DelGaudio J M, Fleming D J, Esclamado R M, Carroll W R, Bradford C R
Department of Otolaryngology-Head and Neck Surgery, University of Michigan Hospitals, Ann Arbor.
Arch Otolaryngol Head Neck Surg. 1994 Sep;120(9):959-63. doi: 10.1001/archotol.1994.01880330041008.
To determine the efficacy and safety of vertical hemilaryngectomy (VHL) for the treatment of early glottic carcinoma recurrent after radiation therapy (RT).
Retrospective study.
Major referral center.
Forty patients were identified who underwent VHL for T1 or T2 glottic carcinoma between July 1975 and March 1991, and all were included in this study. Twenty-two patients had received full-course RT before VHL, and 18 patients underwent primary VHL.
The local control rates were determined for T1 and T2 tumors in each group, along with actuarial survival rates and complications.
Local control of tumor for VHL after RT failure was 85% for T1 tumors, 78% for T2 tumors, and 82% overall. Three of four of the local failures in this group occurred in patients who had contraindications to VHL. Total laryngectomy for treatment of local failures in this group increased the local control rate to 93% for T1 tumors, 89% for T2 tumors, and 91% overall. Local control rates for the primary VHL group were 90% for T1 tumors, 75% for T2 tumors, and 83% overall. Total laryngectomy for treatment of local recurrences increased local control to 87% for T2 tumors and 89% overall. Five-year actuarial survival was 85% for each group. Delayed tracheal decannulation occurred more frequently in the patients who had undergone RT.
Our results support the oncologic safety and effectiveness of VHL for the surgical treatment of recurrent early glottic carcinomas after RT, with minimal increased morbidity.
确定垂直半喉切除术（VHL）治疗放疗（RT）后复发的早期声门癌的疗效和安全性。
回顾性研究。
主要转诊中心。
确定了40例在1975年7月至1991年3月期间因T1或T2声门癌接受VHL的患者，所有患者均纳入本研究。22例患者在VHL前接受了全程放疗，18例患者接受了初次VHL。
确定每组T1和T2肿瘤的局部控制率、精算生存率和并发症。
放疗失败后VHL对肿瘤的局部控制率，T1肿瘤为85%，T2肿瘤为78%，总体为82%。该组4例局部复发中有3例发生在有VHL禁忌证的患者中。该组因局部复发而行全喉切除术使T1肿瘤的局部控制率提高到93%，T2肿瘤为89%，总体为91%。初次VHL组的局部控制率，T1肿瘤为90%，T2肿瘤为75%，总体为83%。因局部复发而行全喉切除术使T2肿瘤的局部控制率提高到87%，总体为89%。每组的5年精算生存率均为85%。放疗患者延迟气管造口脱管的发生率更高。
我们的结果支持VHL对放疗后复发的早期声门癌进行手术治疗的肿瘤学安全性和有效性，且发病率增加最小。
