SALVAGE SURGERY FOLLOWING RADIATION FAILURE IN SQUAMOUS-CELL CARCINOMA OF THE SUPRAGLOTTIC LARYNX

Purpose: We analyzed the clinical course of patients who developed loc al (primary) recurrence following high-dose irradiation of squamous ce ll carcinoma of the supraglottic larynx. Methods and Materials: Betwee n October 1964 and July 1991, 206 patients with previously untreated s quamous cell carcinoma of the supraglottic larynx underwent radiothera py with curative intent, Local failure occurred in 46 (22%) patients, Successful surgical salvage was defined as no evidence of recurrent ca ncer for at least 2 years after salvage surgery and continuously there after. Results: Sixteen patients did not undergo salvage surgery becau se of refusal (7 patients), severe medical illness (2 patients), concu rrent distant metastasis (5 patients), or unresectable neck disease (2 patients), Twenty-six patients underwent total laryngectomy, and 4 pa tients had a voice-sparing procedure, Successful salvage was achieved in 50% of patients who underwent surgery, The rate of successful salva ge did not correlate with preirradiation T-stage or time to failure af ter irradiation, Most of the failures after surgery were because of fa ilure to control the primary cancer. The overall rate of postsurgical complications was 37%, No operative or perioperative deaths occurred, The 5-year survival rate for all 46 patients, calculated from the date of irradiation failure, was 20%, while the 5-year survival rate after salvage surgery for the 30 patients who underwent the procedure was 2 9%. Conclusion: There are few data in the literature regarding the cli nical outcome in patients whose tumors are not controlled by initial r adiotherapy, In the current and previous series, one-half to two-third s of patients who developed primary failure underwent salvage surgery, which was successful in approximately half of the operated patients, leading to a 25-30% rate of long-term disease-free survival among the entire group of patients who developed failure.