Clinically staged T3N0M0 laryngeal cancer: how is it best treated? Definitive radiotherapy with salvage surgery v/s combined surgery and radiotherapy

Abstract

Controversy surrounds the optimum treatment of T3N0 cancer larynx. Curative radiotherapy with salvage surgery in reserve is an accepted methodology as is also a combined protocol of surgery and radiotherapy. A retrospective analysis of the survival results of 119 cases of clinically staged T3N0 cancer larynx treated over a 14-year period at a single centre with either of the above two modalities has been undertaken. The selection of the treatment modality for an individual patient was decided jointly by the patient and the clinicians at a combined cancer clinic. The combined surgery plus radiotherapy treatment group was comprised of a relatively greater number of transglottic tumours while the curative radiotherapy group had a higher proportion of glottic tumours. Actuarial four-year disease-free survival rates were significantly better with combined treatment (79.3 per cent) than with radical radiotherapy and surgical salvage (65.3 per cent) − p value = 0.024. In the radical radiotherapy group, failure was almost always at the primary site and the probability of surviving with an intact larynx was approximately half of the total survival. As per this study, a policy of radical radiotherapy (with salvage surgery for failure) for unselected clinically staged T3N0 cancer larynx, does not provide for comparable cure rates or for satisfactory laryngeal preservation.