The evaluation of treatment of patients with extensive squamous cancer of the vocal cords.

Fifty-one patients with previously untreated squamous carcinoma originating on the true vocal cord, staged T4, were analyzed. Forty-eight of the 51 patients were selected for treatment. Total laryngectomy was the minimal surgical procedure, and the pathologist confirmed the presence of cancer outside the confines of the larynx in 47 of 48 patients. Seventy-three percent of the patients were thought clinically to have negative nodes, but examination by the pathologist showed a 20 percent false negative rate in this evaluation. Twenty-one percent of the patients had received an emergency tracheostomy prior to being referred to out institution. An additional 8 percent required an emergency tracheostomy or laryngectomy. Radiation therapy was employed postoperatively for 16 patients. Twenty-six (54 percent) of the 48 patients had no further evidence of cancer after treatment. In evaluating the failures, previous tracheostomy, extension of the disease to the pharyngeal wall, and positive cervical lymph nodes were found to effect adversely the survival of the patient; however, extension of the disease into the trachea, when it occurred alone, was not an adverse factor. In this patient group with a median age of 66 years, 27 percent died of causes other than the cancer within four years. Based on the data in this series, postoperative radiation therapy is now being routinely given to patients with disease extending to the pharyngeal wall, those with nodes in the neck, and those who have had an emergency tracheostomy previously.