Early-stage Glottic Carcinoma Research Articles

Targeting Anterior Commissure Involvement with Hyperfractionated Radiotherapy for T1-T2 Squamous Cell Carcinoma of the Glottic Larynx.

Anterior commissure is involved in about 20% of early-stage glottic squamous cell carcinomas (EGSCCs). Treatment outcomes and prognostic factors for EGSCC with anterior commissure involvement (ACI) were evaluated by focusing on hyperfractionated radiotherapy (74.4 Gy in 62 fractions). One-hundred and fifty-three patients with T1-T2 EGSCC were included in this study. The median total doses for T1a, T1b, and T2 were 66, 74.4, and 74.4 Gy, respectively. Overall, 49 (32%) patients had T1a, 38 (25%) had T1b, and 66 (43%) had T2 disease. The median treatment duration was 46 days. The median follow-up duration was 5.1 years. The 10-year overall and cause-specific survival rates were 72% and 97%, respectively. The 10-year local control rates were 94% for T1a, 88% for T1b, and 81% for T2 disease. Local control rates in patients with ACI were slightly better than those in patients without ACI with T1a and T1b diseases; however, the difference was not significant. The 10-year laryngeal preservation rate was 96%. Six patients experienced grade 3 mucositis, and four patients had grade 3 dermatitis. Hyperfractionated radiotherapy was effective for T1 disease with ACI, but insufficient for T2 disease with ACI. Our treatment strategy resulted in excellent laryngeal preservation.

258 Radiotherapy in the Treatment of Early-Stage Glottic Laryngeal Carcinoma - Experience from a Hospital Center

258 Radiotherapy in the Treatment of Early-Stage Glottic Laryngeal Carcinoma - Experience from a Hospital Center

Second look, in primary site recurrence or second primary for T1 and T2 glottic cancer treated by CO2 laser

Background: Aim was to analyze the impact of second-look surgery in the surveillance of T1 and T2 glottic cancer treated with CO2 laser. Methods: Retrospective review of 98 patients treated between February 2005 and December 2022. Results: Among 98 patients with early glottic cancer (T1/T2), 56 (57%) with suspected recurrence underwent a second-look surgery. Of all patients, 38 (38.77%) recurred 6 months after initial resection, 17 of which (45%) had a lesion in a different site from the primary. Of these 38 patients, 22 (58%) underwent laser surgery once, 12 (32%) underwent laser surgery twice, and 4 (10%) underwent laser surgery on three occasions during follow-up. The 5-year disease-free survival, 5-year survival, and larynx preservation rates were, respectively, 54%, 82%, and 90.8%. Conclusions: Transoral resection is currently the first treatment option for early-stage glottic carcinoma because diagnosis and prompt treatment can be provided on an outpatient basis at the same time.

Impacts of Postoperative Enteral Nutrition and Rosiglitazone on Quality of Life Together with Prognosis of Patients with Early-Stage Glottic Laryngeal Carcinoma

We aimed to clarify the influence of postoperative enteral nutrition and rosiglitazone on the quality of life and prognosis of patients with early stage glottic laryngeal carcinoma. Low-temperature plasma radiofrequency ablation was performed in the control group, while the observation group additionally received rosiglitazone and postoperative enteral nutrition. After therapy, the observation group had lower fundamental frequency perturbation and amplitude perturbation and higher harmonic-to-noise ratio and effective rate than the control group. One month after treatment, the serum levels of albumin, prealbumin, and hemoglobin in the observation group were higher than those in the control group. Moreover, peripheral blood immune markers, CD3+, CD4+, and CD4+/CD8+ levels were higher in the observation group, while CD8+ levels were lower. The incidence rate of adverse reactions was lower in the observation group than in the control group. The five-year survival rates were 77.14% (27/35) and 54.29 % (19/35) in the observation and control groups, respectively. Postoperative enteral nutrition and rosiglitazone can prolong survival, improve immune function and quality of life in patients with early-stage glottic laryngeal carcinoma, and reduce adverse reactions during treatment, which is an ideal treatment plan.

The outcome of early-stage glottic carcinoma patients treated with radiotherapy: Egyptian National Cancer Institute (NCI-Egypt) experience.

Radiotherapy (RT) is an appropriate treatment option for early-stage glottic cancer (ESGC) that achieves high local control and preserves voice quality. However, the optimal radiation treatment schedule remains unknown. We present our institution's 14-year experience in treating ESGC with definitive radiotherapy between 2005 and 2019 inclusively. We reviewed the medical records of 104 patients; 63 (60.5%) were treated with conventional fractionation (CF), and 41 (39.5%) were treated with hypofractionated radiotherapy (HF). The clinical T-stage was T1a in 50 patients (48%), T1b in 27 (26%), and T2 in 27 (26%). Age, gender, anterior commissure involvement, stage, radiotherapy technique, radiation fraction size, and overall treatment time (OTT) were analyzed as prognostic factors. The survival outcomes, local regional control (LRC), and laryngeal preservation rate were evaluated. The 5-year overall survival (OS) and LCR were 83.3% and 78%, respectively. On univariate analysis, treatment with CF (p = 0.02), prolonged OTT > 49 days in CF and > 40 days in HF (p = 0.04), and RT total dose < 66 Gy (p = 0.03) were associated with poor LRC. Multivariate analysis showed a non-significant association with LRC (all p > 0.05). The 5-year OS rate in the CF and HF-treated patients was 84.9% and 72.1%, respectively (p = 0.99), and in patients who had T1a, T1b, and T2 disease, were 78.2%, 96.0%, and 82.1%, respectively (p = 0.43). All patients and tumor variables showed no statistically significant association with OS. Only low-grade acute toxicity was observed. Non-inferiority results supported the HF schedule to ESGC, including high local disease control and decreased overall treatment time. Our study supports its efficacy in the primary care of ESGC with manageable side effects.

Treatment Outcome of Early-stage Laryngeal Carcinoma Treated with Radical Radiotherapy Using Different Techniques: A Retrospective Study

Aim: The aim was to evaluate the treatment outcomes and prognostic characteristics of patients with early-stage glottic laryngeal carcinoma who underwent radical radiotherapy (RT) with different techniques.Materials and Methods: Radiotherapy was applied using the 2D conventional technique, 3DCRT (three dimensional conformal radiotherapy and IMRT (intensity modulated radiation therapy). Clinical T stages were 12 (48%) for T1a, 5 (20%) for T1b and 8 (32%) for T2. Stage and anterior commissure involvement were analyzed as prognostic factors. Results: There were 12 (48%) patients with T1a, 5 (20%) patients with T1b and 8 (32%) patients with T2 cancer. 5 years of overall survival and diseases free survival for T1a, T1b, T2 were found to be 91%, 80%, 62% and 91%, 80%, 62% respectively. 5 year survival for patients without and with involvement of anterior commissure was 92% and 67% respectively. Hence, showing poor survival in patients with T2 lesion or T1 lesion with involvement of anterior commissure. Conclusion: In early-stage laryngeal carcinomas, radical RT is a function sparing and effective treatment modality with excellent survival rates, regardless of treatment techniques.

Outcomes of hypofractionation for early-stage glottic carcinoma.

Our goal is to evaluate hypofractionation in early-stage glottic carcinoma of a single center in line with randomized trials. Between June 2016 and January 2021, 33 early glottic carcinoma patients treated with IMRT (intensity-modulated radiotherapy) in the Radiation Oncology Department were analyzed. Descriptive statistics and survival analysis were applied. Survival analysis and curves were done via the Kaplan-Meier method. Survival curves were analyzed due to the T stage. Log-rank test was used for the analysis of T stage survival curves. Twenty (60.1%) patients were T1 whereas six (18.2%) and seven (21.2%) were Tis. 56.25 Gy, 63 Gy, and 65.25 Gy were delivered to the patients with Tis, T1, and T2, respectively. All groups were treated with 2.25 Gy per fraction. T2 stage had lesser DFS (disease-free survival) compared to Tis and T1 stage and it was statistically significant (P = 0.035). Hypofractionation with 2.25 Gy per fraction may be standard for early glottic carcinoma with similar results compared to microsurgery and conventional fractionation radiotherapy.

Clinical Outcomes of Radiotherapy for Stage 1 Glottic Carcinoma: Comparing Accelerated Hyperfractionation and Once-daily Fractionation.

Accelerated hyperfractionation (AHF) is used in head and neck cancer to improve the local control (LC) rate, but reports of outcomes for early-stage GC are limited. The outcomes of radiotherapy (RT) for stage 1 glottic carcinoma (GC) were retrospectively analyzed, comparing AHF and once-daily fractionation (ODF) using 2.0-2.4 Gy. A total of 102 patients with stage 1 GC underwent RT alone between 2007 and 2021, with 43 in the AHF group and 59 in the ODF group. A p-value less than 0.05 was considered to indicate a significant difference. The 5-year LC rate was 98% in the AHF group and 91% in the ODF group (p=0.19). During RT, significantly more patients in the AHF group required opioids due to mucositis than in the ODF group (74% vs. 25%, p<0.001), and the rate of aspiration pneumonia tended to be higher in the AHF group than in the ODF group (7% vs. 0%, p=0.072). There was no difference in the LC rate between AHF and ODF for stage 1 GC. Moreover, the AHF group required opioids at a higher rate and tended to have a higher risk of developing aspiration pneumonia.

The Comparison of Electroacoustic and Subjective Voice Quality in Type 3 and 4 Transoral Laser Cordectomy for Early-Stage Glottic Carcinoma.

One of the main issues in early-stage glottic carcinoma management is the voice quality following different types of treatment modalities. In type 3 and 4 transoral laser cordectomies, the voice outcomes can show significant differences due to the extent of the vocal muscle resection. This study aims to compare the voice quality in patients who underwent type 3 and 4 laser cordectomy for early-stage glottic carcinoma. A total of 30 patients who underwent type 3 (15 patients) and type 4 (15 patients) laser cordectomy for T1a glottic carcinoma between May 2018 and 2020 were included in this retrospective comparative study. Electroacoustic voice analysis and Voice Handicap Index-10 were performed in the postoperative twelfth month and the outcomes were compared between two laser cordectomy groups. The mean age of all patients was 48.6 ± 4.2 years. Noise-to-harmonic ratio, jitter, shimmer, pitch perturbation quotient and amplitude perturbation quotient values were significantly different between two groups (p < 0.05). Fundamental frequency and Voice Handicap Index-10 scores showed no statistically significant difference (p > 0.05). This study reports significantly better results for type 3 against type 4 laser cordectomy by means of objective voice analysis outcomes, except fundamental frequency. On the other hand, self-reported subjective analysis showed very similar results for both groups. Further studies combining data with multiple objective and subjective analyses with larger patient series and longer follow-up are warranted.

Oncologic outcomes of transoral laser microsurgery versus open partial laryngectomies in the management of early stage glottic carcinoma

BackgroundThe oncologic outcomes between transoral laser microsurgery (TLM) and open partial laryngectomy (OPL) using comprehensive analysis in one clinical center is rare. The purpose of this study was to evaluate the oncologic outcomes of TLM in patients with early stage glottic carcinoma, and to compare the results with OPL. Subjects and methodsRecords of 425 glottic carcinoma patients with T1 - T2 stage treated with TLM, vertical partial laryngectomy (VPL), and cricohyoidoepiglottopexy (CHEP) from 2005 to 2010 were retrospectively analyzed. The overall survival (OS), disease-specific survival (DSS), and laryngeal function preservation (LFP) of these three treatments were assessed. ResultsOne hundred and twenty-two patients were treated with TLM. Regarding OPL, 167 patients underwent VPL, and 136 patients underwent CHEP. The mean age was 59.7 years, with men accounting for 97.2 % of all cases. The OS, DSS, and LFP rates of patients with anterior commissure (AC) involvement undergoing TLM were worse than those of patients without AC involvement, but these differences were not statistically significant. The 5-year OS, DSS, and LFP of patients undergoing TLM were 88.4 %, 89.9 %, and 83.5 %, respectively, and the oncologic outcomes of patients undergoing TLM, VPL, and CHEP were not statistically different. ConclusionGlottic carcinoma patients with early stage treated with TLM experience satisfactory oncologic outcomes. No compelling difference in oncologic outcomes among three treatments of TLM, VPL and CHEP, as well as VPL and CHEP can be alternatives to patients who are not suitable for receiving TLM.

Early-Stage Glottic Carcinoma in the United States: Demographics and Treatment Choice.

Limited investigation of factors potentially contributing to treatment choice in early-stage glottic carcinoma (EGC) has been performed with large-scale data. The National Cancer Database (NCDB) represents >72% of all new cancer cases in the United States. We hypothesized that NCDB variables may lend insight into treatment decisions between surgery and radiation for EGC. The NCDB was queried for all cases of T1-2 N0 M0 glottic carcinoma from 2004 to 2016. We used multivariable logistic regression analysis to examine factors associated with first-line treatment modality:radiation therapy (RT) versus surgery. All reported odds ratios (OR) were adjusted for age, gender, race, insurance, residence in a metropolitan area, region, and facility volume. 34,991 EGC patients received treatment: 6,687 (19%) surgery; 20,289 (58%) RT; and 8,015 (23%) surgery and RT. OR for receiving RT (vs. surgery alone) were >2 for: more advanced T stage cancers (OR 2.5 [95%CI: 2.3, 2.7]), treatment at non-academic facilities (OR 2.8, [95%CI: 2.6, 3.0]), and shorter travel distances to treatment centers (OR 2.2, [95%CI: 2.0, 2.4]). Surgery was more likely with treatment in the western US, higher income, private insurance, living in a metropolitan (vs. non-metropolitan) area, female gender, older age, and low facility volume. Hispanic ethnicity, education level, and race were not associated with treatment type in the multivariable model. Most patients in the NCDB receive first-line treatment with radiation for EGC, and this decision is associated with various tumor, patient, and treatment facility characteristics. 4 Laryngoscope, 133:901-907, 2023.

Stereotactic Ablative Radiotherapy for Early-Stage Glottic Larynx Carcinoma: Results From the Phase II LT-SABR Study

<h3>Purpose/Objective(s)</h3> Traditional radiotherapy for early-stage larynx cancer irradiates the whole larynx over 5.5-6 weeks. Phase I data suggest that stereotactic ablative radiotherapy (SAbR) is a viable strategy in this population to reduce the irradiated volume and compress the treatment time. This phase II study evaluated the efficacy of gLoTtic larynx SAbR (LT-SABR), utilizing a 5 or 16 fraction regimen depending on treatment volume and smoking status. <h3>Materials/Methods</h3> Eligibility required stage 0-II biopsy-proven carcinoma of the true glottic larynx, including squamous cell variants. The arytenoid cartilage could not be involved beyond the vocal process, and patients smoking more than one pack-per-day were excluded. The planning target volume (PTV) consisted of the gross tumor volume, including respiratory motion assessed on a 4D-CT, with a 3 mm AP/LR margin and 5 mm SI margin. Patients without active smoking and PTV volume < 10 cc receive 42.5 Gy in 5 fractions, two fractions per week; all other patients received 58.08 Gy in 16 daily fractions. The routine beam arrangement included 2 coplanar VMAT arcs and 2 non-coplanar arcs. Patients were treated with swallow-gating using surface imaging. The study required 25 patients to show that the local control probability is non-inferior to 75% at 2 years. <h3>Results</h3> A total of 25 patients were accrued to this study, with 21 and 4 treated with 5 and 16 factions, respectively. The stage distribution was CIS (n=1), T1a (n=16), T1b (n=5), and T2 (n=3). The median age was 72 years, with a prior smoking history in 16 and active smoking in one. Dosimetry metrics (mean values) are summarized in the Table. At a median follow-up of 21.1 months (IQR 14-31.8) in surviving patients, there have been two in-field recurrences (one in each dose cohort). One was salvaged with partial laryngectomy and the other died from local and regional disease. The cumulative risks of local failure were 4.2% and 9.3% at 1 and 2 years, respectively. There have been no acute or late grade 3+ toxicities. The baseline, 6 and 12 month total Voice Handicap Index (VHI) scores were: 53.0 (n=25), 9.8 (n=18), and 18.4 (n=15). The improvements in VHI between 6/12 months and baseline were both statistically significant (p<0.001). <h3>Conclusion</h3> Highly conformal stereotactic radiotherapy is safe and efficacious for early-stage glottic larynx cancer, with encouraging patient-reported outcomes. Additional follow-up and ultimately comparative studies are necessary to validate this paradigm.

Comparison of Partial Laryngectomy Versus Radiotherapy for the Treatment of Early Glottic Carcinoma: Complications and Oncological Results: A Nonrandomized Clinical Trial

The aim of this non-randomized clinical trial was to evaluate tumor outcomes and subjective quality of voice following radiotherapy and partial laryngectomy in early-stage glottic laryngeal cancers. Non-Randomized Clinical Trial. Otolaryngology and radiation oncology clinics of Imam Khomeini (an affiliated hospital of Tehran University of Medical Sciences) and Amir Aalam Hospitals. Fifteen patients with early-stage glottic laryngeal carcinoma were admitted to the otolaryngology clinic, divided into two treatment groups: radiotherapy and partial laryngectomy. Of the total 50 patients, 25 had a partial laryngectomy and 25 radiotherapies. The comparison of the average of the Voice Handicap Index (VHI) showed significant improvement of vocal quality after treatment for both partial laryngectomy and radiotherapy (P&lt;0.0001 for both). But there was no significant difference in VHI mean scores between the two treatment groups (patients treated by partial laryngectomy and radiotherapy). Short- and long-term complication was higher in patients undergoing surgery than radiotherapy group (P&lt;0.0001). With regard to oncological outcome after one and eight-year after treatment, no differences were observed in the two treatment groups; there was a significant relationship between smoking cessation and recurrence of disease in the partial laryngectomy treatment group (P=0.012). There was no significant difference in voice quality and life expectancy of patients operated on using open surgery and patients treated with radiotherapy in this series. Open surgery may have more noticeable complications than radiotherapy.

Oncological Outcomes of Transoral Laryngeal Microsurgery with Fiber-Optic Diode Laser for Early Glottic Cancer: A Single-Center Experience

Backgroud/Objectives: Transoral laser laryngeal microsurgery (_LTLM) has been widely used in the treatment of early-stage glottic laryngeal squamous cell carcinoma (LSCC) for the past few decades. Although T stage, tumor grade, anterior commissure involvement, type of cordectomy, positive surgical margin, and postoperative additional therapies were accused as the prognostic factors for recurrence, there is still controversy about these data in the literature. The purpose of this study was to evaluate the oncological results of our patients with early glottic LSCC treated with _LTLM as a single-modality therapy in a single-center study. Methods: Patients with early-stage (T_is-1–2/N₀) glottic LSCC who underwent _LTLM as a primary treatment from 2011 to 2019 were retrospectively reviewed. The clinicopathological factors and oncologic outcomes were analyzed. Results: One hundred and sixty-one patients were enrolled in this study. The 5-year overall (OS), disease-specific (DSS), disease-free (DFS), and laryngectomy-free survival rates were 84.5%, 97.9%, 79.2%, and 93.5%, respectively. The most common stage, histopathological type, and type of endoscopic cordectomy were T₁ stage, well-differentiated cancer, and type 2 cordectomy, respectively. A positive surgical margin was defined in 20 (12.4%) patients. There was a significant relationship between histopathological grade and positive surgical margins (p = 0.038). OS and DSS rates of “wait and see” modality were lower, while DFS of radiotherapy was lower than that of other treatment modalities in patients with positive surgical margins, but the differences were not statistically significant. Nineteen (11.8%) patients had a recurrence. DSS was statistically significantly lower in patients with recurrence (p < 0.001). Conclusion: The results of our study showed that anterior commissure involvement, surgical margin positivity, and higher T stage statistically did not reduce survival rates in early-stage LSCC patients treated with _LTLM. As the histopathological grade of the tumor worsens, the risk of surgical margin positivity increases. RT may have a negative effect on recurrence and organ preservation in the additional treatment of patient with positive surgical margins.

Early-Stage Glottic Squamous Cell Carcinoma in the Era of Image-Guided Radiotherapy.

Early-stage squamous cell cancer (SCC) of the glottis has a good prognosis. Therefore, patients have long survival outcomes and may potentially suffer from late toxicities of radiotherapy. Radiotherapy with a conventional parallel-opposed-pair or anterior-oblique beam arrangements for stage 1 and 2 glottic SCC have field borders that traditionally cover the entire larynx, exposing organs-at-risk (e.g. carotid arteries, contralateral vocal cord, contralateral arytenoid and inferior pharyngeal constrictor muscles) to high radiation doses. The potential long-term risk of cerebrovascular events has attracted much attention to the dose that carotid arteries receive. Swallow and respiratory motion of laryngeal structures has been an important factor that previously limited reduction of the radiation treatment volume. Motion has been evaluated using multiple imaging modalities and this information has been used to calculate PTV margins for generation of more limited target volumes. This review discusses the current literature surrounding dose-effect relationships for various organs-at-risk and the late toxicities that are associated with them. This article also reviews the currently available data and effects of laryngeal motions on dosimetry to the primary target. We also review the current limitations and benefits of a more targeted approach of radiotherapy for early-stage glottic SCCs and the evolution of CT-based IGRT and MR-guided radiotherapy techniques that may facilitate a shift away from a conventional 3D-conformal radiotherapy approach.

Prognosis and Outcomes in Early Stage Glottic Carcinoma Involving the Anterior Commissure Treated with Laser CO2 Surgery: A Retrospective Observational Analysis.

The anterior commissure (AC) is the area where the vocal cords attach to the thyroid cartilage through Broyles' ligament. Many authors argue that involvement of the anterior commissure in early stage glottic carcinoma (I, II) constitutes a risk factor for local recurrence. The objective of this study is to evaluate whether anterior commissure involvement in early stage glottis cancer is an independent risk factor for recurrence and mortality. The study included all those patients diagnosed with glottis carcinoma in stages I and II of the AJCC treated by transoral laser surgery at the Hospital San Pedro (Logroño, Spain) between 2005 and 2015. Patients were divided into two groups according to the presence (AC1) or absence (AC0) of involvement of the commissure. Of 29 patients treated, 44.8% were AC1. Patients with anterior commissure involvement had more local recurrence (p = 0.2701); higher mortality rate (p = 0.2256); lower disease-free survival (p = 0.0881) and a lower overall survival (p = 0.0331). The 5-year survival rate was 24.5% lower in patients with invasion of the anterior commissure. The involvement of the anterior commissure is an independent risk factor that should be considered in the prognosis of laryngeal cancer.

Monitoring expiratory carbon monoxide to study the effect of complete smoking cessation on definitive radiation therapy for early stage glottic carcinoma

Background Previous studies reported that cigarette smoking during radiation therapy was associated with unfavorable outcomes in various cancers using medical interviewing or monitoring of cotinine. Here, we evaluated the effect of smoking cessation on definitive radiation therapy for early stage glottic carcinoma by monitoring expiratory carbon monoxide (CO). Material and methods We enrolled 103 patients with early glottic carcinoma (T1N0/T2N0 = 79/24) who underwent conventional radiotherapy between 2005 and 2016. The median age was 70 years. Pathologically, all patients had squamous cell carcinoma. Since 2009, we confirmed smoking cessation before radiation therapy by medical interviews. Since 2014, we measured expiratory CO to strictly monitor smoking cessation. The patients were divided according to diagnosis years: ‘no cessation’ (2005–2008), ‘incomplete cessation’ (2009–2013), and ‘complete cessation’ (2014–2016). We retrospectively analyzed the local recurrence rate and disease-free survival (DFS). Results The median follow-up period was 60.1 months (range, 1.9–110.0 months). The 2-year local recurrence rate in the ‘complete cessation’ group was 5.3% and tended to be lower than that in the ‘incomplete cessation’ group (13.7%) and ‘no cessation’ group (21.2%). Multivariate analysis revealed that ‘no cessation’ was a risk factor for DFS (hazard ratio [HR] = 4.25) and local recurrence rate (HR = 16.5, p < .05) compared to ‘complete cessation.’ Discussion We confirmed that the ‘complete cessation’ group had better prognosis than the ‘no cessation’ group by monitoring expiratory CO during radiation therapy for early stage glottic carcinoma. Moreover, monitoring expiratory CO was easier and more suitable than conventional methods for evaluating smoking cessation because it provided real-time measurements.

Transoral Laser Surgery for Early Glottic Carcinoma: A Single Surgeon Experience of 101 Consecutive Cases

Purpose: Investigate the clinical and oncological results of early-stage glottic laryngeal carcinoma patients performed by a single surgeon. Methods: This study was carried out at a tertiary academic center. A total of 101 patients were included (92 males [91.1%], 9 females [8.9%]). Mean age was 62.98 ± 10.2 years (range 33–87). Recurrence, disease-free survival, overall survival, laryngeal preservation rates were analyzed. Results: Tumor stage was Tis (carcinoma in situ) in 11 patients (10.9%), T1a in 66 patients (65.3%), T1b in 12 patients (11.9%), and T2 in 12 patients (11.9%). Postoperative pathology was squamous cell carcinoma in 69 patients (68.3%), carcinoma in situ in 26 patients (25.7%), and high-grade dysplasia in 6 patients (5.9%). Five patients (5.0%) underwent type 1, 7 (6.9%) type 2, 45 (44.6%) type 3, 24 (23.8%) type 4, 6 (5.9%) type 5a, 8 (7.9%) type 5c, 4 (4.0%) type 5d, and 2 (2.0%) type 6 cordectomy. Median follow-up time was 30 months (range 14–66). There were 5 recurrences (5.0%). Three-year disease-free survival was 94.4%. Three-year disease-free survival for stage I and II patients was 94.9 and 91.7%, respectively. Overall survival was 93.8%. Only 1 patient died related to cardiovascular disease. Disease-specific survival was 100%. Conclusions: In conclusion, this is a large case series with good oncological outcomes presented with the perspective of a single surgeon. The data of the study is in accordance with the previous reports.

Application of a thyroid cartilage window technique for transoral resection of early glottic cancer involving the anterior commissure

Background Management of early stage glottic carcinoma involving the anterior commissure is challenging. Aims/objectives This study aimed to evaluate the efficacy of a thyroid cartilage window (TCW) technique for transoral laser resection of early glottic cancer with involvement of the anterior commissure. Material and methods Twenty-one patient who underwent a TCW technique for transoral resection early glottic carcinoma involving the anterior commissure, were retrospectively analyzed. The technical nuances, organ preservation rate and voice outcomes, local and regional recurrence, and perioperative comorbidities, were assessed. Results All 21 patients underwent a TCW technique for resection, both the organ preservation rate and negative margin achieved 100%. The local control rate achieved 100%, and the 5 years recurrence free survival was 90.5%. For two patients with subglottic involvement (9.5%), regional recurrence with confirmation of a positive pre-laryngeal lymph node was observed. Postoperative granuloma was detected in all 21 patients, 13 of whom spontaneously disappeared (61.9%); whereas the remaining 8 patients (38.1%) demonstrated a consistent presence of granuloma more than 12 weeks, and they accepted surgical extirpation of granuloma under surface anesthesia. The laryngeal web developed in all 21 patients, while no dyspnea and local recurrence were present. By comparison with preoperative baseline, postoperative self-assessment voice demonstrated a significant improvement (p = .01), while objective voice indices were not significantly altered (p > .05). Conclusions and significance TCW technique is a valuable means for transoral resection of early glottic laryngeal cancer involving the anterior commissure, with acceptable voice quality and seemingly low comorbidities.

Radiotherapy Versus Surgery-Which Is Better for Patients With T1-2N0M0 Glottic Laryngeal Squamous Cell Carcinoma? Individualized Survival Prediction Based on Web-Based Nomograms.

BackgroundBoth radiotherapy and surgery are now recommended for early stage glottic laryngeal squamous cell carcinoma (LSCC), and both have their own advantages in patients with different characteristics. For each patient, it is hard to determine whether radiotherapy or surgery is more appropriate.MethodsPatients with T1-2N0M0 glottic LSCC who received radiotherapy or surgery in the 2004–2016 SEER database were reviewed, then randomly divided into training and validation cohorts. Propensity score matching was used to eliminate the baseline variations, and competing risk analyses helped to exclude the effects of other causes of death. Based on univariate and multivariate analyses, we built two nomograms to visually predict the survival of each patient with different characteristics who received radiotherapy or surgery, then validated the accuracy in both training and validation cohorts. Using nomogramEx, we quantified the algorithms of the nomograms and put the nomograms on the websites.ResultsA total of 6538 patients in the SEER database were included. We found that therapy (p = 0.004), T stage (p < 0.001), age (p < 0.001), race (p < 0.044), grade (p = 0.001), and marital status (p < 0.001) were independent prognostic factors. Two nomograms were built to calculate the survival for each patient who received radiotherapy (C-index = 0.668 ± 0.050 in the training cohort and 0.578 ± 0.028 in the validation cohort) or underwent surgery (C-index = 0.772 ± 0.045 in the training cohort and 0.658 ± 0.090 in the validation cohort). Calibration plots showed the accuracy of the nomograms. Using the nomograms, we found that 3872 patients (59.22%) had no difference between the two therapies, 706 patients (10.80%) who received radiotherapy had better survival outcomes, and 1960 patients (29.98%) who underwent surgery had better survival outcome.ConclusionNomograms were used to comprehensively calculate independent factors to determine which treatment (radiotherapy or surgery) is better for each patient. A website was used to offer guidance regarding surgery or radiation for patients and physicians.