The failure rates of early stage glottic squamous cell carcinoma (SCC) treated with radiation therapy as a single modality can reach 5–13% for T1 tumors and 25–30% for T2 tumors [
A 47-year-old male was treated with a salvage vertical partial hemilaryngectomy after failed radiation for an early stage (cT1a) squamous cell carcinoma of the glottis. The recurrent tumor was initially staged as rT1a with normal vocal cord mobility (Figure
Axial computed tomography image of radiation recurrent glottic cancer shows no evidence of invasive disease into the thyroid cartilage prior to initial salvage surgery.
Low magnification (20x) hematoxylin and eosin pathological photomicrograph showing squamous cell carcinoma invading into ossified cartilage.
The important clinicopathologic features of the presented patient highlight the fact that a recurrent laryngeal SCC may be clinically understaged. The reasons for this have been outlined in pathological studies [
Accurate assessment of the paraglottic space is critical when considering surgical organ preservation strategies. The traditional contraindications for partial laryngeal surgery are contralateral vocal cord involvement, arytenoid involvement (except for vocal process), subglottic extension greater than 5 mm, cartilage involvement, and vocal cord fixation [
Appropriate preoperative staging is paramount. Cartilage biopsies carry a high risk of chondronecrosis and are inadvisable [
We have described a two-staged laryngeal reconstruction technique after vertical partial laryngectomy, which creates a temporary laryngostome with turn-in flaps following resection, the creation of a titanium-mesh composite prefabricated flap during the second stage, and closure during the third stage [
Recurrent or persistent glottic SCC must be carefully evaluated with endoscopy, PET-CT, and diffusion-weighted MRI, if possible [
The authors declare that there is no conflict of interests regarding the publication of this paper.