Management and outcome of early glottic carcinoma

Abstract

OBJECTIVE AND STUDY DESIGN: We designed a retrospective study to analyze treatment methods and outcomes for patients with lesions ranging from carcinoma in situ to invasive T1 glottic squamous cell carcinoma. Patients with nonsquamous cell carcinoma, verrucous variant of squamous cell carcinoma, anterior commissure involvement, and T2 lesions were excluded. SETTING: University of Pittsburgh School of Medicine, a tertiary referral center. RESULTS: Fifty-four patients met the inclusion criteria. Mean follow-up was 49 months (range 24 to 96 months). Forty-eight of 54 (89%) were treated with endoscopic excision. Forty of these 48 patients (83%) were successfully treated with endoscopic excision(s) as the only treatment modality. Four patients had persistence of disease despite multiple endoscopic excisions. Two of these patients underwent hemilaryngectomy, 1 received radiation treatment, and 1 received radiation therapy followed by a hemilaryngectomy. Four patients had recurrence of disease. Two patients with recurrence required radiation therapy and 2 patients required a total laryngectomy. With the selective application of multiple endoscopic excisions, radiation therapy, and more invasive operation, 100% of patients are without evidence of disease with a laryngeal preservation rate of 96%. CONCLUSIONS: This study supports the use of endoscopic excisional biopsy as the primary treatment modality for lesions ranging from carcinoma in situ to invasive T1 glottic carcinoma. This study also highlights the importance of close clinical follow-up and the potential need for further treatment. By reserving open operation and radiation therapy to selective cases, we successfully treated all patients while limiting the disadvantages of radiation therapy and more invasive operation to the minority of patients.