T2‐T3 carcinoma of the supraglottic larynx: A comparison of surgery and radiotherapy

Abstract

This paper compares results for T2-T3 carcinoma of the supraglottic larynx treated with radiotherapy (RT), supraglottic laryngectomy, or total laryngectomy. Two hundred thirty patients with T2-T3 carcinoma of the supraglottic larynx were treated at the University of Florida between 1964 and 1989. All had a minimum 2-year follow-up. Patients were treated with RT alone (160), supraglottic laryngectomy (25), or total laryngectomy (45). The probabilities of local control, local-regional control, distant metastasis, and survival were calculated by the Kaplan-Meier product-limit method and comparisons were made between the three treatment methods. American Joint Committee on Cancer (AJCC) stage, T stage, anatomic suitability for a supraglottic laryngectomy, treatment group, and presence or absence of a pretreatment tracheostomy were evaluated in multivariate analyses for the various end points. The 2-year local control rates for patients treated with RT alone, supraglottic laryngectomy, and total laryngectomy for T 2 lesions were 87%, 82%, and loo%, respectively, and rates forT3 lesions were 70%, 71%, and 81%. In the multivariate analyses, T stage was of independent prognostic significance for the end point of local control, whereas AJCC stage was a significant prognostic factor for control above the clavicles and cause-specific survival. The incidence of severe complications was as follows: RT (6%), supraglottic laryngectomy (20%), and total laryngectomy (16%). In this analysis of T2-T3 supraglottic larynx carcinomas, treatment with RT offered equivalent local control rates, local-regional control rates, and survival rates with fewer severe complications compared with supraglottic laryngectomy. Although total laryngectomy was associated with a modest improvement in local-regional control, the differences were not statistically significant, and this procedure would rarely be indicated today for T 2 lesions and uncommonly for T 3 lesions. Radiut Oncol Invest 1995;2:237-244. o 1995 Wiey-Liss, hc.

Carcinoma of the supraglottic larynx: Treatment results with radiotherapy alone or with planned neck dissection

“…Varying opinions exist in the literature regarding the optimal treatment of supraglottic carcinoma 4, 6, 7, 14, 16, 19–22, 24, 26, 27, 36, 39, 57–60. Because there are no randomized data comparing radiotherapy with conservation surgery for early, “favorable” tumors, it is necessary to examine nonrandomized data.…”

“…Almost all patients with supraglottic carcinoma are potential candidates for curative treatment with external beam irradiation, except those with high‐volume, advanced disease. In contrast, it is difficult to define the proportion of patients suitable for conservation surgery (Table 4) for several reasons: (1) publications pertaining to supraglottic laryngectomy frequently do not state the denominator from which the patients were selected, (2) patients whose treatment is converted from conservation surgery to a total laryngectomy at the time of operation are often excluded,36 and (3) the percentage of suitable patients varies with referral patterns 3, 6, 8, 14…”

“…Patients were clinically staged according to the 1998 American Joint Committee on Cancer (AJCC)35 staging system. Previous publications on supraglottic carcinoma from this institution have used the 1983 AJCC staging system 4–7, 34, 36, 37. Patients were restaged in this series according to the 1998 AJCC system, thereby causing a certain amount of “negative” stage migration, or the reverse Will Rogers effect.…”

“…Controversy exists in the literature regarding the optimal treatment of supraglottic carcinomas 1–22. Early‐stage, “favorable” lesions are usually treated with supraglottic laryngectomy or radiation, depending on the extent and location of the tumor, patient condition, and preference of the clinicians involved.…”

Predictors of outcome for advanced‐stage supraglottic laryngeal cancer

“…The choice of treatment is determined by patient and tumorrelated factors, institutional practice, and physician preference. Conservation surgery by supraglottic laryngectomy 1 or by transoral endoscopic laser resection [2][3][4] may be used for T1,T2, and low volume T3 lesions, whereas high-volume T3 and T4 tumors need more extensive surgery involving total laryngectomy and bilateral neck dissection. Primary radiation may be used for T1,T2, or low-volume T3 tumors where the neck disease is also of low volume.…”