Cancer of the Larynx

Abstract

THE PURPOSE OF this report is to discuss the indications and limitations of radiotherapy in cancer of the larynx and to analyze the extent to which these and other results call for a revision of opinion on the present treatment of this disease. This paper is based upon a study of 107 consecutive, microseopicaUY'prO'ved"cancersof:the larynx treated by radiation in the Chicago Tumor Institute from the time it opened in April 1938 through December 1942,2 with a minimum observation period of five years. The controversy regarding the best treatment for laryngeal cancer revolves about two questions: 1. Is radiotherapy or surgery preferable for early true cord lesions suitable for laryngofissure? 2. Is radiotherapy or surgery preferable for operable laryngeal cancer suitable for laryngectomy? The main difficulty in attempting to answer these questions is due to the following circumstances: (a) Curability of early lesions of the vocal cord by laryngofissure is between 80 and 85 per cent and the curability of more advanced but operable cancer of the larynx by laryngectomy has increased to about 60 per cent. Surgeons understandably hesitate to substitute a newer method for an older and more established procedure until adequate evidence is available. (b) Whereas surgical technic for laryngeal cancer has become more or less standardized, the development of the principles and technic of irradiation is in mid-progress. As the technic improves, the curability increases, a fact that has not received adequate attention in the literature quoting comparative results of the two methods. (c) One obvious difficulty is that, generally speaking, the radiotherapist occupies himself largely with the treatment of cancer discarded by the surgeon and thus has only a limited opportunity to treat early and hence favorable cases. A study of the literature elicits the significant fact that, with isolated exceptions, the largest cancer clinics throughout the world treat only 8 or 10 operable cancers of the larynx each year. Since many cases are treated surgically, it becomes clear that the accumulation of enough operable cases treated by radiotherapy is a long and difficult task; yet only in this way will it ever be possible to settle the question of the relative merits of surgery and irradiation in laryngeal cancer. In spite of these difficulties, there has accumulated during the last twenty-five years sufficient experience to permit certain conclusions and to indicate the trend toward further progress. The first successful results of radiotherapy in laryngeal cancer were reported in 1922 by Regaud, Coutard, and Hautant before the International Congress of Otology in Paris (1). The report dealt with six advanced inoperable carcinomas treated with roentgen rays. The first large series was reported in 1932 by Coutard (2), who obtained 27 per cent five-year cures in 142 patients treated in the Curie Institute of Paris. In 1941, Ahlborn (3) reported 76 carcinomas of the larynx treated in the Radiumhemmet in Stockholm between 1930 and 1939.