The continuous intra-arterial infusion of anticancer drugs combined with radiation therapy is very useful and effective for some head-and-neck carcinomas such as maxillary or lingual one; however, it is hardly available for laryngeal carcinoma. It is very difficult in the larynx to infuse chemotherapeutics by retrograde catheterization through superficial temporal artery, because there are various types in the division of superior thyroid artery, i. e. a division from external carotic artery, from carotic bifurcation and from common carotic artery. The infusion of the agent is possible under direct insertion of the catheter into superior thyroid artery after skin incision. This procedure is emphasized during surgery of the larynx, especially in some cases of partial laryngectomy.
Out of 122 cases of laryngeal carcinoma 5 cases died of carcinoma in the lung, 10 cases of the recurrence in the cervical lymph nodes and only 2 cases of the recurrence in the base of tongue and the thyroid gland. As to the survival ratio of the partial laryngectomy, local recurrence in the laryngeal cavity was noticed in 4 of 14 cases without radiation therapy, 2 of 4 cases with preoperative radiation and 3 of 10 cases with postoperative radiation; all the cases were controlled by the followed total laryngectomy. It means that the carcinoma in the laryngeal cavity can be well controlled by the total laryngectomy, and that the presurgical intra-arterial infusion method of chemotherapy as well as the preoperative radiation therapy are not necessary in the laryngeal carcinoma.
The local recurrence of carcinoma was noticed in 5 of 23 cases which were initially treated by radiation and in 2 of 6 cases of partial laryngectomy when the involved vocal cord was movable (T1, T2). When the carcinoma extended to the other region (T3) or the affected vocal cord was immovable, the local recurrence was found in 3 of 5 cases of radiation but in none of 7 cases of partial laryngectomy. These results indicate that 1) radiation therapy should be preferred to surgery in cases of glottic carcinoma when both vocal cords are movable, 2) partial laryngectomy, especially the hemilaryngectomy is chosen in cases when the carcinoma extends to the supraglottic region or the vocal cord is immovable in the involved side, 3) in more extended cases, total laryngectomy is the safest.
