INTRODUCTION: Radiation therapy is often the first method of treating
patients with early cancer of the glottis. There is a substantial
failure rate among these patients. Total laryngectomy has usually been
the means of treating patients with failure after radiation. In recent
decades, partial laryngectomy has been used for salvage in such
patients. This article will discuss the use of partial laryngectomy for
radiation failure both from the oncologic result as well as the
morbidity.
PATIENTS AND METHODS: Between 1984 and 1995, 27 patients with
early-stage laryngeal carcinoma underwent salvage partial laryngectomy
after irradiation failure. Vertical laryngectomy was performed in 18
patients (13 with T1 N0 and 5 with T2 N0) and horizontal-supraglottic
laryngectomy in 9 patients (3 with T1 N0, 1 with T2 N0, and 5 with T2
N1). The mean follow-up was 4.1 years. RESULTS: Local control was
obtained in 77.7% of patients with glottic lesions (T1: 84.6%; T2:
60%, P = NS) and in 55.5% of patients with supraglottic lesions (T1:
66.6%; T2: 50%; P = NS). There was no regional recurrence in the
vertical laryngectomy group, whereas the regional control rate in the
horizontal-supraglottic laryngectomy group was 77.7%. Distant control
was achieved in 94.4% of patients with glottic disease and in 77.7% of
patients with supraglottic disease. The overall survival rate for
glottic lesions was 88.8% (T1: 92.3%; T2: 80%; P = NS) versus 66.6%
for supraglottic lesions (T1: 100%; T2: 50%; P = NS).
CONCLUSION AND SIGNIFICANCE: Vertical laryngectomy was not associated
with an increased complication rate. Morbidity in the
horizontal-supraglottic laryngectomy group was higher, but a
satisfactory functional outcome was obtained in all cases. Therefore, in
early laryngeal cancer (glottic T1 42, supraglottic T1) partial
laryngectomy can be performed with good expectation of cure and
satisfactory laryngeal function. In T2 supraglottic lesions, the
oncologic results are less satisfactory; further research is required
for developing more efficient complimentary or alternative treatments
modalities