title: Carbon dioxide laser salvage surgery after radiotherapy failure in T1 and T2 glottic carcinoma.
abstract: OBJECTIVE
  Recurrent glottic carcinoma after radiotherapy (RT) may be managed by open neck or endoscopic surgery. The impact of endoscopic treatment with CO(2) laser for recurrent glottic carcinoma after RT is reported.
  
  
  METHODS
  We present the oncologic and vocal outcomes of a retrospective study based on a series of 16 patients with rT1 and rT2 glottic carcinoma who were endoscopically managed between February 1995 and December 1999 after RT failure. All patients were males with a mean age of 68.7 years (range, 50 to 87 years). Before RT, the lesions had been staged as T1 N0 in 11 patients and T2 N0 in 5, and after RT as rT1 N0 in 12 and rT2 N0 in 4. According to the European Laryngological Society classification, a total of 9 transmuscular, 3 total, and 4 extended cordectomies were performed. Mean follow-up was 45 months (range, 9 to 79 months).
  
  
  RESULTS
  Endoscopic salvage surgery was successful in 14 patients. One of them developed a second recurrence and was definitively cured with an additional endoscopic procedure. Two of the 16 patients had recurrent disease after salvage laser surgery and died due to progression of disease. Ultimate local control with laser alone at 3 years was 87.1%, according to the Kaplan-Meier method. Laryngeal preservation was obtained in all survivors after endoscopic rescue surgery. Voice analysis showed a clear correlation between the amount of vocal cord tissue resected and decrease of the vocal outcome.
  
  
  CONCLUSIONS
  The present series indicates that selected recurrences after primary RT for T1 and T2 glottic carcinoma are eligible for endoscopic salvage surgery with oncologic results comparable to those with open neck procedures but with a lower complication rate and a favorable functional outcome.
authors.affiliation: Department of Surgical Sciences and Organ Transplantations, Section of Otorhinolaryngology, University of Cagliari, Italy. puxeddu@unica.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Puxeddu
authors.forename: Cesare
authors.initials: C
authors.lastname: Piazza
authors.forename: Maria C
authors.initials: MC
authors.lastname: Mensi
authors.forename: Gian Peppino
authors.initials: GP
authors.lastname: Ledda
authors.forename: Federico
authors.initials: F
authors.lastname: Argiolas
authors.forename: Giorgio
authors.initials: G
authors.lastname: Peretti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide; D005260:Female; D005931:Glottis; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy; D017211:Treatment Failure
chemical_list: D002245:Carbon Dioxide