Is radiotherapy recommended after supraglottic laryngectomy?

The oncologic safety and functional preservation of supraglottic partial laryngectomy

OBJECTIVE

The purpose of this study was to evaluate the appropriateness of the conservative surgery as the initial treatment of supraglottic cancer by the comparative study of supraglottic partial laryngectomy with radiation therapy.

METHODS

We analyzed 48 patients diagnosed as having supraglottic cancer who underwent supraglottic partial laryngectomy and 20 patients treated with radiation therapy as initial treatment from 1991 to 2005. Oncologic safety was evaluated by comparison of survival rates. Swallowing test was performed with videoesophagofluoroscopy under the category of the pharyngeal phase and the presence or absence of aspiration. Phonologic analysis was performed with acoustic waveform analysis and stroboscopy.

RESULTS

Positive resection margin was observed in 12 of the patients who received supraglottic partial laryngectomy (SPL), and its relationship with the primary subsite was evaluated. For the patients in stages I and II, the overall survival rate in each of the SPL group and the radiotherapy (RTx) group was 87% and 80%, respectively. For the patients in stages III and IV, the overall survival rate was 87% and 80%, respectively. On evaluation of swallowing and phonation function, no significant difference was noted between the SPL group and the RTx group.

CONCLUSION

This study suggests that for patients with supraglottic cancer, SPL provides acceptable survival, swallowing, and phonologic results in comparison with radiation therapy.

Laringuectomía supraglótica. Todavía en la brecha

INTRODUCTION

Horizontal supraglottic laryngectomy (HSL) allows the preservation of a functioning larynx and avoids a permanent tracheostoma. Its use and training have been conditioned by the employment of organ preservation programs and endoscopic laser surgery.

OBJECTIVE

To show functional and oncological long-term results of HSL.

MATERIAL AND METHOD

110 patients treated with HSL with a minimum of 5 years follow-up.

RESULTS

Local control, 89% for T1, 91% for T2, 80% for T3 and 91% for T4. Regional control 80.9%. Cause specific survival, 77.6%, 72.6% and 67% at 3, 5 and 10 years, significantly influenced by N-stage. Functional larynx preservation, 87%, with a 8.5% of non-decanulated patients.

CONCLUSION

HSL is a safe surgical procedure, with similar functional and oncological results to other therapeutic options. Its indications should be considered according to own experience and results.