Management of 33 cases with supraglottic carcinomas stage T3 / 中国癌症杂志

ABSTRACT

Purpose:To investigate the curative effect of T3 lesions of supraglottic carcinoma in our hospital and discuss the management of T3 lesions.Methods:33 cases of T3 supraglottic carcinoma hospitalized in Cancer Center of Sun Yat sen University of Medical Sciences from 1982 to 1991 were reviewed. All primary lesions were resected by surgery, including 27 total laryngectomy and 6 horizontal supraglottic laryngectomy. The treatment modality of the neck was as follows Among 13 clinically positive neck 2 underwent radical neck dissection, 11 underwent selective neck dissection. Among 20 clinically N0 cases 1 underwent elective neck dissection and the rest watchful waiting. In this group 19 cases were treated by definitive surgery, the rest 14 cases managed by surgery plus radiotherapy.Results:The 5 year survival rate in our group was 63.6%(21/33), the 5 year tumor free survival rate was 57.6%(19/33) and the 5 year cumulative survival rate by Kaplan Meier was 63.9%. The 5 year survival rate in partial laryngectomy and total laryngectomy was 80% and 59.9% respectively, no significant difference was shown by Kaplan Meier analysis(Log Rank=0.82, P =0.3646). The 5 year survival rate in definitive surgery and surgery plus radiotherapy was 56.4% and 67.3% respectively. There was also no significant difference by Kaplan Meier analysis (Log Rank=0.61, P =0.4341). 5 cases presented primary relapse and 12 cases neck relapse in our group. The primary and neck control rate was 84.8%(28/33)and 63.6%(21/33)respectively.Conclusions:For T3 subtypes with pre epiglottic space or tongue base infiltration, horizontal supraglottic laryngectomy could abtain better result. One should be careful when applying partial laryngectomy in T3 with cord fixation. Although surgery plus radiotherapy could not significantly influence survival, it could have a tendency to get higher 5 year survival rate than definitive surgery. Radiotherapy and chmotherapy need to be study further.