T3 GLOTTIC CARCINOMA REVISITED - TRANSGLOTTIC VS PURE GLOTTIC CARCINOMA

Objective: To compare results of treatment of patients who have T3 tra nsglottic carcinoma with patients who have T3 pure glottic carcinoma. Design: A retrospective cohort study from January 1976 to December 199 0 with a minimum 2-year follow-up. Setting: Eye and Ear Hospital, Univ ersity of Pittsburgh Medical Center. Patients: The medical records of 161 patients with T3 glottic carcinoma were reviewed. We excluded 17 p atients who were unavailable for follow-up or who had died of other ca uses but were free of glottic carcinoma. Therefore, 144 patients were entered into this study-79 patients with transglottic carcinoma and 65 with pure glottic carcinoma. Intervention: Three treatment groups con sisted of the following: 30 patients in whom a full course of radiatio n therapy failed and who subsequently underwent salvage surgery; 92 pa tients who underwent surgery only; and 22 patients who underwent surge ry and had postoperative radiation therapy. Seventy-five patients had total laryngectomy, and 69 had total laryngectomy with neck dissection . Main Outcome Measures: Cervical metastasis, extracapsular spread, lo cal failure, stomal recurrence, distant metastasis, and 2 years with n o evidence of disease. Results: Patients with T3 transglottic carcinom a had a higher incidence of occult cervical metastasis (12% vs 9%), ov erall cervical metastasis (27% vs 17%), and extracapsular spread (43% vs 27%) than did patients with T3 pure glottic carcinoma. Two years of no disease was similar in these two groups (80% vs 79%). Extracapsula r spread had a notable effect on distant metastasis and on 2 years of no disease. Conclusion: Patients with T3 transglottic carcinoma had a higher incidence of cervical metastasis and extracapsular spread than patients with T3 pure glottic carcinoma. Every patient with T3 transgl ottic carcinoma should be treated with total laryngectomy with neck di ssection.