Initial Treatment and Conservation Salvage Surgery of Early Glottic Cancer

Choi, Jong Yoon; Baek, Chung Hwan; Jeong, Han Sin; Chung, Man Ki; Chung, Young Jun; Lee, Hyeok Jun; Son, Young Ik

Abstract

BACKGROUND AND OBJECTIVES
Surgery or radiation therapy is most widely employed in the treatment of early glottic cancer with no significant difference in the survival rate. Various treatment modalities including surgery, radiation therapy or combined therapy can also be adopted for recurring early glottic cancer. Nowadays, conservation salvage surgery presents as an excellent alternative to the traditional total laryngectomy with favorable results. The objective of this study is to compare the outcome of each treatment modality for early glottic cancer and evaluate the role of conservation salvage surgery for recurring cases. SUBJECTS AND METHOD: Seventy-three patients with early glottic cancer (stage Tis, T1, T2 N0M0) were treated between January 1995 and December 2001, and followed up for at least over an year. They were divided into two groups with the standards of whether they had surgery or radiation therapy as an initial treatment. Then, both groups were analyzed for local control and recurrence rate after initial treatment and conservation salvage surgery for recurrent case, respectively. RESULTS: Twenty-four patients had conservation surgery and 49 had radiation therapy as an initial treatment. Local control rate was 100% for conservation surgery, 93.9% for radiation therapy and there was no significant difference between groups. Recurrence rate for each group was 8.3% and 15.3%, respectively, but no statistical difference was found. Twelve patients showed recurreence or had remnant cancer. Conservation salvage surgery including laser cordectomy, hemilaryngectomy, frontolateral hemilaryngectomy, and supracricoid partial laryngectomy had been performed in 10 cases. In all cases, laryngeal preservation was possible and there was no recurrence of tumor during follow up periods. CONCLUSION: As an initial treatment modality, conservation surgery and radiation therapy was proven to be equally effective for early glottic cancer with no significant difference in local control and recurrence rate. For the recurrent cases, conservation salvage surgery including supracricoid partial laryngectomy was shown to be a very useful treatment modality with good oncological results and excellent laryngeal preservation.