THE TREATMENT OF EARLY SQUAMOUS-CELL CARCINOMA OF THE PIRIFORM FOSSA

The treatment of early piriform fossa cancer can be either primary rad iotherapy with salvage surgery, if necessary, or with primary surgery. The present study investigates 65 patients with T1, greater-than-or-e qual-to 2 or T3 stage disease with no cervical lymph node metastases a t presentation. Of this group, 17 were treated by primary irradiation, 34 underwent primary surgery and 14 were unsuitable for any curative treatment. The adjusted actuarial 5-year survival rate for those patie nts receiving primary radiotherapy was 55% (95% CI 16-78%) and for the surgery group it was 44% (95% CI 18-67%). This difference was not sig nificant (chi1(2) = 1.29). The median survival for untreated patients was 7 months (4-12 months). There was no significant differences in th e time to recurrence at the primary site or in the neck, or in surviva l after recurrence at these sites. Thirty-five per cent of patients tr eated by primary irradiation were controlled at the primary site compa red with 68% in the surgical group. Failure in the neck was similar fo r the two groups at 12% and 15% respectively. Salvage surgery was effe ctive for the radiotherapy group with eight out of 11 patients being s uitable for treatment. In the final analysis in the radiotherapy group two patients were alive and with their larynx and two alive without t heir larynx, the remainder of patients having died from the original t umour, intercurrent disease or second primary tumours. The survival fi gures for the surgery group were proportionately similar except of cou rse, that all patients had lost their larynx. Radiotherapy with salvag e surgery for recurrence is a safe oncological treatment option. A hig h failure rate at the primary site is disappointing but if placed in p erspective still allows half the survivors to retain their larynx.