title: Treatment considerations for early glottic carcinoma: lessons learned and a primer for the general otolaryngologist.
abstract: In this commentary, we review our experience with early glottic carcinomas in an attempt to identify points to consider when developing a treatment protocol and technical considerations in oncologic resection to maintain laryngeal function. We highlight several consistent themes: (1) difficult exposure is not always a contraindication to endoscopic resection; (2) depth of invasion may be apparent only intraoperatively; (3) radiation therapy should be offered for deeply invasive cancers requiring extensive cordectomy or for patients who cannot afford lengthy vocal downtime; however, (4) radiation therapy leads to acute dysphagia and collateral damage to the contralateral vocal fold that is avoided with surgery; (5) good voice can be obtained after healing if resection is limited to intramuscular cordectomy; (6) the key to optimal vocal results is adequate glottal closure; and (7) second look operations are occasionally necessary, and therefore preoperative counseling should include this possibility. Since both surgery and radiation therapy achieve excellent oncologic control, a patient-centered approach is preferred in management.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Nausheen
authors.initials: N
authors.lastname: Jamal
authors.forename: Elazar
authors.initials: E
authors.lastname: Sofer
authors.forename: Dinesh K
authors.initials: DK
authors.lastname: Chhetri
mesh_terms: D000328:Adult; D000368:Aged; D005931:Glottis; D006097:Granulation Tissue / Q000473:pathology; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D007822:Laryngeal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D007828:Laryngoscopy; D053685:Laser Therapy; D008297:Male; D009361:Neoplasm Invasiveness; D024162:Second-Look Surgery; D014827:Vocal Cords / Q000601:surgery
keywords: endoscopic laryngectomy; glottic cancer; laryngeal dysplasia; radiation therapy; swallowing outcomes; voice outcomes