Does Vocal Cord Fixation Preclude Nonsurgical Management of Laryngeal Cancer?

Abstract

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...

Long‐term functional and survival outcomes after induction chemotherapy and risk‐based definitive therapy for locally advanced squamous cell carcinoma of the head and neck

“…Functional outcomes are influenced by a number of patient, clinical, and treatment factors. Baseline dysfunction, laryngeal or hypopharyngeal tumors, and T4 staging have been shown to portend unfavorable functional outcomes after organ preservation . A majority of patients in this trial (64%) had T1 to T2 disease, few (9%) had laryngeal or hypopharyngeal tumors, and only 2 (4%) had MBS‐evidence of baseline aspiration, explaining in part the satisfactory long‐term functional outcomes we observed.…”

RETRACTED: Laryngeal Function After Radiation Therapy

“…Furthermore, recovery of vocal fold mobility after CRT was reported in 65% (52% full and 13% partial recovery) of patients with baseline fixation. 32 The recovery of vocal fold mobility after CRT was associated with significantly higher 5-year overall survival and local control and lower rates of persistent feeding tube and tracheostomy dependence.…”

Posttreatment Non-Improved Vocal Cord Mobility Indicates the Need of Salvage Surgery for Hypopharyngeal Carcinomas

“…Solares et al. ( 4 ) analyzed the 5-year local control rate of 23 patients with advanced laryngeal carcinoma who had initial vocal cord fixation and then accepted concurrent chemoradiotherapy. Fifteen patients with improved cord mobility had a 100% 5-year OS rate, whereas those with persistent fixed cord mobility after treatment had a 25% 5-year OS rate ( P <0.001).…”

“…In clinical practice, we have observed that the cord mobility status might change after non-surgical treatment in patients with laryngeal and hypopharyngeal cancers. A few studies have analyzed this phenomenon in patients with laryngeal cancers, but the authors did not agree on whether remobility of the vocal cord could predict a good prognosis ( 3 , 4 ). No literature has focused on the value of improved cord mobility after non-surgical therapy in HPSCC.…”