Role of radiotherapy in cancer of the larynx as related to the TNM system of staging. A review.

Abstract

An account of the results of treatment of cancer of the larynx is given employing the clinical staging presented by a committee member of the International Union Against Cancer. This system of staging may be valuable and may permit a better comparison of results and selection of treatment methods. It is only by constant comparison and review of the various modes of treatment that we can hope to achieve better results. Surgery and radiotherapy are complementary. External radiotherapy is the recommended choice of primary therapy in the early (T1T2N0M0) lesions. In patients with moderately advanced tumors (T3N0M0), 3 different plans of therapy may be offered: a. planned preoperative radiation therapy followed by total laryngectomy and radical neck dissection; b. initial radiotherapy followed by total laryngectomy and elective neck dissection in selective cases only, i.e., in patients where there is evidence of residual tumor in the larynx; c. initial total laryngectomy and elective radical neck dissection with or without postoperative radiation therapy. Some authors claim good results with plan a; others prefer plan b because a greater number of surviving patients retain their voice. Plan c is losing in popularity but is still recommended by some authors in supraglottic cancer. As the tumor extends to other regions with fixation or outside the larynx (T4N0M0), or metastasizes to cervical nodes (N1-3), total laryngectomy or laryngopharyngectomy with radical neck dissection may give the best chance for long time survival. Radiotherapy is an important adjuvant and is probably most effective when given preoperatively.