Carcinoma of the subglottic larynx

Primary epidermoid carcinoma of the subglottic region is extremely rare. Review of the tumor registry at Memorial Sloan-Kettering Cancer Center over the past 25 years showed only 16 patients who could be classified as having primary carcinomas arising in the subglottic larynx. Their ages ranged from 33 to 77 years. There were 13 men and 3 women. The most common symptom was hoarseness of voice (13 patients), followed by respiratory difficulty, and hemoptysis. One patient had stage I disease, two had stage II disease, five had stage III disease, and eight patients had stage IV disease. The thyroid gland was commonly involved in T4 lesions. Thirteen patients underwent total laryngectomy and 3 had partial laryngectomy. Thirteen patients were followed for more than 5 years. There was one postoperative death. One patient who had recurrence of tumor in the neck died 6 months later. One patient died after 1 year due to local recurrence and carotid rupture. One patient with initial bilateral metastatic neck nodes died from progressive, rapid, diffuse metastasis within 6 months. The 5 year determinate cure rate was, therefore, 70 percent (10 of 14). Herein, we have attempted to study the natural history of primary tumors of the subglottic region and elucidate causes of treatment failure. It appears that wide-field laryngectomy in conjunction with appropriate thyroidectomy and tracheoesophageal groove node dissection is the optimal initial treatment. Postoperative radiotherapy should be considered in advanced cases.