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Background: Treatment selection for squamous cell carcinoma patients aged over 84 years is controversial. This retrospective chart review examined and compared characteristics of laryngeal squamous cell carcinoma in very elderly (over 84 years) and younger patients (approximately 65 years). The secondary objective was to further evaluate the outcome of radiotherapy as a treatment modality in this patient population. Methods: Of all 23 very elderly patients with laryngeal squamous cell carcinoma treated with radiotherapy, with or without surgery, in the Davidoff Cancer Center, from 1992 to 2012, 19 had sufficient data for analysis, and comprised the study group. Results: Median age at diagnosis was 86 years. Disease stage at diagnosis was I, II, III and IVA in 53 per cent, 21 per cent, 21 per cent and 5 per cent, respectively. Median radiotherapy dose was 60 Gy given in 25 fractions. Three patients had recurrence. No patient discontinued treatment because of toxicity. Median overall survival was 3.6 years (range, 0–10 years). Conclusion: Very elderly laryngeal squamous cell carcinoma patients may derive a similar survival advantage as younger counterparts. Modern radiotherapy is effective and safe for treating laryngeal squamous cell carcinoma in this study population. Further, large-scale studies are needed. [ABSTRACT FROM AUTHOR]

Objective: Current evidence suggests there is no difference between endoscopic laser surgery and radiotherapy with regards to oncological outcomes of early laryngeal cancer. Patient management may therefore be directed towards voice and quality of life outcomes. This systematic review compares functional outcomes with respect to voice character, swallowing outcomes and quality of life for endoscopic laser surgery versus radiotherapy for T1 and T2 stage laryngeal carcinoma. Method: Search terminology was designed by both authors and used in Cochrane, PubMed and Web of Science databases. Studies of adult patients treated for primary T1 and T2 laryngeal squamous cell carcinoma utilising one objective (validated) measure of quality of life, swallowing or voice were included. Results: Initial searches identified 1767 studies. After inclusion and exclusion criteria were applied, 42 studies were identified for full-text review. Conclusion: This review concluded that neither treatment is clearly advantageous. Future research should be composed of further prospective studies that use a standardised assessment regime to allow valid comparison. [ABSTRACT FROM AUTHOR]

Background: Transoral laser microsurgery for glottic squamous cell carcinoma is the standard of care at many institutions. Repeat transoral laser microsurgery for recurrence may avoid the need for radiotherapy and total laryngectomy. This study aimed to identify oncological and functional outcomes in a cohort of patients who had undergone repeat transoral laser microsurgery procedures. Method: A retrospective review of prospectively collected data of patients treated with transoral laser microsurgery for carcinoma in situ or tumour stages T1 or T2 glottic cancer, from 2003 to 2018. Results: Twenty patients were identified. Additional treatment was not needed in 45 per cent of patients. The five-year overall survival rate was 90 per cent. The disease-specific survival rate was 100 per cent. The laryngeal preservation rate was 85 per cent. There was improvement in mean Voice Handicap Index-10 scores following repeat transoral laser microsurgery treatment, when comparing the pre- and post-operative periods (mean scores = 15.5 vs 11.5, p = 0.373). Conclusion: Repeat transoral laser microsurgery can be an oncologically safe alternative to other salvage therapies for glottic squamous cell carcinoma recurrence, without sacrificing functional outcomes. [ABSTRACT FROM AUTHOR]

Background: Early laryngeal cancer treated with definitive radiotherapy or surgery has a high cure rate. This study evaluated the patterns of treatment failure and long-term results of early laryngeal cancers treated with definitive radiotherapy. Method: From January 2002 to December 2014, a total of 242 patients with early-stage laryngeal cancers were treated with radical radiotherapy. Results: All patients had squamous cell carcinoma of the larynx (92 per cent male and 8 per cent female). Median follow-up was 4.5 years. The majority of patients were smokers (57.4 per cent). Local failure was seen in 12.5 per cent of stage I patients and 22.8 per cent of stage II patients. The 5-year overall survival and disease specific survival were 84 per cent and 91 per cent, respectively. Conclusion: In summary, radiotherapy is a suitable treatment modality for patients with early-stage laryngeal cancer, with an overall locoregional control rate of 84 per cent. Patients who fail radiotherapy may still undergo salvage laryngectomy. [ABSTRACT FROM AUTHOR]

Objectives: To assess five-year local control and ultimate local control rates of patients treated for locally advanced T3–4 glottic carcinoma with surgery only, radiotherapy only, or surgery plus radiotherapy. Cancer-specific survival, overall survival and rates of malignancy development were also assessed. Methods: A retrospective review was conducted on patients from 1967 to 2015, with analysis of local control, ultimate local control, overall survival and cancer-specific survival performed using Kaplan–Meier and Cox regression. Results: Of 169 eligible patients, the majority (59 per cent) were treated with surgery plus radiotherapy, with laryngectomy being the most common surgical procedure. Local control and ultimate local control rates were higher with surgery only (94.1 per cent) and surgery plus radiotherapy (87.9 and 86.8 per cent respectively), compared to radiotherapy only (46.8 and 52.4 per cent) (both p < 0.001). Cancer-specific survival, overall survival and malignancy development did not differ between groups. Conclusion: Surgery, with or without radiotherapy, offers significantly higher five-year local control and ultimate local control for patients with advanced glottic carcinoma, compared to radiotherapy only. [ABSTRACT FROM AUTHOR]

Objective:This study aimed to assess the influence of supra- and subglottic extensions and vocal fold mobility on outcome in a large monocentric cohort of 148 patients treated for tumour–node–metastasis stage T2N0 glottic carcinomas.Methods:In all, 107 glottic carcinoma patients had normal vocal fold mobility (T2aN0), and 41 had impaired vocal fold mobility (T2bN0). Treatment decisions were made by a multidisciplinary team.Results:Vocal fold mobility was associated with overall survival, disease-free survival, local control, larynx preservation and laryngectomy-free survival. For patients with T2a lesions, local control, laryngectomy-free survival and disease-free survival improved after surgery but overall survival did not. For patients with T2b lesions, local control, laryngectomy-free survival, disease-free survival and overall survival were all higher after surgery than after radiotherapy.Conclusion:This study highlights for the first time the importance of vocal fold mobility in treatment outcomes and is the first to assess its influence on survival. Updated tumour–node–metastasis classifications should consider the distinction between T2a and T2b lesions. [ABSTRACT FROM PUBLISHER]

Background:A case of salvage supracricoid laryngectomy with cricohyoidoepiglottopexy after failed radiation therapy and vertical partial laryngectomy had successful oncological and functional outcomes. This is the first reported application of salvage supracricoid laryngectomy with cricohyoidoepiglottopexy after the failure of two major treatments.Case report:A 65-year-old man was referred for salvage supracricoid laryngectomy with cricohyoidoepiglottopexy. The right recurrent hemilarynx was successfully resected. After pexis, the right lobe of the thyroid gland was repositioned to overlap and reinforce the pexis gap and fill the devoid portion of the strap muscular closure. Multiple scattered foci (recurrent tumour–node–metastasis stage T2) were identified around the arytenoid cartilage and beneath the musculocutaneous flap. Four years after supracricoid laryngectomy with cricohyoidoepiglottopexy, the patient's recovery was following a favourable course and he had satisfactory laryngeal function.Conclusion:Appropriate case selection and proficient surgical skills were essential for a successful outcome. Head and neck surgeons should not be afraid to adopt functional preservation open surgical procedures in well-selected and well-motivated patients. A requirement for more challenging surgical procedures and meticulous rehabilitation processes should not exclude appropriate treatments from a surgeon's repertoire. [ABSTRACT FROM PUBLISHER]

Objective:To report and discuss the outcome of a treatment algorithm for patients with tumour stage 1 glottic squamous cell carcinoma.Method:A retrospective outcome analysis study was performed using data from a tertiary referral centre.Results:Sixty-nine patients were treated with radiotherapy and 26 with surgery, in accordance with the treatment algorithm. Five-year overall survival rates were the same for both treatment groups (92 per cent). Five-year disease-specific survival rates were 100 per cent for surgery, 98 per cent for radiotherapy and 99 per cent overall. The overall 5-year laryngeal preservation rate was 89.1 per cent, being 95.7 per cent for surgery patients and 86.7 per cent for radiotherapy patients (p = 0.502). There was no significant association between laryngeal preservation rates and age (p = 0.779), anterior commissure involvement (p = 0.081), tumour stage (1a or 1b) (p = 0.266) or treatment modality (surgery or radiotherapy; p = 0.220). There was no significant difference in local recurrence rates between the two treatment groups (19.3 per cent for radiotherapy vs 10.0 per cent for surgery; p = 0.220). The overall 5-year regional recurrence rate was 1.2 per cent.Conclusion:Tumour stage 1 glottic carcinoma can be managed with different treatment modalities, following an individualised treatment algorithm, with results comparable to published outcomes. [ABSTRACT FROM PUBLISHER]