HEMILARYNGECTOMY FOR GLOTTIC CARCINOMA AFTER RADIATION-THERAPY FAILURE

Objective: To determine the efficacy and safety of vertical hemilaryng ectomy (VHL) for the treatment of early glottic carcinoma recurrent af ter radiation therapy (RT). Design: Retrospective study. Setting: Majo r referral center. Patients: Forty patients were identified who underw ent VHL for T1 or T2 glottic carcinoma between July 1975 and March 199 1, and all were included in this study. Twenty-two patients had receiv ed full-course RT before VHL, and 18 patients underwent primary VHL. M ain Outcome Measures: The local control rates were determined for T1 a nd T2 tumors in each group, along with actuarial survival rates and co mplications. Results: Local control of tumor for VHL after RT failure was 85% for T1 tumors, 78% for T2 tumors, and 82% overall. Three of fo ur of the local failures in this group occurred in patients who had co ntraindications to VHL. Total laryngectomy for treatment of local fail ures in this group increased the local control rate to 93% for T1 tumo rs, 89% for T2 tumors, and 91% overall. Local control rates for the pr imary VHL group were 90% for T1 tumors, 75% for T2 tumors, and 83% ove rall. Total laryngectomy for treatment of local recurrences increased local control to 87% for T2 tumors and 89% overall. Five-year actuaria l survival was 85% for each group. Delayed tracheal decannulation occu rred more frequently in the patients who had undergone RT. Conclusions : Our results support the oncologic safety and effectiveness of VHL fo r the surgical treatment of recurrent early glottic carcinomas after R T, with minimal increased morbidity.