A 'watchful waiting' policy for in situ carcinoma of the vocal cords.

Forty-five patients with vocal cord (VC) carcinoma in situ diagnosed by biopsy or VC stripping have been retrospectively analyzed. Eighteen patients received irradiation therapy immediately on diagnosis. The initial local control (LC) rate was 72% (13/18); the salvage-augmented LC rate was 94% (17/18). Twenty-seven patients with in situ carcinoma were treated expectantly ("watchful waiting"), receiving definitive radiotherapy or definitive surgery only if invasion was subsequently verified histologically. One third of the patients' carcinomas have not become invasive (mean follow-up, 50 months). Of the two thirds that became invasive, one third were more advanced than T1N0 when treated--often because patients missed scheduled follow-up appointments. Nevertheless, the initial LC rate was 65% (11/17); the salvage-augmented LC rate was 88% (15/17). Total laryngectomy was required twice as often in the watchful waiting group as in the immediately treated group.