title: Diagnosis and treatment of recurrent laryngeal cancer following initial nonsurgical therapy.
abstract: Surgery is the preferred modality for curative treatment of recurrent laryngeal cancer after failure of nonsurgical treatments. Patients with initial early-stage cancer experiencing recurrence following radiotherapy often have more advanced-stage tumors by the time the recurrence is recognized. About one third of such recurrent cancers are suitable for conservation surgery. Endoscopic resection with the CO(2) laser or open partial laryngectomy (partial vertical, supracricoid, or supraglottic laryngectomies) have been used. The outcomes of conservation surgery appear better than those after total laryngectomy, because of selection bias. Transoral laser surgery is currently used more frequently than open partial laryngectomy for treatment of early-stage recurrence, with outcomes equivalent to open surgery but with less associated morbidity. Laser surgery has also been employed for selective cases of advanced recurrent disease, but patient selection and expertise are required for application of this modality to rT3 tumors. In general, conservation laryngeal surgery is a safe and effective treatment for localized recurrences after radiotherapy for early-stage glottic cancer. Recurrent advanced-stage cancers should generally be treated by total laryngectomy.
authors.affiliation: Department of Head and Neck Surgery, Hospital Aristides Maltez, Salvador, Brazil.
authors.forename: Ivan Marcelo Gonçalves
authors.initials: IM
authors.lastname: Agra
authors.forename: Alfio
authors.initials: A
authors.lastname: Ferlito
authors.forename: Robert P
authors.initials: RP
authors.lastname: Takes
authors.forename: Carl E
authors.initials: CE
authors.lastname: Silver
authors.forename: Kerry D
authors.initials: KD
authors.lastname: Olsen
authors.forename: Sandro J
authors.initials: SJ
authors.lastname: Stoeckli
authors.forename: Primož
authors.initials: P
authors.lastname: Strojan
authors.forename: Juan P
authors.initials: JP
authors.lastname: Rodrigo
authors.forename: João
authors.initials: J
authors.lastname: Gonçalves Filho
authors.forename: Eric M
authors.initials: EM
authors.lastname: Genden
authors.forename: Missak
authors.initials: M
authors.lastname: Haigentz
authors.forename: Avi
authors.initials: A
authors.lastname: Khafif
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
authors.forename: Peter
authors.initials: P
authors.lastname: Zbären
authors.forename: Carlos
authors.initials: C
authors.lastname: Suárez
authors.forename: Dana M
authors.initials: DM
authors.lastname: Hartl
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rinaldo
authors.forename: Kwang Hyun
authors.initials: KH
authors.lastname: Kim
authors.forename: Luiz P
authors.initials: LP
authors.lastname: Kowalski
mesh_terms: D003952:Diagnostic Imaging; D006801:Humans; D007822:Laryngeal Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy* / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods; D007828:Laryngoscopy; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D018579:Patient Selection; D016879:Salvage Therapy