Abstract
The treatment of laryngeal cancer is selected in consideration of a tumor site, TN staging, growth pattern of the tumor and the others, resulting in the relatively good 5-year-survivals in comparison with other cancers.
However, the prognosis of the patients with advanced supraglottic cancer and/or metastasis to the neck lymph nodes has been poor.
The 192 cases of laryngeal cancer were treated at our institution between September 1986 and December 1996. Seven cases of N2c at the time of therapy and 5 cases of pT4pN2c by bilateral neck dissections were reviewed. Those 12 cases were classified in supraglottic cancer, including one case with multicentric lesions. Radiation therapy was carried out in two cases (T1 and T2), one of which needed neck dissection later. Total laryngectomy with bilateral neck dissections were performed in other cases. Postoperative irradiation was carried out in 4 of 5 cases of pT4pN2c. Those cases resulted in no evidence of disease (6 cases), death of distant metastasis (5 cases) and death of another cancer (1 case) without local and neck recurrence.
Prophylactic neck dissection is important except for T1, some of T2 cases. It is stressed that bilateral thorough neck dissection for T4 supraglottic cancer cases and postoperative irradiation for pN2c case are effective. A strategy to distant metastasis is the theme to improve the cure rate of T4N2c cases.
