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Oncological Results

Mohssen Ansarin, MD; Marek Planicka, MD; Silvana Rotundo, MSc; Luigi Santoro, MSc; Valeria Zurlo, PhD; Fausto Maffini, MD; Daniela Alterio, MD; Augusto Cattaneo, MD; Fausto Chiesa, MD

Arch Otolaryngol Head Neck Surg. 2007;133(12):1193-1197.

Objective  To evaluate local control, organ preservation, and complications after endoscopic laser surgery for early recurrent glottic cancer after radiotherapy.

Design  Retrospective study.

Setting  European Institute of Oncology, Milan, Italy.

Patients  The study, which was conducted between May 1999 and September 2005, included 37 consecutive patients (33 men and 4 women) with recurrent glottic cancer after radiotherapy. Selection criteria were as follows: rcTis, rcT1, or rcT2 with subglottic or supraglottic involvement of less than 5 mm and no arytenoid invasion; adequate laryngeal exposure; no previous open surgery; no contraindications to general anesthesia; and signed consent.

Interventions  Endoscopic laser surgery with curative intent using types III to V cordectomies according to the European Laryngological Association.

Main Outcome Measures  Five-year actuarial recurrence-free and overall survival, complications, and rate of laryngeal preservation.

Results  The clinical classifications of the recurrences were rcTis (n = 4), rcT1a (n = 10), rcT1b (n = 11), and rcT2 (n = 12). The pathologic classifications of the recurrences were rpT0 (n = 2), rpTis (n = 5), rpT1a (n = 9), rpT1b (n = 3), rpT2 (n = 14), and rpT3 (n = 4). The median follow-up was 44 months (range, 18-88 months). New recurrences developed in 13 patients (35%): 11 were treated by total laryngectomy, 1 by supracricoid laryngectomy, and 1 by chemotherapy. Three patients died of laryngeal cancer, 1 is alive with disease, and 1 died of a second cancer. Five-year actuarial recurrence-free and overall survival rates were 58% and 86%, respectively. The larynx was preserved in 26 patients (70%). Laryngeal stenosis was the most common major complication (in 3 of 4 women and 1 of 33 men).

Conclusions  Endoscopic laser surgery is a safe and effective salvage procedure in selected cases involving glottic recurrence after radiotherapy. Oncological results are satisfactory, and organ preservation can be achieved in a high proportion of cases; however, the risk of laryngeal stenosis is high in women.

Author Affiliations: Divisions of Head and Neck Surgery (Drs Ansarin, Planicka, Zurlo, Cattaneo, and Chiesa and Ms Rotundo), Epidemiology and Biostatistics (Mr Santoro), Pathology (Dr Maffini), and Radiotherapy (Dr Alterio), European Institute of Oncology, Milan, Italy.