Hemilaryngectomy for salvage of radiation therapy failures

Radiation therapy has been the treatment most frequently used for early vocal cord cancer with surgery usually in the form of total laryngectomy held in reserve as a salvage option. We report our experience in selected patients who, having failed radiation therapy for their early vocal cord cancers, underwent frontolateral hemilaryngectomy as attempted salvage surgery. Between 1977 and 1986, fourteen patients at the University of Pittsburgh Eye and Ear Hospital underwent hemilaryngectomy for salvage of their stage I vocal cord squamous cell carcinoma after full-course radiation therapy had been unsuccessful. Over this same time period, 77 patients underwent total laryngectomy for salvage of radiation therapy failure. Three patients failed hemilaryngectomy, two of whom were ultimately salvaged with total laryngectomy. Thus a 79% salvage rate was achieved with hemilaryngectomy with an average followup of 90 months. The overall cure rate was 93% (13 of 14) with voice preservation in 86% (12 of 14). Decannulation, postoperative infection, and initiation of oral intake were not influenced by age. Such problems occurred more often in patients undergoing radiation therapy compared to those undergoing hemilaryngectomy without previous radiation therapy. These results indicate that hemilaryngectomy may be used for the salvage of radiation therapy failures of stage I vocal cord carcinoma with good success and without undue morbidity.