The significance of extension and impaired mobility in cancer of the vocal cord

Bogaert, Walter Van den; Ostyn, Frans; Schueren, Emmanuel van der

doi:10.1016/0360-3016(83)90096-2

Cited by 42 publications

(14 citation statements)

References 9 publications

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“…Fixed vocal cord lesions are indicative of deep muscle or cartilage infiltration, and thus, under the American Joint Committee on Cancer (AJCC) classification, they are given at least a T3 designation 4. Return of vocal cord function after nonsurgical therapy, however, may predict a better outcome 5–7…”

Section: Introductionmentioning

confidence: 99%

Does vocal cord fixation preclude nonsurgical management of laryngeal cancer?

Solares

Wood

Rodriguez³

et al. 2009

The Laryngoscope

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Section: Introductionmentioning

confidence: 99%

Does vocal cord fixation preclude nonsurgical management of laryngeal cancer?

Solares

Wood

Rodriguez³

et al. 2009

The Laryngoscope

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“…They concluded that the adverse prognostic influence of impaired mobility is eliminated by the treatment policy of surgery for those patients with poor regressions after radiotherapy. 5 In another study, Spaulding et al studied 98 patients with pretreatment vocal cord fixation. They evaluated the predictive value of cord mobility status after 50 Gy.…”

Section: Introduction Introduction Results Resultsmentioning

confidence: 98%

“…4 Return of vocal cord function after non-surgical therapy, however, may predict a better outcome. [5][6][7] At our institution concurrent chemoradiotherapy has been used as a definitive treatment option for SCC of the larynx. Our purpose was to cull our experience with T3/T4 laryngeal SCC and pre-treatment vocal cord fixation to evaluate non-surgical management outcomes and further to assess the implications of persistent post-treatment vocal cord immobility.…”

mentioning

confidence: 99%

Does Vocal Cord Fixation Preclude Nonsurgical Management of Laryngeal Cancer?

Solares¹,

Wood²,

Rodriguez³

et al. 2009

The Laryngoscope

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The presence of pre-treatment vocal cord fixation has been reported as a predictor of a poor functional outcome following chemoradiotherapy, 1 with treatment failure more often requiring salvage laryngectomy.2 Impaired vocal cord motion has been associated with worse local control and survival after non-surgical therapy. 3Fixed vocal cord lesions are indicative of deep muscle or cartilage infiltration and thus, under the AJCC classification, they are given at least a T3 designation (i.e. at least stage III disease). 4 Return of vocal cord function after non-surgical therapy, however, may predict a better outcome. [5][6][7] At our institution concurrent chemoradiotherapy has been used as a definitive treatment option for SCC of the larynx. Our purpose was to cull our experience with T3/T4 laryngeal SCC and pre-treatment vocal cord fixation to evaluate non-surgical management outcomes and further to assess the implications of persistent post-treatment vocal cord immobility.Twenty three patients with squamous cell cancer of the larynx treated with concurrent chemoradiotherapy with pre-treatment vocal cord fixation were identified: 19 males and 4 females. The median age was 59 (range 39-73) years. The primary site was located in the supraglottic larynx in 11 (47.8%) and glottic larynx in 12 (52.2%). Eight (34.8%) patients were treated with once daily radiation, the remaining 15(65.2%) were treated twice daily. All but 1 patient were able to complete both courses of concurrent chemotherapy with their radiation. Using the 2002 AJCC staging system, 14 patients (60.9%) had T3 tumors and 9 (39.1%) had T4 tumors. None of these variables differed statistically between the two groups of patients.With a median follow-up of 68 (range 34-191) months, the projected five-year overall survival was 100% among patients who recovered function vs. 25% among those who did not (p < 0.001) [ Figure 1]. Five-year freedom from recurrence was 86.7% among patients who recovered function vs. 25% among those who did not (p < 0.001) [ Figure 2]Five-year local control without surgery was 86.7% among patients who recovered function vs. 30% among those who did not (p = 0.003) [ Figure 3]. A laryngectomy was required and was successful in 2 of the 15 (13.3%) patients from the group that recovered function. Four of the eight patients (50%) who did not recover function underwent a total laryngectomy. Of these, two patients had persistent disease at the primary site and total laryngectomy achieved local control, and two patients had primary site recurrence that could not be controlled with surgery. Two additional patients in the group not recovering function were not candidates for surgical salvage, one never achieved local control while the other had an extensive local recurrence. Recurrences were diagnosed within 2 years of treatment. Ultimately, of the 8 patients who did not recover function, four patients died of local disease, 2 patients died of distant disease, and 2 patients were cured.Persistent tracheotomy, feeding tube dependence or laryngec...

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“…Tumour-related factors with prognostic value usually reflect different aspects of tumour extension on and beyond the true vocal cord (10-12, 16, 17, 19, 20). Impaired cord mobility has been described as a significant risk factor in several reports (10,15,17,19,23), and a subdivision of T2 tumours into a T2b group with impaired mobility has been proposed (2). Other tumour-related factors discussed are tumour size (21), involvement of the anterior commissure (7,8,15,20), and histologic grade (6,10,16,21).…”

Section: Discussionmentioning

confidence: 99%

“…These were T-stage, number of involved sites, cord mobility and subglottic extension. Subglottic extension has been recognized by others as a possible risk factor of unclear significance (7,10,19,20). …”

Section: Discussionmentioning

confidence: 99%