A critical review of radiotherapy in the management of T1 glottic carcinoma.
BACKGROUND
It is generally believed that patients presenting with T1 glottic cancer can be treated with either surgery or radiation therapy (RT) with similar expectations relative to tumor control. Accordingly, many institutions routinely treat patients with T1 glottic cancer with RT. This retrospective study was undertaken to ascertain the efficacy of RT in the treatment of these patients.


METHODS
The records of 40 patients initially treated with RT between 1974 and 1989 were retrospectively reviewed. Parameters assessed included incidence of tumor control, need for and type of subsequent salvage surgical procedures, quality of voice, and ultimate survival rate.


RESULTS
In a group of 38 evaluable patients, 10 (26%) developed recurrence in the larynx and 2 (5.6%) in the cervical lymphatics. Salvage surgery resulted in 6 (16%) total laryngectomies. Death from T1 glottic cancer occurred in 1 (2.6%) patient. Speech results were judged good in 24% of patients, whereas 66% were felt to have impaired speech with elements of glottic fry, harshness, low pitch, and inefficient breath support. The additional costs incurred by patients requiring subsequent intervention are substantial.


CONCLUSIONS
Cordectomy may be a superior option for management of T1 glottic cancer. Initial tumor control is probably superior and literature review suggests that surgery may be a more economical option and should be seriously considered for the management of T1 glottic cancer. This is a US government work. There are no restrictions on its use.
Otolaryngology-Head and Neck Surgery Service, Madigan Army Medical Center, Tacoma, WA 98431.
M R
MR
Morris
D
D
Canonico
C
C
Blank
D002278:Carcinoma in Situ / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D007825:Laryngectomy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000628:therapy; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D011832:Radiation Injuries / Q000453:epidemiology; D012189:Retrospective Studies; D016879:Salvage Therapy; D013068:Speech Production Measurement; D015996:Survival Rate; D016896:Treatment Outcome