Diagnosis and treatment of recurrent laryngeal cancer following initial nonsurgical therapy

Authors

  • Ivan Marcelo Gonçalves Agra MD, PhD,

    1. Department of Head and Neck Surgery, Hospital Aristides Maltez, Salvador, Brazil
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  • Alfio Ferlito MD, DLO, DPath, FRCSEd ad hominem, FRCS (Eng, Glasg, Ir) ad eundem, FDSRCS ad eundem, FHKCORL, FRCPath, FASCP, IFCAP,

    Corresponding author
    1. Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy
    • Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy
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  • Robert P. Takes MD, PhD,

    1. Department of Otolaryngology–Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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  • Carl E. Silver MD,

    1. Departments of Surgery and Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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  • Kerry D. Olsen MD,

    1. Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
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  • Sandro J. Stoeckli MD,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, Kantonsspital, St. Gallen, Switzerland
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  • Primož Strojan MD, PhD,

    1. Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
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  • Juan P. Rodrigo MD, PhD,

    1. Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
    2. Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
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  • João Gonçalves Filho MD, PhD,

    1. Department Otorhinolaryngology–Head and Neck Surgery, Centro de Tratamento e Pesquisa Hospital do Cancer A.C. Camargo, São Paulo, Brazil
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  • Eric M. Genden MD,

    1. Department of Otolaryngology–Head and Neck Surgery, The Mount Sinai Medical Center, New York, New York
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  • Missak Haigentz Jr MD,

    1. Department of Medicine, Division of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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  • Avi Khafif MD,

    1. Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
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  • Randal S. Weber MD,

    1. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Peter Zbären MD,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital, Berne, Switzerland
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  • Carlos Suárez MD, PhD,

    1. Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
    2. Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
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  • Dana M. Hartl MD, PhD,

    1. Department of Otolaryngology–Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France
    2. Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France
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  • Alessandra Rinaldo MD, FRCSEd ad hominem, FRCS (Eng, Ir) ad eundem, FRCSGlasg,

    1. Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy
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  • Kwang Hyun Kim MD, PhD,

    1. Department of Otolaryngology–Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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  • Luiz P. Kowalski MD, PhD

    1. Department Otorhinolaryngology–Head and Neck Surgery, Centro de Tratamento e Pesquisa Hospital do Cancer A.C. Camargo, São Paulo, Brazil
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Abstract

Surgery is the preferred modality for curative treatment of recurrent laryngeal cancer after failure of nonsurgical treatments. Patients with initial early-stage cancer experiencing recurrence following radiotherapy often have more advanced-stage tumors by the time the recurrence is recognized. About one third of such recurrent cancers are suitable for conservation surgery. Endoscopic resection with the CO2 laser or open partial laryngectomy (partial vertical, supracricoid, or supraglottic laryngectomies) have been used. The outcomes of conservation surgery appear better than those after total laryngectomy, because of selection bias. Transoral laser surgery is currently used more frequently than open partial laryngectomy for treatment of early-stage recurrence, with outcomes equivalent to open surgery but with less associated morbidity. Laser surgery has also been employed for selective cases of advanced recurrent disease, but patient selection and expertise are required for application of this modality to rT3 tumors. In general, conservation laryngeal surgery is a safe and effective treatment for localized recurrences after radiotherapy for early-stage glottic cancer. Recurrent advanced-stage cancers should generally be treated by total laryngectomy. © 2011 Wiley Periodicals, Inc. Head Neck, 2012.

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