Management of stage II (T2N0M0) glottic carcinoma by radiotherapy and conservation surgery

✍ Scribed by J. Gershon Spector; Donald G. Sessions; K. S. Clifford Chao; Jason M. Hanson; Joseph R. Simpson; Carlos A. Perez

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 137 KB
• Volume: 21
• Category: Article
• ISSN: 1043-3074
• DOI: 10.1002/(sici)1097-0347(199903)21:2<116::aid-hed4>3.0.co;2-8

✦ Synopsis

Background:

The best therapeutic approach for the treatment of stage ii (t2n0m0) glottic carcinoma is controversial.

Methods:

A retrospective tumor registry data retrieval of patients with stage ii glottic carcinoma treated with curative intent at washington university medical center-barnes hospital between january 1971 and december 1989 (surgery) and december 1995 (radiotherapy) was performed.

Results:

Among 134 patients with stage ii glottic carcinomas treated with curative intent and function preservation, there were 47 patients treated with low dose radiotherapy (median dose, 58.5 gy at 1.5-1.8 gy daily fractions), 16 patients with high dose radiotherapy (67.5-70 gy) at higher daily fractionation doses (2-2.25 gy), and 71 patients underwent conservation surgery. the overall local control rate was 85%. the overall salvage rate was 68%. the 5-year actuarial and disease specific survivals were 81.5% and 92%, respectively. unaided phonation was achieved in 84.4% of the patients. an incidence of 10.4% regional metastases, 2.2% distant metastases, and 6% second primary tumors was documented. there were no statistical differences in local control, voice preservation, and 5-year actuarial and disease specific cure rates between conservation surgery and high dose radiation (p = .89). low dose radiation had statistically lower local controls, 5-year survival, and voice preservation (p = .014). in advanced t2b disease, treating the ipsilateral neck nodes reduced regional metastases (p = .02).

Conclusions:

High dose and daily fractionation (70 gy at 2 gy daily fraction doses) radiation achieved results equivalent to those of conservation surgery in 5-year local control, survival, and voice preservation. in advanced t2b disease, treatment of the ipsilateral neck nodes by radiotherapy or functional neck dissection reduced regional metastases.