Early Vocal Fold Cancer Presents Delicate Choices

The patient was treated with excision using the mucosal flap technique. He recovered well, but was lost to follow-up. Then, a year later, he came back reporting severe hoarseness.

A biopsy showed invasive squamous cell carcinoma on the left cord and severe dysplasia on the right. Vocal cord motility was preserved, and there was no cervical adenopathy, Dr. Medina said. CT scans showed that the lesion was very superficial, there is no invasion of the paraglottic space.

Randal Weber, MD, Chairman of the Department of Head and Neck Surgery at the M. D. Anderson Cancer Center at the University of Texas in Houston, said he had asked the patient about these options. I would present both options to him: laser incision versus standard radiation therapy, he said. I think it’s important that he stop smoking. I would make every effort to get that therapy under way. I’m in favor of radiation.

Dr. Eisele said he would order an MRI for more information. When you’re dealing with recurrence, it’s not uncommon for that to be more advanced than the original lesion, he said. You’ve achieved negative margins of resection before. Something else is going on. I would just rule out more advanced disease than you can see here endoscopically.

He said, at this point, he would favor radiation therapy, but I think he’s a candidate for a number of different approaches.

Certainly he’s a candidate for transoral surgical resection, he said. I think patients really need to be presented with all the options. And we’ve got to acknowledge our biases and try to steer them to make a decision that’s appropriate for the individual.

Photodynamic therapy was also mentioned as an option, but the consensus was that that approach required some refinement.

And the panel dismissed the idea of chemotherapy in early vocal fold cancer. Nowadays, I think for medical-legal reasons it’s impossible to propose such treatment for these patients, Dr. Brasnu said. Morbidity is too high.

Dr. Weber agreed. It’s not something that I would do off a protocol, he said. You have to remember when you look at the major trials, there’s about a 1 to 2 percent mortality rate with chemotherapy. So I think you’ve got to be very careful about pursuing that.

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