Conservation surgery for T2 and T3 carcinomas of the supraglottic larynx

The treatment of choice for supraglottic carcinomas of intermediate size (stages T2 and T3) remains controversial. Between 1974 and 1983 in our institution, 139 patients with supraglottic carcinoma of intermediate size were judged retrospectively to have been technically amenable to conservation surgery. Primary disease control at three years was achieved in 100% of the patients treated by supraglottic laryngectomy, 91% (34 patients) of those treated by total laryngectomy, and 69% (81 patients) of those treated by radiotherapy. Of the latter group, 62% were salvaged by total laryngectomy yielding a net three-year local control of 85%. Determinate five-year survival rates were 89% for supraglottic laryngectomy, 78% for total laryngectomy, and 70% for radiotherapy. Significant problems with aspiration occurred in four patients (16%) who were treated by conservation surgery, and two patients (8%) required a permanent tracheostomy. The results of this study show that supraglottic laryngectomy with postoperative radiotherapy as indicated is a highly effective method for the local control of supraglottic carcinoma of intermediate size that is amenable to conservation surgery.