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Management of advanced glottic carcinomas.
M S Razack1, T Maipang, K Sako
1Department of Head and Neck Surgery and Oncology, Roswell Park Memorial Institute, Buffalo, New York 14263.
American Journal of Surgery
|October 1, 1989
Summary
Initial total laryngectomy offers better survival for advanced glottic cancer. Surgery alone showed higher 5-year disease-free rates than surgery with neck dissection, though recurrences necessitated further treatment.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Head and Neck Cancer Research
Background:
- Advanced glottic cancers (T3/T4) present significant treatment challenges.
- Surgical intervention is a primary modality for these advanced stages.
Purpose of the Study:
- To evaluate the efficacy of initial surgical treatment for T3/T4 glottic cancers.
- To compare outcomes between total laryngectomy and total laryngectomy with regional node dissection.
Main Methods:
- Retrospective analysis of 128 patients with T3/T4 glottic cancers undergoing initial surgery.
- Comparison of disease-free survival rates between total laryngectomy (n=59) and total laryngectomy with neck dissection (n=69).
- Assessment of regional recurrence rates and salvage treatment outcomes (radiotherapy, re-operation).
Main Results:
- 5-year disease-free survival: 58% for total laryngectomy vs. 49% for total laryngectomy with neck dissection.
- 47% of surgically treated patients experienced regional recurrences.
- Salvage radiotherapy achieved a 23% success rate in selected patients with postoperative recurrences.
- Initial radiotherapy (6,600 rads) resulted in 28% 5-year disease-free survival.
Conclusions:
- Initial total laryngectomy demonstrates superior survival outcomes for advanced glottic carcinoma compared to combined surgery and neck dissection.
- High rates of regional recurrence after initial surgery underscore the need for effective salvage strategies.
- Further investigation into optimizing treatment pathways for advanced glottic cancer is warranted.