Radiation therapy in carcinoma of the false cord.

Abstract

It is widely recognized that radiation therapy offers an excellent chance of cure to patients with early vocal-cord cancer. Fairly reliable correlation of clinical staging with prognosis permits a meaningful selection of either surgery or radiation therapy as the treatment of choice. Carcinoma of the false cord, being relatively uncommon, is seldom referred to in the literature as a distinct entity, and the value of radiotherapy in its treatment is not well established. Reports dealing with vocalcord tumors employ precise anatomical terms and some form of staging, while false-cord tumors are either not staged or are grouped with tumors of distinctly different anatomic site and clinical behavior. In some versions of the “extrinsic-intrinsic” classification, false-cord tumors are grouped with cancers of the pyriform sinus and hypopharynx and share the poor prognosis of the latter group (1). In current nomenclature, these tumors appear under the more restricted category of “supraglottic laryngeal” tumors together with a reasonable attempt at staging. This improvement, however, is vitiated by the almost automatic implication that supraglottic cancers are, by that group designation, surgical problems (2, 3). It must be admitted that clinical reports tend to support this conclusion by demonstrating that persistent local disease and metastatic lymphadenopathy are frequent sequelae to radiation therapy, but the value of these reports is somewhat clouded by a consistent failure to relate results to precise locations and stages of disease. Too often, failure which should be related to stage is erroneously related to site, and the fine distinctions which are considered essential to proper management of vocal-cord cancer are not drawn. This report deals with radiation therapy as the sole treatment of a small group of patients presenting at McPherson Eye, Ear, Nose and Throat Hospital and Duke University Medical Center. Most of these patients have been followed five years or more. Incidence Over a four-year period beginning in 1961, approximately 2,500 new cancer cases were seen and treated in the Radiation Therapy Division of Duke University Medical Center. Of this group, 59 presented with early endolaryngeal cancers, divided into 53 true-cord and 6 false-cord cases (Fig. 1), an incidence of 11 per cent among early endolaryngeal tumors. This figure agrees quite well with the 10 per cent reported by Coutard and Valat in their classic monograph on false-cord tumors (4). Clinical Staging The staging used is a modification of that suggested by the American Joint Committee for Cancer Staging and End Results Reporting in 1962 (5). As it applies to vocal-cord cancer, the single category T-2 of the original staging system includes both mobile and fixed cords. We recommended preoperative treatment and delivered 4,800 R in twenty-nine days, beyond which he refused further irradiation or surgery.