Management of early glottic cancer in a Veteran population: impact of risk factors on disease recurrence and treatment selection

Presentation: AHNS-014
Topic: Other
Type: Oral
Date: Wednesday, May 1, 2019
Session: 2:00 PM - 2:45 PM Scientific Session 2 - HPV Negative I
Authors: Tanner Fullmer, MD1, Heath D Skinner, MD, PhD2, David J Hernandez, MD1, Vlad C Sandulache, MD, PhD1
Institution(s): 1Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, 2Department of Radiation Oncology, The University of Pittsburgh

Background: Transoral laser microsurgery (TLM) is an alternative to external beam radiation (EBRT) in the treatment of early glottic cancers. Outcome data comparing these two modalities is sparse and mixed. Here we directly compare treatment outcomes in a large cohort of patients treated within the Veterans Affairs (VA) system.  

Objective: To evaluate survival outcomes in a cohort of early glottic cancers.

Study design: Retrospective review.

Methods: Patient demographics, tumor characteristics, treatment method, clinical and functional outcome data were collected and analyzed for 140 patients with T1 and T2 squamous cell carcinoma of the glottis treated at the Michael E. DeBakey VA Medical Center between 2000 and 2015.

Results: Treatment selection was compliant with current NCCN guidelines. Recurrence was noted in 20% of patients, mainly at the primary site (75%). Disease free and overall survival at 2 years were 85% and 75% respectively, with a mean follow up of 4.7 years. Twenty percent of patients had a diagnosed second malignancy and of those, half were active at time of last follow up. Among patients for whom cause of death was available at last follow up, none exhibited disease specific death.

A plurality (30%) of patients with a diagnosis of T1 glottic SCCA demonstrated findings of pre-malignant lesions either at a second site within the larynx at time of diagnostic biopsy or on biopsies obtained on another date during their clinic follow up; 42% of patients continued to smoke during and following treatment. Interim analysis of data from the first 70 (2005 to 2011) patients prompted a treatment shift toward TLM. For the second half of the cohort (2011 to 2015), implementation of TLM did not decrease locoregional control, disease specific survival or overall survival compared to radiation (p>0.1 for all 3 outcome measures).

Conclusions: Despite early T-stage at presentation, a high rate of local-regional recurrence was noted in Veterans with glottic cancer.  Possible factors associated with this finding are field cancerization and a high rate of continued carcinogen exposure (during and following treatment).  Treatment change to TLM was initiated due to the high rate of recurrence/second primary and was successful in maintaining locoregional control and survival while decreasing EBRT utilization.