Partial laryngectomy after radiation failure

Of patients given radiation therapy as primary treatment for limited carcinoma of the larynx, 15-32% will not be cured by this modality. The recurrent tumor and primary site can be encompassed with a partial laryngectomy in a certain number of these individuals. This report reviews the subject of partial laryngectomy after radiation failure and reports experience with 18 patients who had partial laryngectomies to control recurrent or persistent carcinoma after full dose radiation therapy. Four patients had biopsy cures. Local tumor control was achieved by partial laryngectomy in 10 of 14 patients. Three of 4 partial failures were salvaged with total laryngectomy. Major wound complications were noted in 4 patients. Prolonged healing was observed in most patients. Prognosis is probably as good with partial laryngectomy as with total laryngectomy.     

Voice quality after radiation therapy for early glottic cancer

OBJECTIVE: To evaluate the voices of irradiated patients with early glottic carcinoma and to compare these with the voices of healthy volunteers. DESIGN: Case-control study. SETTING: University Department of Otorhinolaryngology and Cervicofacial Surgery, University of Ljubljana, Ljubljana, Slovenia. SUBJECTS AND METHODS: The voice samples (sustained vowel) of 50 patients (44 men and 6 women) who had been irradiated for T1 (43 subjects) or T2 (7 subjects) glottic squamous carcinoma at least 1 year prior to the study were analyzed with the Multi-Dimensional Voice Program (Kay Elemetrics Corp, Lincoln Park, NJ) and compared with those of a normal group of 50 age- and sex-matched volunteers. Average fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, and degree of voiceless elements were determined. In the irradiated group, videostroboscopy was performed. The patients assessed their voice fatigue. RESULTS: The irradiated subjects demonstrated significantly higher values for jitter, shimmer, and degree of voiceless elements than did the healthy volunteers. The values for noise-to-harmonic ratio were higher in the irradiated group, but the difference was not significant (P =.08). The values for fundamental frequency were almost equal in both groups. In most of the irradiated subjects, some irregularities of the vocal fold vibration were noticed. Many of these patients also reported voice fatigue. CONCLUSIONS: Radiation therapy for early glottic cancer results in poorer voice quality compared with normal age- and sex-matched speakers. In most of the irradiated patients, greater than normal effort in voice production was found based on patient assessment. This may result from stiffness of the vibratory source and inadequate compensatory maneuvers in phonation. We suggest that voice therapy during and after radiation therapy may result in better voice quality.     

Partial laryngectomy after irradiation failure

Forty-three patients who had partial laryngectomies after radiotherapy were evaluated. Forty-two had failed irradiation for laryngeal carcinoma. Nine had supraglottic procedures, 3 endoscopic, and 31 vertical partial. Twelve (28%) required subsequent completion laryngectomy. Major complications included laryngeal stenosis in 1, incompetent laryngeal sphincters in 2, mucocutaneous fistulas in 3, and delayed deglutition in 3. Six patients had positive permanent section margins. In 5 of those, intraoperative frozen sections had been taken and were negative. Recurrent or persistent disease was eventually demonstrated in all patients with positive margins. The 2-year determinant disease-free survival rate for stage I and II disease was 85%. Three-year disease-free survival was 50% for stage III and IV disease. Partial laryngectomies, including supraglottic, can be done after irradiation failure with a high expectation of cure and acceptable morbidity. Immediate additional operation should be considered in patients with positive margins.     

Supracricoid laryngectomy as salvage surgery after failure of radiation therapy

Supracricoid laryngectomy can be an alternative in selected patients with a local recurrence after radiotherapy when endoscopic treatment or more conservative external approaches are not indicated. In this study, we reviewed our experience in patients who underwent salvage supracricoid laryngectomies for local recurrence following radiotherapy. Between 1997 and 2005, salvage supracricoid laryngectomy was performed in nine consecutive patients. The primary tumour was located in the glottis in eight cases and in the supraglottis in one case. The reconstruction method consisted of a cricohyoidoepiglottopexy in six cases and a cricohyoidopexy in three. One patient died of a complication associated to salvage treatment and another died as a consequence of a new recurrence of the laryngeal tumour. All patients were decannulated and recovered the ability to swallow. The mean cannulation and nasogastric feeding tube times were 11 and 27 days, respectively. The mean hospitalisation time was 34 days. Six patients had wound healing complications, all of which were solved without further surgery. Laryngeal function was preserved in 78% of the patients treated. In conclusion, supracricoid laryngectomy is an effective technique as salvage treatment in selected cases of local recurrence after radiotherapy and it can be an alternative to total laryngectomy when other methods of salvage conservation laryngeal surgery are not indicated.     

Partial vertical laryngectomy for recurrent glottic carcinoma

Partial vertical laryngectomy for recurrent glottic carcinoma was performed in 61 patients according to stringent criteria. The great majority of the recurrent tumours appeared within 2 years of radiotherapy (80%). The mean follow-up after surgery was 79 months. At 5 years 85% of the patients were free of local recurrence. Nine patients (15%) developed a local recurrence; eight of them underwent total laryngectomy; one patient refused the operation and died. Seven patients died of other causes. The actuarial overall survival rate was 88% at 5 years. Post-operative complications were seen in 12 patients (20%); nine of these patients developed airway problems. One patient underwent total laryngectomy for severe aspiration, the others finally were decannulated. The results of this study indicate that partial vertical hemi-laryngectomy for irradiation failures is a safe procedure with good results without undue morbidity.     

声门型喉癌T_3病变喉部分切除术后疗效评价

目的　探讨喉部分切除术对声门型喉癌T3 病变的可行性及修复材料的选择。方法　对 1986年 1月～ 1994年 1月 78例行喉部分切除术的声门型喉癌T3 病变患者的术式及修复方法进行了回顾性分析。结果　患者 3年、5年生存率分别为 88 5 %、75 6 % ,局部复发率 15 4%。应用了梨状窝粘膜 甲状软骨板外侧软骨膜、会厌软骨瓣及带状肌双肌双蒂瓣 3种方法修复创面 ,均获得了较好的喉功能恢复。结论　喉部分切除术是根治声门型喉癌T3 病变合理、有效的方式 ,但不能完全替代全喉切除术 ,应根据切除范围选择合理的修复方式。     

声门型喉癌T3病变喉部分切除术后疗效评价

目的 探讨喉部分切除术对声门型喉癌Ｔ３病变的可行性及修复材料的选择。方法 对１９８６年１月～１９９４年１月７８例行喉部分切除术的声门型喉癌Ｔ３病变患者的术式及修复方法进行了回顾性分析。结果 患者３年、５年生存率分别为８８．５％、７５．６％,局部复发率１５．４％。应用了梨状窝粘膜＋甲状软骨板外侧软骨膜,会厌软骨瓣及带状肌双肌双蒂瓣３种方法修复创面,均获得了较好的喉功能恢复。结论 喉部分切除术是根治声     

Partial laryngectomy with imbrication laryngoplasty for glottic carcinoma

BACKGROUND: Treatment options for unilateral glottic carcinoma include radiation therapy, partial laryngectomy, and endoscopic cordectomy. We used partial laryngectomy with imbrication laryngoplasty (PLIL) for definitive treatment with curative intent in a select group of patients. STUDY DESIGN: Retrospective multicenter review of 24 patients treated with PLIL. Data collection included demographics, tumor characteristics, time to decannulation, time to oral food intake, local control, survival, voice result as judged by the physician, voice result as judged by the patient, and patient satisfaction. SETTING: Five academic medical centers. METHODS: PLIL includes a composite resection of the entire vocal fold, with its ligament, muscle, adjacent paraglottic tissues, and the adjacent block of thyroid cartilage. A neocord is reconstructed by imbricating the remaining thyroid cartilage strips and covering them with a false vocal fold flap. RESULTS: A total of 24 patients (T1, n = 13; T2, n = 10; and T3, n = 1) underwent PLIL. Median time to decannulation was 4 days, and median time to oral food intake was 5 days. Clear margins were achieved in 23 patients (96%). Follow-up ranged from 1 to 11 years (median duration of follow-up, 5.5 years). In the patients who had clear margins at the initial surgery, the rate of overall disease control was 100%. Voice quality was judged by the physician as good or excellent in 100% of the patients who underwent PLIL, and as better than typical hemilaryngectomy in 23 patients (96%). Twenty-three patients (96%) were satisfied with their voice quality. CONCLUSIONS: PLIL provides us with a single modality curative approach to unilateral glottic carcinoma. It also provides rapid recovery of oral and/or nasal airway and swallowing, excellent voice quality, and a disease-control rate similar to or better than other treatment modalities.     

Definitive radiation therapy for early glottic cancer: experience of two fractionation schedules

Objectives

The authors would report the results of definitive radiation therapy (RT) for early glottic cancer by two different radiation dose schedules.

Methods

From February of 1995 till June of 2008, 157 patients with T1-2N0 glottic cancer were treated with curative RT at Samsung Medical Center. All patients had squamous cell carcinoma, and there were 89 patients (56.7%) with T1a, 36 (22.9%) with T1b, and 32 (20.4%) with T2. Two different radiation dose schedules were used: 70 Gy in 35 fractions to 64 patients (40.8%, group A); and 67.5 Gy in 30 fractions to 93 patients (59.2%, group B). The median treatment durations were 50 days (range, 44 to 59 days) and 44 days (range, 40 to 67 days) in the groups A and B, respectively.

Results

The median follow-up durations were 85 and 45 months for the groups A and B. No severe late complication of RTOG grade 3 or higher was observed, and there was no difference in acute or chronic complication between the groups. Twenty-four patients experienced treatment failure: local recurrence only in 19 patients; regional recurrence only in one; combined local and regional recurrence in four; and systemic metastasis in none. The overall 5-year disease-free survival and disease-specific survival rates were 84.7% and 94.8%. The disease-free survival rate in the group B was better (78.3% vs. 90.8%, P=0.031). This difference was significant only in T1 stage (83.4% vs. 94.6%, P=0.025), but not in T2 (62.7% vs. 60.6%, P=0.965). Univariate analysis showed that the tumor extent, cord mobility, T-stage, and the dose schedule had significant influence on the disease-free survival, and multivariate analysis showed that only the tumor extent and the dose schedule were associated with the disease-free survival.

Conclusion

Superior disease-free survival could be achieved by 2.25 Gy per fraction without increased toxicity over shorter RT duration, when compared with 2.0 Gy per fraction.     

Partial laryngectomy for recurrent cancer after irradiation

Attention is drawn to the problems of surgical resection by partial laryngectomy after full therapeutic dosage of Telecobalt irradiation. Material is presented from 2 main treatment centres to indicate trends in surgical treatment and the complications experienced. End results are given which confirm a reasonable expectation of cure and functional conservation by vertical partial laryngectomy for recurrence of glottic cancer after irradiation. However, the results of treatment of recurrent supraglottic cancer by horizontal partial laryngectomy gave much cause for concern in terms of complications and survival. In conclusion an attempt is made, based on the quoted experience, to define the position of conservation surgery after full dosage irradiation of the larynx.     

Partial laryngectomy with imbrication laryngoplasty for unilateral glottic carcinoma

Treatment options for unilateral glottic carcinoma include radiation therapy, partial laryngectomy, and endoscopic cordectomy. We use partial laryngectomy with imbrication laryngoplasty (PLIL) as a single modality curative approach in a selected group of patients with unilateral glottic carcinoma. PLIL includes a composite resection of the entire vocal fold with its ligament, muscle, adjacent paraglottic tissues, and the adjacent block of thyroid cartilage. A neocord is reconstructed by imbricating the remaining thyroid cartilage strips and covering them with a false vocal fold flap. PLIL provides a rapid recovery of oral/nasal airway and swallowing, excellent voice quality, and a disease-control rate similar or better than other treatment modalities.     

Hemilaryngectomy rescue surgery for radiation failure in early glottic carcinoma

Radiotherapy for early glottic carcinoma has produced excellent results and low complication rates. Therefore, hemilaryngectomy and other forms of vertical partial laryngectomy have been used mainly for rescue therapy following radiation failure. Over a 9-year period selective application of this approach was used in eight patients out of 122 laryngeal cancer surgeries performed. Five patients were T1N0 and three were T2N0 at the time of initial diagnosis and at the time of recurrence. Three patients had healing problems postoperatively. Tracheal decannulation time was increased compared to patients who had hemilaryngectomy without previous radiotherapy. To date there has been no recurrence of carcinoma at any site with a mean follow-up of 58 months in surviving patients. This experience confirms reports which indicate that with careful selection, radiation failures for early glottic carcinoma can be rescued by hemilaryngectomy achieving excellent tumor control and moderately good preservation of laryngeal function.     

Analysis of swallowing after partial frontolateral laryngectomy with epiglottic reconstruction for glottic cancer

The aim of the study was to evaluate swallowing using a reproducible objective methodology and to seek preoperative factors that could influence swallowing outcomes in patients operated on for partial laryngectomy. Twenty-four patients who underwent partial frontolateral laryngectomy with epiglottic reconstruction for T1bN0 or T2N0 glottic carcinoma between 2008 and 2012 were retrospectively evaluated. Using fiberoptic endoscopic and videofluoroscopic evaluation, early (15 days postoperatively) and late (2 months postoperatively) scores were obtained for all patients to quantify their swallowing skills. Eighty-three percent of patients achieved at least partial oral feeding at time of hospital discharge and 87.5 % achieved exclusive oral feeding within 2 months postoperatively. Early score was good or excellent in 50 %, average in 4.2 % and poor in 41.8 %. Regarding late scores, 63 % were classified as having a good or excellent late score, 7 patients (29 %) were classified as “middle result” because their time to recover was longer (i.e. between 1 and 2 months postoperatively), and two patients had a poor late score. Finally, at last follow-up, only one patient was partially fed by gastrostomy (180 days after surgery). T stage (p = 0.04) was the only factor influencing early swallowing outcomes and length of hospital stay was longer for poor scores than for good late results (p = 0.02). Our findings show good outcomes in terms of postoperative swallowing. Objective assessment of deglutition is essential for a better understanding of the mechanisms of postoperative swallowing disorders and for patient selection.     

Predicting failure to speak after laryngectomy

Postlaryngectomy speech rehabilitation involves interactive psychosocial and physiological considerations. Progress may be facilitated by early identification and timely management of counterproductive factors. A retrospective review of patient records was conducted to identify salient factors in the rehabilitative processes of these patients. A method for using these factors predictively is proposed. Application of this procedure may result in improved efficiency of treatment and management of clinical resources.     

声门型喉癌部分喉切除术后复发原因探讨及预防

目的：探讨声门型喉癌术后复发的原因，提出有效的防治措施。方法：对我院191年8月－2001年8月收的46例声门型喉癌部分喉切除术后复发病例进行回顾性分析，对原发肿瘤的部位、手术方式及复发肿瘤的部位进行了分析。结果：46例首次复发声门型喉癌病例中，局部复发32例，其中喉内第二原发病变致术后局部复发13例，占40．6％（13／32）。颈部复发14例，其中上颈部是颈部复发的重要部位，占42．9％（6／14）。喉内局部复发再次手术治疗后第2次复发的9例中，上颈部和局部复发仍是主要的复发部位，占55．6％（5／9）。结论：正确处理晚期声门型喉癌和喉内局部复发癌的上颈部淋巴结及正确认识声门型喉癌内第二原发病变并作相应的处理是降低声门型喉癌术后复发的重要措施。     

Analysis of failure following transoral laser surgery for early glottic cancer

This study aimed at clarifying further the clinical behavior of early glottic cancer following transoral laser surgery and to determine, using retrospective analysis, whether the site of tumor involvement along the vocal fold has prognostic significance. The study included all patients treated with transoral laser surgery, for early glottic cancer (T1/T2N0M0) between May 1998 and January 2012 in a university affiliated tertiary care medical center. Data on demographics, site and extent of disease, treatment and outcome were collected and analyzed. Patients with insufficient data and/or follow-up of <2 years were excluded from the study. One-hundred and twenty-one patients were eligible for the study. Mean follow up time was 6.7 years (range 2–12 years). Overall recurrence rate following primary transoral laser surgery was 16.5 %. Histological grade was associated with higher recurrence rate (p = 0.008). Anterior commissure involvement was associated with reduced disease-free survival and tumors extending to the middle third of the true vocal fold were associated with lower recurrence rate. As per the results, anterior extension of glottic tumors is associated with higher recurrence rate compared to middle vocal fold extension, presumably due to earlier detection, better visualization and different biological behavior pattern of middle vocal fold tumors. Patients with higher grade tumors should be closely monitored for disease recurrence.