T1a glottic cancers may be removed by "cold steel" excision biopsies

Phonosurgical excision biopsies are gradually replacing traditional punch biopsies during direct lar-yngoscopy. As excision aims at removing all pathologic tissue, some malignant lesions may be completely removed. We present our experience with phonosurgical excision biopsies of T1a glottic cancers without primary radiotherapy.

From 2001 till 2010, 24 patients with T1a glottic squamous cell carcinoma did not receive primary radiotherapy as tumours could not be observed at the post-operative control or because of concurrent malignancy or the presence of other co-morbidity. All lesions were excised by instrumental ("cold steel") phonosurgery in which only the epithelial layer above the vocal ligament was removed (type 1 cordectomy). All patients were closely followed by an ear-nose-throat (ENT) surgeon in collaboration with a radiation oncologist.

Relapse was observed in nine of the 24 patients (37.5 %), all within 12 months. The per-operative evaluation of resectability and the results of margin biopsies were insufficient for prediction of recurrence risk. Neither tumour size, primary or secondary excision nor differentiation of the carcinoma influenced the relapse rate.

T1a glottic cancers may be removed by "cold steel" phonosurgical excision biopsies, but this is inferior to treatment with radiotherapy or laser-assisted phonosurgery. As more than half of the patients did not need radiotherapy, phonosurgery may be considered as sole treatment in selected cases, provided close follow-up with videostroboscopy for the first year after surgery is performed.

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