Management of early supraglottic laryngeal carcinoma by irradiation with surgery in reserve.

The results of radical radiotherapy with surgery in reserve for 136 patients with stage T1 and T2 NO supraglottic laryngeal carcinoma seen during a 20-year period are analyzed herein. Approximately one half of all patients were alive and well five years after treatment, while one fifth of patients died of supraglottic cancer. The cancer in two thirds of these patients was locally controlled by irradiation; of particular note was an 11% to 18% recurrence rate in patients whose necks were initially noted to be free of cancer. Analysis of the results of irradiation treatment disclosed a major reduction in nodal recurrence from the use of irradiation fields larger than 7 X 7 cm (3%, as compared with 19% with a smaller irradiation field). During the 20-year period of the study, there was a major reduction observed in tumor-related deaths; this is attributed to the use of larger irradiation fields and more aggressive use of surgery for irradiation failures. The results obtained are compared herein with the results of primary surgery, and conclusions are drawn as to the optimal management of early-stage supraglottic cancer.