喉頭癌の初回治療方針

Abstract

For the past ten years, the choice of treatment modalities for laryngeal carcinoma has depended not only on the T-stage but also on the cancer characteristics including the growing type, anatomical location and extension, and depth of invasion. A total or an extended total laryngectomy has been indicated for the following lesions; 1) glottic T2 invading the subglottic region (especially that of anterior type), T3 and T4, 2) supraglottic T2 invading the ventricle, the vocal cord and/or the anterior commissure, T3 and T4, 3) transglottic carcinomas and 4) subglottic carcinomas. To prevent local recurrence in case of (extended) total laryngectomy, it is important to understand the feature of tumor extension outside of the larynx and confirm the extent of the lesion directly by opening the larynx at the midline of the cricoid lamina.A total of 735 patients were treated at our hospital between 1979 and 1988. Forty-six percent of the patients received radiation (60-70 Gy) whereas the remaining patients underwent laryngectomy (partial laryngectomy in 4%, total laryngectomy in 50%). Only two local recurrences were observed in the totally laryngectomized patients. The overall 5-year cumulative survival rate was 72.4 % (cause specific 87.3%, minimum follow up interval : 5 years, n=319). The cumulative survival rates for stage III and IV lesions were 62.6%, and 55.6% for glottic, 62.5% and 51.2% for supraglottic, and 65.5% and 35.9% for transglottic lesions, respectively.