Radiation Failures in Cancer of the Larynx

Abstract

Overwhelming statistics have been published regarding the success of radiation therapy in the management of laryngeal carcinoma. The fate of those patients whose cancers are not controlled by radiotherapy is often left to speculation. An analysis is made of 61 patients with early and advanced laryngeal cancer treated initially with radiation therapy and subsequently operated upon because of recurrent or persistent tumor. Frequently, diagnosis of recurrence is difficult or delayed. Preservation of voice can only be accomplished when recurrence of T1 and T2 lesions is detected early and strict criteria are followed. Conservation surgery is not feasible for early lesions which progress after radiation failure. Advanced T2 and T4 lesions which become radiation failures also require laryngectomy for salvage. In cancer of the larynx, there is a definite, identifiable group of patients in whom surgery would be advisable as the initial therapy.

Supracricoid Partial Laryngectomy After Failed Laryngeal Radiation Therapy

“…Kirchner 29 emphasized that if initial curative laryngeal RT for squamous cell carcinoma was unsuccessful, islands of tumor remained throughout the field, resulting in a wide area of recurrence. Various authors have also reported that vertical partial laryngectomy after RT failure for glottic carcinoma should not be attempted if 1. the true vocal cord was immobile, 2. the arytenoid cartilage or its mucosa were directly involved by tumor, 3. the tumor involved more than one third of the opposite true vocal cord, 4. there was either evidence of perichondritis or thyroid cartilage invasion, and 5. transglottic spread of disease was noted 1‐15 …”

“…The exact site involved by recurrent tumor is presented in Table I. According to the reported selection criteria, 1‐15 contraindications for salvage vertical partial laryngectomy (VPL) in the patients with glottic tumor included fixation of the true vocal cord (3 patients), transglottic extent of disease (1 patient), anterior infraglottic extent of disease (4 patients), invasion of more than one third of the contralateral true vocal cord (2 patients), invasion of the anterior aspect of the ipsilateral arytenoid cartilage (3 patients), and recurrent tumor exceeding its original limits (9 patients). Similarly, 13 horizontal partial laryngectomy was not indicated due to anterior commissure invasion, posterior vestibule invasion, and recurrent tumor exceeding its original limits in all 3 patients with supraglottic tumor.…”

“…Successful management of laryngeal recurrence after failed radiation therapy(RT) with vertical or horizontal partial laryngectomy requires strict selection criteria resulting in highly selected patients 1‐15 . Viani et al 16 also reported that many patients with laryngeal recurrence after failed RT had an advanced tumor by the time of the diagnosis, with almost half being transglottic T3 or T4 tumors.…”

Pharyngocutaneous fistulae following total laryngectomy

“…Fistula formation seems to be part of a prognostically unfavourable picture. Of the 12 Pharyngocutuneous Jistulae '9 Group I (23) Fistulae (7) No fistulae (16) It may be mentioned that all of the fistulae closed spontaneously without surgical treatment. Bresson ct ul.…”

Salvage Conservation Laryngeal Surgery After Radiation Therapy Failure

“…All this often leads to late discovery of the recurrence, leaving many patients who are eligible for surgical salvage needing to undergo total laryngectomy. 15,34 Som 35 was the first to publish results on CLS as salvage therapy after RT in 1951. More recently, Ganly and colleagues 28 noted that local control rates for salvage total laryngectomy were 65% to 85% for T1 and T2 glottic tumors, whereas local control rates for salvage CLS range from 66% to 96%.…”