title: The treatment of early laryngeal cancers (T1-T2 N0): surgery or irradiation?
abstract: BACKGROUND
  Carcinoma of the larynx is the most common cancer affecting the head and neck region. In Northern Europe, early laryngeal cancer is almost universally treated by irradiation, but elsewhere it is treated by surgery. The main aim of this study was to determine whether there was any difference in survival between the two main therapeutic options. The secondary aim was to assess speech and voice quality in a small, randomized sample of patients from each treatment group.
  
  
  METHODS
  The subjects investigated were 488 patients with T1-2, N0 squamous cell carcinoma of the larynx. The patients form an unselected sequential group of our institution's experience with treating this disease over three decades. Four hundred nineteen patients were treated by irradiation, and 69 were treated with surgery. Most surgical patients were treated earlier in the series, whereas radiotherapy later became the treatment of choice. The primary outcome measures were recurrence at the primary site, recurrence in the neck, and tumor-specific survival. The secondary outcome measure was speech and voice quality. Statistical analysis was by univariate and multivariate analysis of association and survival. Surgery included horizontal or vertical partial laryngectomy and various minor procedures on the glottis, including cordectomy. Over a 30-year period, radiotherapy was administered to a dose of 60-66 Gy given over 30-33 daily fractions.
  
  
  RESULTS
  Surgery tended to be performed early on in the series and radiotherapy thereafter. Surgery was more likely to be carried out for supraglottic disease. These differences apart, the radiotherapy and surgery groups of patients were well matched. The 5-year tumor-specific survival for those treated by irradiation was 87% and for surgery it was 77% (p=.1022). Glottic cancer and T1 disease were associated with high 5-year survivals: 90% and 91%, respectively. Supraglottic site and T2 disease both had a poorer prognoses: 79% and 69%, respectively. The differences for both sets of data were significant. There was no significant difference in primary site recurrence rates for the two treatment modalities, but regional recurrence was higher in the surgery group. Further analysis demonstrated that this was not a function of surgery per se but rather of the unit's policy toward the N0 neck at the time surgery was carried out. Regarding speech and voice quality, radiotherapy was far superior to surgery. All patients in the radiotherapy group but only 3 of 10 in the surgery group were judged to have a good or normal voice (p=.0017).
  
  
  CONCLUSIONS
  Both surgery and irradiation are equally effective at treating early laryngeal carcinoma. Speech and voice were highly significantly better in patients treated by irradiation than in those treated by surgery.
authors.affiliation: Head and Neck Oncology Group, Department of Medicine, University of Liverpool, 3rd Floor, Clinical Sciences Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK. profasjones@beestoncastle.fsnet.co.uk
authors.forename: Andrew Simpson
authors.initials: AS
authors.lastname: Jones
authors.forename: Brian
authors.initials: B
authors.lastname: Fish
authors.forename: John Eugene
authors.initials: JE
authors.lastname: Fenton
authors.forename: David John
authors.initials: DJ
authors.lastname: Husband
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D015996:Survival Rate; D016896:Treatment Outcome; D014831:Voice / Q000502:physiology / Q000528:radiation effects