Does vocal cord fixation preclude nonsurgical management of laryngeal cancer?

Clementino Arturo Solares, Benjamin Wood, Cristina P. Rodriguez, Robert R. Lorenz, Joseph Scharpf, Jerrold Saxton, Lisa A. Rybicki, Marshall Strome, Ramon Esclamado, Pierre Lavertu, David J. Adelstein

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives/Hypothesis: To determine whether vocal cord fixation precludes nonsurgical management of T3/T4 laryngeal carcinoma. Study Design: A retrospective chart review. Methods: Between 1989 and 2005 patient records with T3/T4 squamous cell carcinoma of the larynx with vocal cord fixation at presentation were reviewed. All were treated with a concomitant cisplatin-based chemoradiotherapy protocol and were part of the institutional head and neck cancer chemoradiotherapy registry. Only patients with adequate preand post-treatment fiberoptic evaluations were included. Charts were reviewed for demographics and tumor characteristics; return of vocal cord function; local, regional, or distant recurrence after treatment; and need for salvage surgery. The Kaplan-Meier method was used to estimate outcomes, and the logrank test was used to compare those patients whose vocal cords remained fixed to those with recovery of function. Results: Twenty-three patients met the inclusion criteria, 19 males and 4 females. The median age was 59 years (range, 39-73). Fourteen patients had T3 and nine had T4 tumors. Twelve patients recovered full range of mobility, three had partial recovery, and eight did not recover motion. The median followup was 68 months (range, 34-191). Comparing patients with post-treatment partial or fully mobile cords to those with persistent fixation revealed the following: A projected five-year overall survival of 100% versus 25%, (P <.001), freedom from recurrence of 86.7 versus 25% (P <.001), local control without surgery of 86.7% versus 30% (P=.003), and survival with functional larynx of 86.7% versus 25% (P=.008), respectively. Conclusions: Nonsurgical therapy in patients with pretreatment vocal cord fixation is feasible. However, persistence of vocal cord fixation after definitive chemoradiotherapy is a poor prognostic sign and early surgical intervention should be considered.

Original languageEnglish (US)
Pages (from-to)1130-1134
Number of pages5
JournalLaryngoscope
Volume119
Issue number6
DOIs
StatePublished - Jun 1 2009

Fingerprint

Laryngeal Neoplasms
Vocal Cords
Chemoradiotherapy
Larynx
CD4-Positive T-Lymphocytes
Recurrence
Survival
Recovery of Function
Therapeutics
Head and Neck Neoplasms
Cisplatin
Registries
Squamous Cell Carcinoma
Neoplasms
Demography
Carcinoma

Keywords

  • Chemoradiotherapy
  • Laryngeal carcinoma
  • Organ preservation
  • Vocal cord fixation

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Solares, C. A., Wood, B., Rodriguez, C. P., Lorenz, R. R., Scharpf, J., Saxton, J., ... Adelstein, D. J. (2009). Does vocal cord fixation preclude nonsurgical management of laryngeal cancer? Laryngoscope, 119(6), 1130-1134. https://doi.org/10.1002/lary.20225

Does vocal cord fixation preclude nonsurgical management of laryngeal cancer? / Solares, Clementino Arturo; Wood, Benjamin; Rodriguez, Cristina P.; Lorenz, Robert R.; Scharpf, Joseph; Saxton, Jerrold; Rybicki, Lisa A.; Strome, Marshall; Esclamado, Ramon; Lavertu, Pierre; Adelstein, David J.

In: Laryngoscope, Vol. 119, No. 6, 01.06.2009, p. 1130-1134.

Research output: Contribution to journalArticle

Solares, CA, Wood, B, Rodriguez, CP, Lorenz, RR, Scharpf, J, Saxton, J, Rybicki, LA, Strome, M, Esclamado, R, Lavertu, P & Adelstein, DJ 2009, 'Does vocal cord fixation preclude nonsurgical management of laryngeal cancer?', Laryngoscope, vol. 119, no. 6, pp. 1130-1134. https://doi.org/10.1002/lary.20225
Solares CA, Wood B, Rodriguez CP, Lorenz RR, Scharpf J, Saxton J et al. Does vocal cord fixation preclude nonsurgical management of laryngeal cancer? Laryngoscope. 2009 Jun 1;119(6):1130-1134. https://doi.org/10.1002/lary.20225
Solares, Clementino Arturo ; Wood, Benjamin ; Rodriguez, Cristina P. ; Lorenz, Robert R. ; Scharpf, Joseph ; Saxton, Jerrold ; Rybicki, Lisa A. ; Strome, Marshall ; Esclamado, Ramon ; Lavertu, Pierre ; Adelstein, David J. / Does vocal cord fixation preclude nonsurgical management of laryngeal cancer?. In: Laryngoscope. 2009 ; Vol. 119, No. 6. pp. 1130-1134.
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abstract = "Objectives/Hypothesis: To determine whether vocal cord fixation precludes nonsurgical management of T3/T4 laryngeal carcinoma. Study Design: A retrospective chart review. Methods: Between 1989 and 2005 patient records with T3/T4 squamous cell carcinoma of the larynx with vocal cord fixation at presentation were reviewed. All were treated with a concomitant cisplatin-based chemoradiotherapy protocol and were part of the institutional head and neck cancer chemoradiotherapy registry. Only patients with adequate preand post-treatment fiberoptic evaluations were included. Charts were reviewed for demographics and tumor characteristics; return of vocal cord function; local, regional, or distant recurrence after treatment; and need for salvage surgery. The Kaplan-Meier method was used to estimate outcomes, and the logrank test was used to compare those patients whose vocal cords remained fixed to those with recovery of function. Results: Twenty-three patients met the inclusion criteria, 19 males and 4 females. The median age was 59 years (range, 39-73). Fourteen patients had T3 and nine had T4 tumors. Twelve patients recovered full range of mobility, three had partial recovery, and eight did not recover motion. The median followup was 68 months (range, 34-191). Comparing patients with post-treatment partial or fully mobile cords to those with persistent fixation revealed the following: A projected five-year overall survival of 100{\%} versus 25{\%}, (P <.001), freedom from recurrence of 86.7 versus 25{\%} (P <.001), local control without surgery of 86.7{\%} versus 30{\%} (P=.003), and survival with functional larynx of 86.7{\%} versus 25{\%} (P=.008), respectively. Conclusions: Nonsurgical therapy in patients with pretreatment vocal cord fixation is feasible. However, persistence of vocal cord fixation after definitive chemoradiotherapy is a poor prognostic sign and early surgical intervention should be considered.",
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AU - Saxton, Jerrold

AU - Rybicki, Lisa A.

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N2 - Objectives/Hypothesis: To determine whether vocal cord fixation precludes nonsurgical management of T3/T4 laryngeal carcinoma. Study Design: A retrospective chart review. Methods: Between 1989 and 2005 patient records with T3/T4 squamous cell carcinoma of the larynx with vocal cord fixation at presentation were reviewed. All were treated with a concomitant cisplatin-based chemoradiotherapy protocol and were part of the institutional head and neck cancer chemoradiotherapy registry. Only patients with adequate preand post-treatment fiberoptic evaluations were included. Charts were reviewed for demographics and tumor characteristics; return of vocal cord function; local, regional, or distant recurrence after treatment; and need for salvage surgery. The Kaplan-Meier method was used to estimate outcomes, and the logrank test was used to compare those patients whose vocal cords remained fixed to those with recovery of function. Results: Twenty-three patients met the inclusion criteria, 19 males and 4 females. The median age was 59 years (range, 39-73). Fourteen patients had T3 and nine had T4 tumors. Twelve patients recovered full range of mobility, three had partial recovery, and eight did not recover motion. The median followup was 68 months (range, 34-191). Comparing patients with post-treatment partial or fully mobile cords to those with persistent fixation revealed the following: A projected five-year overall survival of 100% versus 25%, (P <.001), freedom from recurrence of 86.7 versus 25% (P <.001), local control without surgery of 86.7% versus 30% (P=.003), and survival with functional larynx of 86.7% versus 25% (P=.008), respectively. Conclusions: Nonsurgical therapy in patients with pretreatment vocal cord fixation is feasible. However, persistence of vocal cord fixation after definitive chemoradiotherapy is a poor prognostic sign and early surgical intervention should be considered.

AB - Objectives/Hypothesis: To determine whether vocal cord fixation precludes nonsurgical management of T3/T4 laryngeal carcinoma. Study Design: A retrospective chart review. Methods: Between 1989 and 2005 patient records with T3/T4 squamous cell carcinoma of the larynx with vocal cord fixation at presentation were reviewed. All were treated with a concomitant cisplatin-based chemoradiotherapy protocol and were part of the institutional head and neck cancer chemoradiotherapy registry. Only patients with adequate preand post-treatment fiberoptic evaluations were included. Charts were reviewed for demographics and tumor characteristics; return of vocal cord function; local, regional, or distant recurrence after treatment; and need for salvage surgery. The Kaplan-Meier method was used to estimate outcomes, and the logrank test was used to compare those patients whose vocal cords remained fixed to those with recovery of function. Results: Twenty-three patients met the inclusion criteria, 19 males and 4 females. The median age was 59 years (range, 39-73). Fourteen patients had T3 and nine had T4 tumors. Twelve patients recovered full range of mobility, three had partial recovery, and eight did not recover motion. The median followup was 68 months (range, 34-191). Comparing patients with post-treatment partial or fully mobile cords to those with persistent fixation revealed the following: A projected five-year overall survival of 100% versus 25%, (P <.001), freedom from recurrence of 86.7 versus 25% (P <.001), local control without surgery of 86.7% versus 30% (P=.003), and survival with functional larynx of 86.7% versus 25% (P=.008), respectively. Conclusions: Nonsurgical therapy in patients with pretreatment vocal cord fixation is feasible. However, persistence of vocal cord fixation after definitive chemoradiotherapy is a poor prognostic sign and early surgical intervention should be considered.

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KW - Laryngeal carcinoma

KW - Organ preservation

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