Curative radiotherapy for anterior commissure laryngeal carcinoma

There is continuing controversy surrounding the most effective treatment of glottic carcinoma involving the anterior commissure (AC). Surgery has been the preferred method of treatment, since studies previously indicated earl y tumor invasion of the thyroid cartilage at the AC, thereby assuming less curability by radiotherapy (RT). Subsequent laryngeal anatomic studies and refinement of RT techniques have brought into question the ineffectiveness of curative irradiation. A retrospective review of 174 patients with early- stage glottic carcinoma treated with standard fractionation curative RT rev ealed 34 patients with T1 and T2, lesions involving the AC. Allowing for a follow-up of at least 3 years, we observed only a 12% (4 of 34 patients) lo cal recurrence rate after RT alone, with excellent voice quality and no maj or complications related to the irradiation. The 4 local recurrences Were c ontrolled by total laryngectomy, although 2 patients developed distant meta static disease. Radiotherapy represents an effective method of treating T1 squamous cell carcinoma of the glottis with AC involvement. The small numbe r of T2 glottic carcinomas in this study prevents a meaningful conclusion c oncerning treatment of these lesions.