Survival rates in conservation surgery of the larynx

Chondrosarcoma of the larynx: the role of radiotherapy revisited--a case report and review of the literature

BACKGROUND

Experience in the treatment of laryngeal chondrosarcoma is based on about 250 cases reported to date. The standard therapy is conservative surgery. Radiotherapy has universally been regarded as ineffective in the treatment of this disease.

METHODS

A patient with a laryngeal chondrosarcoma was observed for 11 years after radical radiotherapy. The literature on laryngeal chondrosarcoma was critically reviewed, with emphasis placed on radiotherapy.

RESULTS

The review of the literature revealed that experience with radiotherapy of laryngeal chondrosarcoma has been lacking, with fewer than 10 cases with short follow-up documented up to now. Meanwhile, increasing evidence of the efficacy of radiotherapy in the treatment of skeletal chondrosarcoma has emerged. The authors report the first case of chondrosarcoma of the larynx in which radical radiotherapy resulted in a long term remission of more than 10 years.

CONCLUSIONS

Radiotherapy should be considered when radical surgery is not feasible without severe mutilation. It should also be considered for the treatment of residual disease. Laryngectomy should be restricted to salvage treatment when radiotherapy fails. In this study, radiotherapy appeared to be an effective modality in the treatment of low grade laryngeal chondrosarcoma, and these results contrast with the current widespread disapproval of this treatment.

Radiation therapy of glottic carcinoma: Peter MacCallum Cancer Institute experience

The medical records of patients with T1N0, T2N0 and T3N0 squamous cell carcinomas of the glottis treated at the Peter MacCallum Cancer Institute between January 1983 and October 1988 were retrospectively reviewed. One hundred and twenty-seven patients were identified. There were 93 T1, 26 T2 and eight T3 tumours. These patients were treated with curative radiotherapy (60-70 Gy). The survival from glottic cancer of patients with T1, T2 and T3 tumours at 5 years was estimated to be 97, 62 and 100% respectively. The local disease free survival for T1 and T2 disease at 5 years was estimated to be 82 and 65% respectively. The local disease free survival for T3 tumours at 2 years was estimated to be 63% with 5 year survival not yet reached. The surgical salvage rates for 24 radiotherapy failures were 77, 25 and 66% for T1, T2 and T3 tumours respectively. Radiotherapy remains the treatment of choice for T1 tumours and a viable alternative to primary laryngectomy in more advanced glottic tumours, with salvage surgery in reserve.

Vertical partial laryngectomy: our results after treating 81 cases of T2 and T3 laryngeal carcinomas

From 1976 to 1989, 81 patients with T2 and T3 laryngeal carcinomas were treated with vertical patrial laryngectomy at the University ENT Department of Thessaloniki, Greece. All patients were male with a median age of 56 years (33-71 years). Four patients had N1 lymph nodes. Ten patients received post-operative radiotherapy. Seventeen patients developed local recurrences or distant metastases. Mean follow-up was more than seven years. Absolute three-year survival was 94.6 per cent for 74 patients and absolute five-year survival was 89.6 per cent for 58 patients. Actuarial five-year survival of the whole group of 81 patients was 91 per cent calculated with the Kaplan-Meier method. Recurrence rate and survival of stage II and III patients are also discussed and compared using the log-rank test. We conclude that vertical partial laryngectomy is a very successful treatment selection for T2 glottic and false vocal cord carcinomas and for some selected T3 glottic lesions.

A therapeutic approach to early vocal cord carcinoma

One hundred and twenty patients with early glottic carcinoma received radiation therapy at the University of Maryland Hospital from 1959 to 1977. The radiation dose ranged from 55 Gy in 4 weeks for small T1a lesions to 65 Gy in 61/2 weeks for T2 lesions. The local control rates by irradiation alone for stages T1a, T1b, and T2 were 92, 91 and 88 per cent, respectively, while 5-year determinate disease-free survival rates were 96 per cent for stage I disease and 88 per cent for stage II disease. Most of the local failures were salvaged by surgery, with a low complication rate. Regional metastases were uncommon, and occurred in 7 per cent in stage I and in 6 per cent in stage II disease. Factors increasing the risk of failures appeared to be bulky tumor, anterior commissure involvement and subglottic extension.

Current trends in the treatment of cancer of the larynx

The case histories of 250 patients with cancer of the larynx presenting to the Peter MacCallum Hospital, the Alfred Hospital and the Royal Melbourne Hospital in the ten-year period 1966 to 1975 have been reviewed to determine: The results of primary irradiation treatment of T1N0 and T2N0 glottic cancer; The comparative results of primary irradiation plus salvage surgery as compared with primary radical surgery for T3N0 glottic and supraglottic cancer; and The surgical morbidity of secondary salvage laryngectomy following irradiation as compared with that of primary total laryngectomy. These findings are compared with those of a previous study of cancer of the larynx for the period 1956 to 1965.

Carcinoma of the endolarynx: results of irradiation

Irradiation at the University of Michgan in the 1960's was carried out in 192patients with endolaryngeal carcinoma. Thirty-two and 66% of the cases were located inthe supreaglottic and glottic regions respectively. Cases were classified in stages appropiate TNM GROUPING. Results were analyzed with respect to tumor location, size, anddose-time relationship. Early lesions were controlled more often than advanced ones. Radical surgery to the primary and/or neck improved overall survival, which was 89% at 5years for 127 glottic carcinoma cases and 61% for 61 patients with supraglottic tumors. No significant complications were found following radiation therapy.