title: Surgical options in radiotherapy-failed early glottic cancer.
abstract: After failure of curative radiotherapy (RT), surgery is the main therapeutic option to control recurrent laryngeal cancer. Recurrences after RT for T1-T2 tumours of the glottic larynx are often diagnosed at a more severe stage than the original disease and, thus, usually treated by radical approaches. Our aim is to investigate the feasibility of more conservative strategies for proper treatment of post-RT recurred glottic cancer. We collected and reviewed our files from 1990 to 2006, selecting 75 patients which matched the following inclusion criteria: (1) patient was originally diagnosed with early stage squamous cell carcinoma of the glottic larynx (stage I-II according to 2010 TNM), (2) patient was treated by RT with curative intent, (3) patient presented a recurrence of disease after RT which was surgically treated at our Institution. T stage at first diagnosis was T1a in 41 cases (55%), T1b in 12 (16%) and T2 in 22 (29%). At clinical examination of RT-recurred lesions, we documented advanced lesions (rT3-rT4) in 29 out of 75 patients (39%). Overall, an upstage was reported for 56% RT-recurred cancers, while 37.3% remained at the same stage than the original tumour and 6.7% were downstaged. Twelve patients (16%) underwent salvage partial laryngectomy (SPL), while 63 (84%) received a salvage total laryngectomy (STL). Multivariate analysis showed that rTNM according to the AJCC-UICC of 2010 was the only prognostic factor for both disease-free survival (p = 0.042) and overall survival (p = 0.004). Considering the prognostic impact of rT and rN we documented a statistical significance only in terms of overall survival for both factors (p = 0.004 and p = 0.04, respectively). Although STL remains the most frequent treatment choice for failures after RT in laryngeal carcinomas, SPL represents a valid option for selected patients with limited recurrence and can deliver good oncologic and functional results if performed according to careful indications.
authors.affiliation: 1st Clinic of Otolaryngology/Head and Neck Surgery, Department of Translational Surgery, University of Florence, V.le Morgagni 85, Florence, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Santoro
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Meccariello
authors.forename: Giuditta
authors.initials: G
authors.lastname: Mannelli
authors.forename: Belinda
authors.initials: B
authors.lastname: Bini
authors.forename: Fabiola
authors.initials: F
authors.lastname: Paiar
authors.forename: Oreste
authors.initials: O
authors.lastname: Gallo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005931:Glottis / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D000077195:Squamous Cell Carcinoma of Head and Neck; D017211:Treatment Failure; D016896:Treatment Outcome