Carcinoma of the larynx

Abstract

The medical records of 144 patients seeking primary care for epidermoid carcinoma of the larynx at the Ellis Fischel State Cancer Hospital from 1940 through 1967 were reviewed and data abstracted for computer analysis, studying approximately 150 different social, clinical, therapeutic, and pathologic variables, some of which are presented in this paper. The clinical staging system of the American Joint Committee for Cancer Staging and End Results Reporting was used to compare the results of various therapeutic modalities utilizing the life table or actuarial method with and without age correction.

There was a preponderance of patients with advanced cases, 43 per cent having clinically positive nodes. The five year age-corrected actuarial survival was 71 per cent with stage I, 61 per cent with stage II, 25 per cent with stage III, and thirty-five with stage IV lesions. The consistent superiority in cure rate by surgery over radiotherapy for the various clinical stages was evident in this series.

Of the twenty-five patients in whom laryngectomy was performed after radiation failure, approximately half were salvaged. No patient with recurrence after laryngectomy was salvaged by subsequent radiotherapy. The operative mortality for the patients having undergone previous radiotherapy was 24 per cent compared with 8 per cent for patients without previous radiotherapy. An analysis of specific complications suggests a greater incidence of more serious complications after surgery in the patients with previous irradiation, although no statistically significant difference could be found either in complication rate or postoperative mortality between those with and without irradiation. Speech rehabilitation was poor in this particular group of indigent patients with only 36 per cent of those undergoing laryngectomy developing effective means of speech.

The value of the American Joint Committee's Staging System for Cancer of the Larynx as well as some of its shortcomings are pointed out. A new method for more efficiently utilizing the Staging System is presented.