| Early vocal cord carcinoma in obese patients: a surgical lesion. | |
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MedLine Citation:
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PMID: 3586807 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Early epidermoid carcinoma of the vocal cord is treated successfully by radiation therapy with high 5-year survival rates, low morbidity, and preservation of excellent voice quality in most cases. Typically, surgery is reserved for salvage of radiation failure and provides overall 5-year survival rates of 98% and 90% for T1 and T2 lesions, respectively. The extremely obese patient, often with a short neck and excessive amounts of subcutaneous fat, is difficult for both radiotherapist and surgeon to diagnose and treat. The recent observation of an unusually high rate of radiotherapy failure in a cluster of obese patients with early vocal cord cancer called attention to this problem. Because the larynx is near the thoracic inlet in obese patients, they are not suitable for administration of radiotherapy by accurate opposed lateral portals. The patients reported herein were treated entirely with anterior oblique portals. Of the five obese patients who underwent primary radiation therapy for early vocal cord cancer, three developed recurrent disease (60%) and a fourth developed a severe perichondritis requiring tracheostomy. Two patients with recurrent disease were successfully salvaged with total laryngectomy, while the third patient refused surgery and died 2 years later. The sixth patient was treated by partial laryngectomy with imbrication reconstruction and is alive and without evidence of disease 2 years following surgery. Recurrence rates and complication rates following primary radiation therapy for early vocal cord cancer appear to be unacceptably high in obese patients treated with anterior oblique portals. Therefore, we recommend conservation laryngeal surgery for obese patients with early vocal cord cancer who cannot undergo "standard" radiotherapeutic techniques. |
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Authors:
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D M Moore; G J Juillard; P H Ward |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Laryngoscope Volume: 97 ISSN: 0023-852X ISO Abbreviation: Laryngoscope Publication Date: 1987 Jun |
Date Detail:
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Created Date: 1987-07-13 Completed Date: 1987-07-13 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8607378 Medline TA: Laryngoscope Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 686-8 Citation Subset: IM |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Carcinoma, Squamous Cell / radiotherapy*, surgery Combined Modality Therapy Humans Laryngeal Neoplasms / radiotherapy*, surgery Laryngectomy Male Middle Aged Neoplasm Recurrence, Local Obesity / complications* Prognosis Vocal Cords* |
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