Prospective validation of an institutional treatment strategy for T1N0M0 glottic carcinoma

Eur J Surg Oncol. 2019 Jul;45(7):1188-1195. doi: 10.1016/j.ejso.2019.03.032. Epub 2019 Mar 27.


Introduction: The aim of this study was to assess the validity of a treatment strategy for T1N0 glottic squamous cell carcinoma.

Methods: One hundred and seventeen patients were prospectively treated according to institutional guidelines. using 1) laser microsurgery (L) for exophytic tumor, limited to one vocal cord, without extension to the anterior commissure or the vocal process of the arytenoid cartilage, 2) radiotherapy (RT) for large or infiltrative tumor reaching the anterior commissure or the vocal process of the arytenoid cartilage, poor endoscopic exposure and cT1b or 3) partial laryngectomy (PL) for tumor infiltrating the anterior commissure. Ninety-five patients were treated with RT and 22 with surgery alone (S) [L:19; PL:3].

Results: The 5-year overall survival (OS) and disease-specific survival (DSS) were 81.5% and 97.1% (median follow-up: 73 months), respectively. There was no statistically significant difference in OS or DSS between patients treated with RT or S (logrank test: p = 0.974 and 0.978). The 5-year ultimate local control rate reached 98.3%. The local control rate with larynx preservation was 94.9% with no difference between RT (94.7%) and S (95.5%) (χ2: p = 0.891). Continued smoking after RT was significantly associated with a lower 5-year OS (77.9% versus 87%), [HR 3.458; p = 0.043 (95%CI 1.010-11.837)].

Conclusions: For patients with T1 glottic carcinoma, and based on our previous studies, these data prospectively confirm the oncologic validity of an institutional treatment strategy. Continued smoking after RT correlated with poor OS.

Keywords: Laser microsurgery; Partial laryngectomy; Radiotherapy; Squamous cell carcinoma; T1N0 glottic cancer.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alcohol Drinking / epidemiology
  • Antineoplastic Protocols
  • Arytenoid Cartilage / pathology
  • Disease-Free Survival
  • Female
  • Glottis / pathology
  • Glottis / surgery*
  • Head and Neck Neoplasms / mortality
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / therapy
  • Humans
  • Kaplan-Meier Estimate
  • Laryngeal Neoplasms / mortality
  • Laryngeal Neoplasms / pathology
  • Laryngeal Neoplasms / therapy*
  • Laryngectomy / methods*
  • Larynx / pathology
  • Laser Therapy / methods*
  • Male
  • Microsurgery / methods*
  • Middle Aged
  • Neoplasm Invasiveness
  • Prospective Studies
  • Radiotherapy / methods*
  • Radiotherapy, Conformal / methods
  • Radiotherapy, Intensity-Modulated / methods
  • Smoking / epidemiology
  • Squamous Cell Carcinoma of Head and Neck / mortality
  • Squamous Cell Carcinoma of Head and Neck / pathology
  • Squamous Cell Carcinoma of Head and Neck / therapy*
  • Survival Rate
  • Tumor Burden
  • Vocal Cords / pathology
  • Vocal Cords / surgery