CO<SUB>2</SUB>レーザー手術を組み入れた喉頭癌の治療成績

Abstract

In this study, we analyzed the treatment outcomes of 200 cases with laryngeal squamous cell carcinoma at Saga Medical School Hospital from 1985 to 1997. In all were 142 cases of glottic type, 54 cases of supraglottic type and 4 cases of subglottic type carcinomas. The breakdown of treatment procedures for the 122 stage I and II cases of the glottic type was as follows : initially treated by CO2 laser surgery alone (55 cases), CO2 laser surgery followed by irradiation therapy (39 cases), partial laryngectomy (3 cases), total laryngectomy (24 cases) and total laryngectomy with elective neck dissection (1 case). The treatment courses for 23 early stage cases of the supraglottic type were : initially treated by laser surgery followed by irradiation therapy (3 cases), partial laryngectomy (5 cases), total laryngectomy (11 cases) and total laryngectomy with elective neck dissection (4 cases). The 20 advanced stage cases of the glottic type were treated by total laryngectomy (12 cases), total laryngectomy with radical neck dissection (7 cases) and total laryngectomy with elective neck dissection (1 case). The treatments for the 31 advanced cases of the supraglottic type included : treated by total laryngectomy (4 cases), total laryngectomy with radical neck dissection (16 cases), total laryngectomy with elective neck dissection (6 cases), partial laryngectomy, radical neck dissection and concomitant chemoradiotherapy (1 case), irradiation (1 case), chemotherapy (2 cases) and CO2 laser surgery followed by irradiation therapy (1 case). The cause specific 5-year survival rates of the glottic type cases for stage I through IV were 98.5%, 95.2%, 90.9% and 50.0% respectively. Those of the supraglottic type were 100%, 86.2%, 90.9% and 54.3% respectively. The 5-year larynx preservation rate of the glottic type cases for stage I through IV were 90.4%, 46.9%, 0%, and 0% respectively. Those of the supraglottic type cases were 71.4%, 18.8%, 14.3% and 17.6% respectively. We concluded that, in most patients with early stage disease (stage I or II) especially of glottic cancer, the preservation of larynx was achieved by laser surgery alone. In contrast, advanced stage carcinoma of the larynx required chemo-radiation therapy combined with surgery.