POSTOPERATIVE RADIOTHERAPY OF LARYNGEAL CARCINOMA - RETROSPECTIVE ANALYSIS OF 145 CASES

The present study retrospectively analyzes the results of postoperativ e radiotherapy in patients with laryngeal carcinoma, which subsequent to laryngectomy were irradiated at the Department of Radiology of the LMU Munchen between 1972 and 1982. Except the analysis of the total co llective subsets in regard to localization, T-stage, N-stage, histolog ic grading, and a complete operation (R0 or R1 resection) were formed to evaluate the prognostic relevance of those parameters. A total of 1 45 patients with a mean age of 55.7 years and an observation period of at least 3 years was examined. 140 patients were male, 5 female. 71 p atients suffered from glottic tumors (T1: 1 patient, T2: 44 patients, T3: 25 patients) and 74 from supraglottic tumors (T1: 14 patients, T2: 38 patients, T3: 7 patients, T4: 17). According to the TMN classifica tion of the UICC from 1979 14 patients had a stage T1, 82 a stage T2, 32 a stage T3, and 17 a stage T4. 45 of the 145 patients had a pathohi stologically diagnosed involvement of the lymph nodes of the neck. The patients were predominantly treated with Co-60 photon irradiation wit h a dose of (60) Gy using lateral portals of the neck. For all patient s a 5-year survival rate of 60.4 % analyzed by the Kaplan and Meier me thod was found. The 5-year probability of relapse free survival was 66 .8 % and the 5-year rate of locoregional relapse free survival was 74. 4 %. For glottic T1 / 2 tumors and the 5-year probability of relapse f ree survival was 88 % for supraglottic 76.6 % versus 61.7 % for glotti c T3 tumors and 56.8 % for supraglottic T3 / 4 tumors. The lymph node stage followed by grading were the prognostically most relevant factor s. Patients with no lymph node involvement had a 5-year probability of relapse free survival of 79.4 % versus 38.6 % in patients with histop athological lymph node involvement. Patients with tumors of a high his tological grading had a 5-year probability of relapse free survival of 84.4 % versus 56.7 % in patient with tumors of a low grading. Localiz ation and T-stage were seen to have low prognostic value. By showing n o significant difference in 5-year rates of relapse free survival betw een patients with a R0 resection and patients with a R1 resection we c ould demonstrate the importance of postoperative irradiation. With reg ard to the occurrence of 12 tracheostomal recurrences with a unfavoura ble prognosis it is concluded that a sufficient dose at the area of th e stoma should be obtained.