SALVAGE SURGERY AFTER RADIOTHERAPY FAILURE IN T1-T2 SQUAMOUS-CELL CARCINOMA OF THE GLOTTIC LARYNX

Background. This study was undertaken to analyze the clinical course o f patients who developed local (primary) recurrence after high-dose ir radiation of T1-T2 squamous cell carcinoma of the glottic larynx. Meth ods. Between May 1977 and December 1989, 247 patients with previously untreated T1 and T2 invasive squamous cell carcinoma of the glottic la rynx were treated for curative intent with radiotherapy. Local recurre nce occurred in 26 of 247 patients (11%). Successful surgical salvage was defined as no evidence of recurrent cancer for at least 2 years af ter salvage surgery and continuously thereafter. Results. Two patients refused to undergo salvage surgery and one patient had unresectable d isease. Of 23 patients who underwent salvage surgery, 19 had a total l aryngectomy and 4 had a voice-sparing procedure. One patient who was c ontinuously free of disease, died less than 24 months after salvage su rgery; this patient was excluded from all local control and survival a nalyses, leaving 22 patients available for analysis. Successful salvag e was achieved initially in 13 (59%) of the 22 patients. Two patients with local failure after voice-sparing salvage surgery underwent compl etion laryngectomy; one was salvaged, so that 14 of 22 (64%) were ulti mately salvaged. The rate of successful salvage did not correlate with preirradiation T stage, time to failure after irradiation, or time fr om clinical suspicion of recurrence to histologic proof. In a subgroup of patients (those with positive margins, tumor extension into the so ft tissues of the neck, or two or more adverse histologic features), t he risk of local-regional recurrence after salvage laryngectomy was 80 %. Conclusions. There are few data in the literature regarding the cli nical outcome of patients whose tumors are not controlled by initial r adiotherapy. This series and previous publications from other institut ions indicate that most patients who develop primary failure undergo s alvage surgery, which is successful in approximately 50-80% of the pat ients. The rate of surgical complications is acceptable and is related to radiotherapy dose. At our institution, most patients who had recur rence after radiotherapy underwent total laryngectomy. More than 50% o f the patients who experienced recurrence after irradiation originally had tumors of such extent that they would have required total larynge ctomy if surgery had been recommended instead of radiotherapy for the initial treatment. It is reasonable to consider reirradiation in patie nts with a very high risk of local-regional recurrence after salvage l aryngectomy.