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  • Title: Does vocal cord fixation preclude nonsurgical management of laryngeal cancer?
    Author: Solares CA, Wood B, Rodriguez CP, Lorenz RR, Scharpf J, Saxton J, Rybicki LA, Strome M, Esclamado R, Lavertu P, Adelstein DJ.
    Journal: Laryngoscope; 2009 Jun; 119(6):1130-4. PubMed ID: 19358250.
    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 pre- and 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 log-rank 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 follow-up 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. Laryngoscope, 2009.
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