Prognostic factors in glottic carcinoma clinical stage I and II treated by surgery or radiotherapy

Decision making regarding selection of treatment for early glottic carcinoma remains controversial. This study was undertaken to assess the impact of such factors as patient age, stage of tumor, site and size of characteristic of the lesion, and other characteristics relative to disease free and overall survival rates.

The records of 145 consecutive patients with stage I and II glottic carcinomas treated between 1954 and 1990 were reviewed retrospectively. Surgery was performed on 50 patients (34.5%), and irradiation therapy was performed on 95 (65.5%). Cox's regression model was used to estimate the hazard ratios of recurrence and death.

Median follow-up was 69.3 months. Death due to cancer or treatment complications occurred in 29 patients, whereas 25 patients died due to causes not related to cancer. Five-year rates for overall survival and disease-free intervals were 94.6% and 70.8%, respectively. Tumor control was achieved by initial surgery or irradiation in 78% and 69.5%, respectively. T stage and vocal cord mobility in this series were not associated with prognosis. Arytenoid involvement intended to indicate a worse prognosis. Other site involvement such as anterior commissure had no prognostic impact.

Although stage I and II glottic cancers represent a heterogenous group, survival rates after surgery or radiotherapy vary relatively little. Death due to occurred in 17.9% of patients included in this series, whereas 17.2% died due to causes not related to cancer. Local recurrence following irradiation (29.5%) occurred more frequently than following surgery (10%). The choice of treatment modality for stage I and II glottic cancer should be justified by patient preference, involvement of anterior commissure, and impairment of vocal cord mobility and should not be a contraindication to radiotherapy.