Vocal Cord Function Return After Larynx Preservation is Associated With Recurrence‐Free Probability

Abstract

ObjectivesVocal cord fixation is one of the main upstaging features of laryngeal cancer. In our previously conducted retrospective study, vocal cord (VC) mobility restoration after chemoradiotherapy was a favorable prognostic variable. In this prospective study, we examined the significance of VC mobility restoration after definitive treatment as a prognostic variable.MethodsIn this prospective cohort study, we enrolled 30 patients with squamous cell carcinoma of the larynx with VC impairment/fixation (T2/3, T4a) who underwent definitive chemoradiotherapy with complete response. Video laryngoscopy before and at 3 months after treatment was used to evaluate VC mobility. The primary endpoint of the study was the local recurrence‐free probability. Secondary endpoints included recurrence‐free probability, disease‐specific survival (DSS), and overall survival (OS).ResultsThe median age of patients was 62 years (IQR 54–67). The primary subsites were the glottis (n = 13) and supraglottis (n = 14). After treatment, 18 (60%) patients had a full recovery of VC mobility, and 12 (40%) patients' VCs were fixed or impaired. Five‐year local recurrence‐free probability was worse in the VC‐impaired group compared to a group with restored VC mobility (46% vs. 85%, p = 0.012). Recurrence‐free probability, OS, and DSS differences were not statistically significant in both groups. VC mobility restoration predicted local recurrence‐free probability on univariable analysis (HR 6.15, 95% CI 1.23–30.6).ConclusionIn this prospective study, we show that the absence of VC mobility restoration is associated with worse local recurrence‐free probability after definitive laryngeal preservation treatment. Patients with persistent vocal cord immobility warrant closer follow‐up to detect recurrence early.Level of EvidenceIII Laryngoscope, 2024