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Supraglottic Laryngeal Cancer: Analysis of Treatment Results
Author(s) -
Sessions Donald G.,
Lenox Jason,
Spector Gershon J.
Publication year - 2005
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/01.mlg.0000166896.67924.b7
Subject(s) - medicine , neck dissection , laryngectomy , larynx , cancer , radiation therapy , statistical significance , surgery , stage (stratigraphy) , population , gastroenterology , paleontology , environmental health , biology
Objective: This study reports the results of treatment for supraglottic laryngeal cancer with nine different treatment modalities with long‐term follow‐up. Study Design: Retrospective study of 653 patients with supraglottic laryngeal squamous cell cancer treated from April 1955 to January 1999. Methods: The study population included previously untreated patients with cancer of the supraglottic larynx treated with curative intent by one of nine treatment modalities and who were eligible for 5‐year follow‐up. The treatment modalities included subtotal supraglottic laryngectomy (SSL), SSL with neck dissection (SSL/ND), total laryngectomy (TL), TL/ND, radiation therapy (RT), SSL/RT, SSL/ND/RT, TL/RT, and TL/ND/RT. Multiple diagnostic, treatment, and follow‐up parameters were studied using standard statistical analysis to determine significance. Results: None of the nine treatment modalities produced a survival advantage, either overall or within the stages. Overall disease specific survival (DSS) by treatment modality included SSL 88.9%, SSL/ND 75.8%, TL 83.3%, TL/ND 66.7%, RT 47.2%, SSL/RT 68.9%, SSL/ND/RT 68.1%, TL/RT 59.3%, and TL/ND/RT 46.7%. Improved DSS and cumulative disease specific survival rates were associated with patients under the age of 65 years ( P = .0001), early stage disease, N0 disease ( P = .0001), clear resection margins ( P = .0094), and no recurrence ( P = .0001). Posttreatment function showed that 90% of patients were functional in everyday life, 90.7% were eating satisfactorily, 91.4% were breathing naturally, and 83% of SSL patients, 85.7% of RT patients, and 52.8% of TL patients had “good” voices. Laryngeal preservation was accomplished in 86.1% of SSL patients and 72.7% of RT patients ( P = .0190). Conclusions: No treatment modality produced a survival advantage. Because SSL produced the best rate of laryngeal preservation, we recommend its use in treating the primary in eligible patients. The importance of clear resection margins is stressed. Patients with N+ disease should have the neck treated. Patients with N0 disease may be observed safely with no loss of survival advantage. Because of the pattern of recurrence and the high rates of distant metastasis and second primary cancers, follow‐up for a period of not less than 8 years is recommended.