Outcome of Open Surgical Therapy for Glottic Carcinoma

1993 ◽  
Vol 102 (10) ◽  
pp. 752-755 ◽  
Author(s):  
Jonas T. Johnson ◽  
Sheng-Po Hao ◽  
Eugene N. Myers ◽  
Robin L. Wagner
Keyword(s):  
Neck Dissection ◽  
Distant Metastasis ◽  
Medical Records ◽  
Glottic Cancer ◽  
Partial Laryngectomy ◽  
Glottic Carcinoma ◽  
Early Glottic Cancer ◽  
Regional Control ◽  
Open Surgical Therapy ◽  
Voice Preservation

A retrospective review was undertaken of the medical records of 270 patients with carcinoma of the glottic larynx. Patients were staged pathologically, and clinical pathologic correlates were made with outcome. In 92 patients with early glottic cancer, the 2-year rate of no evidence of disease for T1 was 98%, and for T2, 84%. Vertical partial laryngectomy resulted in voice preservation in 89%. Patients treated for advanced (T3 or T4) glottic carcinoma underwent total laryngectomy with or without neck dissection. Cervical nodes were involved in 22% of T3 and 41% of T4 patients at the time of treatment. Survival with no evidence of disease was chiefly determined by the development of regional recurrence, distant metastasis, and new primary cancer. Distant metastasis was associated with extracapsular spread (p = .003). Patients treated for T4 glottic carcinoma with neck dissection had improved survival compared with patients treated with laryngectomy alone (p = .006). Improved survival must be aimed at regional control, prevention, and management of distant metastasis and new primary carcinoma.

Predictive Factors of Carcinological Outcomes for Glottic Cancer Treated With Transoral Laser Cordectomy

2020 ◽  
Vol 2 (1) ◽  
pp. 01-04
Author(s):  
ALJ zineb
Keyword(s):  
Predictive Factors ◽  
Laser Surgery ◽  
Local Control Rate ◽  
Glottic Cancer ◽  
Glottic Carcinoma ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Early Glottic Cancer ◽  
Transoral Laser Surgery ◽  
Preservation Rate

Tran’s oral laser surgery is at the forefront of the therapeutic arsenal of epidermoid glottic cancer, but its indications for certain local extensions are controversial. We have analyzed through a retrospective study of 37 patients with T1 or T2 epidermoid glottic carcinoma, treated with transoral laser surgery, the post-surgical outcomes regarding the relapse-free survival, local control rate, laryngeal preservation rate and overall survival, correlated to the initial local extension. This study aimed at clarifying further the clinical behavior of early glottic cancer following transoral laser surgery and to determine, using retrospective analysis, and the predictive factors of carcinological outcomes.

Longitudinal analysis of Voice Handicap Index in early glottic cancer patients treated with transoral laser microsurgery: age, gender, stage and time dependence

2019 ◽  
Vol 133 (4) ◽  
pp. 318-323 ◽  
Author(s):  
C Lane ◽  
M Rigby ◽  
R Hart ◽  
J Trites ◽  
E Levi ◽  
...  
Keyword(s):  
Voice Handicap Index ◽  
Glottic Cancer ◽  
Glottic Carcinoma ◽  
Transoral Laser Microsurgery ◽  
Laser Microsurgery ◽  
Early Glottic Cancer ◽  
Related Quality ◽  
The Voice

AbstractObjectivesTransoral laser microsurgery is an increasingly common treatment modality for glottic carcinoma. This study aimed to determine the effect of age, gender, stage and time on voice-related quality of life using the Voice Handicap Index-10.MethodsPrimary early glottic carcinoma patients treated with transoral laser microsurgery were included in the study. Self-reported Voice Handicap Index testing was completed pre-operatively, three months post-operatively, and yearly at follow-up appointments.ResultsVoice Handicap Index improvement was found to be dependent on age and tumour stage, while no significant differences were found in Voice Handicap Index for gender. Voice Handicap Index score was significantly improved at 12 months and 24 months. Time versus Voice Handicap Index modelling revealed a preference for non-linear over linear regression.ConclusionAge and stage are important factors, as younger patients with more advanced tumours show greater voice improvement post-operatively. Patient's Voice Handicap Index is predicted to have 95 per cent of maximal improvement by 5.5 months post-operatively.

scholarly journals Evaluation of acute/late toxicity and local recurrence in Τ1-Τ2 glottic carcinoma treated with accelerated hypofractionated 3D-conformal external beam radiotherapy (3D-CRT)

2013 ◽  
Vol 47 (2) ◽  
pp. 185-191 ◽  
Author(s):  
Vassilis E. Kouloulias ◽  
Anna Zygogianni ◽  
Eftychia Mosa ◽  
Kalliopi Platoni ◽  
John Georgakopoulos ◽  
...  
Keyword(s):  
Local Recurrence ◽  
External Beam Radiotherapy ◽  
Late Toxicity ◽  
Glottic Cancer ◽  
Primary Study ◽  
Radiation Toxicity ◽  
Glottic Carcinoma ◽  
Conventional Fractionation ◽  
Effects Of Radiation ◽  
Voice Preservation

Background.The aim of the study was to evaluate the efficacy, as well as the acute and late toxicity of an accelerated hypofractionated 3DCRT schedule as radical treatment in patients with organ confined glottic cancer cT1-2N0. Patients and methods. Between June of 2004 and September 2010, 47 retrospectively selected patients (29 males, 18 females) diagnosed with organ confined T1 or T2 glottic cancer, were treated with external 3DCRT in an accelerated hypofractionation schedule. The median age was 70 years. A dose of 64.4 Gy in 28 daily fractions was prescribed. The primary study endpoints were to assess the acute and late effects of radiation toxicity, according to the EORTC/ RTOG scale, as well as the therapeutic impact of this schedule in terms of local recurrence. Results. The median follow up was 36 months. At the end of radiotherapy, grade I, II and III acute toxicity was observed in 34, 9 and4 patients, respectively. Late grade I and II toxicity was observed in 25 and in 8 patients respectively. Only two local recurrences were observed, 15 and 24 months post 3DCRT respectively. Conclusions. Our radiotherapy schedule achieves a high locoregional control rate with the advantage of voice preservation. The proposed hypofractionated schedule can be recommended as a standard radiotherapy treatment, since these results are comparable with those of conventional fractionation schedules.

Partial Vertical Laryngectomy in the Treatment of Early Glottic Cancer

1998 ◽  
Vol 107 (7) ◽  
pp. 593-597 ◽  
Author(s):  
Tzung-Shiahn Sheen ◽  
Jenq-Yuh Ko ◽  
Yen-Liang Chang
Keyword(s):  
Neck Dissection ◽  
Glottic Cancer ◽  
Salvage Operation ◽  
Early Glottic Cancer ◽  
Larynx Preservation ◽  
Neck Recurrence ◽  
Group 5 ◽  
Lost To Follow Up ◽  
Recurrence Group

Treatment of early glottic cancer is still controversial. A retrospective study was conducted to analyze the results of 49 partial vertical laryngectomies in our department. All patients except 1 were successfully decannulated. The quality of voice was suboptimal but serviceable in all patients. Overall, there were 9 recurrences: 7 in the larynx and 2 in the neck. In the laryngeal recurrence group, 5 of 6 patients were successfully salvaged with total laryngectomy. One patient died of acute renal failure 1 month after salvage operation. Another patient survived 4.5 years after cisplatin-based chemotherapy. In the neck recurrence group, 1 patient was successfully salvaged with neck dissection; the other was lost to follow-up after neck dissection. The actuarial 5-year survival rate was 97.4% and the larynx preservation rate was 88%. The recurrence rate was 14%, when 2 of the 7 laryngeal recurrences were excluded because they occurred beyond 5 years. The results of this series were encouraging. We suggest that partial vertical laryngectomy is a good treatment modality for selected early glottic cancers, especially those of the T1 group.

scholarly journals Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

2014 ◽  
Vol 128 (12) ◽  
pp. 1089-1094 ◽  
Author(s):  
A Deganello ◽  
G Meccariello ◽  
B Bini ◽  
F Paiar ◽  
R Santoro ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Positive Node ◽  
Glottic Cancer ◽  
Elective Neck Dissection ◽  
Recurrent Tumour ◽  
Node Negative ◽  
Early Glottic Cancer ◽  
Node Positive ◽  
Laryngeal Surgery ◽  
Curative Radiotherapy

AbstractObjectives:To assess the clinical utility of elective neck dissection in node-negative recurrent laryngeal carcinoma after curative radiotherapy for initial early glottic cancer.Methods:A retrospective review was undertaken of 110 consecutive early glottic cancer patients who developed laryngeal recurrence after radiotherapy (34 recurrent T1, 36 recurrent T2, 29 recurrent T3 and 11 recurrent T4a) and received salvage laryngeal surgery between 1995 and 2005.Results:Six patients presented with laryngeal and neck recurrence and underwent salvage laryngectomy with therapeutic neck dissection, 97 patients with recurrent node-negative tumours underwent salvage laryngeal surgery without neck dissection and only 7 underwent elective neck dissection. No occult positive lymph nodes were documented in neck dissection specimens. During follow up, only three patients with neck failure were recorded, all in the group without neck dissection. There was no significant association between the irradiation field (larynx plus neck vs larynx) and the development of regional failure. A higher rate of post-operative pharyngocutaneous fistula development occurred in the neck dissection group than in the group without neck dissection (57.2 per cent vs 13.4 per cent, p = 0.01). Multivariate logistic regression analysis showed that early (recurrent tumour-positive, node-positive) or delayed (recurrent tumour-positive, node-negative) neck relapse was not significantly related to the stage of the initial tumour or the recurrent tumour. An age of less than 60 years was significantly associated with early neck failure (recurrent tumour-positive, node-positive).Conclusion:Owing to the low occult neck disease rate and high post-operative fistula rate, elective neck dissection is not recommended for recurrent node-negative laryngeal tumours after radiation therapy if the initial tumour was an early glottic cancer.

scholarly journals Our Approach for Optimizing Vocal Outcomes in Transoral Laser Microsurgical Resection of Early Glottic Carcinoma

2016 ◽  
Vol 6 (2) ◽  
pp. 68-72
Author(s):  
Shraddha Deshmukh
Keyword(s):  
Residual Disease ◽  
Critical Factor ◽  
Glottic Cancer ◽  
Type I ◽  
Glottic Carcinoma ◽  
Early Glottic Cancer ◽  
Microsurgical Resection ◽  
Moderate Change ◽  
Early Glottic Carcinoma ◽  
Vocal Outcome

ABSTRACT Objectives To assess oncologic and functional outcomes of early glottic cancer cases treated with transoral laser microsurgical resection (TLMR) and to outline the principles for optimizing vocal outcomes in these cases. Materials and methods Sixty six patients with early glottic cancer (7 CIS, 43 T1a, 15 T1b, 1 T2) underwent TLMR. Postoperatively, voice quality was assessed by Oates Russell Voice Profile. Results Local control was achieved in 95.08% of the cases and larynx was preserved in 98.3%. Residual disease developed in 3 patients. There were eight local recurrences. Single patient of T1b lesion was lost to follow-up and came back with stridor and underwent total laryngectomy. Conclusion Early glottic cancers can be effectively treated by TLMR with good oncologic outcome. Depth of infiltration of lesion is the most critical factor affecting the postoperative vocal outcome. In our study near-normal conversational voice to moderate change in voice was found after type I, II, and III cordectomies. Surprisingly, type VI cordectomy also gave a serviceable vocal outcome with moderate change in voice. In our opinion, type IV cordectomy does not give a serviceable vocal outcome even if performed unilaterally. Thus radiotherapy should be strongly considered in such cases for better vocal outcome. How to cite this article Nerurkar NK, Deshmukh S. Our Approach for Optimizing Vocal Outcomes in Transoral Laser Microsurgical Resection of Early Glottic Carcinoma. Int J Phonosurg Laryngol 2016;6(2):68-72.

scholarly journals Factors affecting voice quality in early glottic cancer before and after radiotherapy

2019 ◽  
Vol 53 (4) ◽  
pp. 459-464 ◽  
Author(s):  
Jana Mekis ◽  
Primoz Strojan ◽  
Irena Hocevar Boltezar
Keyword(s):  
Anterior Commissure ◽  
Voice Quality ◽  
Vocal Folds ◽  
Medical Documentation ◽  
Glottic Cancer ◽  
Glottic Carcinoma ◽  
Early Glottic Cancer ◽  
Factors Affecting ◽  
Maximum Phonation Time ◽  
Multimodal Methods

Abstract Background Radiotherapy (RT) is a successful mode of treatment for early glottic cancer. The aim of the study was to assess voice quality both before and 3 months after successful RT using multimodal methods while also identifying the factors affecting it. Patients and methods In 50 patients with T1 glottic carcinoma, the subjective (patients’ assessment of voice quality [VAS], Voice Handicap Index [VHI] questionnaire, phoniatricians’ assessment using the grade/roughness/ breathiness [GRB] scale), and objective assessments (fundamental laryngeal frequency [F0], jitter, shimmer, maximum phonation time [MPT]) of voice quality were performed before RT and 3 months post-RT. The data on gender, age, extent of the tumors, biopsy types, smoking, local findings, and RT were obtained from the medical documentation. Results Three months after the treatment, VAS, VHI, G and R scores, F0, and MPT significantly improved in comparison with their assessment prior to treatment. Before the treatment, the involvement of the anterior commissure significantly deteriorated jitter (p = 0.044) and the involvement of both vocal folds deteriorated jitter (p = 0.003) and shimmer (p = 0.007). After the RT, F0 was significantly higher in the patients with repeated biopsy than in the others (p = 0.047). In patients with post-RT changes, the B score was significantly higher than in those without post-RT changes (p = 0.029). Conclusions Voice quality already significantly improved three months after the treatment of glottic cancer. The main reason for the decreased voice quality prior to treatment is the tumor’s extent. Post-RT laryngeal changes and repeated biopsies caused more scarring on vocal folds adversely influencing voice quality after the treatment.

Radiotherapy for T1 Carcinoma of the Glottis

1995 ◽  
Vol 81 (6) ◽  
pp. 414-418 ◽  
Author(s):  
Vincenzo Tombolini ◽  
Alfredo Zurlo ◽  
Paola Cavaceppi ◽  
Agatina Sarro ◽  
Carlo Guidi ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Voice Quality ◽  
Field Size ◽  
Glottic Cancer ◽  
Surgical Approaches ◽  
Glottic Carcinoma ◽  
Laryngeal Function ◽  
Radiotherapy Alone ◽  
Voice Preservation ◽  
University Of Rome

Aims and background The management of patients with T1 carcinoma of the glottic larynx is controversial, because surgery and radiation therapy are reported to be effective treatments. Several studies have shown radiotherapy to be safe and effective, with a high percentage of voice preservation and minimal complications, but most Italian physicians prefer to surgically treat such patients. Methods From 1980 to 1990, 36 patients with stage I squamous cell glottic carcinoma were treated with radiotherapy alone at the Institute of Radiology of University of Rome “La Sapienza”. In all patients the irradiation fields were limited to the larynx, with field size ranging from 4 × 4 cm to 7 × 7 cm. Total tumor doses ranged between 51 and 70 Gy (median 60 Gy) with a mean number of 30 fractions of 2 to 3 Gy per fraction (3 or 5 fractions per week). Results After a median follow-up of 98 months, we observed an overall survival rate at 5 years of 91.4% and actuarial 10-year survival of 85.7%. Local control was achieved in 97.1% of cases, with an event-free survival of 94.2% at 5 and 10 years. No major complications like necrosis or persistent edema of the larynx were observed. Minor complications like dysphonia (8%) and dysphagia (5.5%) were temporary; laryngeal function was completely preserved at the end of therapy. Final voice quality ranged from good to excellent. Conclusions Our series confirms that radiation therapy has a major role in the management of early glottic cancer, with results comparable to surgical approaches and with better voice preservation.

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