Curative radiotherapy for stage II-III squamous cell carcinoma of the glottic larynx

The authors report the analysis and outcome of curative radiotherapy for stage II and III squamous cell carcinoma of the glottic larynx. Thirty-nine men with invasive, previously untreated squamous cell carcinoma of the glottic larynx were referred for curative radiotherapy from May 1976 through June 1991, to the Veterans Administration Medical Center in Minneapolis, Minnesota, U.S.A. Thirty-eight patients had T2N0 disease, and one had T2N1 disease. All patients were treated by megavoltage units (two by cobalt 60 and 37 by 4 mV-linear accelerator). The median fractional dose was 1.80 Gy, and the median total tumor dose was 70.20 Gy. Surgical salvage was reserved for irradiation failure. All patients had a minimum 5-year follow-up. The Kaplan-Meier method was used for survival analysis. The 5-year disease-free survival with voice preservation after radiotherapy was 70.2% (80% for T2a and 64% for T2b patients). The ultimate 5-year disease-free survival for all T2 patients after surgical salvage was 91%. In nine patients, ten second primary malignancies were diagnosed during follow-up. Nine of these second lesions occurred in the aerodigestive tract. Curative radiotherapy using conventional fractionation regimen with surgical salvage for irradiation failure is an efficacious modality for T2N0 and T2N1 squamous cell carcinoma of the glottic larynx. A high incidence of second malignancy was noted in our series.