Salvage vertical partial laryngectomy for radiation failure in early glottic carcinoma.

Abstract

Partial laryngectomy after failure of radiotherapy for early glottic cancer is an accepted surgical salvage procedure. However, there have been only a few studies on recurrent disease or long-term survival. Twenty-one patients who were treated with salvage partial vertical laryngectomy (PVL) following failure of primary radiotherapy were prospectively studied. Median follow up was 69 months (range 24-204 months). Patients were seen at two- monthly intervals for the first 24 months and then 3-4 monthly for 5 years after their partial surgery or until death. Local control was 71.4% (15/21). Among the six patients who recurred within the larynx, two patients developed a second primary; one on the ipsilateral false cord at 24 months and the other on the contra-lateral vocal cord at 10 years. The no evidence of disease rate following salvage PVL was 95%, 85% and 73% at 12,24 and 36 months, respectively, with a mean disease free interval of 34.9 months (range 7-120). Survival was 90%, 85% and 80% at 12, 24 and 36 months,respectively, with a median survival of 152 months for the group. Three patients died of their disease and four from other causes. Four local recurrences occurred within 32 months. Two developed neck metastases and died of their disease. Four patients were treated successfully with completion laryngectomy. Only one of these died, but this was due to a second primary squamous cell carcinoma in the lung. Three of the four patients with local recurrence shad an extended procedure. Partial vertical laryngectomy is an excellent alternative to total laryngectomy for salvage following failure of -radiation. Although local recurrence occurred more frequently in those patients having an extended partial procedure, this was not statistically different.