Carcinoma in situ of the glottic larynx: excision or irradiation?

The management of glottic carcinoma in situ (CIS) is controversial, with vocal cord stripping (S) generally accepted as the standard treatment, and radiotherapy (RT) as an alternative. We present our experience with 34 patients treated by either stripping or RT.

++Between 1974 and 1990, 34 patients with CIS of the glottic larynx larynx were treated at McGill University teaching hospitals. The median age at diagnosis was 67 years, with a male:female ratio of 6:1. All patients had CIS involving the glottis and the pathology was reviewed on all patients. Twenty-one patients were treated by S and 13 patients by RT as the primary treatment.

With a median follow-up of 96 months (25-209 months), the 15-year actuarial survival rate is 95% for all patients, with 100% and 87% survival rates for S and RT groups, respectively (p = 0.25). One patient in the RT group developed a subglottic invasive squamous cell carcinoma. On the other hand, 11 patients in the S group developed recurrence and were treated by repeat S (6 patients) or RT (5 patients), with a salvage rate of 100%.

Although most patients with CIS of the glottis are traditionally treated with vocal cord S, RT is effective in terms of freedom from recurrence; it is an attractive option and should be considered in patients with lesions recurring after stripping as well as in those whose follow-up presents a problem.