Laryngeal dysplasia: epidemiology and treatment outcome

A retrospective analysis was undertaken of 65 patients with long-term follow-up for laryngeal squamous dysplasia. Based on the degree of dysplasia demonstrated on initial biopsy, 0 of 6 patients showing hyperkeratosis without dysplasia, 3 of 26 patients (12%) showing mild dysplasia, 5 of 15 patients (33%) showing moderate dysplasia, 4 of 9 patients (44%) showing severe dysplasia, and 1 of 9 patients (11%) showing carcinoma in situ eventually progressed to invasive carcinoma. An analysis was made of the impact of various treatment modalities in 33 patients demonstrating moderate dysplasia, severe dysplasia, or carcinoma in situ. Invasive carcinoma developed in 10 of 21 patients (48%) treated endoscopically and 0 of 12 patients treated by more aggressive therapy, including external beam radiotherapy, partial laryngectomy, or total laryngectomy. Of the patients in the endoscopic therapy group who developed invasive carcinoma, all were salvaged successfully. The overall rate of laryngeal preservation was 15 of 21 patients (71%) in the endoscopic treatment group and 11 of 12 patients (92%) in the aggressive treatment group. This difference is not statistically significant. We conclude that there is a moderately high rate of progression to invasive carcinoma in patients undergoing repeated endoscopic therapy for intraepithelial neoplasms of the larynx. However, with close, long-term follow-up, patients undergoing endoscopic therapy have an overall outcome similar to that in patients treated with partial laryngectomy or radiotherapy prior to developing invasive disease.