A Clinical Observation of the Laryngeal Carcinoma, and a Clinical Study on the Lymphatic Stream in Larynx and Neck

Abstract

I have observed clinically the 215 cases of laryngeal cancer treated in the Otolaryngological Clinic of Kyushu University during 9 years from August, 1957 to July, 1966. There were 192 male and 23 female patients among them and the ratio of male to female was 8.4: 1. The range of age was from 38 years old to 84 years old and its distribution was as follows: 38-39 years old 2 cases (0.9%), 40-49 years old 16 cases (7.4%), 50-59 years old 58 cases (27%), 60-69 years old 96 cases (44.7%), 70-84 years old 43 cases (20%).
In the prognosis, 55 cases (25.6%) of the all cases died (24 died from laryngeal cancer and 21 from other diseases). The total survival ratio was 74.4%, the 5-year survival ratio being 69%.
The next table shows the analysis of the results according to the treating method.
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The T. N. M. classification was done on the all cases and its conclusions were as follows.
1. Radiation therapy was most effective for the T1N0 group of glottic cancer. Especially, the interstitial radium-irradiation (Sasaki's method) which was carefully indicated proved 100% curability.
2. Partial resection was effective against the confined supraglottic cancer.
3. Laryngectomy was very effective for the T1N0 and T2N0 groups, but there were many recurrence cases in the T3N0_group. So T3N0 group should be treated not only by laryngectomy but by prophylactic neck dissection.
4. Laryngectomy combined with prophylactic neck dissection was effective for the T3N0 group, and the T4N0 group should be treated by some more strong and combined therapy.
The second subject of my clinical study is as follows. Radio-isotope Au¹⁹⁸ of 100μc was injected in the mucous membrane of the various sites of the larynx and in the submucous soft tissue of the ventricular band of 10 cases who were over 50 years old, on the supposition that the cancer invaded the various sites deeply, and the condition of lymphatic stream from the larynx to the cervical lymph nodes was examined by multiscintigram.
The results were as follows
1. Radio-isotope Au¹⁸⁹ clearly transferred to the deep cervical lymph nodes of the injected side in the most sites of the larynx.
2. In the arytenoid radio-isotope Au¹⁹⁸ transferred to the bilateral cervical lymph nodes. So the neck dissection should be exercised not only on the affected side, but the prophylactic neck dissection should be done on the other side, when the arytenoid region suffered from cancer, even if it was unilateral.
3. In the ventricular band the transference of radio-isotope Au¹⁹⁸ showed different when I injected in the depth of 3 and 5mm in one side of it. The radio-isotope Au198 injected there clearly transferred to the bilateral cervical and tracheal lymph nodes. The dissection of the tracheal lymph nodes should be done, not to mention the bilateral neck dissection, in the cases whose cancers developed deeply, though it was unilateral supraglottic cancer.
For that reason, clinically the T. N. M. classification is much more useful than many other classifications in the past.
This classification is the one in which much consideration was paid to the site and extent of the lesion, but not sufficiently to the depth of it.
Actually, it may be very difficult to make a clinical diagnosis about the deep development of cancer, and there is much room left for improvement at this point.