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Objectives: To evaluate the safety and clinical effectiveness of transoral laser microsurgery (TLM) with potassium‐titanyl‐phosphate (KTP) laser ablation for glottic neoplasms. Data Source: MEDLINE via PubMed, SCOPUS, Web of Science, and Cochrane Library. Review Methods: A systematic review and meta‐analysis of studies assessing the safety and efficacy of KTP laser therapy in patients with early‐stage glottic neoplasms. Results: Eight studies were included. After an average follow‐up of 3.3 years, the overall survival and disease‐free survival for patients who underwent KTP were 90.7% (95% CI 85%–96.5%) and 98.5% (95% CI 97.3%–99.8%), respectively. In the single‐arm meta‐analysis, the pooled estimate of recurrence was 7.7% (95% CI 3.4%–12%). The overall voice handicap index (VHI) estimate attributed to KTP in the single‐arm meta‐analysis was 6.76 (95% CI [3.05, 10.48]) and 5.21 (95% CI [2.86, 7.56]) within 6 months and after a one‐year follow‐up, respectively. Conclusion: KTP laser ablation is a safe and effective method for treating patients with early glottic neoplasms. Laryngoscope, 133:1806–1814, 2023 [ABSTRACT FROM AUTHOR]

Objective: Limited investigation of factors potentially contributing to treatment choice in early‐stage glottic carcinoma (EGC) has been performed with large‐scale data. The National Cancer Database (NCDB) represents >72% of all new cancer cases in the United States. We hypothesized that NCDB variables may lend insight into treatment decisions between surgery and radiation for EGC. Methods: The NCDB was queried for all cases of T1‐2 N0 M0 glottic carcinoma from 2004 to 2016. We used multivariable logistic regression analysis to examine factors associated with first‐line treatment modality: radiation therapy (RT) versus surgery. All reported odds ratios (OR) were adjusted for age, gender, race, insurance, residence in a metropolitan area, region, and facility volume. Results: 34,991 EGC patients received treatment: 6,687 (19%) surgery; 20,289 (58%) RT; and 8,015 (23%) surgery and RT. OR for receiving RT (vs. surgery alone) were >2 for: more advanced T stage cancers (OR 2.5 [95%CI: 2.3, 2.7]), treatment at non‐academic facilities (OR 2.8, [95%CI: 2.6, 3.0]), and shorter travel distances to treatment centers (OR 2.2, [95%CI: 2.0, 2.4]). Surgery was more likely with treatment in the western US, higher income, private insurance, living in a metropolitan (vs. non‐metropolitan) area, female gender, older age, and low facility volume. Hispanic ethnicity, education level, and race were not associated with treatment type in the multivariable model. Conclusion: Most patients in the NCDB receive first‐line treatment with radiation for EGC, and this decision is associated with various tumor, patient, and treatment facility characteristics. Level of Evidence: 4 Laryngoscope, 133:901–907, 2023 [ABSTRACT FROM AUTHOR]

Objectives: Preoperative anterior commissure (AC) evaluation in glottic cancer is crucial for therapeutic decisions. Endoscopy is often inadequate to precisely detect the presence of cancer in the AC; thus, computed tomography (CT) scan could help. We investigated the relation between AC thickness on CT scan (in mm), AC involvement by cancer at histology, and radiologic signs of anterior paraglottic space (PGS) infiltration. Study Design: Retrospective observational study. Methods: An experienced radiologist retrospectively measured AC thickness and identified signs of anterior PGS infiltration on pretreatment contrast-enhanced CT scans of 80 patients with primary glottic cancer. The gold standard to define the presence of cancer in the AC was histology. The receiver operating characteristic (ROC) curves were used to determine the potential cut-off values of AC thickness (Youden index method) able to maximize both sensitivity and specificity in identifying the presence of cancer in the AC at histology and PGS infiltration on CT scan. Results: AC was significantly thicker in patients with cancer in the AC at histology (P < .001) and in patients with PGS infiltration on CT scan (P < .001). The cut-off values to discriminate the presence of cancer at histology and PGS infiltration on CT scan were 3.62 and 2.6 mm, respectively. We found a substantial agreement between anterior PGS infiltration on CT scan and the presence of cancer in the AC at histology (Cohen Kappa: P = .70). Conclusion: AC thickness and radiologic signs of PGS infiltration on pretreatment CT scan could represent a method to predict the presence of cancer in the AC at histology. [ABSTRACT FROM AUTHOR]

Objectives: This study was designed to evaluate significant differences in treatment and survival outcomes between patients with T1a and T1b glottic cancer. Methods: Patients within the SEER Research Plus, 18 Registries dataset who were diagnosed with Stage I T1a or T1b cancer of the glottis between 2004 and 2015 were included in this study. Data prior to 2004 could not be included, as the SEER database did not distinguish between T1a and T1b glottic cancer until that year. Results: The 5‐year disease‐specific survival for T1a patients was significantly better than that of patients diagnosed with T1b glottic cancer. Age and year of diagnosis were also independent factors that impacted mortality. More patients who were diagnosed with T1b glottic cancer underwent external beam radiation than those diagnosed with T1a glottic cancer. Conclusion: Our data shows that there are several independent factors effecting mortality including T classification, age at time of diagnosis, and year of diagnosis. T1a glottic cancers also show a significantly better prognosis compared with T1b. T1b glottic cancers are much more likely to be treated with primary radiotherapy compared with surgery. Level of Evidence: 4 Laryngoscope, 132:2187–2193, 2022 [ABSTRACT FROM AUTHOR]

Objective: To analyze oncological efficacy and voice outcomes of the 445-nm blue laser (BL) in the treatment of early glottic carcinoma and compare results with the 532-nm potassium-titanyl-phosphate (KTP) laser., Study Design: Single institution, retrospective chart review., Methods: All patients who underwent microlaryngoscopic KTP or BL laser excision of early glottic carcinoma from 2018 to the present day with at least 1-year follow-up were included. Primary and recurrent disease, including radiation and surgical failures, were included. Demographic data, voice outcomes and oncologic outcomes were compared between the two laser groups., Results: Forty-nine patients met the inclusion criteria for the BL group and 88 for the KTP group, with average follow-up of 635 and 1236 days, respectively. Oncologic outcomes were not significantly different, with disease-specific survival rates of 95.9% for BL and 100% for KTP (p = 0.13), organ preservation rates of 98.0% for BL and 95.6% for KTP (p = 0.39), and local control rates of 93.9% for BL and 92.1% for KTP (p = 0.81). Both BL and KTP groups showed significant improvement in CAPE-V (p = 0.04, 0.006 respectively) and VHI-10 scores (p = 0.003, <0.00001) following surgery., Conclusions: Photoangiolytic removal of early glottic carcinoma with BL appears to be equally safe and effective as with KTP laser at minimum one-year follow-up, and with excellent voice outcomes. Additional study will be warranted over time to assess long-term outcomes in BL patients., Level of Evidence: 3 Laryngoscope, 2024., (© 2024 The Author(s). The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: This is an ancillary study of a multi‐institutional randomized non‐inferiority phase III trial of accelerated fractionation (AF) versus standard fractionation (SF) radiation therapy for T1‐2N0M0 glottic cancer (JCOG0701). Biopsy specimens of tumors from the patients enrolled in the JCOG0701 are collected and the association between clinical outcomes and histopathologic features such as expression of epithelial cell adhesion molecule (EpCAM), p53, and p16 were investigated. Methods: Five slices of undyed slides from biopsy specimens were sent to the National Cancer Center Hospital and all the specimens were assessed for the expression of EpCAM, p53, and p16. The primary objective was to investigate the association between 3‐year progression‐free survival (PFS) and expression of EpCAM, p53, and p16. Results: A total of 88 out of 370 patients were enrolled in this ancillary study. The 3‐year PFS for tumors with strong expression of EpCAM was 70.6% (95% CI 43.1%–86.6%), while that of tumors without strong expression of EpCAM was 77.5% (95% CI 65.9%–85.5%) with no remarkable difference between groups (P =.67). Likewise, there was no significant difference in 3‐year PFS between tumors regardless of p53 or p16 status. However, in a subgroup analysis for 17 patients with a strong expression of EpCAM, AF showed better 3‐year PFS than SF (100% vs 54.5%, P =.07). Conclusions: From the current study, it could not be concluded that EpCAM, p16, and p53 were prognostic factors for early‐stage glottic cancer after primary radiation therapy. AF might be an appropriate fractionation for tumors with a strong expression of EpCAM. Level of Evidence: 3 Laryngoscope, 131:1522–1527, 2021 [ABSTRACT FROM AUTHOR]

Objectives: Multiple population studies have shown racial discrepancies in head and neck cancer treatment and outcomes. We sought to characterize the impact of race on clinical outcomes for patients with early glottic squamous cell carcinoma (SCC) in a tertiary institution which provides equivalent access to care.Methods: We retrospectively reviewed all early glottic (T1-T2) squamous cell carcinoma at a single institution, the Michael E. DeBakey Veterans' Administration Medical Center (MEDVAMC). Data collected included demographic information, primary and adjuvant treatment modalities, time to diagnosis, time to treatment, recurrences, recurrence treatment modality, secondary malignancies, recurrence-free survival (RFS), and overall survival (OS).Results: One hundred seventeen patients with a primary diagnosis of T1-T2 glottic squamous cell carcinoma were included. Black and white patients demonstrated equivalent rates of recurrence, RFS, and OS. There was no significant difference in treatment delivery by race for all recorded parameters. T1b tumors were associated with an increased risk of recurrence which did not translate into a statistically significant decrease in RFS or OS. Surgical treatment was associated with increased recurrence but similar RFS and OS compared to radiation-based treatment. Secondary malignancies were common; 12% of patients were diagnosed with a second primary lung cancer during the study period.Conclusion: At our institution, race did not impact survival when access to care, treatment selection, and delivery are equivalent for early glottic SCC. Secondary lung cancer is a critical risk factor for mortality in this patient group and requires long-term surveillance and monitoring.Level Of Evidence: 4 Laryngoscope, 130:1733-1739, 2020. [ABSTRACT FROM AUTHOR]

Objectives: Good laryngeal exposure (GLE) is typically regarded as an essential prerequisite for transoral laser microsurgery (TLM). The Laryngoscore is a preoperative scoring system aimed at predicting glottic visualization through the laryngoscope using easy patient-derived parameters. However, the presence of subjective variables may hamper its reliability and reproducibility. The aim of the present study was to provide a validation of the Laryngoscore and to develop a revised mini-version of the same, called mini-Laryngoscore (mLS), which could allow even quicker, yet sufficiently accurate, preoperative prediction of GLE.Study Design: Prospective cohort study.Methods: We prospectively evaluated 310 consecutive patients submitted to TLM between 2014 and 2017, grading each patient according to the variables considered in the Laryngoscore.Results: Among the 11 variables of the previous Laryngoscore, three were confirmed as statistically significant at validation: interincisors gap, thyromental distance, and upper jaw dental status. We chose these three variables as part of the revised mLS (ranging from 0 to 4). In our cohort, 30% of the patients obtained a score of 0, 57% a score of 1, 11% a score of 2, and 2% a score of ≥3. GLE was achieved in 97%, 85%, 65%, and 20% of cases, respectively.Conclusion: Our validation confirmed the predictive ability of the Laryngoscore. Furthermore, although composed of only three clinical parameters, the mLS was still able to convey useful information regarding the possibility of obtaining GLE.Level Of Evidence: 2 Laryngoscope, 129:1617-1622, 2019. [ABSTRACT FROM AUTHOR]

Objective: Laryngeal exposure is one of the most limiting factors in transoral laser microsurgery (TLM) for glottic cancer. We evaluated the correlation between the degree of laryngeal exposure, as assessed by an easy previously described scoring tool (Laryngoscore), and histopathologic surgical margin status after TLM.Study Design: Prospective evaluation of 147 patients affected by Tis-T2 glottic cancer treated by TLM with curative intent between January 2012 and April 2016.Methods: All patients were preoperatively assessed and classified as having good (group A including Laryngoscore class 0-I) or suboptimal laryngeal exposure (group B including class II-III). Margins were classified as negative (more than 1 mm margin between healthy tissue and tumor) or positive (one/multiple superficial or deep margins involved by invasive or in situ carcinoma). Patients with multiple superficial or deep margin positivity were scheduled for TLM re-excision, open partial laryngectomy, or postoperative radiotherapy.Results: Twenty-one type I, 54 type II, 19 type III, 7 type IV, 41 type V, and 5 type VI cordectomies (according to the European Laryngological Society classification) were performed with an en-bloc or multi-bloc technique according to the size, site, and exposure of the lesion. Group A included 109 (74%) and group B included 38 (26%) patients. Positive surgical margins were overall observed in 39 (26.5%) cases: 21 (19.2%) in group A versus 18 (47.4%) in group B (P = 0.001).Conclusion: Laryngeal exposure is one of the most important factors influencing TLM resection of glottic cancer within safe surgical margins. The importance of its adequate preoperative assessment cannot be overemphasized.Level Of Evidence: 2b. Laryngoscope, 128:1146-1151, 2018. [ABSTRACT FROM AUTHOR]

The article discusses a study conducted to use single-sided adhesive tape to fashion a keel to manage laryngeal webs to restore patient's voice and improve the airway. It also assesses and compares the adhesive integrity of two different, easily available adhesive materials after they had been incubated in saline at 368C. It is noted that General Merchandise Brown Tape is an inexpensive, easily reproducible, and successful alternative to endoscopic silicone laryngeal keels.

Objectives/hypothesis: The purpose of this study was to report the outcomes of a retrospective consecutive cohort study of patients with T1N0M0 glottic carcinoma treated with 4-MV or 6-MV radiotherapy.Study Design: Retrospective case-control study.Methods: This was a retrospective review of all patients with T1N0M0 glottic carcinoma treated with radiotherapy between January 2000 and December 2012 in the Department of Radiation Oncology at National Cancer Center Singapore. A total of 124 patients were included. Clinical endpoints of interest were: local control (LC), overall survival (OS), and disease-specific survival (DSS). Other prognostic factors for LC were also analyzed: age, gender, smoking status, T substage, dose fraction, field size, anterior commissure involvement, total dose, and overall treatment time.Results: Six-megavolt photon radiotherapy was used in 73 patients and 4-MV photon radiotherapy in 51 patients. Median follow-up was 4.9 years. The 5-year LC and OS were as follows: 4 MV, 91.6% and 83.4%; 6 MV, 88.8% and 82.8%; and the 5-year LC, OS, and DSS for all patients were 90.4%, 83.3%, and 98.3%. There was no significant difference in LR and OS between 4-MV and 6-MV radiotherapy (P = .92, P = .16, respectively). In the univariate analysis of LC, none of the prognostic factors was statistically significant. Twenty patients (23%) developed second primary cancers, the majority in the lungs.Conclusions: Six-megavolt photon radiotherapy yields comparable results to 4-MV photons. Bolus and computed tomographic simulation are useful to ensure adequate dose coverage of target volume. Follow-up postradiotherapy should incorporate chest imaging, smoking cessation advice, and thyroid function test.Level Of Evidence: 4 Laryngoscope, 127:1061-1067, 2017. [ABSTRACT FROM AUTHOR]

Objective: To identify and compare treatment and system factors associated with survival in early-stage glottic cancer.Study Design: Retrospective study of cases in the Commission on Cancer National Cancer Database.Methods: Adult patients with early glottic cancer (stage I or II) diagnosed between January 1, 2004, and December 31, 2012, were included. Demographic, tumor, and survival variables were included in the analyses. Multivariate Cox regressions as well as univariate Kaplan-Meier analyses were conducted.Results: In total, 5,627 patients were included in the study. Treatment factors associated with improved survival included larynx-preserving surgery alone (hazard ratio [HR] 0.740; P = 0.001) and larynx-preserving surgery with radiation (HR 0.837; P = 0.010) when compared to radiotherapy alone. System factors associated with worse survival included intermediate- (HR 1.123; P = 0.047) or low- (HR 1.458; P = 0.017) volume centers; Medicaid (HR 1.882; P < 0.001), Medicare (HR 1.532; P < 0.001), or other government insurance (HR 2.041; P < 0.001); and delay between diagnosis and treatment greater than 100 days (HR 1.605; P = 0.006).Conclusion: A number of treatment and system factors were found to be significantly associated with survival when controlling for patient and tumor factors. These may present targets for the improvement of outcomes in early-stage glottic cancers.Level Of Evidence: 4. Laryngoscope, 127:616-622, 2017. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: The goal of the study was to identify geographic trends in the primary treatment of early-stage glottic cancer.Study Design: Retrospective analysis of the United States National Cancer Institute's Surveillance, Epidemiology, and End-Results (SEER) database.Methods: Using the most up-to-date November 2014 submission of the SEER database in addition to SEER-18 data files, a cohort was created of stage I to II squamous cell glottic cancer from 2004 to 2012. The treatment groups (radiation and surgery) were compared with respect to several pretreatment covariates including age, race, gender, state where they received treatment, year of diagnosis, and American Joint Committee on Cancer (AJCC) stage.Results: In analyzing geographic trends, a statistically significant difference in treatment received by region and state was found (P < .0001.). When examining patient demographics, there was no statistically significant difference in treatment by age (P = .5206), AJCC stage (P = .4922), or year of diagnosis (P = .6593). There was a significant difference in racial distribution by treatment (P = .0038), with patients receiving surgery more likely to be black than patients receiving radiation (12% vs. 10%). In analyzing overall survival (OS), there was no significant difference in OS among the four US treatment regions (P = .2508).Conclusions: Geographic factors impact overall treatment of early-stage glottic cancer. In addition, it was determined that race was a factor that correlated to differences in treatment modality. Finally, overall survival across the United States was determined to be significantly better in patients receiving radiation therapy.Level Of Evidence: 4 Laryngoscope, 126:880-884, 2016. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To test the hypothesis that subligamental cordectomy produces superior acoustic outcome than subepithelial cordectomy for early (T1-2) glottic cancer that requires complete removal of the superficial lamina propria but does not involve the vocal ligament. Study Design Computer simulation. Methods A computational tool for vocal fold surgical planning and simulation (the National Center for Voice and Speech Phonosurgery Optimizer-Simulator) was used to evaluate the acoustic output of alternative vocal fold morphologies. Four morphologies were simulated: normal, subepithelial cordectomy, subligamental cordectomy, and transligamental cordectomy (partial ligament resection). The primary outcome measure was the range of fundamental frequency (F0) and sound pressure level (SPL). A more restricted F0-SPL range was considered less favorable because of reduced acoustic possibilities given the same range of driving subglottic pressure and identical vocal fold posturing. Results Subligamental cordectomy generated solutions covering an F0-SPL range 82% of normal for a rectangular vocal fold. In contrast, transligamental and subepithelial cordectomies produced significantly smaller F0-SPL ranges, 57% and 19% of normal, respectively. Conclusion This study illustrates the use of the Phonosurgery Optimizer-Simulator to test a specific hypothesis regarding the merits of two surgical alternatives. These simulation results provide theoretical support for vocal ligament excision with maximum muscle preservation when superficial lamina propria resection is necessary but the vocal ligament can be spared on oncological grounds. The resection of more tissue may paradoxically allow the eventual recovery of a better speaking voice, assuming glottal width is restored. Application of this conclusion to surgical practice will require confirmatory clinical data. Level of Evidence N/A. Laryngoscope, 125:1892-1899, 2015 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis The goal of the study was to determine the role of routine total thyroidectomy and hemithyroidectomy in patients undergoing total laryngectomy for laryngeal squamous cell carcinoma. Study Design The study group consisted of 343 patients who underwent total laryngectomy (98 treated with surgery alone, 136 treated following radiation failure, and 109 following chemoradiation failure). Total thyroidectomy was performed in all obstructing and bilateral lesions or if there was suspicion of contralateral lobe involvement. Hemithyroidectomy was performed in all lateralized lesions. Retrospective histopathologic analysis of thyroid specimens was subsequently performed. Results In all, 262 patients underwent total thyroidectomy during total laryngectomy, six of which demonstrated squamous cell carcinoma evident within the thyroid gland (4 from transglottic lesions, 2 from subglottic lesions). Hemithyroidectomy was performed in 81 patients, with only one patient demonstrating evidence of squamous cell carcinoma within the thyroid gland. Hypothyroidism was observed in 88% (n = 61) of patients who underwent thyroid lobectomy alone, requiring hormone supplementation. Conclusion Routine surgical management of the thyroid gland should not be performed, except in cases of subglottic primary lesions, lesions with significant subglottic extension, or transglottic lesions. Despite efforts to preserve the contralateral thyroid lobe in cases of selective lobectomy, these patients often have a high rate of hypothyroidism, and a total thyroidectomy should be considered when involvement of the thyroid gland is suspected. Level of Evidence N/A. Laryngoscope, 125:1835-1838, 2015 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To compare voice handicap and quality of life after radiotherapy (RT) versus transoral laser surgery (LS) for T1a glottic carcinoma. Study Design Retrospective study (1996-2011) of patients treated with RT or LS for T1a glottic squamous cell carcinoma with curative intent. Methods Disease-free patients were assessed using Voice Handicap Index (VHI 30) and European Organization for Research and Treatment of Cancer Head and Neck Quality of Life (EORTC QLQ-HN35) questionnaires. Results Of 147 patients, 95 (65%) completed the questionnaires: fifty-one patients an average of 8 years after RT and 44 patients an average of 4 years after LS (no difference in age or sex ratio). The average total VHI 30 was 13.1 for RT and 29.2 for LS ( P < .0001), with average emotional, physical and functional subscores significantly different. The average total EORTC QLQ-HN35 was 37.7 for RT versus 40.7 for LS ( P = .7), with a difference only in the speaking subscore ( P = .04). Conclusions Long-term subjective voice-related quality of life was worse after LS, with no difference in other domains. These results should be interpreted in light of the biases inherent in retrospective studies. Level of Evidence 4. Laryngoscope, 124:1398-1401, 2014 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: This study aims to assess the oncologic results of open and transoral surgical techniques in T1a and T1b category glottic carcinomas. Study Design: Retrospective clinical study. Methods: The files of 438 T1a and T1b glottic cancer cases managed with primary surgery were reviewed. Transoral laser surgery and open surgical procedures used to treat these cases, including cordectomy, vertical partial laryngectomy, and frontolateral partial laryngectomy, were compared for disease specific survival and local control rates. In addition, all techniques were compared for incidence of major complications and related tracheotomies. Results: No statistically significant differences were noted between laser surgery and open procedures with regard to disease specific survival and local control for both T1a and T1b cases. Laser surgery showed a significantly lower incidence of complications and tracheotomies. Conclusions: Laser surgery appears to be a very effective management modality for T1 glottic cancer with comparable results to open procedures and a lower incidence of complications. A transcervical approach should be reserved only for selected cases where individual anatomic factors do not permit complete tumor exposure during diagnostic microlaryngoscopy. Laryngoscope, 2009 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Transoral laser microsurgery for the treatment of glottic carcinoma with anterior commissure (A-com) involvement is associated with a high rate of recurrence. We prospectively evaluated the outcomes of laser microsurgery and the efficacy of second-look operation in these patients. Study Design: Prospective evaluation. Methods: Twenty-seven patients with glottic carcinomas involving the A-com underwent transoral laser microresection. Twenty-five patients underwent second-look operations 3 months after laser surgery. Results: After transoral laser microresection, all patients achieved microscopic clear resection margins. Local recurrence was found in 7 of 27 patients (25.9%). Regional recurrence was found in two patients. Patients with recurrences underwent laser re-resection or neck dissection; four received radiotherapy, two lost their larynxes, and three died of disease. At second-look operation, early local recurrence was found in two patients, and anterior glottic webs and granulomas causing dysphonia were treated in 8 and 11 patients, respectively. Conclusions: Laser microsurgery is an effective treatment modality in early glottic cancer with A-com involvement but is still associated with a high rate of recurrence. Second-look operation may help detect early local recurrence and treat postoperative airway or voice problems. [ABSTRACT FROM AUTHOR]

Objectives: Functional surgery of unilateral T2b to T3 glottic cancer and cricoid chondrosarcoma is possible using the technique of tracheal autotransplantation. The objective of this paper is to report the functional and oncologic outcome of 24 consecutive patients treated with this technique between 2001 and 2007. Methods: Seventeen patients, of whom nine were previously irradiated, had unilateral glottic cancer with impaired mobility of the vocal fold. Clinical staging was T2b to 3N0. Seven patients had a chondrosarcoma of the cricoid cartilage. In a first operation, an extended hemilaryngectomy was performed, and a radial forearm flap, comprising a distal fascial and a proximal skin component, was transferred to the neck. The fascial paddle was wrapped around the upper 4-cm segment of cervical trachea, and the skin paddle was used for temporary closure of the extended hemilaryngectomy defect. The definitive reconstruction was performed after 2 to 3 months and consisted of removal of the skin paddle from the laryngeal defect and a transplantation of a patch of revascularized cervical trachea to reconstruct the laryngeal defect. Results: Swallowing and speech were restored after the first operation. The glottic and subglottic airway lumen was restored during the second operation. The tracheostomy could be closed in 20 patients. After a median follow-up period of 33 (range, 1-66) months or almost 3 years, 23 patients remained free of tumor recurrence. Conclusions: Tracheal autotransplantation can be recommended as a functional treatment for selected T2b to T3 glottic cancers and for unilateral chondrosarcomas of the cricoid cartilage. The technique is oncologically robust while resulting in good postoperative function. [ABSTRACT FROM AUTHOR]

Objective/Hypothesis: To evaluate incidence, site of occurrence and outcome of second malignant neoplasia (SMN) in patients with T1 glottic cancer treated with radiation. Study Design: Retrospective. Methods: Between February 1964 and May 1993, 158 patients with T1 squamous carcinoma of the larynx were treated with definitive radiation. Incidence, site (aerodigestive tract or not) and outcome of SMN were analyzed. Median follow-up was 63 months (range, 12-245 mo). Results: Thirty-four patients developed SMN, for an overall incidence of 22%. Twenty-four (67%) SMNs occurred in an aero-upper-digestive-tract site compared with nine (25%) occurring in a non-aero-upper-digestive tract site. The incidence of SMN observed was higher than would be expected for the general population at risk. The observed-to-expected ratios (OER) for all SMN, aero-upper-digestive SMN and non-aero-upper-digestive SMNs were 1.73, 5.53, and 0.62, respectively. Overall 5- and 10-year survivals were 76% and 57%, respectively, for those who did not develop SMN, as compared with 68% and 26%, for those who developed SMN ( P = .003). Overall, 13 patients (8.2%) have died from laryngeal cancer, while 23 (15%) died from SMN ( P = .001). Conclusion: This study confirms a higher incidence of SMN in T1 glottic cancer patients, compared with the general population. The majority of cases occur in aero-upper-digestive sites. These patients are more likely to die from their SMN than from glottic cancer. Patients with T1 squamous cell carcinoma of the glottic larynx represent a group of head and neck cancer patients who should be targeted in studies evaluating the potential benefits of chemoprevention, and aggressively counseled for social and/or behavioral modifications. [ABSTRACT FROM AUTHOR]