One hundred and one cases of early and late supraglottic tumors covering a period of 22 years have been evaluated. The early stages, without lymph node metastasis, show a 75% 2-year control and a 50% 5-year survival. T h e local control rate is 75% in those patients treated at a dose equivalent to more than 1700 rets. More advanced supraglottic tumors with lymph node metastasis have shown a 15% 2-year control rate, 10% 5-year survival when treated with irradiation alone. W e are now treating the more advanced tumors with clinical adenopathy with a course of preoperative irradiation of 4000 to 5500 rads in 5 to 6Y2 weeks followed at a n appropriate interval in all cases with radical surgical removal of the primary and draining node areas. Conservation surgery is being considered in the advanced cases as a n alternative to total laryngectomy. Lesions without clinical nodes in the supraglottic area should be treated by radiation therapy alone. At least 6000 rads in 6% weeks should be delivered to the primary and node-draining areas. Conservation surgery in these earlier cases can be reserved for radiation treatment failures, thus sparing the voice in 75% or more of the cured patients.
E HAVE REVIEWED THE EXPERIENCE I N
the treatment of supraglottic carcinoma with radiation therapy at the University of California, from 1946-1969, in an attem.pt to more precisely determine the role of this modality in the management of the disease. It is our conclusion that in the earlier stages radiation therapy alone, with surgery reserved for radiation failure, and in the later stages a combination of preoperative irradiation and surgery, form the most effective treatment for supraglottic cancer, associated with the least morbidity.
Methods
All patients with carcinoma of tlie supraglottic area treated between January