Five hundred cancers of the larynx and pyriform sinus. Results of treatment by radiation and surgery.

Abstract

AbstractThree hundred eighty cancers of the larynx and 120 of the pyriform sinus were treated in the 15 years from 1958‐1973 at Yale‐New Haven Hospital. They were studied for response to treatment by surgery, radiation or a combination of the two. Overall control rates in the entire group of 500 were 51% for radiotherapy, 51% for surgery. Further analysis showed significant differences in the results obtained by stage and by location for surgery and radiotherapy. The total number of cases treated by combined therapy was relatively small, except for pyriform sinus.Radiotherapy success showed a steep gradient from 82% in Tl lesions to 5% in T4. The gradient for surgery was less steep with 64% success for Tl and 40% for T4. Both radiotherapy and surgery were most successful in glottic cancer and least successful in the pyriform sinus. However, the success range varied more with radiation than with surgery (83% success in glottic cancer, 5% in pyriform sinus cancer for radiotherapy; 81% in glottic cancer and 24% in pyriform sinus for surgery). Late primary recurrences (3 years or more after radiation therapy) developed only in the glottic group.Recurrent cancer at the primary site in non‐glottic lesions appeared within 2 years after radiotherapy in 65 of the 66 local recurrences. Similarly, 77 of the 82 local recurrences of non‐glottic cancer after surgery appeared within 2 years.With only 1 exception in 34 cases, surgical salvage of radiation failures succeeded only in glottic cancer.Of the 136 T1 glottic lesions there were no discernible regional metas‐tases. In the remaining 73 glottic T2 and T3 lesions, cervical node me‐tastases developed in 8 lesions.Supraglottic cancer was the most likely to produce cervical node metastasis from an early primary lesion (5 Tl lesions among 10 supraglottic lesions with unrecognized positive nodes).Eight of the 65 patients with fixed cervical node metastasis were controlled with no evidence of disease after 3 years.Among the treatment failures, most of those in the radiotherapy group were due to uncontrolled primary disease (72%). The failures among the surgical group were due mainly to metastasis (72%).Final controls obtained by surgery, radiotherapy, combined treatment and secondary salvage of radiation or surgical failures were as follows: glottic 82%; supraglottic 58%; transglottic 58%; subglottic 60%; pyriform sinus 17%.