Treatment Of Early Glottic Carcinoma Research Articles

A meta-analysis for the effectiveness external radiation vs transoral laser surgery for treatment of early glottic carcinoma

To investigate the effectiveness external radiation (XRT) vs transoral laser surgery (TOL) for treatment of early glottic carcinoma. Medline (1990-2010), Embase (1990-2010), Cochrane Library, CBM (1990-2010), CNKI (1994-2010), Wanfang Database were searched for published case-control studies investigating the effectiveness external radiation vs transoral laser surgery for treatment of early glottic carcinoma. The odds ratio was calculated. Meta-analyses were performed by RevMan5. 0. 2 Software. In the complications of this study, there was significant heterogeneity in the literatures, so Meta analysis was given up. In the recurrence and 5-years locoregional control, XRT group was no significant difference with TOL group by eliminating the heterogeneity or using the subgroup analysis, but the results till showed there was less recurrence and more locoregional control in TOL group than those in XRT group. In death of disease, overall survival and laryngeal preservation, the differences were statistically significant. TOL could be complete in the clinic and the cost was much more cheaper than XRT. So TOL could be used as the first choice for the treatment of early glottic carcinoma versus XRT. But for larger tumors, involving the anterior commissure, there was no clear conclusion. Based on literatures, traditional surgery was the proposed choice. We recognize that the datas included in our study are retrospective studies, for a more scientific conclusion, we need more RCTs.

Comparison of Endoscopic Laser Resection versus Radiation Therapy for the Treatment of Early Glottic Carcinoma

Comparison of Endoscopic Laser Resection versus Radiation Therapy for the Treatment of Early Glottic Carcinoma

Voice Quality After Treatment of Early Glottic Carcinoma

Increasing incidence of laryngeal carcinoma and advancement in diagnostics and therapy methods, have led to constant exploration in that field. Early glottic carcinoma can be treated successfully with several procedures: cordectomy through laryngofissure, laser cordectomy, and radiotherapy. Our objective was to assess the voice quality after these different modalities of treatment. Prospective controlled study with 69 patients, treated in a 1-year period for glottic Tis and T1a carcinoma at the tertiary medical centre. Nineteen of our patients were treated endoscopically with CO(2) laser (types III-IV cordectomy according to recommended European Laryngological Society classification of endoscopic cordectomies). Thirty-five patients underwent cordectomy through laryngofissure, 15 patients had radiotherapy. Multidimensional computer analysis of voice and speech was conducted 1, 6, and 12 months after the treatment. Three programs included 14 parameters, which were observed. While comparing the parameters between the groups, there were significant differences in the values of fundamental frequency (Hz), jitter (%), normalized noise energy (dB), standard deviation of fundamental frequency (Hz), percent silent time (%), and sound-pressure level in the different follow-up periods (P<0.05). In the long run, patients treated with radiotherapy show better voice quality in comparison with other two groups.

Glottic laser surgery: outcomes according to 2007 ELS classification

The aim of the present investigation was to analyze the oncological results of a series of early stage glottic carcinomas treated with CO(2) laser-assisted endoscopic surgery. We focused on prognosis factors with significant impact on local control and disease-free survival (DFS). This retrospective study was conducted on a series of 177 consecutive patients with pT1-T2 glottic carcinomas treated with CO(2) laser-assisted endoscopic surgery in the period 2000-2007. All considered patients had at least a 24-month follow-up period (mean follow-up 49.1±23.0months). The overall survival and the disease-specific survival rates were respectively 90.8 and 98.8%. The rates of local control with primary laser surgery, ultimate local control with laser alone, and laryngeal preservation were 86.3, 94.3, and 97.7%, respectively. Arytenoids (p=0.006) and limited subglottic involvements (p=0.0002) have a significant impact on DFS. Endoscopic laser surgery is the gold standard in the treatment of early glottic carcinoma because of high local control rates with laser alone, day surgery modality, very low morbility, good post-operative voice quality in most of the cases, and low costs.

Hypofractionated Radiotherapy in the Treatment of Early Glottic Carcinoma

ABSTRACTIntroductionGiven the high probability of cure, the aims of treatment are cure, laryngeal preservation and good voice quality while making effective use of available resources. In this study we analyze locoregional control (LRC) and survival following hypofractionated radiotherapy in early stage glottic squamous cell carcinoma treated at Shaukat Khanum Memorial Cancer Hospital and Research Center.Materials and methodsBetween October 2003 and June 2009, 87 patients with early glottic squamous cell carcinoma were treated with hypofractionated radiotherapy. All patients were included in the study (M: 94%; F:6%). Median age was 60 years (range: 21-81 years). Sixty-six percent of patients were smokers. AJCC stage was T1 in 95% and T2 in 5% of the patients. Radiotherapy dose was 55 Gy in 20 fractions over 4 weeks. All patients were treated on cobalt-60. Median radiotherapy treatment time was 28 days (range: 23-35 days).ResultsThe LRC rate after primary radiotherapy at 5 years was 91% (95% CI: 88-94%). The 5 years overall and disease-specific survival was 86% (95% CI: 81 and 91%) and 97% (CI 95%: 95 and 99%) respectively. Patients with T1a and T1b disease had LRC rates of 95 and 88% (p = 0.32). The LRC rates for patients with and without anterior commissure involvement at 5 years were 80 and 96% (p = 0.02) respectively.ConclusionHypofractionated radiotherapy 55 Gy in 20 fractions is comparable to conventional fractionation schedules in terms of locoregional control and survival while offering potential for optimizing resources usage.

Result of Laser Cordectomy in Early Glottic Cancer and Observation of Malignant Transformation from Precancerous Lesion

Background and Objectives : Laser cordectomy has been widely acknowledged to have advantages for the treatment of early glottic carcinoma. This study was performed to assess the results of laser cordectomy for its oncologic safeness, time-effectiveness, and to report a few interesting precancerous cases that have progressed to glottic cancer. Subjects and Method : Subjects (47) who had undergone laser cordectomy for the treatment of early glottic cancer from April 2006 to July 2009 were enrolled in this study. We analyzed the oncologic outcomes, the duration of hospital treatment after the surgery, and postoperative complications by reviewing of medical records. Results : For 47 cases, the mean age was 66 years and the mean follow up period was 22.6 months. The mean duration of treatment was 1.9 days. Among them, 24 cases were classified into T1a, 12 T1b, and 2 T2. Local recurrence was observed in 2 cases, so salvage treatments, such as radiation therapy or near total laryngectomy, were performed, and both of them were alive in the disease-free state. The most common complication was anterior commissure web, which was observed in 6 cases (15.8%), followed by granuloma observed in 5 cases (13.1%). Serious complications such as aspiration, respiratory distress, and dysphagia were not found in any of 47 cases. Also, we could observe 3 cases in which the precancerous glottic lesion had progressed to glottic carcinoma over a long period of time. Conclusion : Laser cordectomy might be the treatment of choice for patient's convenience because of its excellent oncologic outcomes, low morbidity, and time-effectiveness.

Evaluation of treatment results with regard to initial anterior commissure involvement in early glottic carcinoma treated by external partial surgery or transoral laser microresection

Modalities of surgical treatment of early glottic carcinoma include transoral laser microresection and external partial surgery. This is a retrospective analysis of 119 glottic carcinomas treated by external partial surgery (57 pT1a, 1 pT1b, 10 pT2) or transoral laser microresection (46 pT1a, 4 pT1b, 1 pT2) with special regard to initial anterior commissure involvement. Local recurrence in external partial surgery was 12%. Three- and 5-year local control was 86%. Local recurrence in transoral laser microresection was 16%. Three- and 5-year local control was 88% and 70%, respectively. No significant correlation was found between local control and surgical approach. An analysis of all 119 tumor revealed that anterior commissure involvement significantly decreased local control. Initial anterior commissure involvement was associated with a higher risk of local recurrence. Overall, treatment of glottic carcinoma involving the anterior commissure requires much experience and advanced surgical skills regardless which technique is preferred.

Diode laser microsurgery for treatment of Tis and T1 glottic carcinomas

Purpose The aim of the study was to demonstrate the oncologic safety of diode laser surgery in the treatment of early glottic carcinoma. Materials and methods The study included 45 patients affected by Tis and T1 glottic squamous cell carcinomas and treated endoscopically by diode laser (60 W, 810 nm). The endoscopic resections were graded according to the European Laryngological Society Classification including 5 types of cordectomy. These cases were classified according to the 2002 American Joint Committee on Cancer-International Union Against Cancer (AJCC-UICC) TNM system and included 9 Tis (20%), 31 T1a (68.9%), and 5 T1b (11.1%) glottic carcinomas. The length of follow-up ranged from 24 to 86 months, with an average follow-up period of 36 months. The case study included 39 males (86.7%) and 6 females (13.3%), aged 35 to 81 years, with a mean age of 51 years. Results There were 5 recurrences (11.1%): 4 local (8.9%), in which 3 were salvaged, and 1 (2.2%) regional. Three patients (6.7%) developed second primary cancers on the controlateral cord after a mean of 18 months. All local recurrences occurred in patients with T1b lesions. Forty patients (88.9%) were alive and disease-free at a median follow-up of 36 months. The overall larynx preservation was 97.6%. The actuarial recurrence-free survival analysis by the Kaplan-Meier method showed a survival of 92.3% at 2 years, 89.2 at 5 years, and 85.6 at 7 years. Conclusions Diode laser microsurgery is an oncologically safe, function-preserving modality for the treatment of Tis and T1 glottic carcinomas. This surgical technique provides excellent local control of disease and laryngeal preservation.

Treatment of Early-Stage Glottic Cancer by Transoral Laser Resection

We reviewed outcomes of treatment of early glottic carcinoma by transoral laser resection. We performed a retrospective study of tumor stage, type of cordectomy (European Laryngological Society), resection margins, local control, and laryngeal preservation. Of 142 patients treated with curative intent, 79 (92% male; average age, 63 years) were retained for this study, on the basis of availability of information regarding resection margins, the absence of adjuvant radiotherapy, and followup of at least 2 years. The tumors were classified pTis (n = 21), pT1a (n = 51), or pT1b (n = 7) and were treated by cordectomy types I (23%), II (30%), III (27%), IV (6%), and V (14%). The average follow-up was 56 months (range, 24 to 150 months). The overall 5-year actuarial recurrence-free survival rate was 89%, and the 5-year actuarial disease-specific survival rate was 97.3%. There were 11 local recurrences (14%); 7 were treated by another laser resection, 1 by radiotherapy, 1 by supracricoid partial laryngectomy, and 2 by total laryngectomy. The overall rate of final local control with the laser alone was 100% for patients with initially positive margins, 95% for those with initially suspicious margins, and 94% for those with free margins. The overall rate of organ preservation was 100% for patients with positive or suspicious margins and 96% for those with free margins. Margin status (p = .39), cordectomy type (p = .67), and anterior commissure involvement (p = .16) were not statistically related to recurrence (Kaplan-Meier calculations with nonparametric univariate analysis). The recurrence rate was significantly higher for T1b tumors, however (p = .001). Laser microresection provides high rates of local control and organ preservation for early glottic cancer. Positive or suspicious margins were not related to recurrence, nor was anterior commissure involvement. This study implies that suspicious margins can be managed with a "watch-and-wait" attitude. Re-treatment with laser, external partial laryngectomy, and radiotherapy remain therapeutic options for recurrences.

The Impact of the Glottic Configuration After Frontolateral Laryngectomy on the Perceptual Voice Analysis: A Preliminary Study

After the surgical treatment for early glottic carcinoma, the patients end up with voice disturbances in different grades. The aim of this study was to characterize the laryngeal configuration regarding the anterior commissure synechia and its relationship to the perceptual vocal quality. Twenty-five patients underwent frontolateral vertical partial laryngectomy and reconstruction with bipedicle sternohyoid muscle flap resulting from T1b/T2 glottic squamous cell carcinoma from January 1996 to December 2004. Of the 25 patients, 24 were male with a median age of 61 years. The patients were free of disease and the evaluation was performed after a minimum postoperative period of 12 months. Measurements of the anterior commissure synechia and the free border of both vocal folds were simultaneously performed with the perceptual analysis of the voice through GRBAS scale. We calculated the mathematical proportion between the midsagittal dimension of the synechia of the anterior commissure and the measurement of the free border of the intermembranous region of each vocal fold. The higher the relative measurement of the anterior commissure synechia, the worse the overall grade of hoarseness (G) for both vocal folds (P<0.001), the worse the roughness (R) for both vocal folds (P<0.001), and the worse the strained quality (S) for both the reconstructed (P=0.0086) and the preserved (P=0.0026) vocal folds. These results suggest that the relative measurement of the anterior commissure synechia is a crucial factor worsening voice quality and that the perceptual analyses score has a strong correlation to the synechia's impact.

Quality of life and voice in patients after laser cordectomy for TIS and T1 glottic carcinomas

Laser cordectomy is gaining popularity for treatment of early glottic carcinoma, but little is known about vocal and quality of life (QOL) outcomes as a function of extent of resection. We prospectively examined QOL and vocal function of patients with carcinoma in situ (Tis) or T1 glottic carcinomas after laser cordectomy. Patients (n = 75) were grouped into those who underwent unilateral subepithelial or subligamental resection (group A, n = 45); those who underwent unilateral transmuscular or total cordectomy (group B, n = 17); and those who underwent extended or bilateral cordectomy including the anterior commissure (group C, n = 19). The European Organization for Research and Treatment of Cancer head and neck cancer specific module (QLQ-H&N35), voice handicap index (VHI), and objective vocal function were examined before and 1 year after cordectomy and compared among the groups. No major complications were encountered, but local recurrence occurred in 10 patients, with group C showing the highest rate (6/19, 31.6%). Patient-reported speech and social contact scores of QOL questionnaire and VHI scores after surgery were higher in groups B and C than in group A (p < .05). The scores and perceptual and acoustic data were generally improved in all groups after surgery, but were statistically significant only in group A (p < .03). Our data suggest that early glottic cancers with a limited extent and infiltration depth have improved outcomes, both oncologically and functionally, compared to those lesions requiring extensive laser resection.

The role of laser microsurgery in the treatment of laryngeal cancer

Transoral laser microsurgery has developed in recent years into a surgical method that combines a minimally invasive approach with the surgical precision of laser and microscope. The outcomes of laser microsurgical treatment of laryngeal carcinomas are reviewed and compared with the results of competitive standard procedures. Laser microsurgery is widely acknowledged to have advantages in the treatment of early glottic carcinoma. In the treatment of glottic carcinoma causing impaired mobility or fixation of the vocal cord the role of laser surgery has not yet been definitively assessed. Based on published results, primary laser therapy can achieve local tumor control with a functional residual larynx in approximately 70-80% of cases. In patients with early or moderately advanced supraglottic carcinoma, laser microsurgery is comparable to open supraglottic laryngectomy in terms of local control and survival. With regard to organ preservation, laser microsurgery is comparable to open supraglottic laryngectomy but superior to radiotherapy. Microsurgery can preserve functionally important structures, allowing for early swallowing rehabilitation while avoiding tracheotomy. This review elucidates the role of laser microsurgical partial resections of the larynx in comparison with other treatment modalities.

Functional Outcomes after CO2 Laser Treatment of Early Glottic Carcinoma

To analyze vocal outcome after endoscopic CO2 laser treatment of early glottic carcinoma by perceptive and objective assessment. Retrospective study. Retrospective analysis of 141 consecutive patients undergoing surgery for previously untreated early glottic carcinoma between October 1993 and July 2003. Five types of laser cordectomies as classified by the European Laryngological Society classification were performed. Comparison of voice results between the different types of cordectomies as well as with a control group was performed. There was no significant difference in the vocal parameters between subepithelial and subligamental cordectomies and controls (P > .05). There was, however, a significant difference between the groups of transmuscular, total, and extended cordectomies and controls (P < .05). Good oncologic results and vocal outcomes with no difference between controls and subepithelial and subligamental cordectomies support the use of CO2 laser endoscopic surgery as the first line of treatment for early glottic cancer.

Tratamiento del cáncer glótico precoz con cirugía transoral láser CO2

ObjectiveWe present our outcome in the treatment of 125 patients with malignant glottic lesions between 1992 and 2003 in a retrospective study. Patient and methodsWe analyze 125 cases of patients, with previously untreated carcinoma of the larynx with histological diagnosis, treated with Transoral Laser Microresection. We will pay special attention to those tumors involving the Anterior Commissure. We will also analyze several parameters relaed to the post and intraoperatory histopathological report, in order to decide adjuvant therapies. We will also analyze the technique indications, complications, hospital length of stay, oncologic and functional outcomes, survival and follow up of recurrences. Outcomes and conclusionTransoral laser microresection is an effective and functional preserving procedure, and nowadays the base of the treatment of early glottic carcinoma. Anterior Commissure involvement is a prognostic factor. Sometimes complementary therapies are needed based on by the histopathological report.

The efficacy of voice therapy in patients after treatment for early glottic carcinoma

After treatment for early glottic carcinoma, a considerable number of patients end up with voice problems that interfere with daily life activities. The objective of this randomized and controlled study was to assess the efficacy of voice therapy in these patients. Of 177 patients, 6-120 months after treatment for early glottic carcinoma, 70 patients (40%) suffered from voice impairment based on a 5-item screening questionnaire. Approximately 60% of those 70 patients were not interested in participating in the current study. Twenty-three patients who were willing to participate were assigned randomly either to a voice therapy group (n = 12 patients) or to a control group (n = 11 patients). Multidimensional voice analyses (the self-reported Voice Handicap Index [VHI], acoustic and perceptual voice quality analysis, videolaryngostroboscopy, and the Voice Range Profile) were conducted twice: before and after voice therapy or with 3 months in between for the control group. Statistical analyses of the difference in scores (postmeasurement minus premeasurement) showed significant voice improvement after voice therapy on the total VHI score, percent jitter, and noise-to-harmonics ratio in the voice signal and on the perceptual rating of vocal fry. Voice therapy proved to be effective in patients who had voice problems after treatment for early glottic carcinoma. Improvement not only was noticed by the patients (VHI) but also was confirmed by objective voice parameters.

Conservative treatment of early glottic carcinomas with exclusive radiotherapy

Early glottic carcinomas can be treated with radiotherapy or surgery with similar local control rates but with better functional results with radiotherapy. The aim of this study was to analyze the results of our experience of exclusive radiotherapy. From 1975 to 2001, 155 patients with Tis, T1 and T2 glottic carcinomas were treated with exclusive radiotherapy. Prognostic factors of survival, local control and larynx-preservation rates were analyzed in uni and multivariate analyses. Median prescribed dose was 65 Gy in 44 days. Overall survival was 75% for the whole group, 75% for Tis, 85% for T1a, 72% for T1b, 59% for T2. Specific survival was 88% for the whole group, 75% for Tis, 94% for T1a, 90% for T1b, 69% for T2. Disease-free survival was 68% for the whole group, 75% for Tis, 77% for T1a, 51% for T1b, 58% for T2. Laryngeal preservation rate was 85% (133/155). Twenty-nine (29/155, 18%) patients developed a local relapse within 31 months. Out of the 10/86 (12%) T1a-Tis relapses, 7/10 patients underwent total laryngectomy and 79/86 larynx were preserved (92%). Out of the 8/22 (36%) T1b relapses, 4/8 patients underwent total laryngectomy. Out of the 11/47 (23%) T2 relapses, 8/11 patients underwent total laryngectomy. Increased overall treatment time, tumor stage, sub-glottis extension were associated with poorer local control. Second malignancies remain a major problem in the outcome of this population. Radiotherapy remains an efficient option in the treatment of early glottic carcinomas providing a high local control rate with excellent functional results in laryngectomy-free patients. This strategy should be discussed according to the tumor stage, feasibility of conservative surgery and patient's preferences.

Conservative treatment of early glottic carcinomas with exclusive radiotherapy

Background. – Early glottic carcinomas can be treated with radiotherapy or surgery with similar local control rates but with better functional results with radiotherapy. The aim of this study was to analyze the results of our experience of exclusive radiotherapy. Patients and methods. – From 1975 to 2001, 155 patients with Tis, T1 and T2 glottic carcinomas were treated with exclusive radiotherapy. Prognostic factors of survival, local control and larynx-preservation rates were analyzed in uni and multivariate analyses. Results. – Median prescribed dose was 65 Gy in 44 days. Overall survival was 75% for the whole group, 75% for Tis, 85% for T1a, 72% for T1b, 59% for T2. Specific survival was 88% for the whole group, 75% for Tis, 94% for T1a, 90% for T1b, 69% for T2. Disease-free survival was 68% for the whole group, 75% for Tis, 77% for T1a, 51% for T1b, 58% for T2. Laryngeal preservation rate was 85% (133/155). Twenty-nine (29/155, 18%) patients developed a local relapse within 31 months. Out of the 10/86 (12%) T1a-Tis relapses, 7/10 patients underwent total laryngectomy and 79/86 larynx were preserved (92%). Out of the 8/22 (36%) T1b relapses, 4/8 patients underwent total laryngectomy. Out of the 11/47 (23%) T2 relapses, 8/11 patients underwent total laryngectomy. Increased overall treatment time, tumor stage, sub-glottis extension were associated with poorer local control. Second malignancies remain a major problem in the outcome of this population. Conclusion. – Radiotherapy remains an efficient option in the treatment of early glottic carcinomas providing a high local control rate with excellent functional results in laryngectomy-free patients. This strategy should be discussed according to the tumor stage, feasibility of conservative surgery and patient’s preferences. Objectif. – Les cancers glottiques peuvent être traités par chirurgie ou par irradiation avec la même efficacité carcinologique mais avec un meilleur résultat fonctionnel après irradiation. L’objectif de cette étude était d’analyser les résultats de notre expérience du traitement de ces cancers par irradiation exclusive. Patients et méthodes. – De 1975 à 2001, 155 patients atteints de cancer glottique classé Tis, T1, T2 ont été traités par irradiation. Les facteurs pronostiques des taux de survie, de contrôle local et de conservation laryngée ont été étudiés dans le cadre d’une analyse unifactorielle et multifactorielle. Resultats. – La dose médiane prescrite était de 65 Gy en 44 jours. Les taux de survie globale à cinq ans étaient de 75 % pour l’ensemble de la population, 75 % si la tumeur était classée Tis, 85 % T1a, 72 % T1b et 59 % T2. Le taux de survie spécifique était de 88 pour le groupe entier, 75 % si la tumeur était classée T1a, 90 % T1b et 69 % T2. Le taux de survie sans maladie était de 68 % pour la population entière, 75 % si la tumeur était classée Tis, 77 % T1a, 51 % T1b et 58 % T2. Le taux de conservation laryngé était de 85 %. Vingt et un malades (18 %) ont souffert d'une récidive locale dans les 31 mois après le traitement. Parmi les 10/86 (12 %) tumeurs classées T1a-TIS ayant récidivé, 7 ont été « rattrapés » par laryngectomie totale. Parmi les 11/47 (23 %) tumeurs classées T2 ayant récidivé, 8 ont été « rattrapées » par laryngectomie totale. Une durée de traitement augmentée, le stade tumoral, une extension sous-glottique étaient associés à une réduction de la probabilité de contrôle local. Les seconds cancers restent un problème majeur dans le suivi de ces malades. Conclusion. – La radiothérapie reste une option thérapeutique efficace dans le traitement des cancers localisés du plan glottique. Elle permet un taux de contrôle local élevé avec d’excellents résultats fonctionnels chez les patients conservant leur larynx. Cette stratégie doit être discutée en fonction du stade tumoral, des possibilités de chirurgie partielle et des préférences du patient.

Laser surgery for the treatment of glottic carcinomas

Purpose: The standard treatment for patients with early glottic carcinoma in Israel has been radiotherapy. In recent years, encouraging results with laryngo-microscopic carbon dioxide laser surgery as a treatment for early glottic carcinoma has changed our treatment strategy. We conducted a retrospective study to investigate the results of carbon dioxide laser excisional technique for early glottic carcinoma (T1, T2). Materials and Methods: Twenty-six had squamous cell carcinoma (SCC), (21 patients with T1 and 5 patients with T2 lesions), 3 had carcinoma in situ, (CIS) and 3 had verrucous carcinoma (VC). Results: All patients were free of disease after salvage treatment at the most recent follow-up. Conclusions: Careful patient selection with endoscopic staging and strict follow-up are essential to secure good results in the treatment of carbon dioxide laser for early laryngeal carcinoma. (Am J Otolaryngol 2003;24:28-33. Copyright 2003, Elsevier Science (USA). All rights reserved.)

Laser cordotomy versus radiotherapy: an objective cost analysis.

This study presents a cost analysis of and comparison between laser cordotomy and external beam irradiation for the treatment of early glottic carcinoma. It compares the curative results of the two modalities from data of a retrospective study at my institution and a literature review of published cure rates. It also reviews the results of objective voice assessments in cases representing both treatments. The findings of this study indicate that the cure rates are equivalent and that voice quality obtained after laser cordotomy is comparable to that obtained after irradiation, yet the total cost of external beam radiotherapy is significantly higher than that of laser surgery. Hence, the findings of this study provide strong support for initially treating early glottic tumors with laser surgery.

Radiotherapy with 6-megavolt photons for early glottic carcinoma: Potential impact of extension to the posterior vocal cord

Purpose: Radiation therapy has a high success rate in the treatment of early glottic carcinoma. Excellent outcomes have been reported from centers using cobalt-60 or relatively low-energy (≤4 MV) radiation therapy to achieve these results. Whether similar outcomes can be achieved with a 6 MV linear accelerator has been less rigorously evaluated. This study assesses the efficacy of 6 MV radiation therapy for early stage glottic cancer and identifies prognostic factors for local control and overall survival in this common disease. Materials and Methods: One hundred twenty-eight consecutive cases of Tis, T1, and T2 squamous cell carcinomas of the glottis from 1982 to 1996 were retrospectively analyzed with regard to local control and survival. All patients were treated with definitive radiation therapy with a 6-MV linear accelerator. Potential prognostic factors for local control and survival were evaluated with univariate and multivariate models. Median follow-up of locally controlled patients was 65 months. Results: The overall 3-year actuarial local control rates for T1 and T2 carcinomas were 86% and 68%, respectively. Patients with lesions involving the posterior third of the vocal cord had significantly worse 3-year local control (76% vs. 86%, P =.038). Radiation therapy technique and overall treatment time did not significantly affect local control. For patients with Tis and T1 lesions, factors associated with significantly worse local control included cordectomy-ineligible disease (P =.024), dose less than 6,600 cGy (P =.024), and lesions limited to the posterior third of the vocal cord (P =.004). Three-year local control was 76%, with doses less than 6,600 cGy and 90% with higher doses. High rates of second primary malignancies were observed and represented the major cause of death. Five-year overall survival was 84%. Conclusions: The use of 6-MV photons for treatment of early glottic cancer seems to achieve local control similar to that reported with lower-energy photons. However, patients with posterior third involvement had a poorer local control rate with standard radiation therapy, thereby suggesting that alternative approaches be considered. (Am J Otolaryngol 2001;22:43-54. Copyright © 2001 by W.B. Saunders Company)