喉頭癌の大切片組織標本による進展形式の検討とその治療成績

抄録

A total of 191 cases of laryngeal cancer were studied. All cases were treated at the Jikei University Hospital during the 10 years period from April 1976 to March 1986. There were 56 cases of supraglottic, 127 cases of glottic, and 8 cases of subglottic. To investigate the growth pattern, large tissue section were prepared from extirpated larynx which were classified 30 cases of supraglottic, 44 cases of glottic, and 5 cases of subglottic, during the 6 year period from January 1980 to March 1986.
As to therapeutic results, cumulative survival rate for all cases was 79.5%(S. E. 3.2%) for 3 year and 72.3%(S. E. 3.8%) for 5 year. When classfied by diagnosis, 3-year cumulative survival rate was 61.9%(S. E. 7%) and 5-year survival rate was 39.6%(S. E. 8.7%) for supraglottic cancer, and the corresponding figures for glottic cancer were 87.0%(S. E. 3.1%) and 85.7%(S. E. 3.4%), respectively.
In cases of supraglottic cancer, the growth pattern of cancer varied greatly according to its location and so were the therapeutic results. Three-year rude survival was 64.3% for cancers with the primary focus located in the false cords and 46.2% for those in the infrahyoid epiglottis (vestibular area). Therefore, it was difficult to obtain a good results by a uniform treatment method. Suitable method should be chosen individually according to the location of cancer. We consider it best to treat chiefly by radiotherapy the cases of unilateral cancer (T_1a) located in the false cords, ventricle, vestibular area or epiglottis, while the other cases are best treated by surgical methods. Radical neck dissection is essential and bilateral neck dissection should be performed in cases where the focus is located in the midline.
Cases of glottic cancer should be treated chiefly by radiotherapy when classified of stage as Stages I and II, and postiradiation observations should be made with chief regards on the anterior commissure and subglottic area. In cases showing invasion of cancer into the false cords or infraglottis total radiotherapy is not indicated.
In cases of subglottic cancer, therapeutic results are poor when the lesion is in the midline below the anterior commissure. However, cases of stage I or more are best treated by a combination therapy of radiotherapy +operation. In these cases radical neck dissection should be performed thoroughly for the paratracheal lymph node.
The anterior commissure plays a role as a barrier for invasion of cancer into the deeper layer, and two pathways of cancer invasion are produced above and under the barrier.
When cancer invades cartilage, invasion starts from the callus portion and proliferation occurs within. Since cancer shows specific growth pattern in the callus differing from the primary lesion, due consideration should be exercised for handling of the unaffected side.