Total laryngectomy for squamous cell carcinoma: recognizing disease patterns to aid detection of tumor recurrence

Posttreatment head and neck scans are among the most difficult to read due to the potentially complex surgical resection and reconstruction performed and additional radiation therapy changes. We aimed to determine the most common patterns and the timing of tumor recurrence following total laryngectomy for squamous cell carcinoma (SCCa).

Retrospective review of imaging studies from January 2005 to May 2013 of patients with recurrent disease following prior total laryngectomy for locally advanced or locally recurrent SCCa. Patients were only included if recurrence was pathologically proven.

Twenty-one patients met inclusion criteria in the study period. The median time to recurrence following laryngectomy was 13.3 months (range, 1-138 months). Recurrences were most common locoregional to the resection site. The most common site of recurrence as a distant metastasis was the lung. In addition, many patients demonstrated recurrent disease at multiple sites. Four patients demonstrated a second recurrence after salvage therapy of the first, 75% of whom had lung metastases. Subgroup analyses revealed a more rapid average time to nodal recurrence (median: 9.4 months, standard deviation: 5.2) than local recurrence (median: 12.0 months, standard deviation: 37.3). Lung metastases had the longest time to recurrence (median: 20.0 months, standard deviation: 20.5).

Trends of location-specific temporal recurrence for SCCa following total laryngectomy may help the interpreting radiologist to more carefully evaluate particular sites based on the postsurgical time frame. Specifically, in the first 12 months lymph nodes and the surgical anastomoses should be carefully evaluated for new masses. Pulmonary metastases were found with a median onset of 20 months.