JAMA Otol Logo Orlando 2013 AHNS Meeting Location
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American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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THE MANAGEMENT OF EARLY GLOTTIC CANCER IN A VETERANS AFFAIRS MEDICAL CENTER PATIENT COHORT: IMPACT OF RISK FACTORS ON DISEASE RECURRENCE AND TREATMENT ALGORITHMS

Presentation: P041
Topic: Clinical - Gen. Head & Neck Surgery
Type: Poster
Date: Wednesday - Thursday, April 10 - 11, 2013
Session: Designated Poster viewing times
Authors: Vlad C Sandulache, MD, PhD, Alexander H Gelbard, MD, Mark W Kubik, Joseph A Malsky, Earlie H Thorn, Jose P Zevallos, MD
Institution(s): Baylor College of Medicine

Objective: To evaluate survival outcomes in a cohort of early glottic cancers.
Study design: Retrospective review.

Methods: Patient demographics, tumor characteristics, and treatment data were collected for 73 patients with T1 and T2 squamous cell carcinoma of the glottis treated at a tertiary-care Veterans Affairs (VA) Medical Center between 2000 and 2012. Statistical analysis was performed using Kaplan-Meier curves as well as univariate and multivariate regression.

Results: Patients in this cohort averaged 64.8 years of age, with 32% older than 70. Over 94% of patients were smokers with an average pack year history of 56. At last follow up, 37% of patients continued to smoke. Sixty-seven patients were treated with radiation, the remaining 6 with surgery. All treatment was compliant with current NCCN guidelines. Recurrence was noted in 15% of patients, mainly at the primary site (70%). Ninety percent of recurrences were treated surgically. Disease free and overall survival at 2 years were 85% and 75% respectively with a mean follow up of 3.9 years. Six patients required a tracheostomy and 4 required PEG placement during or after completion of treatment. Twenty percent of patients had a diagnosed second malignancy and of those, half were active at time of last follow up. Thirty percent of patients exhibited evidence of field cancerization such as dysplasia during their treatment period. Among patients for whom cause of death was available at last follow up none exhibited disease specific death.

Conclusions: Despite early T-stage at presentation, a high rate of local-regional recurrence was noted in this cohort of patients. Possible factors associated with this finding are field cancerization and a high rate of continued carcinogen exposure. Although organ-sparing, non surgical treatment was used in a majority of patients, a significant percentage of patients were tracheostomy or PEG tube dependent at last follow-up. Prospective studies will determine whether this population would be better served by limited local surgical resection versus radiation therapy.
 

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