Verrucous carcinoma of the larynx: determining the best treatment option.
BACKGROUND
Verrucous carcinoma (VC) of the larynx is a rare variant of well-differentiated squamous cell carcinoma, characterized by locally invasive, exophytic warty growth. The purpose of the present study was to evaluate the experience with this rare disease in Slovenia over a 23-year period and to weigh the potential for cure of different treatment options against the functional outcome.


METHODS
The databases of the Cancer Registry of Slovenia as well as of the registries of all three departments licensed for the treatment of laryngeal cancer in the country were used for the identification of patients. Presentation, diagnosis, treatment and outcome were reviewed retrospectively.


RESULTS
From 1980 to 2002, 30 patients were diagnosed with VC of the larynx, representing 1.23% of all laryngeal malignancies. The most frequent site of origin was the glottis. Twenty-three patients had surgery (functional 13; total laryngectomy 10), three patients had radiotherapy, and a combination of irradiation and concomitant chemotherapy was used in four patients. Only one tumor recurred, six months after primary radiation treatment, but was successfully salvaged with a total laryngectomy. The 5-year overall survival rate of 75% was not significantly different from an age- and sex-matched cohort from the Slovenian population (P=0.071).


CONCLUSIONS
In VC of the larynx, determination of treatment options should be dictated by voice preservation strategies. Surgery remains the gold standard of treatment. However, concomitant radiochemotherapy emerges as an attractive alternative to mutilating surgical procedures.
Strojan
P
P
Department of Radiation Oncology, Institute of Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia. pstrojan@onko-i.si <pstrojan@onko-i.si>
Smid
L
L
Cizmarevic
B
B
Zagar
T
T
Auersperg
M
M
D000368:Aged; D000369:Aged, 80 and over; D018289:Carcinoma, Verrucous / Q000188:drug therapy / Q000453:epidemiology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D017524:Slovenia / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome