Interjugular neck dissection and post-operative irradiation for neck control in advanced glottic cancers--are we justified?
At the Kidwai Memorial Institute of Oncology, advanced laryngeal cancers are subjected routinely to primary surgery and/or post-operative radiotherapy (RT). The surgery consists of wide field laryngectomy which entails total laryngectomy, ipsilateral/bilateral thyroid lobectomy, bilateral paratracheal clearance, and bilateral clearance of levels 2, 3 and 4 lymphatics. Post-operative RT is indicated in event of the following histopathological (HPE) situations to consolidate local-regional control: (1) T4 primary; (2) significant subglottic extension; and (3) jugular/paratracheal metastatic deposits. This prospective study highlights the therapeutic efficacy of this protocol at our centre in 45 consecutive T4/T3 glottic cancers and specifically evaluates the role of interjugular dissection and/or post-operative RT in prevention of regional recurrence. Fifty-two per cent of primary lesions needed a post-surgical upstaging as against 14 per cent of the neck lesions. Accordingly 91 per cent of the cases (41/45) qualified for post-operative RT and 82 per cent (37/41) complied with the prescribed schedule. Recurrent disease in the lateral neck was noted in 2/37 who received the prescribed schedule and 1/4 non-compliant cases; while a recurrent central neck disease was noted in 1/37 and 1/4 of these cases respectively. All cases were followed-up for a period of two years and 66 per cent of the evaluable cases for a period of five years. This study confirms conclusively that our treatment schedule yields extremely gratifying two-year local-regional control rates of 89 per cent which translates into a two and five-year actuarial survival rate of 92 and 70 per cent respectively.
Shenoy
A M
AM
Department of Head and Neck Surgery, Kidwai Memorial Institute of Oncology, Bangalore, India.
Nanjundappa
A
A
Kumar
P
P
Kumar
R V
RV
Reddy
B K
BK
Kannan
V
V
Anantha
N
N
D003131:Combined Modality Therapy; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D007825:Laryngectomy; D015182:Lymphatic Irradiation; D008207:Lymphatic Metastasis; D037981:Neck Dissection; D011446:Prospective Studies