CARCINOMA IN-SITU OF THE GLOTTIC LARYNX - EXCISION OR IRRADIATION

Background. The management of glottic carcinoma in situ (CIS) is contr oversial, with vocal cord stripping (S) generally accepted as the stan dard treatment, and radiotherapy (RT) as an alternative. We present ou r experience with 34 patients treated by either stripping or RT. Metho ds. Between 1974 and 1990, 34 patients with CIS of the glottic larynx were treated at McGill University teaching hospitals. The median age a t diagnosis was 67 years, with a male:female ratio of 6:1. All patient s had CIS involving the glottis and the pathology was reviewed on all patients. Twenty-one patients were treated by S and 13 patients by RT as the primary treatment. Results. With a median follow-up of 96 month s (25-209 months), the 15-year actuarial survival rate is 95% for all patients, with 100% and 87% survival rates for S and RT groups, respec tively (p = 0.25). One patient in the RT group developed a subglottic invasive squamous cell carcinoma. On the other hand, 11 patients in t he S group developed recurrence and were treated by repeat S (6 patien ts) or RT (5 patients), with a salvage rate of 100%. Conclusion. Altho ugh most patients with CIS of the glottis are traditionally treated wi th vocal cord S, RT is effective in terms of freedom from recurrence; it is an attractive option and should be considered in patients with l esions recurring after stripping as well as in those whose follow-up p resents a problem.