A carefully planned clinical program of combined pre‐operative radiation and surgery has been conducted by the Department of Otolaryngology at The Mount Sinai Hospital for the past 14 years in an effort to improve the survival rates for advanced cancer of the larynx and laryngopharynx. The Combined Therapy Program, introduced in 1958, encompassed three separate but interdependent phases. The first stage consisted of a strict protocol of 5,500 rads of Cobalt 60 teletherapy administered over a five to six‐week period. The second stage involved a rest period of three to six weeks to allow for proper healing of radiation reactions. The third stage comprised the radical procedure which included a wide field laryn‐gectomy, ipsilateral hemithyroidectomy and radical neck dissection. Whenever indicated, a contralateral neck dissection was performed as soon as feasible. The protocol described above was applied only to those patients who fit all the criteria that categorized them as having advanced cancer of the larynx and laryngopharynx. In this study all patients had a biopsy proven diagnosis of squamous cell carcinoma. A very careful statistical analysis has been made of the survival experience of this series of cases. The three and five‐year survival rates have been computed by the actuarial method,1 which when compared to the direct method, adds more reliability to the results. The direct method removes those cases not treated at least three and five years ago in computing three and five‐year survival rates, while the actuarial procedure includes all cases in the computation of survival rates. Between November, 1958, and March 1, 1972, 64 patients had been treated by combined therapy. According to the American Classification2 the 64 cases are composed of 20 Stage II (T2N0 excluded), 12 Stage III and 32 Stage IV cases. According to the actuarial method the absolute survival rates for all cases were 77 percent and 59 percent for three and five years respectively. The corresponding determinate rates were 88 percent and 86 percent. Analyzing the results according to stages, the three‐year determinate rates ranged from 100 percent for Stage II to 79 percent for Stage IV. The corresponding absolute rates ranged from 89 percent to 70 percent. The five‐year determinate rates ranged from 100 percent to 74 percent, while the absolute five‐year survival rates ranged from 50 percent for Stage II to 66 percent for Stage IV. This apparent reversal is far from being statistically significant because of considerable sampling error. The complications seen in patients treated with combined therapy have been essentially the same as those patients who undergo radical surgery without pre‐operative radiation. Several preventive measures have been utilized during surgery, and it is to be emphasized that there have been no deaths related to complications, and all patients ultimately healed completely. The important controversy which exists in the‐ combined method of therapy concerns the question of using low dosage pre‐operative radi...
Altlhough, ordiniarily, not difficult of execution, yet, the consequences which are liable to follow the -complete and permanent obstruction of one of the two vessels which supply the brain with the greatest share of its blood, will always render this operation a subject of grave consideration before its execution.Cerebral softening, with its concomitant symptoms, secondary hemorrhage, etc., are complications of the original disease for which ligature of the carotid may have been undertaken, which no prudent surgeon will heedlessly enicounter."Great importance was attaclhed to the operation by surgeons of this early period due to the variety of diseases and accidents for which it was undertaken.Patients with such common ailments as headache, neuralgia, epilepsy, and aortic aneurysm were considered suitable subjects for this operation regardless of its appallingly high mortality rate. The propriety of such operations was questioned by the more conservative surgeons, but the procedure became more and more popular up to the turn of the present century. Recently, few l)ertinent reports have appeared in the literature. The procedure is now much less common and the indications for its use are more limited. Improved technic has markedly reduced the postoperative mortality in tuncomplicated cases, but, as Doctor Wood foresaw, the operation continues to be a serious one, which requires grave consideration before its execution.Before discussing the present series of 20 cases, in which ligation of the common carotid became necessary, it might be interesting to examine briefly into the history of the operation itself. We know that the art of ligature for hemorrhage was known to the ancients, and Garrison20 states that: "Helio-
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