T2‐T3 carcinoma of the supraglottic larynx: A comparison of surgery and radiotherapy

Abstract

AbstractThis paper compares results for T2‐T3 carcinoma of the supraglottic larynx treated with radiotherapy (RT), supraglottic laryngectomy, or total laryngectomy. Two hundred thirty patients with T2‐T3 carcinoma of the supraglottic larynx were treated at the University of Florida between 1964 and 1989. All had a minimum 2‐year follow‐up. Patients were treated with RT alone (160), supraglottic laryngectomy (25), or total laryngectomy (45). The probabilities of local control, local‐regional control, distant metastasis, and survival were calculated by the Kaplan‐Meier product‐limit method and comparisons were made between the three treatment methods. American Joint Committee on Cancer (AJCC) stage, T stage, anatomic suitability for a supraglottic laryngectomy, treatment group, and presence or absence of a pretreatment tracheostomy were evaluated in multivariate analyses for the various end points. The 2‐year local control rates for patients treated with RT alone, supraglottic laryngectomy, and total laryngectomy for T2 lesions were 87%, 82%, and 100%, respectively, and rates for T3 lesions were 70%, 71%, and 81%. In the multivariate analyses, T stage was of independent prognostic significance for the end point of local control, whereas AJCC stage was a significant prognostic factor for control above the clavicles and cause‐specific survival. The incidence of severe complications was as follows: RT (6%), supraglottic laryngectomy (20%), and total laryngectomy (16%). In this analysis of T2‐T3 supraglottic larynx carcinomas, treatment with RT offered equivalent local control rates, local‐regional control rates, and survival rates with fewer severe complications compared with supraglottic laryngectomy. Although total laryngectomy was associated with a modest improvement in local‐regional control, the differences were not statistically significant, and this procedure would rarely be indicated today for T2 lesions and uncommonly for T3 lesions. © 1995 Wiley‐Liss, Inc.