Cancer of the Larynx: Treatment Results after Primary Radiotherapy with Salvage Surgery in a Series of 1005 Patients

Abstract

The aim of this study is to present and discuss the results of initial radiotherapy with salvage surgery and to compare them with those from centres where primary surgery is the prevailing principle. The series comprised 1005 consecutive patients treated during the period 1965-1998. Salvage surgery was performed if patients had residual tumour or developed recurrence. Disease-specific survival (DSS) and crude survival (CS) after 5 years, among 643 patients with glottic carcinomas treated with curative radiotherapy was 88.6% (SE = 1.3) and 65.3% (SE = 2.0), respectively. Among T1 glottic carcinomas the locoregional control was 88%, i.e. 88% of patients were cured after radiotherapy alone, and the DSS was 99% both evaluated after 5 years, i.e. the salvage surgery added approximately 11% to the survival of T1 glottic patients. Only 4% (12/312) of T1 glottic patients had laryngectomies. Locoregional control among T2 glottic cases was 67% and the DSS 88%, but, 18% (41/233) of patients lost their larynx. The corresponding results among T3 glottic cases were 30% and 59%, i.e. the organ preservation was close to 50%. Among patients with supraglottic carcinomas, the two estimates were 440 and 63%, respectively. Compared with our results, recent results published in the literature after initial laser surgery of T1 glottic carcinomas indicate that there are only minor differences in DSS and organ preservation, but it is generally agreed, but not proven, that voice quality after radiotherapy is better. T2 glottic carcinomas treated by initial supracricoid partial laryngectomy in a selected series have yielded very high DSS rates with better organ preservation than was observed in the present series. As to T3 glottic carcinomas, initial surgery does not produce better survival rates than those produced in the present series but our organ preservation is higher. The treatment of patients with supraglottic carcinoma has benefited from optimization of radiotherapy during recent decades. The role of initial laser surgery is as yet undecided.

A genetic view of laryngeal cancer heterogeneity

“…Reported 5-year OS is typically reported as 70 to 90%. 81,82 Locally advanced (Stages III and IVA/B) Advanced disease requires multimodal approach, usually a combination of chemotherapy (CT) or biotherapy (B) plus RT. Although functional organ sparing approaches permit larynx preservation, they do not provide a survival advantage over total laryngectomy.…”

Glottic laser surgery: outcomes according to 2007 ELS classification

“…Most authors agreed that laser surgery resulted in a deterioration of voice quality [6]. Severe dysphonia after laserassisted surgery was obviously due to the fact that most cordectomies were systematically sub-perichondral.…”

Prognostic role of epidermal growth factor-like domain 7 protein expression in laryngeal squamous cell carcinoma

“…The incidence and mortality of laryngeal SCC vary around the world, and are notably higher in Southeast Asia and Eastern Europe. 1 Despite advances in modern interventions, such as irradiation, endoscopic surgery and open surgery, the five-year survival rate of laryngeal SCC has improved only marginally over the past decades. 2 The recurrence rate is still as high as 45-50 per cent.…”