Complications of combined radiation therapy and surgery for carcinoma of the larynx and inferior hypopharynx.

A group of 554 patients was studied to determine and compare the complications of combined preoperative radiation therapy with surgery and combined surgery with postoperative radiation therapy when used for treatment of carcinoma of the larynx and inferior hypopharynx. The complications recorded were infection, slough, carotid blowout, glottic insufficiency, pharyngeal stricture, operative death, chondritis, fistula, and margins of resection involved with tumor. The highest complication rates were in the partial laryngopharyngectomy-postoperative radiation group (63.6%) and in the supraglottic laryngectomy-postoperative radiation group (52.9%). Most of the increase in total complication rate was attributable to higher rates of glottic insufficiency and margins involved with tumor categories. The lowest complication rates were in the hemilaryngectomy with no radiation group (4.5%) and the total laryngectomy-postoperative radiation group (12.8%). The complication rate for the supraglottic laryngectomy-postoperative radiation group (52.9%) was significantly higher than for the preoperative radiation-supraglottic laryngectomy group (26.4%). Within the partial laryngopharyngectomy group, there was no significant difference in total complication rate between the use of preoperative (47.2%) or postoperative radiation (63.6%). Within the total laryngectomy group there was no significant difference between complication rates when either preoperative or postoperative radiation was employed. There was no significant difference in the rate of carotid blowout, chondritis, operative death, slough, or fistula, between preoperative or postoperative radiation in any of the surgical groups. In general, patients with conservation surgery seem to tolerate postoperative radiation without a prohibitive increase in complications.