Multifocal carcinoma of the larynx presenting as subglottic carcinoma

The results of treating primary subglottic carcinoma (PSC) with radiation or surgery are disappointing, and recurrent disease is common. The purpose of this study was twofold: first, to present our experience of treating two multifocal patients with PSC and second, to report our treatment results using two different clinical treatment sequences. Between September 1991 and June 2002, we treated five patients with primary squamous cell carcinoma of the subglottis at the Tri-Service General Hospital, Taipei, Taiwan. It constitutes 5.2% of all 96 laryngeal cancers. Two patients were treated with primary surgery and planned postoperative radiation, and two patients were treated with primary radiation and salvage surgery. The fifth patient was treated with radiation alone. At the time of follow-up, four patients were alive without evidence of disease at 58 months, 28 months, 20 months and 11 months, respectively. One patient (T2N0) died of mediastinal lymph node and liver metastasis 2.5 years after being treated with primary surgery and postoperative radiation. In conclusion, our findings revealed that primary radiation in combination with salvage surgery resulted in a better survival rate than primary surgery with planned postoperative radiation. Primary surgery with postoperative radiation was unable to control the multifocal characteristics and occult mediastinal lymphatic drainage. It is important to point out that due to the small sample size and variation in cancer stages, analyses and conclusions regarding two different treatment sequences were not statistically feasible.