Type I to type IV cordectomy, when indicated, can achieve radical treatment of most T1 glottic cancer. Type V cordectomy requires that any suspicion of cartilage invasion, even microscopic, be excluded.

For better understanding of the causation and behavior of T1-T2 commissural glottic laryngeal tumors, we retrospectively analyzed risk factors and outcome related to T class and type of therapy for tumors involving the anterior (184 cases) or the posterior (60 cases) commissure. The patients' smoking habits and alcohol consumption were similar, regardless of involved subsite. The disease-free interval was longer after surgery than after radiotherapy. The survival rates after recovery upon relapse were similar among subsites, T classes, and types of therapy. In anterior commissure tumors, the larynx remained preserved more frequently after partial laryngeal resection than after radiotherapy, and was more frequently preserved the lower the T class. In posterior commissure tumors, larynx preservation was less frequent and apparently independent of type of therapy or T class. In conclusion, smoking and alcohol consumption play similar pathogenetic roles in either subsite; partial laryngeal resection gave a higher rate of laryngeal preservation than did radiotherapy; and anatomic peculiarities of the subsites influence tumor behavior.

On the basis of embryology and clinical experience, we have defined here an anterior commissure (AC) subsite of the human larynx and have addressed the issue as to whether the degree of involvement of this subsite is related to the outcome of glottic cancer, in terms of local control within 5 years of therapy. Retrospective analysis of 534 patients included 1) classification of patients according to the TNM, 2) actuarial evaluation of the outcome, 3) reclassification of patients according to the involvement of the AC subsite, and 4) reevaluation of the outcome according to this latter classification. The results showed that the outcome was not well correlated with TNM classification, whereas patients with progressively heavier involvement of the AC subsite had a progressively worse outcome. On the basis of these data, we suggest that TNM classification of cancer involving the AC be implemented by and AC classification, in order to better forecast the prognosis and design specific conservative surgery.

A retrospective review of 182 patients with glottic cancer involving the anterior commissure (AC) is presented. Of these, 123 patients were first treated with conservative surgery and 59 underwent radiotherapy. Patients were staged according to the AJCC system and by the modality of neoplastic involvement of AC (pure AC cancer, glottic cancer involving AC up to the midline, and beyond the midline). Our results indicate a higher rate of local control and of specific-disease survival in the group of patients first treated with surgery than those treated with radiotherapy (86% vs 74% and 97.5% vs 84%, respectively) (p less than 0.05). For pure AC cancers, our results show better local control with primary radiotherapy than with conservation surgery (82% vs 76.5%), but surgical failures have been more successfully salvaged than have radiotherapy recurrences (ultimate local control, 97.5% vs 82%, respectively). These data suggest that the treatment of choice for AC cancers is conservation surgery, particularly frontolateral laryngectomy.

No abstract