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Options for salvage after failed initial treatment of anterior vocal commissure squamous carcinoma

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Abstract

Persistence or recurrent cancer in the anterior commissure (AC) after primary radiotherapy may remain localized to its pretreatment anatomical site. If so, endoscopic CO2 laser excision, in experienced hands, may achieve complete tumor excision and result in cure for many patients. Occasionally, second and third recurrences may be similarly salvaged by further endoscopic surgery. The use of the vertical hemilaryngectomy is an alternative treatment for similar localized lesions, with a higher first time surgical tumor eradication rate, but with a more protracted hospitalization and a less satisfactory voice and swallowing outcome. In both types of such surgical salvage, CT scanning must demonstrate no evidence of cartilage invasion or destruction. When there is evidence of minimal thyroid cartilage invasion, then the supracricoid partial laryngectomy is an alternative conservation option, and is likely to result in a cure, with the retention of a voicing larynx without a stoma. When the tumor has increased in size from the original pretreatment dimension and/or site, then imaging must be used to identify possible cartilage invasion, in which case the likelihood of tumor eradication by endoscopic or external vertical partial laryngectomy is highly unlikely. The indications for the routine use of total laryngectomy for the treatment of recurrent or persistent cancer involving the AC must be reviewed; there is current evidence that cure can be achieved by a less radical procedure. However, total laryngectomy may remain the only treatment option for advanced or aggressive first time recurrence, or in patients who develop subsequent recurrence following previous less aggressive surgery (endoscopic or external).

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Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, Queens Medical Centre, Nottingham, UK

    Patrick J. Bradley

  2. Department of Surgical Sciences, ENT Clinic, University of Udine, Policlinico Universitario, Piazzale S. Maria della Misericordia, 33100, Udine, Italy

    Alfio Ferlito & Alessandra Rinaldo

  3. Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain

    Carlos Suárez

  4. Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain

    Carlos Suárez

  5. Department of Otorhinolaryngology-Head and Neck Surgery, Philipp-University Marburg, Marburg, Germany

    Jochen A. Werner

  6. Department of Otolaryngology-Head and Neck Surgery, The Mount Sinai Medical Center, New York, NY, USA

    Eric M. Genden

  7. Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Ashok R. Shaha

  8. Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands

    C. René Leemans

  9. Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Johannes A. Langendijk

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  1. Patrick J. Bradley
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  2. Alfio Ferlito
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  6. Ashok R. Shaha
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  7. C. René Leemans
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  9. Alessandra Rinaldo
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Correspondence to Alfio Ferlito.

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Bradley, P.J., Ferlito, A., Suárez, C. et al. Options for salvage after failed initial treatment of anterior vocal commissure squamous carcinoma. Eur Arch Otorhinolaryngol 263, 889–894 (2006). https://doi.org/10.1007/s00405-006-0137-4

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  • DOI: https://doi.org/10.1007/s00405-006-0137-4

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