How often is total laryngectomy necessary for the treatment of T1 failures after radiotherapy or cordectomy?

Abstract

Between 1992 and 1998, 547 patients (pts) with laryngeal SCC were diagnosed and treated in our department, 145 (27%) of whom presented with glottic tumors T1N0M0 (125 T1a and 20 T1b). Seventy-eight (54%) were treated surgically with cordectomy and 67 (46%) with radiotherapy. After a median follow-up time of 43 months, 22 (15.2%) of the 145 pts presented with recurrent disease. In more detail, 16 (13%) of the 125 T1a pts and 6 (30%) of the 20 T1b pts had recurrences. Among the 78 surgically treated patients only 4 (5%) had recurrence, while 18 (27%) of the radiotherapy group relapsed. The difference is statistically significant (log rank test, P = 0.0001 < 0.05). After salvage treatment, of the 67 pts of the radiotherapy group 57 (85%) remain disease-free, 49 (73%) retaining their larynx intact and 1 only having undergone cordectomy. Among the cordectomy group 75 (96%) pts remain disease-free with only 1 having had a total laryngectomy. Using the Kaplan-Meier method and calculating the disease-free survival regardless of salvage treatment, there is no doubt that surgical treatment statistically is more successful than radiotherapy (log rank test, P = 0.01 < 0.05). Analysis of parameters such as tumor differentiation and T1a or T1b staging, which indeed influence the overall recurrence rate, did not alter the favorable outcome after surgical treatment.

Treatment of Early-Stage Glottic Cancer by Transoral Laser Resection

“…7 We observed recurrence despite free margins in 5 of 54 patients (9%); this rate is comparable to the results of a previous report in which 3 of 34 patients (8.8%) with free margins had local recurrence. 5 Two patients in our series (2.5%) required total laryngectomy -a rate comparable to those reported in the series of Bron et al 16 (2.6%) and Markou et al 17 (1.3%).…”

Outcomes of transoral laser microsurgical management of T1bstage glottic cancer

“…, 24 Recurrence rates for T 1b stage glottic cancers vary widely from 16 to 50 per cent 11 13 , 25 The success of laser treatment is attributable to the specific set of parameters in study participants, with anterior commissure involvement, oncological margins and endoscopic accessibility all having a larger impact on smaller samples 18 . Recurrence rates in the present study fall within the reported limits.…”

Salvage Laryngectomy in Patients with Recurrent Laryngeal Cancer in the Setting of Nonoperative Treatment Failure

“…4 Recurrent disease, even in the advanced stages, can often be managed by salvage surgical procedures capable of achieving ultimate tumor control in most cases.…”