T1 Glottic Carcinoma Research Articles

Clinico-pathological correlation of T3glottic carcinomas

Controversy surrounds the relative merits of radiotherapy and laryngectomy for the treatment of T3 glottic carcinoma. In this study of 82 patients with non-irradiated T3 glottic carcinomas managed by total laryngectomy, 45% had been clinically understaged and were pT4. There was a significant association between subglottic extension and tracheostomy with understaging. A trend to understage anterior commissure tumours was also evident. Nodal status did not influence understaging and therefore should not determine the choice of treatment of the glottic primary. Laryngectomy is recommended for patients with subglottic extension or a tracheostomy. If radiotherapy is to be used for the remaining tumours, then vigilance against understaging is required.

Hemilaryngectomy for glottic carcinoma after radiation therapy failure.

To determine the efficacy and safety of vertical hemilaryngectomy (VHL) for the treatment of early glottic carcinoma recurrent after radiation therapy (RT). Retrospective study. Major referral center. Forty patients were identified who underwent VHL for T1 or T2 glottic carcinoma between July 1975 and March 1991, and all were included in this study. Twenty-two patients had received full-course RT before VHL, and 18 patients underwent primary VHL. The local control rates were determined for T1 and T2 tumors in each group, along with actuarial survival rates and complications. Local control of tumor for VHL after RT failure was 85% for T1 tumors, 78% for T2 tumors, and 82% overall. Three of four of the local failures in this group occurred in patients who had contraindications to VHL. Total laryngectomy for treatment of local failures in this group increased the local control rate to 93% for T1 tumors, 89% for T2 tumors, and 91% overall. Local control rates for the primary VHL group were 90% for T1 tumors, 75% for T2 tumors, and 83% overall. Total laryngectomy for treatment of local recurrences increased local control to 87% for T2 tumors and 89% overall. Five-year actuarial survival was 85% for each group. Delayed tracheal decannulation occurred more frequently in the patients who had undergone RT. Our results support the oncologic safety and effectiveness of VHL for the surgical treatment of recurrent early glottic carcinomas after RT, with minimal increased morbidity.

Factors associated with recurrence and voice quality following radiation therapy for T1 and T2 glottic carcinomas

Evaluation of 63 patients undergoing primary radiation therapy for treatment of T1 and T2 glottic carcinomas was undertaken to evaluate the success of primary treatment and to identify factors which might influence recurrence or voice quality. Twelve patients (19%) recurred following radiation therapy, with ultimate salvage in 11, for a 3-year survival rate of 98%. Voice preservation was achieved in 83%. Continued smoking after radiation therapy was associated with significantly greater risk of recurrence. Stage of tumor and anterior commissure involvement were not associated with increased recurrences. Sixty-seven percent of patients who did not recur had good voice quality after treatment. Vocal fold stripping or excisional biopsy rather than limited biopsy for initial diagnosis, complications of treatment, and continued smoking after treatment were all significantly associated with an increased risk of poorer voice quality after treatment while bilateral vocal fold tumors were associated with risks that approached significance. Voice analysis of five patients revealed that objective changes in voice can be detected after radiation therapy in those with associated risk factors but may be normal in those without these risk factors.

Early glottic carcinoma treated with open laryngeal procedures.

The purpose of this study was to determine the recurrence rate and long-term survival of patients treated with open cervical procedures. The study is a retrospective analysis of a cohort of patients who underwent an open laryngeal procedure between 1976 and 1986. The median follow-up was 6.6 years. The sample was a consecutive series of 159 patients with early glottic carcinoma without impaired vocal cord mobility. Patients with a history of radiation therapy or surgical treatment elsewhere were excluded. Surgical treatment in this group of 159 patients included 82 frontolateral partial vertical laryngectomies, 61 laryngofissures with cordectomy, 12 hemilaryngectomies, and four anterior commissure procedures. Estimates of survival time beyond the day of surgery, time to first recurrence (local, regional, and distant), and time to first local recurrence were obtained with the Kaplan-Meier product-limit method. Eleven patients experienced recurrent laryngeal cancer. Ten patients underwent laryngectomy for recurrence. One patient underwent an anterior commissure procedure. Three of the 11 patients who underwent re-treatment of the larynx were ultimately salvaged. The probability of survival at 3 and 5 years was 91% and 84%, respectively. The probability of remaining free of local recurrence 3 and 5 years after surgery was 94% and 93%, respectively. In our experience, open laryngeal procedures continue to be excellent treatment for select cases of early glottic carcinoma. They are versatile and efficacious for managing the wide spectrum of larger T1 glottic carcinomas.

喉頭早期癌治療方針の検討

Radiotherapy, laser surgery or a combination of the two have offered patients with early laryngeal cancer a chance for survival without total loss of vocal function, but there is still much controversy in their selection. Treatment of T1a glottic carcinoma with laser surgery alone has been reported to have a cure rate in the vicinity of 90% which is close to or superior to that achieved with radiation therapy alone. This however is not the case in T1b glottic carcinoma and T2 glottic or supraglottic carcinoma, and pre-or postoperative irradiation is often incorporated in an attempt to improve local control. We have shown in a series of 72 patients with early laryngeal cancer that radiotherapy combined with laser surgery may result in delayed healing of the wound, leaving ulcers with white exudate and granulation which are highly problematic in evaluating the lesion. Coated ulcers were seen 2 months after completion of therapy in 14 of the 28 cases (50.0%) that underwent irradiation following laser surgery, while only 6 of the 24 cases (25.0%) treated with laser alone, and only 1 of the 12 cases (8.3%) treated with radiation alone had delayed healing.

Near total laryngectomy with epiglottic reconstruction: Long-term results in 57 patients

Introduction: Extended partial laryngectomy procedures may offer patients the potential for a cure with preservation of voice. This report characterizes our patients managed with near laryngectomy and reconstructed with epiglottic tissue. Materials and Methods: A total of 57 patients with T1 or T2 glottic carcinoma undergoing total laryngectomy with epiglottic reconstruction were reviewed retrospectively. This group included 15 patients with T1 lesions and 42 patients with T2 lesions. In the standard operation the specimen includes the thyroid ala, both vocal cords, both false vocal cords, and one arytenoid cartilage. The epiglottis is mobilized and delivered inferiorly for reconstruction of the glottic larynx. Result: Tumor control was obtained in 93% of T1 patients and 79% of T2 patients. All patients tolerated decannulation. After a mean duration of 12 days (range 5 to 22 days), all patients were able to swallow. Voice evaluation revealed 5 patients had whispery voices, 25 were difficult to understand in a noisy environment, and 27 were easily understood. Discussion: This technique is an effective approach to cancer therapy with cure rates comparable to total laryngectomy. The main limitation of this technique is that voice recovery is unpredictable.

Ploidy status and the response of T1 glottic carcinoma to radiotherapy.

Flow cytometric DNA ploidy measurements were performed on formalin fixed paraffin embedded tumour specimens from patients with a T1 glottic laryngeal carcinoma in order to evaluate the role of DNA content in relation to local control. From 1980 to 1987, a consecutive series of 90 patients with a T1 glottic laryngeal carcinoma were treated by radiotherapy with curative intent. Biopsies from 44 of these patients were readily available for DNA flow cytometry. In this group aneuploidy was associated with a significantly higher risk (P = 0.018) of local recurrence within 2 years after completion of radiotherapy (38% vs. 9% in the diploid group).

Can pretreatment computed tomography findings predict local control in T3 squamous cell carcinoma of the glottic larynx treated with radiotherapy alone?

Purpose : To determine if pretreatment computed tomography findings can predict local control in T3 squamous cell carcinoma of the glottic larynx treated with radiotherapy alone. Methods and Materials : Twenty-nine patients with previously untreated T3 squamous cell carcinoma of the glottic larynx were treated for cure with radiotherapy alone; all had a minimum 2-year follow-up. High-quality pretreatment computed tomography scans were retrospectively reviewed by a single head and neck radiologist for tumor involvement of various anatomic subsites within the larynx, and total tumor volumes were calculated for 18 of the most recent patients using a computer digitizer. A tumor score was calculated and assigned to each primary lesion depending on the extent of laryngeal spread. Results : A significant decrease in the local control rate was observed for cancers involving the face of the arytenoid (11 of 20 [55%] vs. 9 of 9 [100%]; p = .02), or the paraglottic space at the false vocal cord level (7 of 16 [44%] vs. 13 of 13 [100%]; p ≠ < .01). Tumors assigned a high tumor score (6, 7, or 8) had a significantly decreased rate of local control with radiation therapy when compared with tumors assigned a low tumor score (≤ 5): 1 of 7 (14%) vs. 19 of 22 (86%) ( p = .01). Total tumor volume also significantly correlated with the rate of tumor control. For tumors measuring 3.5 cm 3 or less, local control was achieved in 11 of 12 patients (92%), whereas for tumors greater than 3.5 cm 3, local control was achieved in 2 of 6 patients (33%) ( p = .02). Conclusion : Pretreatment computed tomography scans can contribute significantly to the treatment decision for patients with T3 glottic carcinoma and can define a subset of patients with an excellent chance of being cured with preservation of a functional larynx after treatment with radiotherapy alone.

T1–T2 squamous cell carcinoma of the glottic larynx treated with radiotherapy: A multivariate analysis of variables potentially influencing local control

Purpose : To examine various parameters that might influence the probability of local control of T1–T2 glottic carcinoma treated with radiotherapy. Methods and Materials : Two hundred forty-seven patients with invasive, previously untreated T1–T2 squamous cell carcinoma of the glottic larynx were treated with radiotherapy between May 1977 and December 1989. All patients had a minimum 2-year follow-up. To minimize treatment-related variables, only patients with T1 lesions treated once daily at 225 cGy per fraction and patients with T2 lesions treated once daily at 225 cGy per fraction or twice daily at 120 cGy per fraction were included. Surgical alternative, thickness of the neck at the posterior edge of the lateral fields, vocal cord mobility, anterior commissure involvement, gender, and T stage were evaluated in a multivariate analysis. Results : The 5-year local control rates, calculated by the product-limit method, were T1a, 95%; T1b, 96%; T2a, 87%; and T2b, 76%. The 5-year local control rate for patients with T2 lesions treated with once-daily fractionation was 81% compared with 91% for those who received twice-a-day radiotherapy. For the endpoint of local control with irradiation, the surgical alternative ( p = .020) and cord mobility ( p = .001) were of independent prognostic significance. Conclusion : Of the variables analyzed, only vocal cord mobility and surgical alternative significantly influenced local control. Specifically, anterior commissure involvement and neck thickness did not affect local control.

Prognostic factor of telecobalt therapy for early glottic carcinoma.

Local control rates of T1 and T2 glottic carcinoma treated with radiation alone were reported as 80-91% and 63-76%, respectively. The authors investigated the factors that affect the local control rate for early glottic carcinoma. From 1967 through 1982, 330 patients with early glottic carcinoma (T1: 274 patients; T2: 56) were treated with telecobalt therapy at the Department of Radiology, Osaka University Hospital, Osaka, Japan. Five-year actuarial survival rates of patients with T1 and T2 were 79% and 80%, respectively. Five-year local disease control rates of patients with T1 and T2 disease were 81% and 67%, respectively. In 243 of 254 patients treated with 2 Gy a day, tumor response could be evaluated at the dose level of 40 Gy. For tumors treated with a daily dose of 2 Gy, local control rates of 153 tumors that disappeared at 40 Gy and 90 tumors that persisted at 40 Gy were 83% and 62%, respectively (P < 0.001). Field size and daily fraction size did not affect the local control rate. Evaluation of tumor response at 40 Gy was an important indicator of local disease control for early glottic cancers treated with 2 Gy a day.

Comparison of surgery and radiotherapy in T1 and T2 glottic carcinomas : J Ton-Van, J Lefebvre, JC Stern, E Buisset, BC Coche-Dequeant, B Vankemmel. Am J Surg 162:337–340, 1991

Comparison of surgery and radiotherapy in T1 and T2 glottic carcinomas : J Ton-Van, J Lefebvre, JC Stern, E Buisset, BC Coche-Dequeant, B Vankemmel. Am J Surg 162:337–340, 1991

Vertical partial laryngectomy: our results after treating 81 cases of T2 and T3 laryngeal carcinomas.

From 1976 to 1989, 81 patients with T2 and T3 laryngeal carcinomas were treated with vertical patrial laryngectomy at the University ENT Department of Thessaloniki, Greece. All patients were male with a median age of 56 years (33-71 years). Four patients had N1 lymph nodes. Ten patients received post-operative radiotherapy. Seventeen patients developed local recurrences or distant metastases. Mean follow-up was more than seven years. Absolute three-year survival was 94.6 per cent for 74 patients and absolute five-year survival was 89.6 per cent for 58 patients. Actuarial five-year survival of the whole group of 81 patients was 91 per cent calculated with the Kaplan-Meier method. Recurrence rate and survival of stage II and III patients are also discussed and compared using the log-rank test. We conclude that vertical partial laryngectomy is a very successful treatment selection for T2 glottic and false vocal cord carcinomas and for some selected T3 glottic lesions.

Comparison of surgery and radiotherapy in T1 and T2 glottic carcinomas : J Ton-Van, JL Lefbvre, JC Stern, et al. Am J Surg 162:337–341, 1991

Comparison of surgery and radiotherapy in T1 and T2 glottic carcinomas : J Ton-Van, JL Lefbvre, JC Stern, et al. Am J Surg 162:337–341, 1991

Controversies: Recurrent squamous cell carcinoma of the true vocal cord

None of the consultants disagree with the initial plan to treat this T1N0 squamous cell carcinoma of the true vocal cord with radiotherapy. The consensus is that 10% to 20% of these lesions can fail conventional treatment. Dr. Rice cites incorrect radiotherapy ports, understaging, and extension into muscle or cartilage as the likely reasons for failure. He also believes that a patient who continues to smoke is at risk for persistent or recurrent disease. Drs. Wetmore and Singer add that some tumors are radioresistant for indefinable reasons. Although all the consultants agree that the differentiation between severe atypia and carcinoma in situ can be very difficult, Dr. Singer warns that the surgeon should not play a role in the histologic decision-making. He does not make a distinction between the two and suggests treating a lesion on the basis of its clinical behavior. Dr. Rice draws the line at treating T3 glottic carcinomas with radiotherapy. He states that the greater the tumor bulk the less well the lesion will do with radiotherapy. All the experts caution that involvement of cartilage at the anterior commissure and arytenoid is also a reason for failure. Dr. Wetmore adds that subglottic extension and verrucous carcinoma also contribute to radiotherapy failure. The real controversy lay with how to proceed in this case. Dr. Rice suggests excision of the lesion with the laser or microsurgical stripping. If the margins were positive he would proceed with a vertical hemilaryngectomy. Dr. Wetmore would excise the lesion with a CO2 laser and would follow the patient closely thereafter. He would only plan a hemilaryngectomy if the lesion recurred again.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of surgery and radiotherapy in T1 and T2 glottic carcinomas

We retrospectively studied 356 patients who received treatment for T1 and T2 glottic carcinomas. Two hundred and thirty patients were treated with surgery (200 by cordectomy, 15 by vertical partial laryngeetomy, and 15 by subtotal laryngectomy). Radiotherapy was used to treat 126 patients. There were 206 T1 and 24 T2 lesions in the surgically treated group and 107 T1 and 19 T2 lesions in the radiotherapy group. Sixty-four patients received radiotherapy because it was the treatment of choice (scheduled radiotherapy) and 62 patients received radiotherapy because they had medical contraindications for surgery (default radiotherapy). Actuarial survival rates at 5 years were 84% for patients who underwent surgery and 78% for patients who underwent scheduled radiotherapy. In the surgically treated group, there were 10 local recurrences in 170 patients with tumors of the true vocal cord, eight recurrences in 36 patients with anterior commissure lesions, and 6 recurrences in 24 patients with tumors extending to the arytenoid. In the scheduled radiotherapy group, there were 7 local recurrences in 38 patients with true vocal cord tumors, 6 recurrences in 20 patients with anterior commissure tumors, and 5 recurrences in 6 patients with tumors extending to the arytenoid. We conclude that survival is similar in these patients whether they receive operative treatment or scheduled radiotherapy. However, in the radiotherapy group, local recurrences were more frequent in patients with tumors extending to the arytenoid. We advocate extended functional surgery for patients with T1 and T2 glottic lesions except for those with small tumors arising from the middle third of the vocal cord.

Second neoplasms in patients with carcinomas of the vocal cord: Incidence and implications for survival

A retrospective analysis was performed for 218 patients who were managed for carcinomas of the glottic larynx from 1975 to 1988. With a median follow-up of 51 months (range: 24 to 120 months), 41 patients developed a second malignant neoplasm. Six patients had synchronous and 35 had metachronous second malignant neoplasms. The median interval between the diagnosis of glottic carcinoma and a second malignant neoplasm was 31 months. This median interval increased to 43 months when only the metachronous tumors were analyzed. The average annual risk of developing a second malignant neoplasm in a 10-year period was 3.14% Seventy-one percent of them occurred in the upper aerodigestive tract or lungs. When analyzed according to the initial stage of the glottic carcinoma, 23 of 145 (16%) patients with TI or T2 glottic carcinomas developed a second malignant neoplasm, whereas 18 of 73 (25%) patients with T3 or T4 lesions did so. For the T1 T2 group, the average annual risk was 2.5%, as compared to 4.8% for the T3 T4 group ( p = 0.023). The development of a second malignant neoplasm adversely affected survival. The 10-year actuarial survival for those patients who did not develop a second malignant neoplasm was 45%, as compared to 19% for those who did develop a second malignant neoplasm ( p = 0.008). Although second malignant neoplasms occurred in only 19% of the total patient population, their impact on the survival rate of the overall population was equal to that of glottic carcinomas. The median survival after the diagnosis of a SMN was 6 months. The high incidence of second malignant neoplasms in patients with glottic carcinomas warrants careful follow-up and clinical investigation of the use of chemopreventive agents.

Radiotherapy of T1 glottic cancer with 6 MeV X rays

We treated 154 patients with T1 glottic carcinoma with 6 MeV X rays through 16 cm 2 parallel-opposing open fields on a free set-up delivering a median dose of 67 Gy in 6 2 3 weeks. Observed and relative 5-year survival rates for all patients were 87% and 100%, respectively. The local control rate at 5 years was 89%. Of 18 patients who clinically had local recurrence, 17 were salvaged by a secondary treatment. There were no complications requiring medical or surgical attention. A tendency toward increasing local control rates with increasing total doses was observed in the range between 57.5 Gy and 72.5. No significant correlation was found between local control rates and field size, daily dose, or the technique used. A tendency toward a lower local control rate was noted for patients whose anterior commissures were grossly involved; however, it is not known if this could be attributed to the use of 6 MeV X rays. The results are comparable to those obtained with 60Co as reported in the literature. It is concluded that 6 MeV X rays on a free set-up delivering 65–70 Gy in 6 2 3 –7 weeks can be used satisfactorily for the treatment of early glottic carcinoma.

Laser cordectomy for T1 glottic carcinoma: A 10‐year experience and videostroboscopic findings

Fifty-three patients underwent laser cordectomy for T1 glottic squamous cell carcinoma between January 1980 and December 1989--sixteen after having undergone unsuccessful radiation and thirty-seven who had no previous treatment. There was a 51% five-year cure rate in the irradiated group vs. 62% in the nonirradiated group. Extension of tumor to the anterior commissure resulted in a higher failure rate. Patients experienced an overall 5-year cure rate of 98% after surgical or radiation salvage of unsuccessful laser cordectomies. Six patients had preoperative and postoperative videostrobolaryngoscopy. The most common postoperative problem with voice was a breathiness that did not resolve in any of the patients. All patients had absent or moderately reduced amplitude and mucosal wave patterns and imcomplete glottic closure proportional to the amount of cordal tissue removed. Despite it seemingly poor results in carefully selected patients, laser cordectomy is still indicated without compromising the ultimate oncologic results. Advantages over radiation therapy or conservation laryngeal surgery include a short treatment time, requiring only an outpatient surgical procedure at the time of the initial diagnostic and/or staging laryngoscopy, and the avoidance of potential radiation side effects or surgical complications. However, patients should be advised the possibility of persistent postoperative breathy dysphonia, in addition to the possibility of further treatment to effect a long-term cure.

Endoscopic laser surgery for early glottic carcinoma: A clinical and experimental study

The purpose of this study is to define the indications for using the CO2 laser for the treatment of early glottic cancer. For this purpose, 52 consecutive laser resections of Tis to T2 vocal cord carcinomas were studied prospectively. In addition, laser resection was performed in eight human cadaver larynges, which were then examined histologically using whole organ sections. Both tumor size and tumor location had important influences on tumor resectability by laser. All of the Tis, 78% of T1, and one of four T2 carcinomas were successfully treated by laser surgery alone. Of the 10 carcinomas involving the anterior commissure, only four could completely be resected with the laser; of these four, two recurred in the anterior commissure. This finding is corroborated by the histologic study, which clearly shows that anterior commissure resection poses problems. The only laser resection complication of early glottic cancer was persistent hoarseness in one third of the patients. It is concluded that CO2 laser resection is a safe and effective alternative treatment for patients with Tis and T1 glottic carcinoma, provided the anterior commissure is free of tumor.

Conservation surgery for radiation‐failure carcinoma of the glottic larynx

A consecutive series of 28 patients treated by conservation surgery of the larynx for radiation-failure, recurrent rT1 and T2 (postradiotherapy staging) glottic squamous cell carcinoma treated at Memorial Sloan-Kettering Cancer Center from 1966 to 1983 is reviewed. The majority of patients were men with the age ranging from 46 to 76 years. The disease-free interval ranged from 0 to 113 months (median, 8.5 months). The stage at presentation was rT1 in 25 patients and rT2 in 3 patients. Surgery consisted of cordectomy (7 patients), hemilaryngectomy (18), and extended hemilaryngectomy (3). There was no operative mortality. Local recurrence developed in 8 patients (28.5%), cervical metastasis in 2, and distant metastasis in 1. Only 3 patients were salvaged by further treatment. The rate of local control was influenced by positive surgical margins. Overall, voice preservation was achieved in 75% of patients. The ultimate local control was 82.1% during a follow-up period that ranged from 1.3 to 16.7 years (median, 6.3 years). The actuarial survival at 5 and 10 years was 73% and 71% following conservation surgery of the larynx.