title: Primary management of limited laryngeal cancer by radiotherapy and surgical salvage: results of 164 cases treated in a district hospital.
abstract: A total of 164 patients with limited laryngeal cancer (all sites, stages T1T2T3, N0N1) were treated between 1966 and 1979 at the Derbyshire Royal Infirmary by a policy of radical radiation therapy and surgical salvage. Of 122 cases of glottic cancer, 32 recurred of which 12 were successfully salvaged by laryngectomy. The corrected actuarial survival at 6 years was T1 95.1%, T2 83.0% and T3 31.3%. Of 38 cases of supraglottic cancer, 18 recurred but none was salvaged. The corresponding survival rates were T1 84.6% and T2 36.4%. A number of factors were analysed by a multivariate stepwise regression method to assess their impact upon radiation failure. These were: tumour status, nodal disease, the presence of symptoms other than hoarseness, histological grade, age, length of history and dose (TDF). Significant determinants in glottic cancer were tumour stage (P less than 0.0005), nodal disease (P less than 0.05) and presence of symptoms (P less than 0.05). In supraglottic cancer dose (P less than 0.001) and severity of symptoms (P less than 0.005) were predictive. It is concluded that this policy was effective in the management of T1 and T2 glottic cases and that T1 supraglottic cases responded well if an adequate radiation dose was delivered. The more advanced stages in both sites, however, did not fare as well, especially if initially node positive and in the presence of severe pretreatment symptoms. Surgical salvage had little impact on overall survival in this group.
authors.affiliation: Department of Radiotherapy, Derbyshire Royal Infirmary, Derby, UK.
authors.forename: M
authors.initials: M
authors.lastname: McLean
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects; D015996:Survival Rate