Primary radiotherapy with surgery in reserve for advanced laryngeal carcinoma. Results and complications

A retrospective study of a selected group of 58 patients with T3 and T4 squamous cell carcinomas of the larynx presenting between 1974 and 1984 was undertaken. These patients were treated primarily with radical radiotherapy and salvage surgery in reserve. The aim of this study was to examine survival, recurrence rate and the complications after salvage surgery. In 30 patients the tumor was classified as a T3 and in 28 as a T4. In 14 patients (24%) nodal disease in the neck was present prior to the radiotherapy. Follow-up in all patients continued for at least 3 years or until death. Nineteen patients (33%) developed locally recurrent tumor and five (9%) developed nodal metastases to the neck. The recurrence in almost every patient was detected within 2 years after completion of the irradiation. Thirty patients (52%) are alive of whom 29 have no evidence of disease. Of these 30 patients 22 (73%) have their larynx intact and functioning. The 5-year adjusted acturial survival for the whole group of patients is 73%, for the T3N0 group 87% and for the T4N0 group 75%. Patients with nodal disease responded poorly. After salvage surgery severe postoperative complications developed in 37% of the patients. There were no deaths following salvage surgery.