Management Of Supraglottic Cancer Research Articles

Efficacy of routine bilateral neck dissection in the management of supraglottic cancer

In a previous study, we reported that the contralateral undissected neck was the most common site of failure in patients treated for squamous cell carcinoma of the supraglottic larynx. Since then, we have altered our treatment of all patients with T2-T4 supraglottic cancer and selective T1 cases to include routine bilateral neck dissection. In the present study, we compare the long-term efficacy of routine bilateral neck dissections to historic controls in the treatment of patients with supraglottic cancer. A retrospective chart review on all patients undergoing primary surgery for supraglottic carcinoma between 1989 and 2000 was performed. All had undergone routine bilateral neck dissection. The most proximal area of recurrent disease was identified as the site of recurrence. Rates of recurrence, 2-year overall survival, and 2-year disease-specific survival were calculated. Results were compared to historical data using Fisher's exact test. Of 180 patients identified, 115 patients with minimum 2-year follow-up and meeting exclusion criteria were included in the analysis. Four patients (3.5%) experienced local recurrence, 9 patients (7.8%) had cervical recurrence, and 8 patients had distant spread (7.0%). Recurrence in the neck (7.8%) has been significantly reduced from the historical recurrence rate (20%) prior to instituting routine bilateral neck dissections ( P = 0.009). The 2-year survival increased from 72% to 82.6% ( P = 0.0408). Routine bilateral neck dissection decreases cervical recurrence and appears to improve survival in the management of supraglottic cancer.

Efficacy of elective bilateral neck dissection in the management of supraglottic cancer

Efficacy of elective bilateral neck dissection in the management of supraglottic cancer

8:00 am Efficacy of Elective Bilateral Neck Dissection in the Management of Supraglottic Cancer

8:00 am Efficacy of Elective Bilateral Neck Dissection in the Management of Supraglottic Cancer

Management and Outcome Differences in Supraglottic Cancer Between Ontario, Canada, and the Surveillance, Epidemiology, and End Results Areas of the United States

We compared the management and outcome of supraglottic cancer in Ontario, Canada, with that in the Surveillance, Epidemiology, and End Results (SEER) Program areas in the United States. Electronic, clinical, and hospital data were linked to cancer registry data and supplemented by chart review where necessary. Stage-stratified analyses compared initial treatment and survival in the SEER areas (n = 1,643) with a random sample from Ontario (n = 265). We also compared laryngectomy rates at 3 years in those patients 65 years and older at diagnosis. Radical surgery was more commonly used in SEER, with absolute differences increasing with increasing stage: I/II, 17%; III, 36%; and IV, 45%. The 5-year survival rates were 74% in Ontario and 56% in SEER for stage I/II disease (P =.01), 55.7% in Ontario and 46.8% in SEER for stage III disease (P =.40), and 28.5% in Ontario and 29.1% in SEER for stage IV disease (P =.28). Cancer-specific survival results mirrored the overall survival results with the exception of stage IV disease, for which 34.6% of Ontario patients survived their cancer compared with 38.1% in SEER (P =.10). This stage IV difference was more pronounced when we further controlled for possible cause of death errors by restricting the comparison to patients with a single primary cancer (P =.01). Three-year actuarial laryngectomy rates differed. In stage I/II, these rates were 3% in Ontario compared with 35% in SEER (P < 10(-3)). In stage III disease, the rates were 30% and 54%, respectively (P =.03), and in stage IV disease they were 33% and 64% (P =.002). There are large differences in the management of supraglottic cancer between the SEER areas of the United States and Ontario. Long-term larynx retention was higher in Ontario, where radiotherapy is widely regarded as the treatment of choice and surgery is reserved for salvage. In stages I to III, survival was similar in the two regions despite the differences in treatment policy. In stage IV, there may be a small survival advantage in the U.S. SEER areas related to the higher use of primary surgery.

Management of cancer of the supraglottis

We present the results of a retrospective study of 903 patients treated with conservation surgery for carcinoma of the supraglottic larynx so we can evaluate our management of supraglottic cancer with different types of surgery. In 301 patients, an extended supraglottic laryngectomy was performed. The recent selective use of transoral laser resection appears to be a rational approach. The 5-year uncorrected survival was 84%, 81%, 76%, and 55% for stages I, II, III, and IV, respectively. The most common site for local-regional failure was the cervical lymphatics. The percentage of occult disease in the NO neck was 21% and epilaryngeal supraglottic location, locally advanced and GIII tumors have a higher frequency of lymph node involvement. There were no differences between comprehensive and anterolateral elective neck dissections. A bilateral elective neck dissection is recommended. In histologically positive neck disease, the survival rates were better with postoperative radiotherapy only in cases of extracapsular spread.