[Problems in treating early cases of head and neck cancer]

The term "early case" is defined as a Stage I case, i.e. a T1N0M0 case in this paper. Cases of Tis are also included. During the 10-year-period from 1971 to 1980, the rate of early cases to the entire cases was the greatest for the larynx, followed by the nasal cavity, tongue, oropharynx and hypopharynx and cervical esophagus. The purposes of this paper are to review retrospectively the patients with early carcinoma of these organs who were treated in our hospital during the last 23 years, to discuss the no-recurrence rate and function following varying treatments and to propose some improvements in treatment. Carcinomas of the nasal cavity and the maxillary sinus are successfully treated with transoral surgeries with/without chemo-radiotherapy. A Nd-YAG laser is very useful for the surgery. For carcinomas of the oropharynx and oral cavity, surgical removal with/without (chemo-) radiotherapy yielded good results, whereas radiotherapy with/without chemotherapy presented with frequent failures. Extensive surgical removals, however, resulted in significant functional disorders. Currently, we have been using CO2 laser. For those lesions confined to the mucosa, a simple laser excision is applied. For those lesions with extension to the submucous tissue, we first remove the visible and palpable tumor by means of laser and, then, post-laser chemoradiotherapy is applied. The function after these treatments is excellent. For carcinomas of the hypopharynx and cervical esophagus, surgical treatments associated with total laryngectomy yielded better results than those without total laryngectomy. Total laryngectomy, however, causes serious problems in speech communication. Recently, we have tried partial pharyngo-esophagectomy followed by (chemo-)radiotherapy. This seems to be a promising modality. Supraglottic carcinoma was best treated with total laryngectomy. Partial laryngectomy was also successful when conducted by well-trained surgeons. Small lesions were successfully treated with radiation. We feel partial laryngectomy with the use of CO2 laser should be the first choice in many cases. Endolaryngeal laser can be applied to small lesions. For glottic carcinoma, radiotherapy is indicated in most head and neck cancer clinic over the world, and so had been in our hospital until a few years ago. Recently, we have adopted endolaryngeal laser surgery. Laser is advantageous over radiotherapy because it takes less treatment time, it has no side effect or carcinogenicity and it saves radiotherapy as a future treatment for possible recurrence or second primary.(ABSTRACT TRUNCATED AT 400 WORDS)