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Background. Vertical partial laryngectomy (VPL) and radiation therapy (RT) are the recommended conventional conservative options for glottic carcinoma classified as T2. In series presenting more than 100 patients with a minimum 3-year follow-up, however, local recurrence rates were reported as 22-43.5%. The authors' experience with a new strategy based on continuous cisplatin-fluorouracil induction chemotherapy (IC) and supracricoid partial laryngectomy with cricohyoepiglottopexy (CHEP) is presented. Methods. A retrospective analysis of 67 patients who presented with untreated moderately to well differentiated invasive glottic carcinoma classified as T2, managed from 1983 to 1991 with IC and CHEP, was conducted. Statistical analysis of survival, local control, nodal control, distant metastasis, and metachronous second primary tumor incidence was based on the Kaplan-Meier actuarial method. Univariate analysis was performed to analyze the relationships between various factors and survival, local recurrence, and nodal recurrence. Clinical response, histologic response, IC toxicity and postoperative course were reported. Results. The Kaplan-Meier 5-year survival, local recurrence, nodal recurrence, distant metastasis, and metachronous second primary tumor estimate were 92.3%, 5.6%,1.5%,1.8%, and 5.6%, respectively. Overall laryngeal preservation was achieved in 65 patients (97%). Ultimate local control was achieved in all patients but one. Nodal recurrence was statistically more likely in patients presenting with a local recurrence. Analysis of the specimens demonstrated complete histologic response to IC in 25 (37.3%) patients. A strong statistical relation (P 0.0001) was noted between complete clinical response after IC and complete histologic response. Conclusions. The change from the prevailing treatment modalities of RT and VPL to a new multimodal stategy (IC + CHEP) did not decrease survival and allowed for an increase in laryngeal preservation rate. The high rate (37.3%) of complete histologic response suggests that IC deserves further consideration in the management of patients with glottic carcinoma classified as T2. The favorable results achieved in this series, when compared with historic controls, should stimulate prospective clinical trials comparing the two surgical procedures (CHEP vs. VPL with or without IC) for resection of Stage II glottic carcinoma. Cancer 1994; 74:2781-90.

The current studies documented the results achieved with chemotherapy alone with curative intent in a series of 67 patients with invasive squamous cell carcinoma of the pharyngolarynx classified as T1–T4N0M0 complete clinical responders after a platin-based induction chemotherapy regimen. Group I consisted of 36 patients with tumors originating from the glottis. Group II consisted of 31 patients with tumors originating from sites within the pharyngolarynx other than the glottis. A minimum of 3 years of follow-up was achieved. Statistical analyses of survival, local control, lymph node control, distant metastasis, and second primary tumor rates were based on the Kaplan–Meier life-table method. Laryngeal preservation rates and local control rates are presented. The 5-year actuarial survival estimate was 85.1% in Group I patients and 54.8% in Group II patients. Survival was statistically more likely to be reduced in Group II patients compared with Group I patients (P = 0.01). The 5-year actuarial local control estimate was 65.7% in Group I patients and 37.5% in Group II patients. Local failure was statistically more likely to occur in Group II patients compared with Group I patients (P = 0.02). Local control rates after salvage treatment were 100% in Group I patients and 83% in Group II patients. Laryngeal preservation rates after salvage treatment were 100% in Group I patients and 64% in Group II patients. The 5-year actuarial lymph node control estimate was 90% in Group I patients and 73.7% in Group II patients. Lymph node failure was statistically more likely to occur in Group II patients compared with Group I patients (P = 0.04). The 5-year actuarial estimate for patients without distant metastasis was 100% in Group I patients and 90% in Group II patients. Distant metastasis was statistically more likely to occur in Group II patients compared with Group I patients (P = 0.03). The 10-year actuarial estimate for patients without metachronous second primary tumors was 56.4% in Group I and 46.1% in Group II. The current report 1) contradicts the old dogma of nonchemocurability for invasive squamous cell carcinoma of the upper aerodigestive tract and 2) suggests that the use of a platin-based chemotherapy-alone regimen with curative intent in patients with invasive squamous cell carcinoma of the pharyngolarynx who are classified as T1–T4N0M0 complete clinical responders after receiving an induction chemotherapy regimen is best indicated when the tumor originates from the glottis. Cancer 2001;92:1504–11. © 2001 American Cancer Society.

Twenty patients with glottic squamous cell carcinoma and a fixed true vocal cord underwent neoadjuvant chemotherapy followed by supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Phonation, respiration, and deglutition were preserved. Local control was better than has been previously reported for either extended vertical partial laryngectomy or radiation therapy. All patients were monitored for at least 3 years or until death. The Kaplan-Meier 3-year survival, local recurrence, nodal recurrence, distant metastasis, and second primary rates were 75%, 10.8%, 5%, 10.8%, and 10.8%, respectively. Overall local control was achieved in all cases, and laryngeal preservation in 90%. Our experience suggested that neoadjuvant chemotherapy with supracricoid partial laryngectomy with cricohyoidoepiglottopexy deserves further consideration in the treatment of glottic tumors with a fixed true vocal cord.

• We reviewed three cases of neuroendocrine carcinoid tumors of the larynx, located on the arytenoid cartilage, treated between 1962 and 1985 at the Laennec Hospital, University of Paris (France) V. Staging was performed according to the 1979 American Joint Committee for Cancer Staging Classification. None of the lesions were associated with symptoms of the carcinoid syndrome. Local and nodal recurrences, distant metastasis, and survival were analyzed. Among the 112 reported carcinoid (neuroendocrine) tumors of the larynx, arytenoid location represented 28.6% (32/112) of the cases. A review of these 32 patients was performed to analyze the problems associated with that location.(Arch Otolaryngol Head Neck Surg. 1991;117:1395-1399)

• A follow-up study to the initial work of Strome and colleagues in advancing the concept of the myomucosal flap for voicing following total laryngectomy is described. Data are evaluated from 30 patients. Seven of the eight original patients have functioning shunts with excellent voicing and six remain tumor free at more than two years. In the Laennec Hospital (Paris) series of 22 patients, seven shunts are functioning independently. Eleven of 20 inferiorly based flaps stenosed, and all stenoses occurred at the posterior tracheal wall. Technique refinements improved the patency percentage with the seven successes occurring in the last 13 procedures. Four patients in the series had flap necrosis, two of whom had diabetes mellitus and two others extensive paratracheal resections. The technique continues to merit consideration, recognizing that there is a learning curve before success can be anticipated.(Arch Otolaryngol Head Neck Surg 1988;114:1303-1306)

• Nineteen patients who presented with infrahyoid epiglottic squamous cell carcinoma with gross pathological preepiglottic space invasion, not amenable to a partial horizontal supraglottic laryngectomy, were offered a supracricoid partial laryngectomy with a cricohyoidopexy technique; this was an attempt to preserve physiological phonation, respiration, and deglutition while achieving the same local control rate as with a total laryngectomy. Preoperative chemotherapy and bilateral jugulocarotid lymph node dissection were performed in all cases. Patients were monitored for at least 5 years or until death. No patients were unavailable for follow-up. The 5-year actuarial survival (Kaplan-Meier method) was 84.2%. Local recurrence, nodal recurrence, and distant metastasis occurred once in our series, while six patients presented with a second primary tumor. We present, analyze, and compare functional results with those of the previously reported series. Our experience with the supracricoid partial laryngectomy with a cricohyoidopexy, in the face of selected infrahyoid epiglottic squamous cell carcinoma invading the preepiglottic space, not amenable to a partial horizontal supraglottic laryngectomy, suggested that a total laryngectomy might be avoided without decreasing the cure rate.(Arch Otolaryngol Head Neck Surg. 1993;119:881-886)