Transoral Endoscopic Resection of Low-Grade, Cricoid Chondrosarcoma

Abstract

Low-grade chondrosarcomas account for 1% of all laryngeal tumors and typically arise in the cricoid cartilage. They are usually indolent, slow-growing cancers that are locally invasive and rarely metastasize. Surgical excision is considered the treatment of choice. Radiotherapy and chemotherapy generally are ineffective. Surgical management must balance tumor clearance with preservation of laryngeal functions (swallowing, voice, and respiration). Prospective outcome analysis of seven patients operated with endoscopic resection for low grade cricoid chondrosarcomas. Mean age at presentation was 61years (range 49-75), male:female ratio was 4:3. All patients are currently alive and free of disease with an average follow-up of 80months (range 63-138). Overall 5-year survival is 100%, 5-year disease-free survival rate 85.7%, and overall recurrence rates 14.3%. One of the seven patients developed a limited recurrence at 21months and underwent a second endoscopic resection. During initial management two patients needed temporary tracheotomy. Successful decannulation and normal breathing were obtained within 3months with no long-term sequelae. The airway calibre of the remaining patients was minimally affected. All patients have normal postoperative swallowing function and adequate voice that is unassisted by amplification. These findings support the use of endoscopic resection for managing selected newly diagnosed cases of cricoid chondrosarcoma as well as the role of repeated endoscopic resection for managing cases of recurrent cricoid chondrosarcoma.