Clinical assessment of the irradiated larynx. Salvage laryngectomy in the absence of histological confirmation of residual or recurrent carcinoma.

Following radiotherapy for squamous carcinoma of the larynx, it may be impossible to differentiate occult persisting tumour from irradiation effects, possibly with chondroradionecrosis, even after repeated biopsy. In seven of the cases presented, post-treatment laryngoscopy failed to provide histological evidence of residual or recurrent carcinoma, which clinical examination had indicated. Nonetheless, total laryngectomy was performed, subsequently revealing tumour in five of the seven excised larynges. The two tumour-free larynges were associated with cervical metastases. The clinical indications of persisting tumour, the factors compromising post-irradiation evaluation and the role of diagnostic aids are discussed.