T(3) LARYNGEAL-CANCER, PRIMARY SURGERY VS PLANNED COMBINED RADIOTHERAPY AND SURGERY

The Dutch Co-operative Head and Neck Oncology Group performed a retros pective, nationwide study of laryngeal cancer between 1975 and 1984. T he results for T3 laryngeal cancer treated with primary laryngectomy ( n = 137) with post-operative radiotherapy when indicated or planned co mbined (pre-operative) radiotherapy with laryngectomy (n = 113) are an alysed. The disease-free survival independent prognostic factors were treatment modality (planned combined treatment fared better, P = 0.001 ), incomplete resection of disease (P = 0.006), positive lymph nodes i n the neck dissection specimen (P = 0.03) and poor differentiation (P = 0.04). Local control (95% vs. 85%, P = 0.01) as well as regional con trol (96% vs. 79%, P = 0.0001) was improved in the combined group comp ared with the primary laryngectomy group. Regional control was 69% for N0 patients if the neck nodes were not treated electively, compared w ith 98% for the planned combined treatment group. It is concluded that elective treatment of the neck nodes in T3 laryngeal cancer is mandat ory. Radiotherapy is preferred, since as well as regional control, loc al control will also improve.