Management of advanced glottic carcinomas

Article Abstract:

Surgery and radiotherapy are common procedures used to treat head and neck tumors, but it is not always clear how to treat cases of advanced cancer. Radiation therapy is very effective in curing early-stage larynx (voice box) or glottic (part of the larynx) tumors without loss of the voice, but is relatively ineffective in treating advanced carcinoma. On the other hand, laryngectomy (removal of the larynx), with or without neck dissection, is effective but the patient must undergo a permanent tracheostomy (creation of an opening in the neck to allow for breathing). The medical records of 153 patients who were diagnosed with glottic cancer from January 1963 to December 1983 were studied to establish the correlations between initial surgical treatment of advanced glottic cancer and disease-free survival rates, recurrence, and need for second treatment over five years. The majority of patients (135 men and 18 women) were between 50 and 70 years old, and the age range was from 30 to 85 years. Further review of the charts revealed that 138 of the 153 patients were in the advanced stages of disease and of these, 128 patients were treated by surgery (59 had a total laryngectomy and 69 had a laryngectomy plus modified neck dissection, in which lymph nodes and other tissues are removed). After five years or more, the disease-free survival rates for the laryngectomy only group and the laryngectomy plus neck dissection group were 58 percent and 49 percent, respectively. The overall disease-free survival rate was 53 percent. Cancer reappeared in the remaining 47 percent (60 cases); nine cases had inoperable metastases, therefore salvage radiotherapy was performed in 51 cases and was successful for 23 percent. The overall survival rate was about 62 percent. In contrast, a 40 percent survival rate was observed when radiotherapy was the initial treatment followed by salvage surgery. Based on these findings and additional information from other case studies reported in the literature, the authors suggest that total laryngectomy plus neck dissection is the best strategy for effective and successful management of advanced glottic cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Laryngectomy

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Comparison of surgery and radiotherapy in T1 and T2 glottic carcinomas

Article Abstract:

Early stage cancer of the vocal cords can be treated successfully by either surgery or radiotherapy. The decision regarding initial treatment must take into consideration several factors including tumor staging, associated diseases, patient compliance with close follow-up, and patient acceptance of the suggested treatment. A review was undertaken to compare the outcome of 356 patients with early glottic (vocal cord area) cancer who underwent surgery; scheduled radiotherapy; or default radiotherapy (cases in which the patient refused or was medically unable to undergo surgery). The average patient age was 59; 96 percent were men. All were heavy users of alcohol and tobacco. There were 313 patients (88 percent) with T1 tumors (small tumors involving at least the basement layer of tissue); and 43 with T2 tumors (larger tumors, with deeper tissue involvement including extension, but not fixation to, the arytenoid cartilage). Surgery was performed on 230 patients. Surgery included excision of the vocal cords (200 patients); partial vertical laryngectomy, excision of the larynx (15 patients); and subtotal laryngectomy (15 patients). There were 64 patients who underwent radiotherapy as treatment of choice, and 62 patients had default radiotherapy. Five-year actuarial survival rate for surgical patients was 84 percent; for scheduled radiotherapy, 78 percent; and for default radiotherapy, 56 percent. Follow-up ranged from 5 to 18 years. For patients with cancer of the true vocal cord treated surgically 10 of 170 developed recurrence; this compared with 7 of 38 patients treated with radiotherapy. For patients with cancer involving the arytenoid cartilage, 24 were treated surgically and six developed recurrence, compared with six patients treated with radiotherapy, of whom, five developed recurrence. It is concluded that survival is similar for patients treated by either surgery or scheduled radiotherapy; however, recurrence is greater following radiotherapy in those patients with involvement of the cartilage. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Surgical management of squamous cell carcinoma of the floor of the mouth

Article Abstract:

Treatment of squamous cell carcinoma of the floor of the mouth involves surgery, radiation therapy, or a combination of both. The effectiveness of surgery alone for carcinoma of the mouth was investigated in 209 cases; the retrospective analysis of the medical records, accumulated between January 1, 1959 and December 31, 1982, involved collecting data on surgical treatment, sites of treatment failure, and survival. The patients, 168 men and 41 women, ranged in age from 31 to 91 years (average age was 61 years) and were evenly distributed among the progressive stages of the disease (50 percent in the early stages (I and II) and the other half in the late stages (III and IV)). In 73 percent, the mandible (jaw) had to be resected after a primary tumor was removed. Nine late-stage patients had neck masses, which turned out to be the most common site for second tumors and treatment failure for the patient population. There were 10 deaths within 30 days of surgery, with causes including respiratory failure and cardiac arrest. Survival for five years for 198 patients of all stages combined was 49 percent; for stages I through IV, survival was 69, 64, 46, and 26 percent, respectively. Surgical treatment of squamous cell carcinoma of the floor of the mouth has been effective, but it is likely that further improvements in treatment effectiveness will require systemic (affecting the whole body) treatments because of the increased incidence of metastasis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Squamous cell carcinoma, Mouth cancer

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