Elective postoperative radiation therapy following supraglottic laryngectomy:A simple new technique

Abstract

Preventing relapse in the neck is a major contemporary priority in cancers of the supraglottic larynx treated surgically. Previous studies have demonstrated that observing the clinically NO neck, or performing unilateral elective neck dissection, results in unacceptably high mortality. However, neither bilateral elective neck dissections nor postoperative bilateral elective neck irradiation have been uniformly embraced by head and neck oncologists because of fears that they would produce complications and damage the residual larynx. We undertook this study to evaluate the safety of postoperative neck radiotherapy, with the larynx shielded, after supraglottic laryngectomy. We treated 15 patients with T1–2, N0–3 disease by supraglottic laryngectomy followed by elective neck irradiation to a median dose of 56 Gy over 6 weeks. We shielded the residual larynx from irradiation because the primary margins were satisfactory in all of these patients. With follow-up periods ranging from 1.5 to 8.5 years (median 4.5 years), the incidence of complications was 0/15 (0%). The actuarial proportion of the patients who after 5 years remained free of relapse in the larynx was 100%, in the neck was 90%, and at distant sites was 80%. The cause-specific survival of the patients who initially presented with clinically N0–N1 necks was 100%, but with N2–N3 necks was only 20%. In conclusions, fears that postoperative irradiation would damage the residual larynx after supraglottic laryngectomy are quite unfounded when the larynx itself does not need to be irradiated and is shielded. Combining supraglottic laryngectomy with postoperative radiotherapy in this manner proved safe, with a cause-specific survival rate of 100% after 5 years in the patients without advanced neck disease. Better systemic therapy is necessary to help the patients with clinically advanced neck disease. Radiat. Oncol. Invest. 4:239–242, 1996. © 1997 Wiley-Liss, Inc.