Ann Otol Rhinol LaryngollOO:1991
PARTIAL LARYNGECTOMY AFTER IRRADIATION FAILURE SAMUEL
RICHARD D. NICHOLS, MD
A. MICKELSON,
MD
DETROIT, MICHIGAN
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 (280/0) 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 he considered in patients with positive margins. KEY WORDS - laryngectomy, partial laryngectomy, radiotherapy, recurrent tumor, squamous cell carcinoma.
from 60 to 70 Gy. Stage of the disease at diagnosis was 33 stage I, 6 stage II, 1 stage III, and 3 stage IV. None of the patients with stage III and IV disease had impaired vocal cord mobility. One had T2NIMO disease (stage III). Three had T4 primary tumors (stage IV), in each case because of extension of disease outside the larynx.
Limited carcinoma of the larynx can be treated with irradiation or partial laryngectomy. Certain patients fail primary treatment with either modality. Our standard protocol is that patients eligible for vertical partial laryngectomy are treated with irradiation primarily, with partial laryngectomy reserved for failures. The exception is that supraglottic laryngectomy is often recommended instead of irradiation for primary treatment of supraglottic tumors. We reviewed our experience with partial laryngectomy salvage of 18 irradiated patients in 19801 and concluded that such a protocol produced an excellent cure rate. There was some concern about incision of irradiated cartilage, but the study revealed acceptable postoperative morbidity as well.
The tumors originated in the glottis in 33 patients, the supraglottic pyriform sinus in 1, and the supraglottic larynx or immediately contiguous area in 9. The interval between conclusion of irradiation and recurrence or persistence of tumor ranged from 1 to 191 months with a mean of 22.8 months and a median of 10 months. Twenty-seven or 65 % of the patients had recurrences within 12 months, 32 or 76 % had recurrences within 24 months, and 3 patients or 7 % were considered to be free of disease for more than 60 months after irradiation.
We have treated 25 additional patients with partial removal of the larynx after irradiation and report our experience with all 43 patients in this communication.
The surgical procedures performed are listed in Table 1. Fourteen patients had cordectomies. The majority of those patients did not have removal of laryngeal cartilage. Nine had supraglottic laryngectomies. Six of those were considered to be extended operations, usually with removal of portions of the base of the tongue. In one patient, the involved side of the base of the tongue was excised to the region of
MATERIALS AND METHODS
Forty-three consecutive patients who had partial laryngectomies after irradiation of the larynx during the years 1961 to 1988 were evaluated. Fortytwo of the patients had failed irradiation given as primary treatment for carcinoma of the larynx and contiguous areas. One patient was treated with 60 Gy after radical removal of the right submandibular gland for adenocarcinoma. The larynx was in the treatment field for the duration of the irradiation. That patient is included in the evaluation of morbidity of partial laryngectomy after irradiation but not in the estimate of tumor control possible with partial removal of the larynx after irradiation failure.
TABLE 1. SURGICAL PROCEDURES Cordectomy Frontolateral laryngectomy Supraglottic laryngectomy Extended operation Anterovertical laryngectomy Laterovertical laryngectomy Epiglottectomy Endoscopic removal of tumor Total
There were 40 men and 3 women ranging in age from 44 to 75 years. The dose of radiation ranged
From the Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan. Presented at the meeting of the American Laryngological Association, San Francisco, California, April 1-2, 1989. REPRINTS - Richard D. Nichols, MD, Dept of Otolaryngology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202.
176
Downloaded from aor.sagepub.com at University of Sussex Library on June 9, 2016
14 11 9 6 4 2 1
2
43
Nichols & Mickelson, Partial Laryngectomy After Irradiation TABLE2. STATUS OF PATIENTSWHO HAD STAGES I AND II Living with no evidence of disease >5 Y 2 to 5 y
PARTIAL LARYNGECTOMY AFTER IRRADIATION FAILURE SAMUEL
RICHARD D. NICHOLS, MD
A. MICKELSON,
MD
DETROIT, MICHIGAN
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 (280/0) 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 he considered in patients with positive margins. KEY WORDS - laryngectomy, partial laryngectomy, radiotherapy, recurrent tumor, squamous cell carcinoma.
from 60 to 70 Gy. Stage of the disease at diagnosis was 33 stage I, 6 stage II, 1 stage III, and 3 stage IV. None of the patients with stage III and IV disease had impaired vocal cord mobility. One had T2NIMO disease (stage III). Three had T4 primary tumors (stage IV), in each case because of extension of disease outside the larynx.
Limited carcinoma of the larynx can be treated with irradiation or partial laryngectomy. Certain patients fail primary treatment with either modality. Our standard protocol is that patients eligible for vertical partial laryngectomy are treated with irradiation primarily, with partial laryngectomy reserved for failures. The exception is that supraglottic laryngectomy is often recommended instead of irradiation for primary treatment of supraglottic tumors. We reviewed our experience with partial laryngectomy salvage of 18 irradiated patients in 19801 and concluded that such a protocol produced an excellent cure rate. There was some concern about incision of irradiated cartilage, but the study revealed acceptable postoperative morbidity as well.
The tumors originated in the glottis in 33 patients, the supraglottic pyriform sinus in 1, and the supraglottic larynx or immediately contiguous area in 9. The interval between conclusion of irradiation and recurrence or persistence of tumor ranged from 1 to 191 months with a mean of 22.8 months and a median of 10 months. Twenty-seven or 65 % of the patients had recurrences within 12 months, 32 or 76 % had recurrences within 24 months, and 3 patients or 7 % were considered to be free of disease for more than 60 months after irradiation.
We have treated 25 additional patients with partial removal of the larynx after irradiation and report our experience with all 43 patients in this communication.
The surgical procedures performed are listed in Table 1. Fourteen patients had cordectomies. The majority of those patients did not have removal of laryngeal cartilage. Nine had supraglottic laryngectomies. Six of those were considered to be extended operations, usually with removal of portions of the base of the tongue. In one patient, the involved side of the base of the tongue was excised to the region of
MATERIALS AND METHODS
Forty-three consecutive patients who had partial laryngectomies after irradiation of the larynx during the years 1961 to 1988 were evaluated. Fortytwo of the patients had failed irradiation given as primary treatment for carcinoma of the larynx and contiguous areas. One patient was treated with 60 Gy after radical removal of the right submandibular gland for adenocarcinoma. The larynx was in the treatment field for the duration of the irradiation. That patient is included in the evaluation of morbidity of partial laryngectomy after irradiation but not in the estimate of tumor control possible with partial removal of the larynx after irradiation failure.
TABLE 1. SURGICAL PROCEDURES Cordectomy Frontolateral laryngectomy Supraglottic laryngectomy Extended operation Anterovertical laryngectomy Laterovertical laryngectomy Epiglottectomy Endoscopic removal of tumor Total
There were 40 men and 3 women ranging in age from 44 to 75 years. The dose of radiation ranged
From the Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan. Presented at the meeting of the American Laryngological Association, San Francisco, California, April 1-2, 1989. REPRINTS - Richard D. Nichols, MD, Dept of Otolaryngology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202.
176
Downloaded from aor.sagepub.com at University of Sussex Library on June 9, 2016
14 11 9 6 4 2 1
2
43
Nichols & Mickelson, Partial Laryngectomy After Irradiation TABLE2. STATUS OF PATIENTSWHO HAD STAGES I AND II Living with no evidence of disease >5 Y 2 to 5 y
