CLINICAL STUDY OF LARYNGEAL CANCER

Abstract

An analysis of 74 patients with laryngeal cancer treated between February 1985 and July 1995 is presented. Their mean age was 64 years, and the male to female ratio was 14: 1. There were 48 cases of the glottic type, 21 cases of the supraglottic type, 2 cases of the subglottic type, and 3 cases of the transglottic type. Histopathologically. there were 72 cases of squamous cell carcinoma and 2 cases of mucoepidermoid carcinoma. Cervical lymph node metastasis was detected in 12 cases (16%). The incidence of cervical lymph node metastasis in supraglottic carcinoma was significantly higher (p<0.01) than that in glottic carcinoma. There were 12 cases of second primary cancers. The location of the lesions was as follows: lung, 4; esophagus, 2; stomach, 2; prostate, 2; liver, 1; and gingiva, 1. Radical radiotherapy was performed in 52 cases; the local control rate was 98%, and the recurrence rate was 20%. Combined radiotherapy and total laryngectomy or laryngectomy alone was performed in 23 cases, and the recurrence rate was 23%. The recurrence rate for glottic carcinoma after initial therapy was 13%, supraglottic carcinoma 38%, subglottic carcinoma 100% and transglottic carcinoma 33%. Five-year total survival and cause-specific survival rate were 69% and 82%, respectively. Five-year cause-specific survival rates according to subsite were 95% for glottic carcinoma, 69% for supraglottic carcinoma, 0% for subglottic carcinoma, and 50% for transglottic carcinoma. The survival rate in glottic carcinoma was significantly better (p<0.05) than in supraglottic carcinoma. These results led us to establish the following guidelines for the treatment of laryngeal cancer: for T1 or T2 cases of the glottic type, radiotherapy is recommended first; for T3 or T4 cases of the glottic type, total laryngectomy after radiation therapy is recommended; for T1 or T2N0 cases of the supraglottic type, radiotherapy is recommended first; for T2N (+) or T3 or T4 cases of the supraglottic type, total laryngectomy after radiation therapy is recommended. If cervical lymph node metastasis is presently, neck dissection is necessary.