[Clinical study of laryngeal cancer]

An analysis of 74 patients with laryngeal cancer treated between February 1985 and July 1995 is presented. Their mean age was 64 years, and the male to female ratio was 14:1. There were 48 cases of the glottic type, 21 cases of the supraglottic type, 2 cases of the subglottic type, and 3 cases of the transglottic type. Histopathologically, there were 72 cases of squamous cell carcinoma and 2 cases of mucoepidermoid carcinoma. Cervical lymph node metastasis was detected in 12 cases (16%). The incidence of cervical lymph node metastasis in supraglottic carcinoma was significantly higher (p < 0.01) than that in glottic carcinoma. There were 12 cases of second primary cancers. The location of the lesions was as follows: lung, 4; esophagus, 2; stomach, 2; prostate, 2; liver, 1; and gingiva, 1. Radical radiotherapy was performed in 52 cases; the local control rate was 98%, and the recurrence rate was 20%. Combined radiotherapy and total laryngectomy or laryngectomy alone was performed in 23 cases, and the recurrence rate was 23%. The recurrence rate for glottic carcinoma after initial therapy was 13%, supraglottic carcinoma 38%, subglottic carcinoma 100% and transglottic carcinoma 33%. Five-year total survival and cause-specific survival rate were 69% and 82%, respectively. Five-year cause-specific survival rates according to subsite were 95% for glottic carcinoma, 69% for supraglottic carcinoma, 0% for subglottic carcinoma, and 50% for transglottic carcinoma. The survival rate in glottic carcinoma was significantly better (p < 0.05) than in supraglottic carcinoma. These results led us to establish the following guidelines for the treatment of laryngeal cancer: for T1 or T2 cases of the glottic type, radiotherapy is recommended first; for T3 or T4 cases of the glottic type, total laryngectomy after radiation therapy is recommended; for T1 or T2N0 cases of the supraglottic type, radiotherapy is recommended first; for T2N(+) or T3 or T4 cases of the supraglottic type, total laryngectomy after radiation therapy is recommended. If cervical lymph node metastasis is presently, neck dissection is necessary.