpT1a (n=9), rpT1b (n=3), rpT2 (n=14), and rpT3 (n=4). The median follow-up was 44 months (range, 18-88 months). New recurrences developed in 13 patients (35%): 11 were treated by total laryngectomy, 1 by supracricoid laryngectomy, and 1 by chemotherapy. Three patients died of laryngeal cancer, 1 is alive with disease, and 1 died of a second cancer. Five-year actuarial recurrence-free and overall survival rates were 58% and 86%, respectively. The larynx was preserved in 26 patients (70%). Laryngeal stenosis was the most common major complication (in 3 of 4 women and 1 of 33 men).

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