1081 Seventy-five Percent of Extralaryngeal Larynx Cancers Respect the Thyroid Cartilage: A Modern Clinicopathologic Review of 89 Total Laryngectomy Specimens Show New Patterns of Spread

Results: The mean age was 13.5 months (range 0-192). Mean duration of follow-up (FU) was 63 months (range 0-382). The mean largest basal diameter was 13.3 mm (range 3-28) and the thickness was 7.5 mm (range 0.3-26). The subretinal seeds (SRS) were present in 243 (46%) of eyes, vitreous seeds (VS) in 187 (41%) and subretinal fluid in 282 (61%) eyes. EBRT was required in 87 eyes (19%), PL in 94 eyes (20%) and enucleation in 147 eyes (32%). The mean interval between initial diagnosis and EBRT was 6.5 months(median 6, range 0-42), of PL was 9 months(median 12, range 0-79) and of enucleation was 8 months(median 2, range 0-90). The mean RT dose (EBRT) was 3960 cGy. Reasons for EBRT were tumor recurrence 11 (13%), SRS recurrence in 10 (11%), VS recurrence 17 (20%) and prophylactic in 49 (56%). Total eyes treated with EBRT at 1, 3, 5, and 10 years and last FU were66 (14%),56(12%),43 (9%),26(6%)and 87(19%)respectively.Reasonsforplaqueradiotherapywere tumor recurrence 56 (60%), SRS recurrence 19 (20%), VS recurrence 13 (14%), anterior chamber seed recurrence 1 (1%) and non-regression of original tumor 5 (5%). Total eyes with plaque radiotherapy performed at 1, 3, 5, 10 years and at the last FU were 56 (12%), 54 (12%), 42 (9%), 20 (4%), and 94 (20%) respectively. Enucleation was done after failure of treatment with RT. Total eyes with enucleation performed at 1, 3, 5, 10 years and at last FU were 7 (2%), 16 (3%), 17 (4%), 12 (3) and 29 (6%) respectively. Second malignant neoplasm’s (SMN) occurred in 6 (2.6%) patients. Of these, SMN occurred within radiationfield in 67% (4/6). The SMN included osteosarcoma (1 femur, 2 orbit bone), leiomyosarcoma (1 urinary bladder), acute myeloid leukemia (1 AML) and one patient with both rhabdomyosarcoma (temporal fossa) and conjunctival melanoma. Snellen’s Visual acuity was better than 20/ 40 in 16%, 20/50-20/100 in 6%, 20/150-hand motion in 16%, light perception in 6% and fixes and follows in 23% eyes. At last FU, 268 patients were alive and well, 3 were dead with metastases and one with SMN. Conclusions:Radiation therapy is an effective salvage treatment for retinoblastoma with minimal late complications. Second nonocular malignancies are seen in these patients at long term FU and we recommend regular FU of these patients over years. Author Disclosure: K. Turaka, None; C.L. Shields, None; A. Leahey, None; A. Meadows, None.