Local recurrence after vertical partial laryngectomy, a conservative modality of treatment for patients with stage I-II squamous cell carcinoma of the glottis

BACKGROUND. Based on an inception cohort of 103 patients who had local recu rrence (Group I) and a witness group of 311 patients who achieved local con trol (Group II) after vertical partial laryngectomy for Stage I-II glottic carcinoma, the current retrospective study documented the consequences and management of local recurrence. METHODS. Three hundred two patients (97.1%) in Group II and all 103 patient s (100%) in Group I were followed until death or for a minimum of 10 years. Statistical analysis of survival, lymph node control, and distant metastas is was based on the Kaplan-Meier product limit method. RESULTS. The 10-year actuarial survival estimate was 30.8% for Group I pati ents and 63.1% for Group II patients. Survival was statistically more likel y to be reduced in Group I patients (P < 0.0001) than in Group II patients. The percentage of patients who died of their initial disease was 44.6% in Group I and 6.3% in Group II. The 10-year actuarial lymph node control esti mate was 70.2% for Group I and 96.1% for Group II. Lymph node recurrence wa s statistically more likely to occur in Group I patients than in Group II p atients (P < 0.0001). The 10-year actuarial estimate for patients without d istant metastasis was 80.2% for Group I and 96.7% for Group II. Distant met astasis was statistically more likely to occur in Group I patients than in Group II patients (P < 0.0001). Salvage treatment was unsuitable for 4.7% o f patients with local recurrence; for other patients, it yielded a 86.7% lo cal control rate, a 21.4% laryngeal preservation rate, a 4.5% death rate, a nd an 11.2% rate of incidence of severe complications. CONCLUSIONS. Among patients with Stage I-II glottic carcinoma managed with vertical partial laryngectomy, local recurrence results in a reduced rate o f survival as well as a high rate of necessity for salvage total laryngecto my. Cancer 1999;85: 2549-56. (C) 1999 American Cancer Society.